Flapless Procedure Research Articles

Immediate Insertion and Restoration of a Single Implant to Replace Two Adjacent Periodontally Compromised Lower Incisors: A Technique Report with up-to-8 Years Follow-up.

The study investigated the cumulative survival rate (CSR) and marginal bone loss (MBL) of single implants immediately placed and restored with two-unit cantilevered fixed dental prostheses after extraction of two adjacent mandibular incisors with a compromised periodontal condition. Patients in need of extraction and replacement of two adjacent mandibular incisors due to advanced periodontal loss of attachment were treated consecutively. Following a flapless procedure, a single implant was inserted at the time of extraction in one of the two fresh alveoli sockets and immediately restored with a screw retained two-unit provisional FDP. The area of extraction was grafted using xenograft particulate material. Peri-implant soft tissue and hard tissue condition at the last follow-up appointment, marginal bone loss at the last follow-up appointment at least 1 year after the delivery of the final prosthesis, and the final aesthetic result were evaluated. Twenty patients were recruited between January 2014 and December 2019 in a single private practice and each received single implants and immediate provisional restoration with a two-unit cantilevered fixed dental prosthesis. Patients were followed for 22 to 94 months (average follow-up = 4 years) and none of the implants failed resulting in 100% CSR. Cumulative MBL -measured using the VixWin Platinum software -was 1.08 +/- 0.35. A lower MBL was observed in the presence of platform switching (0.63 +/- 0.11 mm) compared to the absence of platform switching (1.27 +/- 0.20 mm). The preliminary results obtained from this study suggest that patients in need of replacing two adjacent periodontally compromised mandibular incisors can be treated with an immediately inserted and restored single implant.

COMPARISON OF VISUAL ACUITY RESULTS AFTER FEMTOSECOND LASER-ASSISTED IN SITU KERATOMILEUSIS (FS-LASIK) AND SMALL INCISION LENTICULE EXTRACTION (SMILE)

Introduction: Two of the most popular refractive surgery methods currently used are Femtosecond Laser-Assisted In Situ Keratomileusis (FS-LASIK) which creates a flap using femtosecond laser and stromal ablation using excimer laser, and Small Incision Lenticule Extraction (SMILE), a flapless procedure in which a lenticule is extracted through a small incision. The aim of this study is to compare the visual acuity results of FS-LASIK and SMILE. Methods: This is a descriptive cross-sectional study. Data were collected from the medical record of patients who underwent FS-LASIK or SMILE procedure at Cicendo Eye Hospital, the national eye centre, in 2022. Patients were followed up at 1 day, 1 week, and 1 month postoperatively and visual acuity outcomes between the two procedures were compared. Results: A slightly higher percentage of eyes in FS-LASIK (46.6%) achieved a UCVA of 1.0 at 1 day postoperatively compared to SMILE (45.5%). At 1 week and 1 month, SMILE showed superior results with 83% and 94.6% of eyes achieving a UCVA of 1.0, meanwhile FS-LASIK had 72.2% and 86.2%. Residual refractive error at 1 month had a median of -0.6146 and -0.3125 in the FS-LASIK and SMILE groups. Conclusion: This study found better UCVA results in the FS-LASIK group compared to the SMILE group at 1 day postoperatively. Meanwhile, UCVA at 1 week and 1 month postoperatively, showed superior results in the SMILE group. Residual refractive error at 1 month postoperatively also showed better results in SMILE than FS-LASIK.

The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial.

To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. gov identification number: NCT05456555.

