Flap Reflection Research Articles

One for all: A multipurpose template for implant placement

A method is presented describing the laboratory fabrication and clinical use of an innovative template. This template was designed to function as a radiographic implant positioning guide, accurate bone sounding guide, surgical guide, an aid in flap reflection and as a pick-up impression tray.

Evaluation of bioactive glass and autogenous bone in the treatment of Grade II furcation involvement: A randomized controlled trial

Introduction: Furcation involvement is an inflammatory process that results in a breakdown of the supporting connective tissue and bone as a result of extension of periodontal destruction between the roots of multi-rooted teeth. Class II furcation lesions are a challenging scenario for periodontal therapy and a serious threat for tooth prognosis where the teeth mortality has been reported to occur more frequently in furcated teeth than in similar teeth without furcation defects. Aims and Objectives: The aim of this study was to compare the efficacy of bioactive glass (BG) grafting material versus autogenous bone grafting in the treatment of Grade II furcation involvement clinically and radiographically. Materials and Methods: A total of 30 patients with buccal mandibular Grade II furcation involvement were divided- by a split-mouth design- into three groups; group (Gp) I involved 30 sites grafted with BG; Gp II involved 30 sites grafted with autogenous bone and Gp III involved 10 sites treated with scaling and root planing only after flap reflection. Results: The postoperative healing periods were, generally uneventful with no postoperative complications. At the last follow-up period, the previous furcation sites were covered with healthy gingiva and there was a great reduction in the surface area of the furcation defects with a marked increase in the gray level in both Gp I and II with no significant difference, while there was a statistically significant difference between Gp I and Gp III and between Gp II and Gp III at 3 months and at 6 months of follow-up periods. Conclusion: The use of BG and autogenous bone grafts has better outcomes in the treatment of Grade II furcation involvement when compared with open debridement alone. The use of bony glass has nearly the same successful outcomes of the autogenous bone graft; however, it is less traumatic to the patient. Clinical Relevance to Interdisciplinary Dentistry Periodontal regenerative procedure using bioactive glass material can be performed to enhance bone formation Class II furcation lesions are a challenging scenario for periodontal therapy and a serious threat for tooth prognosis.

The Efficacy of 1% Chlorhexidine Gel on the Reduction of Dry Socket Occurence Following Surgical Third Molar Extraction— Pilot Study

Aim & Objectives: The aim of this prospective pilot-study was to assess the efficacy of intra alveolar application of 1% chlorhexidine gel (CHX) on the reduction of dry socket (DS) occurrence following surgical extraction of mandibular third molars. Materials and Methods: A randomized split-mouth-design study included twenty-five patients with bilaterally impacted lower third molars (partial or full bone) requiring full thickness mucoperiastal flap reflection for extraction. Following surgical extraction of third lower molar, 2 ml of gel containing 1% chlorhexidine digluconate (Chlorhexamed? Gel 1%) were placed in the experimental side, and saline solution was used for irrigation in the control side of extraction sockets, both followed by suturing of extraction site. The surgeries and follow up examinations were performed by the same surgeon. The follow up visits were performed at 48 hours and on day seven, post surgery where presence or absence of dry socket using the Blum criteria for diagnosis was evaluated and pain intensity by Visual Analogue Scale (VAS) 0 - 100 was observed. Results: In this pilot study, dry socket was present in 4.0 and 28.0% of cases in the experimental and control groups, respectively (P = 0.048). Fisher’s test revealed a statistically significant reduction of dry socket occurrence following the use of 1% CHX gel versus saline solution. Conclusion: The application of CHX gel 1% may significantly reduce the incidence of DS following third molar extraction. Prophylactic use of CHX gel 1% may be suggested in all patients, especially in the patients at risk of development of DS.

Lingual nerve strain during lingual flap reflection & nerve protection: a cadaver study

Placement of a lingual retractor during removal of wisdom teeth polarizes clinicians’ views. Morbidity associated with lingual nerve injury is considerable. The argument of wide exposure is protective of the lingual nerve.

