Comparative efficacy of flapped versus flapless dental implant procedures: A meta-analysis.

Objectives: Dental implant procedures are crucial for replacing missing teeth, with various surgical techniques impacting the outcome. This systematic review and meta-analysis aimed to evaluate the effects of flapped and flapless surgical techniques on implant survival and marginal bone loss (MBL). Methods: We included clinical studies with at least ten subjects, excluding review articles, editorials, and conference abstracts. Studies were sourced from PubMed, Medline, ERIC, and Wiley, published between 2000 and 2022. Data were analyzed using random-effects models to compare implant survival and MBL between flapped and flapless techniques. Results: The review identified 21 studies meeting the inclusion criteria. Flapless techniques showed a higher implant survival rate with an approximate survival rate of 98.6% in prospective cohort studies and 95.9% in retrospective studies. MBL was consistently lower in the flapless group, averaging 0.6-2.1 mm, compared to 1.5-3 mm in the flapped group. Low-risk studies demonstrated more consistent and reliable results, supporting the efficacy of flapless procedures. Conclusion: Flapless implant surgery offers a viable alternative to traditional flapped surgery, showing higher rates of implant survival and less MBL. However, successful outcomes depend on advanced imaging, precise surgical techniques, and adequate training. Further high-quality studies are needed to confirm these findings and refine clinical recommendations.

Flapless early implant placement into the uncalcified provisional matrix-Does it lead to osseointegration of the implant? A preclinical study.

AIM: To test whether early implant placement into the extraction socket containing an uncalcified provisional matrix leads to successful osseointegration and stable marginal bone levels. MATERIALS AND METHODS: In six mongrel dogs, the mandibular molars were extracted. Three weeks later, early implant placement was performed according to three experimental protocols: (i) flapless implant placement with preservation of the provisional matrix; (ii) flap elevation, socket debridement and implant placement; and (iii) flap elevation, socket debridement, implant placement and guided bone regeneration (GBR). One untreated extraction socket served as a control group. Data analyses were based on histologic slides 3 months after implant placement. RESULTS: There were no differences in bone-to-implant contact between the three experimental groups (66.97%, 58.89% and 60.89%, respectively) (inter-group comparison p = .42). Marginal bone levels, first bone-to-implant contact as well as the thickness of the connective tissue did not reveal any significant differences between the groups (p = .85, .60 and .65, respectively). CONCLUSIONS: Flapless early implant placement into posterior extraction sockets was as effective as an open flap approach in conjunction with GBR. Mineralization of the socket seems to occur irrespective of the presence of dental implants or biomaterials.

Long-Term Effect of Guided Implant Surgery on Clinical Outcomes and Peri-Implantitis of Maxillary Implants-An Observational Cohort Study.

(1) Although the accuracy of static computer-aided implant surgery (sCAIP) is well reported, information on its long-term effect on peri-implant health and complications is scarce. (2) Twenty-six patients initially treated were recalled. Implant survival, radiographic bone level, peri-implant health, and complications were registered. A multilevel regression model was applied to study the relationship between the research variables. (3) Sixteen patients participated in this study (average age 58.5 years; range 27.8-73.8). The mean follow-up time was 9.1 years (range 7.3-11.3). Two implants failed, resulting in a survival rate of 97.1%. The mean bone level change corresponded to a loss of 0.63 mm (SD 1.90) for the whole group, 0.17 mm (SD 1.46), and 0.91 mm (SD 2.09) for tooth- and mucosa-supported guides, respectively. The mean PPD for the total group was 4.24 mm (SD 1.25), and 3.79 mm (SD 0.97) and 4.51 mm (SD 1.33) for the tooth- and mucosa-supported guides, respectively. Four implants (6.3%) were diagnosed with peri-implantitis. Coronal deviation was slightly associated with having a negative impact on bone level at follow-up, but this was not statistically significant. Seven patients (43.8%) experienced technical complications. Biological complications were seen in 3/16 patients (18.75%). (4) SCAIP may contribute to more predictable implant placement; the long-term clinical outcome is similar to conventional nonguided surgery.

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.

Tissue-Level Laser-Lok Implants Placed with a Flapless Technique: A 4-Year Clinical Study.