Radiographic evaluation of hard tissue changes in open flap technique versus flapless technique for implant placement

Open flap technique allows the clinician to directly visualize the alveolar bone and assess bone morphology of the ridge.However, this technique is relatively invasive and causes patient discomfort and marginal bone loss due to decreased supraperiosteal blood supply whereas the Flapless technique is one of the latest minimally invasive surgical methods of implant placement without the need to raise a mucoperiosteal flap to overcome the bone resorption process. The present study was designed to evaluate the hard tissue changes in open flap technique versus flapless ṭechnique for implant placement at the different time interval. Minimum thirty edentulous sites from Out Patient Department, Department of Periodontology (IDST) were randomly allocated to the following two groups by the flip of coin: Group I - Implant with open flap technique (fifteen sites) and Group II - Implant with flapless technique (fifteen sites). Patients were evaluated radiographically for crestal bone loss (mesial and distal) at Baseline (Immediately after implant placement), At the time of prosthetic loading and 3 months after prosthetic loading in both the groups. The result of the present study revealed that Sites where implants were placed with flapless technique showed lesser mean crestal bone loss scores as compared to sites where implants were placed with open flap technique, although the difference was insignificant. It can be concluded that flapless procedure may be considered as a better treatment option as compared to implant placed with open flap technique in terms of minimal pain, inflammation and less crestal bone loss associated with flapless technique than open flap technique.

OUTCOMES COMPARISON AFTER SMALL INCISION LENTICULE EXTRACTION (SMILE) AND FEMTOSECOND-LASER ASSISTED IN SITU KERATOMILEUSIS (FS-LASIK) IN LOW-MODERATE MYOPIA PATIENTS

Abstract&#x0D; Introduction &amp; Objectives : Uncorrected myopia is the leading cause of visual impairment globally. It can be corrected by refractive surgeries, such as Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser- Assisted In Situ Keratomileusis (FS-LASIK). SMILE technique is less-invasive than FS-LASIK, characterized by all-in-one femtosecond laser and flapless procedure. Correction of low-moderate myopia requires a special concern because even slight decreased in visual quality may be noticed by the patients and affect their satisfaction. The purpose of this study to compare the refractive outcomes after SMILE and FS-LASIK in low-moderate myopia patients.&#x0D; Methods : This is a prospective analytical observational study that was conducted in a tertiary hospital in Indonesia. Four refractive outcome parameters (predictability, efficacy, safety, and stability) were assessed at 1 day, 1 week, and 1 month postoperatively.&#x0D; Results : SMILE was performed on 22 eyes with spherical equivalent (SE) -3.60±1.07 D and FS-LASIK on 20 eyes with SE -2.91±1.53 D. At 1 month, the predictability as the proportion of eyes within SE ±0.50 D were 95.5% in SMILE and 80% in FS-LASIK (p=0.174), the efficacy as the proportion of eyes achieving uncorrected distant visual acuity (UDVA) ≥20/20 were 63.6% in SMILE and 35% in FS- LASIK (p= 0.064), the stability as the proportion of eyes experiencing SE change &gt;0.50 D were 4.5% in SMILE and 5% in FS-LASIK (p=1.000). No eyes from both groups had corrected distant visual acuity (CDVA) loss of ≥2 lines (p=1.000).&#x0D; Conclusion : SMILE and FS-LASIK were both predictable, effective, safe, and stable for low-moderate myopia patients.

Modified Technique to Rehabilitate American Society of Anesthesiology-III Patient, Through Flapless Procedure With Computed Tomography-Guided Surgery.

The aim was to evaluate the safety and effectiveness of a computed tomography-guided surgery implant placement with a flapless technique and immediate functional loading in an American Society of Anesthesiology-III patient. This technical note involved a 64-year-old American Society of Anesthesiology-III patient. Her hopeless teeth were extracted and a restorative evaluation was provided as a prosthetic reference. The surgical procedure was based on the flapless technique that let us to use local anesthesia. The authors used an All-on-4 concept restoration for maxilla and conventional fixed prosthesis procedures for jaw rehabilitation. The authors placed 4 tilted implants in the upper maxilla and 6 right implants in the jaw. Implants were loaded with a provisional prosthesis on the same day of surgery. Five months later, provisional restoration was removed; the authors placed into the ceramic crowns 2 Procera Implant Bridge (Nobel Biocare) frameworks, developed through computer-aided design/computer-aided manufacturing technology. Computed tomography-guided surgery is a minimally invasive technique that allows, through a flapless approach, safer and more predictable procedures. In this technical note, the authors achieved accurate implant placement and precise fit of restoration with natural looking appearance; this patient-oriented-treatment led to a reduced healing time with better compliance.

