Abstract
Guided implant dentistry using computed tomographic (CT) scans, virtual planning software and mucosa-supported surgical templates is an upcoming technology with the potential for more predictable and less invasive implant placement. While generally associated with a flapless approach, soft tissue punching and removal may not be indicated if available width of keratinized mucosa is limited prior to implant surgery. Two techniques to preserve keratinized peri-implant mucosa (Punch Reposition Technique and Topical Flap Technique) are presented and indications outlined. Appreciation of soft tissue conditions as well as functional and esthetic consequences of mucosal deficiencies (mucosal-driven approach) is recommended to supplement bone- and prosthetic-driven considerations in guided oral implant placement (Trinity Approach).
Highlights
Topical flap technique anatomical parameters.[1]
Mucosa-supported is available around the prospective implant Following a curved crestal incision (outline surgical templates offer the possibility of min- site, the soft tissue can be excised (Figure 1C). corresponding to the planned implant diameimally invasive flapless implant surgery associ- In cases of peri-implant mucosal deficiencies, ter) a trapezoid buccal flap is raised (Figure ated with significant reduction of intraopera- deviation from the routine surgical 2D) prior to reinsertion of the surgical temtive discomfort and postoperative patient mor- protocol may be considered
Surgical steps of implant bed preparation augmentation procedures prior to oral implant placement in the rehabilitation of severely Punch reposition technique and guided implant placement are performed according to the routine protocol atrophic jaws.[4]
Summary
Department of Oral Surgery, Vienna Medical University, Austria shown to be significantly higher when using surgical templates,[7] and may lead to osseointegration failure due to thermal bone damage. Furthermore, the impact of flapless implant placement on peri-implant soft tissue health has been questioned. Significant loss of keratinized mucosa around flapless implants (due to soft tissue punching and removal) can be observed compared to conventional implant placement following mucoperiosteal flaps.[8] Key words: minimally invasive surgery, surgical template, guided implant placement, attached mucosa, flapless surgery.
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