BACKGROUND: The present study aims to analyze the use of Laser-Lok microtextured neck implants placed with a transmucosal surgical approach. The marginal bone level (MBL) and periodontal parameters were evaluated in a cohort prospective 4-year clinical study. METHODS: A total of 41 implants were placed in 36 healthy consecutive patients (16 males, 20 females, mean age 60 ± 9 years). Tapered tissue level implants, characterized by a 2.0 mm laser-microtextured neck, were used with a flapless approach. Customized abutments and provisional resin crowns were positioned. Definitive metal-ceramic crowns were cemented approximately 4 months after insertion. Periapical radiographs were taken after 1, 3, 6, 12, 36 and 48 months from implant placement to evaluate MBL. Gingival thickness (thin/thick), plaque score (PS) and bleeding on probing (BoP) were evaluated. RESULTS: After 48 months, all implants were safe from complications. No complications, peri-implantitis, early implant failures or mucositis occurred. The survival rate was 100%. Mean MBL during the follow-up was -0.15 ± 0.18 at T1, -0.29 ± 0.29 at T3, -0.45 ± 0.37 at T6, -0.53 ± 0.45 at T12, -1.06 ± 1.13 at T 36 and -1.10 ± 0.89 at T 48. Implants placed 2-3 months after tooth extraction revealed lower MBL variation when compared to those placed immediately (in fresh extraction sockets) or in completely healed ridges (delayed group). Narrower diameter implants (3.8 mm) showed significantly higher MBL variation when compared to 4.6 diameter implants. Multilevel analysis at T48 revealed that among all the evaluated variables, implant diameter was the factor mostly associated with MBL modifications (p = 0.027). CONCLUSION: This 4-year clinical study supports the use of Laser-Lok implants placed at tissue level with a flapless approach. A limited bone loss during the 48-month follow-up was observed. Periodontal parameters were stable with no sign of inflammation or soft tissue alteration. The use of Laser-Lok implants with transmucosal surgery represents a suitable technique with a minimally invasive approach.

Guided implant surgery with R2Gate®: A multicenter retrospective clinical study with 1 year of follow-up.

PURPOSE: To present the results obtained with a novel sleeveless and keyless guided implant surgery system. METHODS: Inclusion criteria for this multicenter clinical retrospective study were fully or partially edentulous patients who had been treated with a sleeveless and keyless guided implant surgery system (R2Gate®, Megagen), and who had been rehabilitated with fixed restorations, with a minimum follow-up of 1 year. All surgeries and prosthetic procedures were conducted following the same protocol, and data were obtained from the patients' medical records. The outcomes were the fit and stability of the surgical guide, any intra-operative and immediate post-operative complications, any biologic and prosthetic complications that occurred during the 1-year follow-up period, implant survival, and prosthetic success. RESULTS: Sixty patients were selected for the installation of 124 implants, through a guided procedure: 66 sleeveless, keyless surgical guides were manufactured. The incidence of immediate intra-operative (lack of space: 12.1%; lack of implant stability 2.6%) and immediate post-operative (pain and discomfort: 6.6%; mild swelling 3.3%) complications was low. In total, 112/124 implants (90.3%) were successfully placed with a guided procedure, in 52 patients; among them, 82 (73.2%) were placed with a flapless procedure. Thirty fixtures supported single crowns (SCs), 42 fixed partial dentures (FPDs) and 52 full-arch (FA) restorations. Sixty-two fixed prosthetic restorations (30 SCs, 22 FPDs and 10 FAs) were delivered; among these restorations, 15 (24.1%) were subjected to immediate functional loading. All implants (100%) survived. Two implants had peri­implant mucositis (1.6%), two SCs had abutment screw loosenings (1.6%), two FAs and one FPD had ceramic chipping/fracture (2.4%), for an overall prosthetic success amounting to 88.7%. CONCLUSIONS: Within the limits of this study, this novel guided surgery system appeared to be clinically reliable; further studies are needed to confirm these results. STATEMENT OF CLINICAL RELEVANCE: The use of sleveless and keyless surgical guides can be clinically reliable and may be represent a valid option for the surgeon.

Evaluation of Crestal Bone Loss in Flap vs Flapless Implant Placement Technique: An In Vivo Comparative Study.