Is refractive enhancement a safer option for post laser in situ keratomileusis and small incision lenticule extraction regression - How far we have come?

Is refractive enhancement a safer option for post laser in situ keratomileusis and small incision lenticule extraction regression - How far we have come?

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

PurposeTo present the results obtained with a novel sleeveless and keyless guided implant surgery system. MethodsInclusion 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. ResultsSixty 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 peri‑implant 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%. ConclusionsWithin 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 RelevanceThe use of sleveless and keyless surgical guides can be clinically reliable and may be represent a valid option for the surgeon.

Effect of piezocision procedure in levelling and alignment stage of fixed orthodontic treatment: a randomized clinical trial

This clinical trial compared the time to complete the levelling and alignment stage with flapless piezocision procedure in the treatment of severe maxillary malocclusion with premolar extraction cases. Two-arm parallel group randomized controlled trial was performed at the Orthodontics Unit of Universiti Sains Malaysia, Malaysia. Sixteen patients with severe anterior maxillary crowding (Little’s irregularity index: 7–9 mm) and required bilateral first premolars extraction was recruited. The participants were randomly assigned to a study group according to a simple randomization method using a sealed envelope mentioned about the group name. Both groups were treated with fixed orthodontic appliance using the 0.022-in. slot of McLaughlin Bennett Trevisi prescription brackets. The piezocision group received flapless piezocision corticotomy about 4–5 mm in length and 3 mm depth on the labial mucogingiva between the roots of six anterior teeth. The number of days since treatment started, Little’s irregularity index, gingival recession, pocket depth, pulp vitality, patient perception of the pain and satisfaction level were recorded before the treatment, at about 1 month and 2 months post-treatment, and at the completion of the levelling and alignment stage. The overall time to complete levelling and alignment stage was significantly shorter in the piezocision group than the control group (mean difference = 31.5 days, 95% CI 6.5, 56.5; p = 0.018). Greater reduction in Little’s irregularity index and faster alignment rate in the first 2 months were found in the piezocision group compared to the control group (p < 0.05). No changes in the gingival recession, pocket depth, and pulp vitality in both groups were observed. Patients who received piezocision surgery experienced no or mild pain and were satisfied with the treatment. Flapless piezocision corticotomy is an effective adjunct that shortens treatment time during levelling and alignment stage without any adverse effects on the teeth and surrounding tissues. It is also painless, acceptable and satisfactory to the patients.Trial registration: ACTRN12621001350819.

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 study of refractive outcomes after photorefractive keratectomy and small-incision lenticule extraction in moderate myopia

ObjectivesTo compare the refractive outcomes after photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE) in moderate myopia.BackgroundPRK and SMILE are two flapless procedures for the correction of myopia and astigmatism. In PRK, an excimer laser is used for photoablation, whereas in SMILE, a femtosecond laser is used to create the lenticule.Patients and methodsA retrospective study was conducted on 80 patients (160 eyes) who were classified into two groups: PRK and SMILE. A total of 40 patients (80 eyes) were included in each group. Assessment was between 6 months and 3 years postoperatively comparing the uncorrected distance visual acuity, best-corrected distance visual acuity, and manifest refraction spherical equivalent with the preoperative data in addition to assessing the efficacy, safety, and predictability in each procedure.ResultsThe two groups were matched for age, sex, and preoperative characteristics. The mean postoperative uncorrected distance visual acuity in the PRK group was 0.96 ± 0.06 and in the SMILE group was 0.95 ± 0.08 (P = 0.621). The mean postoperative best-corrected distance visual acuity in the PRK group was 0.96 ± 0.06 and in the SMILE group was 0.97 ± 0.07 (P = 0.735). The mean postoperative manifest refraction spherical equivalent in the PRK group was − 0.24 ± 0.34 and in the SMILE group was − 0.30 ± 0.20 (P = 0.186). The mean efficacy index in the PRK group was 0.99 ± 0.05 and in the SMILE group was 0.99 ± 0.07 (P = 0.456). The mean safety index in the PRK group of all eyes was 1.00 ± 0.03 and in the SMILE group was 1.00 ± 0.04 (P = 0.704). In the PRK group, 90% of all eyes were within ± 0.50 D of intended refraction and 100% were within ± 1.00 D. In the SMILE group, 95% of all eyes are within ± 0.50 D of intended refraction and 100% were within ± 1.00 D.ConclusionPRK and SMILE procedures showed excellent efficacy, safety, and predictability in moderate myopia, whereas SMILE was noticed to be better in predictability than PRK.