Regenerative Treatment for a Peri‐Implantitis‐Affected Implant: A Case Report

Introduction: Peri‐implantitis is an inflammatory disease in the mucosa around an implant that results in bone loss and, if allowed to progress, can result in loss of the implant. This disease has been estimated to have a prevalence varying from 11.3% to 56%. To date, there is little evidence to indicate the most effective method of treatment of peri‐implantitis. This report describes a regenerative treatment for restoration of bone and reduction of probing depth (PD) around a peri‐implantitis‐affected implant.Case Presentation: A 67‐year‐old male patient presented with advanced peri‐implantitis around a mandibular right first molar implant that was placed and restored 3 years before his visit. An examination revealed PD of 7 to 12 mm and bone loss of 7 to 10 mm circumferentially around the implant. Treatment consisted of flap reflection, a six‐step surface decontamination, placement of enamel matrix derivative on the implant surface, and fill of the defect with combined allograft/xenografts mixed with platelet‐derived growth factor. The graft was covered with two absorbable collagen membranes, and the flap was coronally advanced and sutured. A 7‐year follow‐up revealed PD reduction of 4 to 10 mm, bone level gain of 3 to 3.5 mm, and no change in the coronal level of the mucosa (no post‐surgical recession).Conclusion: The technique used in this case report resulted in an outcome that saved the implant, brought the peri‐implant tissues back to health, and reduced PD and increased bone support around the affected implant without soft‐tissue recession.

Removal of impacted mandibular third molars using an inward fragmentation technique (IFT) – Method and first results

PurposeConventional surgical extraction of impacted mandibular third molars (M3M) requires a lateral flap reflection in conjunction with lateral bone removal for outward mobilization of the tooth. The aim of this report is to outline a novel inward fragmentation technique (IFT) in conjunction with an occlusal miniflap approach to reduce the amount of bone removal to a minimum. Patients and methodsSeventeen consecutive patients (7 men and 10 women; mean age 24.4 years, range 18–36 years) required the extraction of 21-impacted M3M with a close relationship to the inferior alveolar nerve (IAN).Occlusal miniflaps were used and only occlusal bone removal was performed to expose the M3M under endoscopic vision. A central space-making cavity was created followed by inward fragmentation and mobilization of the crown and subsequent root removal through the space created. Results20 of 21 sites healed uneventfully, one late infection was observed, no permanent neurosensory lesion occurred. The mean preoperative buccal bone height was 15.5 (11–18) mm and the postoperative buccal bone height 14.7 (11–17) mm. On the 2nd day, the mean swelling level was 1.38 (0–2) on a 4 point scale, the pain level was 2.30 (0–5) on a 10 cm VAS, mean pain duration was 2.04 days. ConclusionAn inward fragmentation technique allows preservation of >90% of the buccal bone height adjacent to mandibular third molars and may reduce postoperative morbidity without raising the risk of IAN lesions.

The extended subtemporal transtentorial approach: The impact of trochlear nerve dissection and tentorial incision

The subtemporal transtentorial approach provides excellent exposure of the incisural space. Incision of the tentorium improves access to the interpeduncular cistern, basilar artery, and rostral ventral pons. Description of the starting and termination points of the tentorial incision has varied greatly. We assessed the impact on surgical exposure of freeing the trochlear nerve (TN) from its dural canal (DC) in addition to dividing and retracting the tentorium. A subtemporal approach was performed on 10 hemispheres of cadaveric specimens. Following exposure of the middle tentorial incisura, the TN is dissected from its DC over a few millimeters. Two retraction sutures are placed along the tentorial edge, posterior to the TN entrance in its DC. The tentorial incision is started between the sutures. Dissection of TN from its DC continues for a short distance. The tentorial incision is extended straight up towards the superior petrosal sinus. Dissection of the TN DC continues anteriorly, up to its entry into the cavernous sinus. The tentorial incision can then be extended, just over the entrance to Meckel’s cave, and the flap reflected far anterolateraly. Using this technique, the exposure of the interpeduncular cistern and its content increased by a mean of 8.2mm (standard deviation [SD] 3.9mm) in the anteroposterior axis and by 5.5mm (SD 1.9mm) in the rostrocaudal axis. Tentorial incision following dissection of the TN from its DC optimizes reflection of the tentorium flap anterolateraly, maximizes the exposure, and improves lighting and visibility as well as maneuverability within the interpeduncular and rostral pre-pontine cisterns.