AIMS: The aims of the study were to assess the technique with-flap and flapless implant placement and to compare crestal bone heights around the implant in flapless and conventional flap technique using digital radiovisiograph, in 3 and 6 months after the surgery. MATERIALS AND METHODS: A total of 20 implants were placed by flap and flapless implant technique; each patient received two implants, except for two patients who received four implants. A radiovisiograph was taken at implant placement, as well as 3- and 6-month intervals. Crestal bone level was compared between flapless and flap during these intervals and compared between intervals for each group. RESULTS: On evaluating the distribution, it was found to be asymmetric and hence lacked normality (K-S = 0.382; p <0.001). On mesial side, bone loss values in group I ranged from 0.40 to 1.10 units with a mean value of 0.71 and a standard deviation of 0.26 units. The median value was 0.70. On evaluating the data for normality, it was found to be symmetric and normal (K-S = 0.166; p = 0.200). CONCLUSION: This study concluded that there are not any significant differences in the crestal bone with both flap and flapless techniques. Comparatively, the flapless approach showed a lesser crestal bone height reduction, which was statistically significant. CLINICAL SIGNIFICANCE: Implant dentistry is nonetheless behind when advances are concerned, we have seen the inclination toward minimal invasive implant techniques to yield better esthetic as well as improved results, thus taking care of patients' discomfort.

Accuracy Evaluation of the Computer-Designed Selective Laser Sintering Surgical Guide for Flapless Immediate Loading Dental Implants Surgery in Edentulous Jaws.

This study was designed to evaluate the accuracy of a novel computer-designed and selectively laser sintered surgical guide for flapless dental implant placement in the edentulous jaw. Fifty dental implants were placed in 11 patients with at least 1 totally edentulous jaw. Initially, cone-beam computed tomography (CBCT) was performed in each patient to define the virtual position of the dental implants based on the assessment of bone availability and the proposed dental prosthesis. After virtual planning, 3D surgical guides were printed using selective laser sintering. CBCT was repeated after the surgery, and the pre- and postoperative images were overlapped in computer-assisted design software to compare the planned and actual positions of the dental implants using a 1-sample t test. The mean ± angular standard deviation between the long axes of the planned and final dental implant positions was 4.58° ± 2.85°; the linear deviation in the coronal position was 0.87 ± 0.49 mm and in the apical region of the dental implants was 1.37 ± 0.69 mm. These differences were statistically significant (P < .001). The proposed modifications reduced the deviations, resulting in an improvement in the technique. We were able to place implants and temporary prostheses using the present protocol, taking into account the differences between the planned and final positions of the dental implants.

Clinical outcomes of immediate implantation and provisionalization combined with guided bone regeneration for a single anterior maxillary tooth with a thin facial bone phenotype / 口腔疾病防治

Objective@#To study the postoperative soft and hard tissue changes and aesthetic effect of immediate implantation and provisionalization (IIPP) combined with guided bone regeneration (GBR) for a single anterior maxillary tooth with a thin facial bone phenotype.@*Methods @# A total of 34 patients with thin facial bone (<1 mm) were categorized into two groups: a flapped GBR group and a flapless group. Tooth extraction and IIPP were conducted at the sites in both groups. Implant survival rates, dimensional changes in soft and hard tissues during the six- and twelve-month follow-ups, the pink esthetic score (PES) and patient satisfaction scores at the twelve-month follow-up were measured.@*Results @#The implant survival rates were 100% in both groups, and no complications occurred during the 12 months after surgery. The facial bone thickness remained over 2 mm on all measured sides, and the height of the facial bone crest remained at 1.39 mm at the 12-month follow-up in the flapped GBR group, while the facial bone thickness remained less than 2 mm on all measured sides, and the height of the facial bone crest remained at 1.03 mm at the 12-month follow-up in the flapless group. The absorption of facial bone at all measured sides in the flapped GBR group was greater than that in the flapless group (P<0.05). There was no significant difference between the two groups in the dimensional changes of labial soft tissues during the six- and twelve-month follow-ups (P>0.05). The mean PES scores were 10.29 ± 2.34 for the flap GBR group and 10.12±1.78 for the flapless group (P = 0.807). The mean patient satisfaction scores were 8.65 ± 1.27 in the flapped GBR group and 8.76 ± 1.25 in the flapless group, and the patients in both of the groups were satisfied with the esthetic outcomes (P = 0.787). @*Conclusion @#IIPP combined with GBR might be a prospective treatment strategy for a single anterior maxillary tooth with a thin facial bone phenotype, but the esthetic risks should never be ignored.

In vivo Comparison of Crestal Bone Heights Following Implant Placement with "Flapless" and "Flap" Techniques in the Sites of Early Loaded Implants.