Yerleştirme Sonrası İyileşme Başlığı ile Kapatılan İmplantlarda İlk Yılda Marjinal Kemik Kaybı Daha Az mı Görülür?

Background: Early peri-implant crestal bone loss during the healing period and the first year on function, is often greater than the bone loss occurring in the following years. Several factors affecting marginal bone loss have been described; such as surgical trauma, flapped or flapless procedures, occlusal overload, microgap and implant crest module. The aim of this study; was to compare the amount of first year peri-implant bone loss in implants closed with cover screw or healing cap. Material and Methods: Patients with same brand, posterior single tooth implants included in this prospective study and divided into two groups. In group I, after implant placement healing cap was placed while in group II, cover screw was placed before primary closure. Panoramic radiographs, taken before and after the implant surgery and after 1 year follow up, were used in bone loss evaluations. Peri-implant bone loss measurements were performed digitally in computer assisted software programme. Results: Thirty implants included in the study with fourteen implants in group I and sixteen implants in group II. There were no perioperative or postoperative complications and no implant failure in all patients. After the first year, mean marginal bone loss was 0.7014 mm (0.2477 mm standard deviation) in group I and 1.3156 mm (0.0943 mm standard deviation) in group II. This 0.6142 mm difference was found statistically significant. Conclusion: Placing healing cap instead of cover screws may prevent periosteal tissue pressure on the crestal bone and reduce the amount of marginal peri-implant bone in the first year.

Evaluation of Bone Regeneration around Implants with and without Flap Elevation

Background:The aim of this study is to clinically evaluate and compare the clinical success and the relative bone healing of the implants which are placed using a flapless procedure and compare it to those placed by the conventional flap technique.Materials and Methods:This study was conducted with ten patients that were randomly divided into two groups. Group A included patients with immediately placed implants after extraction with flap elevation. Group B included patients with immediately placed implants after extraction without any flap elevation. The clinical parameters recorded were Plaque index, Modified Gingival Index, Early Wound Healing Index, Buser's criteria, Distance between implant shoulder and the crestal bone (DIB), and Radiographic Examination in a standardized manner to evaluate changes for the DIB values.Results:There was an improvement in Plaque Score from baseline to 1 month and baseline to abutment placement (6 months), which was statistically significant, but the plaque score from 3 months to abutment placement (6 months) was statistically nonsignificant in both the group. There was an increase in modified gingival score from baseline to 3 months, baseline to abutment placement (6 months), and 3 months to abutment placement (6 months), which was statistically significant in both the groups. The DIB scores in Group A recorded at baseline to 6 months were 2.80 ± 0.57 and 1.90 ± 0.42, respectively, showing a mean difference of −0.90 and P = 0.001 in comparison. Whereas, the DIB scores in Group B at baseline to 6 months were 3.20 ± 0.57 and 2.50 ± 0.50, respectively, showing a mean difference of −0.70 and P = 0.001 in comparison. The DIC scores in Group A at baseline to 6 months were 1.60 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.60 and P = 0.003 in comparison, Whereas the DIC scores in Group B at baseline to 6 months were 1.40 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.40 and P = 0.005 in comparison.Conclusion:Implants placed in fresh extraction sockets with and without mucoperiosteal flap elevation can be successfully done with augmentation procedures. Short-term survival rates and clinical outcomes of both groups were similar and appeared to be predictable treatment modalities.

Accuracy of Computer-Assisted Dynamic Navigation in Implant Placement with a Fully Digital Approach: A Prospective Clinical Trial.