Measuring periodontal biologic distances: Transperiodontal vs transsurgical probing

Objective. Crown-lengthening surgeries are widely indicated in dental practice and the proper measurement of biological distances is imperative for accurate surgical, prosthetic or restorative planning. However, few clinical studies have evaluated the methods for measuring these distances. The aim of this study was to compare the transperiodontal (before incision/BI: immediately before the intrasulcular incision) and transsurgical (after incision/AI: immediately after mucoperiosteal flap reflection) probing methods for measuring the biological distance. Materials and methods. Data from a previous randomized and controlled clinical trial were subjected to a secondary analysis, which included nine patients (26 ± 5 years), with a total of 18 teeth requiring restorative treatment. A single calibrated examiner measured the distances (in millimetres) between the cervical walls of the caries/cavity preparation and the bone crest. Results. Absolute agreement between the distances measured by the BI and AI methods was 88.88%. Mean distances by BI (1.44 ± 0.51 mm; range = 1–2 mm) and AI (1.55 ± 0.61 mm; range = 1–3 mm) showed no significant differences. Conclusions. Transperiodontal probing appears to be suitable for the measurement of biological distances and may be used as an important tool for surgical planning.

Treatment of a cervical resorptive defect in a mandibular first premolar: An 18-month follow-up

The objective of this report is to describe the multidisciplinary management of a cervical resorptive defect using periodontal surgery, endodontic treatment, mineral trioxide aggregate (MTA) and composite resin filling. The resorptive defect was obturated using MTA following the reflection of a mucoperiosteal flap and conventional root canal treatment was completed. The cervical extension of the MTA-filled cavity, which was evident following the suturing of the flap, was reduced and filled with a composite filling material. No complaints were noted by the patient and at the 18-month follow-up the prognosis was favorable. By appropriate multidisciplinary management, root resorptions may be treated successfully. MTA may serve as a good option in such situations owing to its multi-beneficial properties.

Comparative Study Between Two Flaps—Trapezoidal flap (TZF) and Ocshenbein-Leubke Flap (OLF) in Periapical Surgeries

The ultimate goal in surgical endodontics is not only the eradication of periapical pathosis but also preservation of periodontal tissues using suitable surgical techniques. Treatment outcomes are no longer acceptable without considering the esthetic consequences of all involved dentoalveolar structures. It is critical that incisions and tissue elevations and reflections are performed in a way that facilitates healing by primary intention. The large variety of flaps available for periapical surgeries reflects the number of variables to be considered before choosing an appropriate flap design. In this study; Ocshenbein-Leubke (OL) and trapezoidal (TZ) flaps have been compared in terms of their efficacy and comfort. Twenty patients of ASA category I, between the age group of 12-40years were randomly selected to undergo periapical surgery by utilizing one of two flaps. All the subjects were free of periodontal disease. Demographic variables were found to be statistically similar. OL flap was found to be better than TZ flap with respect to time of flap reflection, accessibility, duration of surgery and post-operative pain. The OL flap takes less time for reflection with nearly the same accessibility, less post-operative pain and less complication as compared to TZ flap. We conclude that OL flap gives better results when compared to TZ flap.

New Crestal Approach for Lifting Sinus in the Extremely Atrophic Upper Maxillae

Introduction: Sinus augmentation, when performed with simultaneous or delayed implant placement, is a predictable procedure in augmenting deficient ridges. Traditionally, sinus augmentation was performed with either the lateral window or crestal osteotome approaches. In this case series, a new sinus floor elevation technique is proposed to treat specific cases of extremely atrophic maxillae.Case Series: In this technique, a window is opened from the ridge crest instead of the lateral wall. Particulate bone graft is subsequently packed through the crestal window to elevate the Schneiderian membrane. Primary closure is achieved and implant placement is performed after healing is completed.Conclusion: This new crestal sinus elevation technique combines direct visualization of the Schneiderian membrane with minimal flap reflection in the augmentation of severely atrophic maxillae in preparation for subsequent implant placement.

