Incidence of Peri-Implantitis, Technical and Biological Complications of Single Implants Placed with Flap or Flapless Surgery-A 10-12-Year Case-Series.

BACKGROUND: Long-term follow-up of single implants and crowns is scarce, especially when inserted using flapless surgery. AIM: Evaluate survival, peri-implantitis incidence, and technical/biologic complications of solitary implants/crowns after 10-12 years of function. MATERIAL AND METHODS: 49 patients with 53 single implants, initially operated with a one-stage flap (F) or flapless (FL) surgery and delayed loading, were recalled. Implant survival, radiographic bone-level changes compared to baseline, peri-implant health, and soft tissue aesthetics were registered. Differences in implant level between and within groups were statistically tested using the Mann-Whitney U-Test and Wilcoxon Signed Ranks Test, respectively. RESULTS: 36 patients with 40 implants were reassessed, yielding 100% implant and 97.5% crown survival. The bone loss in F (n = 19) was 0.56 mm (SD 0.89; range -0.9-2.02) and -0.85 mm (SD 0.98; range -2.84-0.53) in FL (n = 21), indicative of bone gain in FL (p = 0.003), the latter due to a difference at baseline but bone-level was comparable (p = 0.126). Groups were comparable for probing pocket depth (PPD); (3.32 vs. 3.19 mm), Bleeding Index (BI); (0.15 vs. 0.22), and gingival recession; (0.38 vs. 0.17 mm). According to international criteria, the peri-implantitis incidence was 0%, but 32.5% of the implants/crowns experienced biological or technical complications irrespective of surgical technique. CONCLUSIONS: Solitary implants and crowns show good long-term clinical outcomes and peri-implant health. Flapless surgery is a good alternative to conventional in straightforward cases with sufficient bone volume and proper treatment planning.

Narrative review regarding the applicability, accuracy, and clinical outcome of flapless implant surgery with or without computer guidance.

BACKGROUND: The advent of computer-guided surgery removed the need for complex surgical interventions such as extensive flap elevations, second stage implant exposure, and complications usually associated with conventional protocols. PURPOSE: (a) Analyze available literature reporting on applicability, accuracy, clinical outcome of flapless surgery with or without computer guidance. (b) Evaluate quality of studies, in terms of scientific level of evidence and ethical committee approval. MATERIALS AND METHODS: A PUBMED search was performed in July 2018. A first search was based on a general search string limited to "Dental Implants" and "flapless surgery." A second search focused on accuracy of computer-guided surgery using search string "Surgery, Computer-Assisted" or "guided surgery," and "Dental implants." The following inclusion criteria were applied: (a) studies in English; (b) human studies (excluding cadaver); (c) systematic reviews; (d) systematic reviews with meta-analysis. Reviews not mentioning accuracy were excluded in search 2. RESULTS: Nine reviews included in total. Implant survival ranged between 89% and 100%. Early surgical and prosthetic complications reported in 9.1% to 36.4% of reviewed papers. Tooth-supported guides show more accuracy than bone or mucosa-supported guides. Fully guided surgery yields higher accuracy, with lower values for horizontal coronal, horizontal apical and angular deviation (1.00, 1.23, and 3.13°mm, respectively) than those placed with half guided surgery (1.44, 1.91, and 4.30 mm, respectively). Thirty-four of 71 human studies included in nine reviews, mentioned ethical committee approval or compliance with Declaration of Helsinki. CONCLUSIONS: Guided flapless surgery is comparable to free-hand surgery in terms of implant survival, marginal bone remodeling, and peri-implant variables. Clinicians advised to take care in all steps of the protocol, and include safety margins around virtually planned implants. Regarding compliance with research ethics, we should question whether scientific reports of clinical trials performed without an ethical umbrella are trustworthy. Compliance of ethics standards is imperative for submitted research papers.

Long-term clinical outcome of single implants inserted flaplessly or conventionally.

BACKGROUND: Flapless implant surgery is mostly performed using guided surgical protocols, however, long-term studies on free-handed flapless surgery for single implants are lacking. PURPOSE: This prospective study evaluates bone level changes, peri-implant health, and complications of solitary implants placed using a conventional flap (F) or flaplessly (FL) after 6-9 years. MATERIALS AND METHODS: Fifty-three single TiUnite Brånemark implants were originally inserted in 49 patients using an one-stage delayed loading protocol with flap (n = 27, F) or flaplessly (n = 26, FL) based on available bone volume and surgeon's decision-making. Thirty-six patients with 37 implants participated in the prospective follow-up investigation 6-9 years later whereby survival, bone level changes, peri-implant health, and complications were assessed. RESULTS: After 88 months (range 76-107), all implants were survived. For F and FL combined, the overall average radiographic bone level was above the first implant thread, 1.26 mm apical of the implant-abutment junction (SD 1.08; 0-4.9) and statistically comparable. Bone loss from time of loading was 0.49 mm (SD 1.1; -1.3 to 2.8) for F and -0.89 mm (SD 1.0; -2.8 to 0.7) for FL (P < .01), suggesting regrowth of bone in FL due to initial countersinking. One implant (2.7%) had a probing depth above 5 mm. CONCLUSION: Free-handed flapless implant surgery for single implants with neighboring teeth is a predictable long-term treatment provided when there is sufficient bone volume.

Clinical outcome and bone preservation of single TiUnite™ implants installed with flapless or flap surgery.

BACKGROUND: Flapless, free-handed implant surgery offers advantages for patient comfort, but studies on long-term clinical success based on marginal bone loss are scarce. AIM: The aim of this study was to compare single implants installed with a flap (F) or flapless (FL) surgery with respect to survival and marginal bone preservation after at least 3 years. MATERIALS AND METHODS: Fifty-three TiUnite™ Brånemark implants, installed in 49 patients (27 females; 22 males; mean age 53 years) were examined. Then, 25 F and 28 FL were delayed loaded; bone level from the abutment-implant level was measured on intraoral radiographs. From 44 (21 F, 23 FL), 31 (18F, 13 FL), and 36 (18 F, 18 FL) implants, radiographs were available at baseline and after 1 and 3 years of function. RESULTS: The overall survival rate was 100% and the overall mean bone loss after an average of 38 months was 1.35 mm (SD 0.91; range 0-3.7). Both F and FL showed increasing bone loss during the first year with a higher bone loss for FL than for F sites (p < .01). Afterward, no further bone loss occurred and both groups were statistically equal (p > .7). On individual implant level, nearly 80% in both F and FL were considered a success showing bone loss between 1.5 and 1.9 mm. CONCLUSIONS: Single implants yield an excellent prognosis with stable bone levels irrespective of the surgical technique, and free-handed flapless surgery is a viable alternative to more extensively planned guided surgery. Proper case selection and clinical experience are considered prerequisites for a predictable treatment outcome.