Conventional Flap Technique Research Articles

A Comprehensive Analysis of Flapless and Conventional Flap Technique in Dental Implant Surgery - A Comparative Study

A Comprehensive Analysis of Flapless and Conventional Flap Technique in Dental Implant Surgery - A Comparative Study

Colgajo fasciocutáneo tipo lengüeta medial como alternativa para el manejo de defectos de tejidos blandos en la pierna

BackgroundSelecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity. ObjectiveDemonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps. Materials and methodsCohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1)medial tab flap, and group 2)conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications. ResultsThe patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2±11.2 days in the tab flap and 16.1±11.2 days in conventional flaps, no statistically significant differences were found between the groups (P=.89).The surgical time for tab flaps was 225.2±117.8minutes, and 191.3±117.2minutes for the comparison flaps (P=.65), there were no statistically significant differences. There were no complications in the medial tab flaps. ConclusionThe findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.

Cost-effectiveness of the Flapless Insertion of Zygomatic Implants Using Dynamic Navigation - A Retrospective Study.

Zygomatic implants are an effective solution for rehabilitation of edentulous atrophic maxillae. However, the conventional technique of zygomatic implant placement is invasive, requires a longer healing period and is economically cumbersome. Therefore, the flapless technique of insertion of zygomatic implants using dynamic navigation system has been introduced. This study aims to compare the cost-effectiveness of flapless insertion of zygomatic implants using dynamic navigation to the conventional flap technique. The study participants were divided into two groups: Group A (n = 20) included patients treated by flapless insertion of zygomatic implants using dynamic navigation and Group B (n = 20) included patients treated with zygomatic implants using the flap technique. An analysis of the effectiveness of the implants was done using the concept of quality-adjusted prosthesis years, and an analysis of the costs was done by evaluating the treatment costs at each step. The data were collected, and analysis was done using IBM SPSS software. The Kruskal-Wallis rank-sum test was employed to analyse variations in costs and effects between the two groups. The study showed that the distribution of costs varies across both the categories of the procedure. Group B shows lesser cost-effectiveness as compared to Group A. The technique of flapless insertion of zygomatic implants is cost-effective. However, further studies considering factors such as time and cost of productivity evaluating the cost-effectiveness should be conducted.

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

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. 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. 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). 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. 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.

An In-Vivo Comparative Study of the Soft Tissue Response and Esthetics of the Titanium Implant with Titanium Collar by Flapless and Conventional Flap Technique.

Background:These days, patients want quick results for tooth replacement and esthetic results. However, there is no direct correlation between the achievement of osseointegration and the outcome of successful treatment always. It is vital to sustaining peri-implant soft tissue health for extensive tenure success of the implant.Aim:The purpose of this trial was to determine, estimate, and compare the soft tissue retort and esthetics of the titanium implants with titanium collar at periodic intervals by flapless and conventional flap technique before and after prosthesis placement.Results:The difference in soft tissue indices namely, gingival index, plaque index, and the modified sulcular bleeding index was insignificant between the two implants placed by flapless and open flap technique 2. There was a significant difference amid the probing depths of the two implants after 3 months of prosthesis positioning where the implant placed by flapless technique showed lesser values as compared to the implant placed by the open flap technique 3. The esthetics of the soft tissues surrounding the titanium implant with titanium collar, when compared, presented a significant difference between the two techniques of implant placement.Conclusion:In conclusion, in recent advancements in dentistry, the flapless technique is becoming prominent because of procedure of minimally invasive surgery in implantology. There are advantages of early re-epithelialization and less inflammation around the soft tissue of the implant in the flapless procedure, provided that the prospective for the establishment of a fully functioning along with aesthetically desirable peri-implant soft tissue collar. The flapless technique accomplishes high degrees of gratification by the patients by shortening the surgery time and minimum invasion to both bone and soft tissue.

Comparative evaluation of crestal bone level by flapless and flap techniques for implant placement: Systematic review and meta-analysis

Aim:To compare the crestal bone level of flapless technique of dental implant placement with the flap technique.Setting and Design:This Systematic review and Meta-analysis was conducted according to the Preferred Reporting Items For Systematic Review and Meta-Analyses (PRISMA) Guidelines and registered with PROSPERO.Materials and Methods:Electronic search of Medline and Google scholar databases for articles from 2010 till March 2020 was performed. Studies comparing the crestal bone level with both the techniques were included. After the collection of data, the risk of bias was assessed for each study.Statistical Analysis Used:Meta-analysis was executed using RevMan 5 software version 5.3.Results:23 studies were included. Statistically significant difference in crestal bone level was found between flapless and flap surgery with mean difference of −0.14 (flapless placement versus flap surgery; 95% CI: −0.24 to −0.03; P = 0.01FNx01). The difference in crestal bone level between the 2 groups was not statistically significant with a mean difference of –0.05(Guided flapless placement versus flap surgery; 95% CI: −0.10 to 0.00; P=0.06). Meta-analysis of the freehand flapless surgery with flap surgery generated a mean difference of −0.20 which was found to be statistically significant (Freehand flapless placement versus flap surgery; 95% CI: −0.37 to −0.03; P=0.02*).Conclusions:Flapless placement of implant can positively influence crestal bone loss in comparison with conventional flap technique.