Extraction of Asymptomatic Tooth With And Without Antibiotic Therapy

Background: Extraction of asymptomatic tooth constitutes a large proportion of maxillofacial surgery procedure and antibiotics are indiscriminately prescribed before and after tooth extraction in Bangladesh. Objectives: This cross sectional study was designed to evaluate the efficacy of postoperative antibiotic therapy in reducing postoperative morbidity in two groups following extraction of asymptomatic tooth. Methods: A total of 112 patients, 54 Female and 58 Male, aged 16 to 35 years comprised the study materials. Diagnosis was made by accurate history, clinical examination and radiographs. Clinical examination was done to assess the presence or absence of local infection, pain, swelling and mucosal coverage whereas Orthopantomogram (OPG) and Intraoral Periapical (IOPA) radiographs were taken to assess the angulations, position and bony coverage. Tooth extraction was performed with buccal guttering technique after adequate elevation and reflection of full thickness mucoperiosteal flap. The Control Group was given Cap. Amoxicillin 500mg, orally daily for 5 days postoperatively. The Study Group was not given antibiotics. Pain, swelling and trismus were evaluated preoperatively and on 2nd, 7th and 14th postoperative day. Data was processed and analyzed using SPSS version 16.0 for windows and was compiled and test of significance was done using Chi square (x²) test and unpaired‘t’ test. Results: Statistical analysis of the data indicated that pain and swelling was significantly reduced and significant maximum mouth opening was achieved, when preoperative and postoperative results were compared, in both the groups P > 0.05, statistically not significant. Conclusion: There were no significant differences among the groups in the incidence of postoperative morbidity (pain, swelling and trismus).DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10996 BSMMU J 2012; 5(1):24-28

THE INNOVATED LASER ASSISTED FLAPLESS CORTICOTOMY TO ENHANCE ORTHODONTIC TOOTH MOVEMENT

Introduction: Corticotomy-facilitated orthodontics provides a means for rapidly moving teeth purportedly with little damaging effects to the periodontium and with greatly reduced treatment time. The aim of this study was to enhance the orthodontic tooth movement by reducing the cortical bone layer (resistant to bone re-sorption relative to spongious bone) following Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er-Cr: YSGG)laser irradiation, without reflection of surgical soft tissue flap. Methods: In the present experimental study, 8 New Zealand Male rabbits were the samples for the research. The right first premolar of each rabbit (experiment group) underwent treatment for mesial movement with 75 gram of orthodontic force by using closed Ni-Ti coil spring (Dentaurum®). Coil spring was fixed in the cervical region of first premolars by means of ligature wire and No-Mix composite (Dentaurum®) and also activated to the cervical site of incisors. The left first premolars of the subjects were considered as the control group. Laser corticotomy was performed in anesthetized rabbits. Samples were sacrificed for determination of tooth movement after initiating premolar protraction on the 21 th day. The amount of orthodontic tooth movement was assessed by using a metal feeler gauge with the precision of 0.01 mm, between mesial surface of the second premolars and distal surfaces of the first premolars. The statistical package of SPSS (Kolmogorov - Smirnov and ANOVA test) was used for analytical evaluation of the measurements. Results: The amount of orthodontic tooth movement in the experimental group (mean=1.653±0.34 mm) was significantly (p<0.001) greater than that of the control group (mean=0.936 ±0.28 mm). The innovated laser assisted corticotomies enhanced the rate of orthodontic tooth movement on the intervention side, significantly (p<0.001). Conclusion: The innovated method of laser assisted flapless corticotomy is a useful procedure for reducing treatment time and damage to periodontium. It also eliminates the necessity of more invasive intervention of flap surgery.

How successful are small‐diameter implants? A literature review

Edentulism is an important issue and will remain so due to high numbers of edentate individuals worldwide. For many years, complete dentures have been the only treatment option for this population. Implant overdentures have been shown to have many advantages over conventional complete dentures. However, although dissatisfied with their mandibular dentures, some edentate elders are reluctant to undergo even simple implant treatment due to factors such as cost and fear of surgery. To address these obstacles, this paper reports on a review of small-diameter implant (SDI) studies that were performed in the last two decades. The aim of this study is to (i) determine the survival of narrow diameter implants, (ii) determine whether survival is dependent on whether these implants are placed using a flap or flapless approach, and (ii) determine whether there is a relationship between length and implant survival in SDIs. In this review, studies were included that (i) involve implants with 3.5 mm diameter or less, (ii) have a randomized clinical trial, retrospective or prospective cohort design with human subjects, (iii) provide a follow up duration of at least 5 months following implant placement, (iv) include data on the survival rate of the implants. Forty one studies meeting the above criteria were published between 1993 and 2011 using SDIs from a variety of companies and surface characteristics with diameters of 1.8 mm to 3.5 mm and lengths of 8 mm to 18 mm. A total of 10,093 SDIs were inserted in approximately 2762 patients. Twenty-six studies involved flap reflection techniques for implant placement, six studies used a flapless technique and two studies used both techniques; in the remaining studies, the technique was not specified. Follow up duration varied from 5 months to over 9 years. The survival rate reported in all screened studies was over 90%, including eight studies in which a 100% survival rate was reported. In 22 studies, the reported survival rate ranged from 95% to 99.9%. Failure was reported most often in short SDIs (less than or equal 13 mm) (n = 88) compared to longer ones (more than 13 mm). Survival rates reported for SDI are similar to those reported for standard width implants. These survival rates did not appear to differ between studies that used flapless and flap reflection techniques. The failure rate appeared to be higher in shorter SDIs than in longer ones in the studies in which the length of the failed implants was reported. SDIs could be considered for use with fixed restorations and mandibular overdentures, since their success rate appears to be comparable to that of regular diameter implants. They might also be an efficient, low-cost solution for elders who wish to reduce problems with denture instability.