Background: This prospective clinical study aimed to investigate a possible deviation between the digitally planned implant position and the position achieved using dynamic navigation. The aim of the study was to establish clinical effectiveness and precision of implantation using dynamic navigation. Methods: Twenty consecutive patients received an implant (iSy-Implantat, Camlog, Wimsheim, Germany). One screw implant was placed in one jaw with remaining dentition of at least six teeth. The workflow was fully digital. Digital implant planning was conducted using cone-beam computed tomography (CBCT) and an intraoral scan of the actual condition. Twenty implants were subsequently placed using a dynamic computer-assisted procedure. The clinical situation of the implant position was recorded using an intraoral scan. Using these data, models were produced via 3D printing, and CBCTs of these models were made using laboratory analogs. Deviations of the achieved implant position from the planned position were determined using evaluation software. Results: The evaluation of 20 implants resulted in a mean angle deviation of 2.7° (95% CI 2.2–3.3°). The 3D deviation at the implant shoulder was 1.83 mm (95% CI 1.34–2.33 mm). No significant differences were found for any of the parameters between the implantation in the upper or lower jaw and an open or flapless procedure (p-value < 0.05). Conclusion: The clinical trial showed that sufficiently precise implantation was possible with the dynamic navigation system used here. Dynamic navigation can improve the quality of implant positioning. In particular, the procedure allows safe positioning of the implants in minimally invasive procedures, which usually cannot be performed freehand in this form. A clinical benefit and effectiveness can be determined from the results.

SMILE - Small Incision Lenticule Extraction

Refractive lenticule extraction is a corneal surgical technique that uses a femtosecond laser exclusively to create an intrastromal refractive lenticule for the correction of myopia and myopic astigmatism. In small incision lenticule extraction (SMILE) the generated refractive lenticule is subsequently extracted through a small incision. The reported efficacy, predictability and safety of the flap-less SMILE procedure is similar to those of femtosecond laser in situ keratomileusis (LASIK). Advantages of SMILE over LASIK include less iatrogenic dry eye, fewer induced higher-order aberrations, and potentially less biomechanical weakening of the cornea. However, there is a steeper surgeon learning curve for SMILE as the procedure is technically more challenging than LASIK. Furthermore, the current SMILE laser platform cannot use cyclotorsion control or eye-tracking technology and retreatment options are more complex compared to LASIK. This review looks at patient selection, surgical method, possible complications, retreatment options, and postoperative outcome of the SMILE technique.

Flapless soft tissue punch technique for implant placement- A case report

Management of edentulous spaces has been revolutionized by dental implants. Dental implant therapy has replaced most of the conventional methods of treating edentulous patients and has become a highly predictable treatment modality. More recently, the concept of flapless implant surgery has been introduced for patients with sufficient keratinized gingival tissue and bone volume in the implant recipient site. In a flapless procedure, a dental implant is installed through the mucosal tissues without reflecting a flap.This case report aims at treating a 42-years old systemically healthy female patient with an edentulous space in relation to 46 by flapless soft tissue punch technique. In this technique, the soft tissue at the surgical site is punched out using a soft tissue punch, followed by osteotomy and implant placement. The final restoration was done at the end of 4 months. Flapless soft tissue punch technique is an innovative minimally invasive method for management of edentulous spaces with sufficient bone width, height and keratinized gingiva, thereby leading to high patient compliance. The added advantage being minimal amount of crestal bone loss.

Effect of flap and flapless procedures in dental implant installation on initial crestal bone loss

Objective: the present study was designed to evaluate the effect of flap and flapless procedures in dental implant installation on initial crestal bone loss. Subjects & Methods: Twelve patients were enrolled in the study. The patients divided into two groups. group I (flapless group), and group II (flapped group). Patients were followed up at the 2nd and 7th days after surgery for severity of pain, swelling, infection, dehiscence of the tissue. The periodontal probing depth was measured. Post-operative implant stability was measured 6 months after surgery. Crestal bone level was measured. Postoperative measurement of bone density was performed 6 months after surgery. Results: The flapless technique group showed statistically significant reduction in pain intensity and swelling than the flap technique. Patients operated with flap technique showed higher pocket depth than patients operated with flapless technique. The implant stability was greater in patients of flapless group than in patients of flap group. The amount of crestal bone loss was less in the flapless group than the flap group. Bone density was increased in the flapless group as well as in the flap group. Conclusion: Both flapless and flap techniques achieved good success rates. The use of flapless technique reduces the postoperative soft tissue inflammation, pain and swelling. The flapless technique significantly reduces the amount of crestal bone loss. The flapless technique has no advantage over flap one in probing depth, implant stability and bone density.