Clinical Evaluation of Placement of Implant by Flapless Technique Over Conventional Flap Technique

AimThe aim of this study was to compare the clinical advantages of flapless implant surgery over conventional flap technique of implant placement by assessing the marginal bone loss in 1 month, 2 months and 3 months postoperatively, pain assessment, number of analgesics taken by the patients postoperatively and the postoperative swelling between two groups.Materials and MethodsThis study was conducted at Department of Oral and Maxillofacial Surgery, Rajas Dental College and Hospital, Tirunelveli. The patients were assigned randomly to one of the two groups—flap (ten patients) or flapless (ten patients). Digital IOPARs were taken postoperatively. The parameters assessed were marginal bone loss (interproximal bone height), pain assessment by a 10-cm visual analog scale, swelling assessment by modification of tape measuring method by Gabka and Matsumara and the number of analgesics tablets taken every postoperative day from the day of surgery to 6 days after surgery.Results and StatisticsDescriptive statistics was done by calculating measures of central tendency (mean) and measures of dispersion (standard deviation) for all the parameters. Inferential statistics were done by unpaired Student’s t test to compare the mean difference between the two groups. The results of this study showed that the mean difference in the bone loss for baseline to the third month for the flap group was 0.34 ± 0.05 and for the flapless group was 0.03 ± 0.004 (p = 0.000***). Pain assessment by visual analog scale was statistically significant in all the 5 postoperative days indicating a better patient compliance in the flapless group and there was no statistical difference in the level of swelling between these two groups.ConclusionWithin the limitations of this study, it can be concluded that flapless implant surgery results in lesser loss of marginal bone and also results in better patient comfort; however, proper patient selection and technique is essential for a successful flapless implant surgery.

FLAPLESS VERSUS CONVENTIONAL FLAP APPROCH FOR DENTAL IMPLANT PLACEMENT IN THE MAXILLARY ESTHETIC ZONE

INTRODUCTION: Dental implantology, a special field of dentistry dealing with the rehabilitation of the damaged chewing apparatus due to loss of the natural teeth, is currently the most intensively developing field of dentistry. Missing teeth can be replaced using dental implants, which are inserted into root bearing parts of the mandible or maxilla. The success and long-term prognosis of implant prosthetic therapy depend primarily on the anchorage of the implant in the jaw bone OBJECTIVES: The main objective of this study was to assess clinically and radiographically the flapless versus conventional flap surgical technique in the maxillary esthetic zone. MATERIALS AND METHODS: This study was a randomized controlled clinical trial. It included 16 dental implants. The patients were divided in to two groups: group A, eight implants were placed in the maxillary aesthetic region using flapless procedure, and group B eight implants were placed in the maxillary esthetic region using flap procedure. All patients followed by clinical and radio-graphical evaluation over a period of 6 months. RESULTS: The flap technique showed statistically significant higher mean pain severity and duration, plaque index, probing depth, healing score than the flapless technique. The radiographic evaluation of the flapless implant surgery showed marked decrease in the amount of crestal bone loss in comparison to conventional flap. The mean horizontal and vertical bone loss around implants was significantly less in group A than in group B. There was no difference in bone density between both groups. CONCLUSIONS: The flapless implant surgery reduces the amount of crestal bone loss, soft tissue inflammation, pain, edema, bleeding and consequently soft tissue recession than the conventional flap technique

Minimally invasive transgingival implant therapy: A literature review.

Transgingival (flapless) implant placement procedure is a minimally invasive surgical technique in which implant is placed without reflecting mucoperiosteal flap and hence the blood supply of bone is not hampered which is advantageous in many ways. To compare the outcomes of various implant placement techniques, an electronic database of various journals from January 1990 to March 2017 were analyzed and only human clinical trials with 6 months follow-up and at least five implants in each group were reviewed. The present literature review focuses on the comparative aspects of flapped versus flapless implants in terms of their survival, marginal bone loss, soft-tissue parameters, and patient-centered outcomes. When the proper protocol is followed by experienced surgeons, no significant difference was observed in survival rate, marginal bone loss, and keratinized mucosal width between flapless and conventional flap technique. Although transgingival approach for implant placement is reported to significantly reduce the surgical time, increased patient comfort and acceptance, i.e. the patient centered outcomes such as postoperative pain, swelling, and visual analog score, are minimized. Hence, it is concluded that transgingival (flapless) implant placement technique is well accepted by the patient with potential outcomes as compared to the conventional implant placement approach.

Estimation of lactoferrin levels in gingival crevicular fluid before and after periodontal therapy in patients with chronic periodontitis.