Invasive cervical resorption: treatment challenges

Invasive cervical resorption is a relatively uncommon form of external root resorption. It is characterized by invasion of cervical region of the root by fibrovascular tissue derived from the periodontal ligament. This case presents an invasive cervical resorption occurring in maxillary lateral incisor, following damage in cervical cementum from avulsion and intracoronal bleaching procedure. Flap reflection, debridement and restoration with glass ionomer cement were performed in an attempt to repair the defect. But after 2 mon, more resorption extended apically. Considering root stability and recurrence potential, we decided to extract the tooth. Invasive cervical resorption in advanced stages may present great challenges for clinicians. Therefore, prevention and early detection must be stressed when dealing with patients presenting history of potential predisposing factors.

Implant-retained Mandibular Overdentures: A Comparative Study of Immediate LoadingvsDelayed Loading after One Year

Purpose: The aim of this study was to compare the clinical and radiographical outcomes of two loading protocols of mandibular overdentures supported by two unsplinted implants. Materials and methods: Twenty completely edentulous patients were included in the study. Patients were categorized in two groups each containing 10 patients. In group A, patients received at least two implants in symphysis areas inserted after a minimal flap reflection, and 2 months after implant placement, a mandibular complete denture was connected to the implants using ball attachments. In second group, prosthesis was loaded immediately after placing the implants in symphysis areas without any flap reflection. Patients were examined at 1, 12, 24 and 48 weeks after loading. At postoperative visits, occlusion was checked and the need for any prosthesis maintenance was recorded. Mobility of the implants, radiolucency around the implant and amount of crestal bone loss was checked and measured for both groups during the checkup sessions. Also any prosthetic problems were recorded. Results: After 12 months of loading, in both group no implant failure was reported and the survival rate was 100% in immediate and delay loading groups. Average of bone resorption in control group at the end of study was 0.84 ± 0.05 mm and in the test group was 0.84 ± 0.03 mm. In all patients after every 6 months the plastic O-rings were changed due to frictional wearing. In test group, in three patients the mandibular denture fractured, while, in control group it happened in two patients. In the test group, two patients experienced unbearable pain, while, in the control group seven patients experienced unbearable pain and they needed analgesics. None of the patients in test group experienced edema, swelling and discomfort after surgery due to flapless surgery, while in the control group four patients experienced edema and swelling after surgery. Conclusion: The results of this study suggest that immediate loading of two implants supporting mandibular overdenture has outcomes comparable with conventional loading protocols. This clinical approach offers good stability and comfort while keeping high implant success rate.

Implant prosthetic rehabilitation following reconstructive custom-made TMJ condyle and fossa prosthesis

Implant rehabilitation involving patients with facial deformities and temporomandibular joint (TMJ) ankylosis requires competence and expertise. It is important to understand that such patients present with minimal or restricted mouth opening, severe joint and facial pain, mandibular deviation, and facial deformities. The case reported here involved two-stage implant rehabilitation for a 54-year-old female patient who had undergone custom-made TMJ condyle and fossa reconstructive prosthesis due to severe facial deformity and ankylosis of the right TMJ following previous unsuccessful surgeries. Following the reflection of a mucoperiostel flap three implants corresponding to the missing maxillary canine, first and second premolars were placed. To achieve better distribution of occlusal load and optimal esthetics, the prosthesis was restored with 3-unit porcelain fused to metal crown and bridge.Clinical Relevance to Interdisciplinary Dentistry This case report signifies the multidisciplinary approach to complex implant dentistry through surgical and prosthodontic functional rehabilitation.It also highlights the importance of restoring the dentition in situations of facial and mandibular reconstruction, whereby we achieve optimal and adequate function and esthetics.This unique case report also will conclude the need for future rehabilitation of patients with TMJ condylar reconstruction, and the special care needed to improve occlusal balance.