PURPOSE: The purpose was to evaluate the difference in crestal bone loss (CBL) around implants with flap and flapless methods followed by early loading. MATERIALS AND METHODS: Twenty implants were placed in twenty patients - ten using flap and ten using flapless techniques. The difference in CBL was measured on standardized digital periapical radiograph taken at 0 week, 6 weeks, 12 weeks, and 6 months. RESULTS: The present study showed the mean CBL on proximal surfaces when evaluated at intervals of 0 week, 6 weeks, 12 weeks, and 6 months for flapless method was significantly lower than with flap method the values of which were +0.07 mm against +0.26 mm on mesial side and +0.15 mm against +0.33 mm on distal side at 6 months. CONCLUSION: The flapless approach is a predictable procedure when patient selection and surgical technique are appropriate, and results in lesser CBL.

Guided Surgery with 3D Printed Device: A Case Report.

Dental surgeons need in-depth knowledge of the bone tissue status and gingival morphology of atrophic maxillae. The aim of this study is to describe preoperative virtual planning of placement of 5 implants and to compare the plan with the actual surgical results. Three-dimensional (3D) planning of rehabilitation using software programs enables surgical guides to be specially designed for the implant site and manufactured using 3D printing. A patient with 5 teeth missing was selected for this study. The patient's maxillary region was scanned with cone-beam computed tomography (CBCT), and a cast model was produced. After virtual planning using ImplantViewer, 5 implants were placed using a printed surgical guide. Two weeks after the surgical procedure, the patient underwent another CBCT scan of the maxilla. Statistically significant differences were detected between the virtually planned positions and the actual positions of the implants, with a mean deviation of 0.36 mm in the cervical region and 0.7 mm in the apical region. The surgical technique used enables more accurate procedures compared with the conventional technique. Implants can be better positioned, with a high level of predictability, reducing both operating time and patient discomfort.

Comparison of different surgical procedures on the stability of dental implants in posterior maxilla: A randomized clinical study.

BACKGROUND: Stability of a dental implant is very important when planning immediate loading and design of a final restoration. The aim of this study was to compare the primary and the secondary stability of dental implants inserted by three different surgical techniques: conventional (standard) technique using a sequence of drills for implant bed preparation, osteotome technique using tapered hand instruments for creating implant sites by condensing the bone and guided flapless implant surgery with surgical templates. MATERIAL AND METHODS: The study included 150 patients (80 males and 70 females), 46-71 years old, who required implant supported fixed partial dentures in the posterior maxilla of D3 or D4 bone density. Patients were randomly assigned into one of the three surgical insertion technique groups. All patients received tapered implants of the same manufacturer of the same length and two different widths (3.3 × 11.5 mm or 4.2 × 11.5 mm). Primary and secondary implant stability were measured by means of resonance frequency analysis (RFA) at the time of implant placement and 5 months after surgery using the Ostell ISQ device (Osstell AB, Sampgatan, Goteborg, Sweden). Statistical analysis included one-sample Kolmogorov Smirnov test, descriptive statistics, multivariate analysis (Bonferoni post-hoc tests) and paired t-tests. RESULTS: Patients in the osteotome group exhibited higher primary stability (P < 0.01) than in the conventional and surgically guided flapless groups. There were no significant differences in the secondary stability (p > 0.05). Wider implants presented higher ISQ values (P<0.01). CONCLUSION: The osteotome technique led to the highest implant primary stability, therefore it can be recommended when immediate loading is planned or for one-piece implant insertion.

3D planning of ear prosthesis and navigated flapless surgery for craniofacial implants: A pilot study.

New 3D digital technologies can be applied to implant-supported ear prostheses to restore anatomical structures damaged by cancer, dysplasia, or trauma. However, several factors influence the accuracy of implant positioning using a cranial template. This pilot study describes an innovative navigated flapless surgery for craniofacial implants, prosthetically guided by 3D planning of the ear prosthesis. Laser surface scanning of the face allowed for mapping of the healthy ear onto the defect site, and projection of the volume and position of the final prosthesis. The projected ear volume was superimposed on the skull bone image obtained by cone-beam computed tomography (CBCT), performed with the navigation system marker plate positioned in the patient's mouth. The craniofacial implants were fitted optimally to the ear prosthesis. After system calibration, real-time navigated implant placement based on the virtual planning was performed with minimally invasive flapless surgery under local anesthesia. After 3 months of healing, digital impressions of the implants were made, and the digital manufacturing workflow was completed to manufacture the ear prosthesis anchored to the craniofacial implants. The proposed digital method facilitated implant positioning during flapless surgery, improving the ear prosthesis manufacturing process and reducing operation time, patient morbidity, and related costs. This protocol avoids the need for a reference tool fixed in the cranial bone, as is usually required for maxillofacial surgery, and confirmed that surgical navigation is useful for guiding the insertion of craniofacial implants during flapless surgery.

