Comparison of flapped versus flapless dental implant insertion subjected to immediate functional loading protocol: A parallel group randomised control trial for radiographic bone density changes

Abstract

Purpose: To evaluate and compare the hard tissue (Bone density) outcomes of flapped and flapless surgically placed dental implants in mandibular posterior region subjected to immediate functional loading protocol. Materials and Methods: Forty patients, meeting predetermined inclusion and exclusion criteria for dental implant placement in mandibular posterior region were recruited for a single center, parallel group, double blinded randomized control trial. Patients were randomly allocated in two groups on the basis of surgical method used for implant placement: flapped & flapless. Implants were loaded functionally with provisional auto-polymerizing composite resin within 48 hours of surgery and after 4 month replaced by metal- ceramic permanent restorations. Outcome Measures: Bone density was measured through cone beam computed tomography (CBCT) in patients of both groups at baseline, 4months, 8months and 12 months. Results: No drop out occurred after 12 months of implant placement. Five implants failed 3 in flapped group and 2 in flapless group. Intergroup comparison (flapped & flapless) of mean bone density in gray scale at different time intervals (baseline, 4 months, 8 months and 12 months) in falpped was lesser than flapless at 4 months [flapped 1081.1±156.66, flapless 1174.6±192.79], at 8 months [flapped 1212.2±121.67, flapless 1317.8±158.21], at 12 months [flapped 1307.9±126.27, flapless 1418.3±162.19] and difference was statistically significant (P values were .008*, Intra group comparison of mean bone density from baseline to different time intervals was higher in flapped group from baseline values and difference was statistically insignificant. (p values were .002, 0.000,.000 at 4 months, 8 months and 12 months respectively) and the mean bone density was, at 4 months [-45.27], at 8 months [-176.32], at 12 months [-272.09]. For flapless group the mean bone density was at 4 months [-42.71], at 8 months [-185.93], at 12 month s[-286.47] and difference