Periodontally accelerated osteogenic orthodontics: Review on a surgical technique and a case report

Modifying the balance between resorption and apposition through selectively injuring the cortical plate of the alveolus has been an approach to accelerate tooth movement and is referred to as periodontally accelerated osteogenic orthodontics. It has gradually gained popularity as an adjunct treatment option for adults, as routine orthodontic tooth movement is difficult and time consuming once the mineralization and maturation of the maxilla and mandible are complete. Case selection is a very important step in which both the orthodontist and the periodontist should agree upon the need for corticotomy. The periodontally accelerated osteogenic orthodontic technique described by Wilcko (2001) involves full thickness flap reflection labially and lingually. Selective alveolar decortications are performed in the form of vertical decortications cuts up to 0.5 mm in depth, interdentally as well as horizontal cuts beyond the apex connecting the vertical decortications cuts. Adequate bio-absorbable grafting material is placed over the decortications site and sutured. Orthodontic tooth movement should start 1 or 2 weeks after the surgery. The present article reviews on contemporary clinical techniques in accelerated osteogenic orthodontics and a case report in which this technique has been implicated.Clinical Relevance to Interdisciplinary DentistryThe term interdisciplinary dentistry depicts the importance of team work. The combined effort of the specialists of the various branches of dentistry will help to deliver the best treatment to the patient by providing a well functioning dentition in a healthy periodontal environment. The present article highlights the importance of an interdisciplinary approach for the purpose of periodontally accelerated osteogenic orthodontics, in the treatment of adult orthodontic patients.

Coronally Advanced Flap Combined With a Subepithelial Connective Tissue Graft Using Full‐ or Partial‐Thickness Flap Reflection

Although the use of a subepithelial connective tissue graft (SCTG) in conjunction with a coronally advanced flap (CAF) is a widely performed periodontal procedure, the creation of a partial-thickness flap can incur a risk of perforation or overthinning of the flap itself. Therefore, the aim of the present trial is to compare the efficacies of partial- and full-thickness flap reflections combined with an SCTG. Twenty patients with Miller Class I or II defects (52 teeth) were selected, and teeth with defects were randomly assigned to the test group (25 teeth) for a CAF and SCTG using a full-thickness flap reflection or to the control group (27 teeth) for a CAF associated with an SCTG and partial-thickness flap reflection. The probing depth (PD), gingival recession (GR), and width of the keratinized tissue (KT) were assessed at baseline and 6 months after surgery. The mean root coverage was 97% in the test group (mean reduction in GR: 2.27 ± 1.15 mm) and 95% in the control group (mean reduction in GR: 1.68 ± 0.74 mm). The gain in KT was 0.46 ± 1.47 mm in the test group and 0.49 ± 1.3 mm in the control group, the PD ranged from 1.33 to 1.55 mm in the test group and from 1.31 to 1.64 mm in the control group; no statistically significant difference was found between the two groups for all of these parameters (P >0.05). The elevation of a full- or partial-thickness flap did not appear to influence the amount of KT or the percentage of root coverage achieved post-surgically. More expanded studies are needed to confirm the present findings.

Risk of Lingual Plate Perforation During Implant Placement in the Posterior Mandible: A Human Cadaver Study

To determine the risk of lingual plate perforations using 2 different implants during implant installation in the posterior mandible, so as to avoid a potentially life-threatening situation and/or a compromise of the success of the surgical procedure. Nine human cadaver jaws and 16 edentulous sites with missing mandibular posterior teeth were used. Upon flap reflection, 3.7 × 10.0 mm and 3.7 × 13 mm Tapered Screw Vent implants were placed in the edentulous sites parallel to the ridge over the center of the alveolar ridge. The occurrence of lingual plate perforations was assessed visually, and the distance of the fenestration from the alveolar ridge crest, if any, was measured. Nineteen dental implants of each were placed in the second premolar and first molar regions. No lingual concavity perforations were found in all sites, except for a lingual fenestration in 1 first molar site when placing the 3.7 × 10 mm implant (0.053%). The risk of a lingual cortical plate fenestration or perforation, due to lingual concavity, in an edentulous posterior mandible in the region of the second premolar or first molar was found to be 0.053% if a regular 3.7-mm diameter tapered implant was used. In the presence of significant lingual concavity in the posterior mandible, a smaller regular diameter implant with a tapered design should be considered to avoid a potential fatal damage of vital structures.