Three-Dimensional Radiographic Outcome of Free-Handed Flaplessly Placed Mini Dental Implants in Edentulous Maxillae after 2-Years Function.

BACKGROUND: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical outcome and carried out 3D- cone-beam computerized tomography (CBCT) analysis of free-handed flaplessly placed one-piece maxillary MDIs by an experienced maxillofacial surgeon. METHODS: Thirty-one patients suffering from an ill-fitting maxillary denture relating to compromised bone volume (as confirmed on CBCT), with a dentate mandible, were selected. They received 5-6 MDIs free-hand flaplessly placed and mentally guided with preoperative CBCT. Final connection and attachment activation took place six months later. After two years each implant was individually assessed with CBCT for perforations on eight sites. Implant survival, prosthetic failure, clinical stability and sinus/nasal complaints were registered after three years. RESULTS: 32/185 (17.3%) MDIs failed during the provisional loading with non-activated attachments; 17 replacements in 10 patients were performed. Of the 170 actively loaded 170 MDIs, 82.3% survived and 27/31 prostheses (87%) were fully functional. In total 98/170 MDIs showed no perforation. Based on 1360 CBCT observations, 231 perforations (16.9%) were registered. Of most perforations 37 (25%) were observed at the apical tip and 37 were positioned (21%) into the sinus/nasal cavity, although without clinical complaints. CONCLUSIONS: Given the compromised population, the minimally invasive procedure and the low treatment cost involved, a failure rate of 17% is substantial, however clinically acceptable given the critical bone condition. However, even in experienced surgical hands, freehanded and flapless placement yield a high risk for implant perforation, although this did not necessarily lead to complications.

Minimal Invasive Flapless Piezotome Alveolar Crest Horizontal Split Technique: Preliminary Results.

INTRODUCTION: Alveolar split crest is an established surgical technique to enable implant insertion into narrow and atrophic alveolar crest. This surgical technique is adopted to position standard or large implants so that postextractive anatomy compromises with this attempt. The aim of this study was to evaluate the horizontal alveolar bone augmentation and its stability along time with a minimally invasive flapless technique. MATERIALS AND METHODS: Twenty-four implants were inserted in 10 patients during a 15-month period. Clinical parameters such as horizontal bone augmentation, intrasurgical complications, patient morbidity, implant loss, and vertical bone loss (VBL) were recorded in the first 3 years after surgery. Using cone-beam computed tomography (CBCT), alveolar bone width was measured for both implants position and bone reconstructions. 6 months later, at the time of implant integration, a new low-dose CBCT was performed. Implant survival (IS) and VBL were evaluated radiographically for 3 years. RESULTS: The initial bone thickness measured on the ridge is between 0.82 mm and 5.40 mm (average 2.43 mm), after the split crest the bone width is between 4.65 mm and 8.09 mm (average 6.39 mm). This leads to an increase in the alveolar bone width of between 0.80 mm and 6.01 mm (average 3.71 mm) on the ridge. No implant was lost at 3 years, and all implants are stable at the end of the study. Three years after the surgery, controls showed a VBL of between 0.0 mm and 1.2 mm (average 0.63 mm) around the inserted implants. These parameters suggest using a flapless technique to reduce bone resorption around the implant neck. CONCLUSION: A minimally invasive approach allows to reduce the surgical trauma and postsurgical discomfort. The complete vascular supply is maintained, the bone resorption is reduced, and the connective epithelium does not undergo postsurgical retraction, achieving the full maintenance of the residual keratinized gingiva. CLINICAL SIGNIFICANCE: A technique such as split crest can be a valid option to avoid autologous or heterologous bone grafts.

Assessing the Accuracy of Low-cost Surgical Guides Generated Using Ridge Mapping by Means of Cone Beam Computerized Tomography.