Background:The lactoferrin (LF) is an iron binding protein present specifically and in abundance in the secondary granules of polymorphonuclear leukocytes (PMN's). It has been suggested that LF in crevicular fluid is a useful marker of PMN activity. Hence, this study aimed to estimate the levels of LF in gingival crevicular fluid (GCF) before and after surgical therapy in chronic periodontitis patients to assess the validity of LF in monitoring of treatment results.Materials and Methods:A total of 30 patients with chronic periodontitis having probing depth of ≥5 mm who were scheduled for periodontal surgery were included in the study. The clinical parameters were recorded and GCF samples were obtained 2 weeks after scaling and root planing and 2 weeks after conventional flap technique. The samples collected were then assayed for LF using Enzyme-linked immunosorbent assay (ELISA).Results:The results showed that LF levels decreased significantly from 266.53 ± 75.86 to 195.47 ± 74.53 after scaling and root planing. There was further significant reduction in LF levels to 90.42 ± 32.89 following 2 weeks of periodontal surgery, indicating decrease in inflammation.Conclusion:There is a significant reduction in GCF LF levels following periodontal surgery. Hence, LF levels in GCF could serve as a useful marker for monitoring of periodontal treatment results.

A Pilot Study of Postoperative Pain Felt After Two Implant Surgery Techniques: A Randomized Blinded Prospective Clinical Study

To evaluate postoperative pain after successful implant surgery and compare pain experienced using conventional flap and flapless techniques. Between January 2007 and September 2012, consecutive patients with bilateral partially edentulous maxillae or mandibles were included in the study. Patients were randomly allocated to receive implants with an atraumatic flapless procedure or with a conventional flap procedure in a split-mouth design in a two-stage surgery. This randomized blinded prospective clinical study considered each patient as one unit. The data were analyzed using the Mann-Whitney and chi-square tests. One hundred eight implants were placed in 19 patients. Radiographic and clinical examination showed that all implants were successful. Postoperative pain was significantly more intense after surgery with the conventional flap technique than after surgery with the atraumatic flapless technique. Likewise, the inflammatory response was more intense with the flap technique. Postoperative pain depends on the surgical technique used and is less intense with a flapless technique.

A modified horizontal gingival incision: An approach to endo-perio lesion - two case reports

Combined Endo-Perio lesions are treated with root canal therapy & periodontal flap surgeries, to rid off endodontic and periodontal lesions respectively. Clinical observations have revealed that the conventional flap techniques employed in the treatment of such conditions resuit in to loss of Inter dental papillae (IDP) & marginal gingiva to a certain degree, leading to open embrasures/recessions that pose problems of food lodgment eventuating in to periodontal problems again. Thus, iatrogenicaly induced open embrasures & food lodgments jeopardize the success of dental therapy. In view of this, a clinical trial has been carried out with an Objective of assessing whcthcr ‘Modificd Horizontal Gingival Incision’ could overcome afore mentioned postoperative sequelae associated with conventional envelope flap techniques. Materials and methods included 20 combined endo-perio lesions that were randomly treated by either of the techniques. Results showed signiflcant loss of IDP as measured through Papilla Index Scores (PIS), followed by food lodgment due to conventional envelope flap techniques, where as the Modified Horizontal Gingival Incision alleviated any such sequelae. Hence it was concluded that this technique successfully aided in preservation of IDP.

What Should Define a “Perforator Flap”?

In spite of the Gent consensus on perforator flap terminology, widespread confusion still exists regarding the true description of these flaps, making it hard to understand these surgical procedures in comparison with conventional flap techniques. The value of perforator flaps can be better understood by further clarifying certain aspects of previous descriptions. The authors would like to propose enriching the standard Gent nomenclature with optional terms that specify additional aspects of the perforator flap such as including the vessel of origin, the type of vascular dissection, the muscle involved, and the type of perforator vessel. When describing a new flap, these terms will help clarify the anatomical aspects and the surgical approach. Lastly, a better understanding will help in the ongoing debates on this type of surgery and will aid in its dissemination and adoption into reconstructive practice.

The V-flap and the Berlin tulip flap: two new concepts in conventional flap techniques

Microsurgical operations are costly and technologically demanding. We have therefore developed new conventional flap techniques using state-of-the-art knowledge of skin anatomy and circulation. The V-flap is a combination of the V-Y advancement flap and two Limberg flaps [2]. Sixty patients treated by the new flap technique have shown a low rate of complication. Even when used in difficult regions of the body or in very large defects, the V flap has proven to be very effective. It has been adopted as a standard flap technique in our hospital. The Berlin tulip flap is another very reliable flap. To form the tulip flap, the outer corners of a subcutaneous pedicle flap are curved backwards. When detached, they can be transposed to the healthy tissue on the contralateral side. This completely relieves the midzone, which then can be safely closed in the same manner as a V-Y flap. The Berlin tulip flap is particularly useful for covering trunk defects and managing sacral ulcers in paraplegics.