Effect of Flap and Flapless Procedures in Dental Implant Installation on Initial Crestal Bone Loss

Effect of Flap and Flapless Procedures in Dental Implant Installation on Initial Crestal Bone Loss

Immediate implant placement and provisionalization: Aesthetic outcome 1 year after implant placement. A prospective clinical multicenter study.

Prospective aesthetic outcomes on a high number of patients after immediate implant placement and provisionalization (IIPP) are lacking. To analyze the aesthetic outcome after IIPP. One hundred consecutive patients with a failing maxillary incisor were provided with an immediately placed and provisionalized nonloaded implant using a flapless procedure and palatal implant positioning. The remaining gap buccally was filled with a bone substitute. Preoperatively (T0), 2 weeks postoperatively (T1), direct after placement of the permanent crown (T2), and 1 year after IIPP (T3), standardized light photographs were made. Change in aesthetic score was the primary outcome measure. Both the white aesthetic score (WES) and pink aesthetic score (PES) were used. In the first year postsurgery, the mean total-WES and total-PES scores raised from 4.5 to 8.2, and from 9.9 to 12.1, respectively. The mean PES scores for mesial and distal papilla, soft tissue marginal level, contour, color, and texture, raised significantly (P < .05), while the alveolar process contour, on average, remained stable from T0 to T3. Within the limitations of this 1-year research, it may be concluded that, following this minimal invasive IIPP procedure, a high aesthetic outcome was achieved.

Complete-arch fixed reconstruction by means of guided surgery and immediate loading: a retrospective clinical study on 12 patients with 1\u2009year of follow-up

BackgroundGuided implant surgery is considered as a safe and minimally invasive flapless procedure. However, flapless guided surgery, implant placement in post-extraction sockets and immediate loading of complete-arch fixed reconstructions without artificial gum are still not throughly evaluated. The aim of the present retrospective clinical study was to document the survival and success of complete-arch fixed reconstructions without artificial gum, obtained by means of guided surgery and immediate loading of implants placed also in fresh extraction sockets.MethodsA total of 12 patients (5 males and 7 females, with a mean age of 50.0 ± 13.8) were enrolled in this study. Implant planning was performed with a guided surgery system (RealGuide®, 3Diemme, Como, Italy), from which 3D-printed surgical templates were fabricated. All implants (Esthetic Line-EL®, C-Tech, Bologna, Italy) were placed through the guides and immediately loaded by means of a temporary fixed full-arch restoration without any artificial gum; the outcome measures were implant stability at placement, implant survival, complications, prosthetic success, soft-tissue stability, and patient satisfaction.ResultsOne hundred ten implants (65 of them post-extractive) were placed flapless through a guided surgery procedure and then immediately loaded by means of provisional fixed full arches. Successful implant stability at placement was achieved in all cases. After a provisionalization period of 6 months, 72 fixed prosthetic restorations were delivered. Only 2 implants failed to osseointegrate and had to be removed, in one patient, giving a 1-year implant survival rate of 98.2% (108/110 surviving implants); 8/12 prostheses did not undergo any failure or complication during the entire follow-up period. At the 1-year follow-up control, soft-tissue was stable in all patients and showed satesfactory aesthetic results.ConclusionsWithin the limits of this study, complete-arch fixed reconstruction by means of guided surgery and immediate loading of implants placed in fresh extraction sockets appears to be a reliable and successful procedure. Further long-term prospective studies on a larger sample of patients are needed to confirm these positive outcomes.