AIM: Assessing the accuracy of surgical guides generated with the help of a simple chair side ridge mapping technique by comparing the planned implant position with the achieved implant position on post-op computerized tomography scans. MATERIALS AND METHODS: In this study, 20 implant sites in patients were selected. Ridge mapping was done through a vacuum press template at three buccal (B1, B2, B3), three lingual (L1, L2, L3), and one crestal (C) points for each implant site. Readings were transferred onto the cast, and surgical guides were fabricated for implant placement. Postoperative cone beam computerized tomography (CBCT) was done to assess planned and achieved implant position. Comparison was done between soft tissue depths and implant distance from the crest of alveolar bone determined by the ridge mapping technique with measurements done on CBCT. The points used for ridge mapping were used as the reference for measurements. The data were analyzed using paired t test. p < 0.05 was considered to be statistically significant. RESULTS: On comparing the mean values of soft tissue depths from the ridge mapping and CBCT data, insignificant differences were found at B1, B2, L1, L2, L3, and C, but significant differences were found at B3. On comparing the implant distances from alveolar bone from both the data, insignificant differences were found at B, B2, B3, L1, L2, and L3 and significant difference was found at the crest in the mean values. CONCLUSION: Under the limitations of the above study, it can be concluded that a simple chairside procedure like ridge mapping can be used as an effective way for guided implant placement in sufficient available alveolar bone.

Survival rate of dental implant placement by conventional or flapless surgery in controlled type 2 diabetes mellitus patients: A systematic review.

INTRODUCTION: Dental implant may serve as a choice of treatment for replacement of missing tooth in diabetic patients with their well-controlled glycemic index. To minimize postoperative complications, dental surgical procedures comprises mainly two types, namely conventional and flapless surgery. OBJECTIVE: The aim of this review is to find the survival rate of the dental implant when placed with either of the technique, that is, conventional or flapless in patients with controlled Type 2 diabetes mellitus from published studies. MATERIALS AND METHODS: A total of 14 studies were included from PubMed database related to the survival rate of dental implant placement by conventional or flapless surgery among patients with controlled diabetes mellitus. The cumulative mean of dental implant survival rate by conventional and flapless techniques calculated from included studies is 94.2% and 92.3%, respectively. CONCLUSION: The survival rate of dental implant placement by conventional and flapless techniques is similar. As few studies on flapless technique are available, therefore researchers in future should explore its advantages and disadvantages.

Analysis of Linear and Angular Deviations of Implants Installed With a Tomographic-Guided Surgery Technique: A Prospective Cohort Study.

The aim of this study was to evaluate the linear and angular deviations of the implants installed by the computerized tomography (CT)-guided surgery technique. Eighteen patients who underwent implant insertion by means of CT-guided surgery participated in this study. Ten of these patients had a fully edentulous maxilla, and 8 had a fully edentulous mandible. The patients received a total of 115 implants, of which 81 implants were installed in the maxilla and 34 installed in the mandible. Tomographic guides were made for tomographic examination in both the upper and lower jaws. After the image acquisition, the virtual planning of the positioning of the implants was performed in relation to the previously made prosthesis. The measurement of the linear and angular deviations between the virtual planning and the final position of the implants was performed with the overlap of the planning and postoperative tomography. There were no differences in the linear and angular deviations of the implants installed in the maxilla and mandible. Compared with the coronal region, there was a trend of greater linear deviations in the apical regions of the implants and a greater tendency toward deviations in the posterior regions than in the anterior regions of both arches. The CT-guided surgery promoted the installation of implants with high accuracy and allowed the installation of straight pillars in all cases evaluated. The linear deviations were not different in the different regions of the mouth or in the different portions of the implants.

Flapless implant placement with digital 3D imaging and planning system in fully edentulous patient: A case report and 5-year follow-up / 대한치과보철학회지

One of the fastest growing segments of implant dentistry is the utilization of computed tomography (CT) scan data and treatment planning software in conjunction with guided surgery for implant reconstruction cases. Computer assisted planning systems and associated surgical templates have established a predictable, esthetic, functional technique for placing and restoring implants. Especially, a philosophy of restoratively driven implant placement has been generally adopted. Recently, a variety of commercial dental fields have released their scanning and fabricating protocols and methods for restorations. This process is still being investigated and developed for the most precise and predictable outcome. This case report describes a female patient who wanted dental implants in fully edentulous areas. Restoratively driven implant placements were performed with surgical guide and the patient was fully satisfied with the clinical results, and at 5-year post restorative follow-up assessment, both implant and prosthesis were proved clinical success.

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.