Flapless Surgical Technique Research Articles

Digital implant placement accuracy: a clinical study on a fully-guided flapless single-unit immediate-loading protocol

AimsThe primary aim of the present study was to measure the discrepancy between the virtual and the actual position of the single-unit implants placed via a digitally-designed fully-guided surgical template using a flapless surgical technique. Prefabricated provisional restorations and periodontal factors were evaluated after the immediate loading of implants and 3 months after the surgery, respectively.Materials and methodsFourteen implants in nine patients were virtually planned after importing intraoral scans and cone-beam computed tomography (CBCT) records into 3D planning software. Accordingly, fully-guided surgical templates, customized abutments, and provisional restorations were designed and fabricated. The implant position after the surgery was compared with its virtual counterpart in terms of angular and apical linear deviations. Implants were immediately loaded after the surgery, and the occlusal level of the delivered provisional restorations was compared with their designed positions. Early implant failure, bleeding on probing, and peri-implant pockets were documented on the 3-month follow-up.ResultsA mean angular deviation of 5.07 ± 2.06° and a mean apical linear deviation of 1.74 ± 0.63 mm resulted. Two out of 14 implants failed within the first 3 months of the surgery, and the occlusal level difference was calculated for nine prefabricated provisional restorations.ConclusionsDIONAVI protocol has been evaluated regarding its accuracy, and an estimation of the expected deviation is presented to the clinicians using this protocol. However, before widespread use, immediate-loading protocols and provisional restorations must be studied further.Trial registrationIRCT, IRCT20211208053334N1. Registered 6 August 2022.

Evaluation of Accuracy in Computer Guided Versus Free Hand Immediate Implant Placement in Fresh Extraction Sockets: a Randomized Controlled Clinical Trial

Background: The aim of this study was to compare between computer guided and free hand immediate implant placement in fresh extraction sockets in terms of accuracy of implant positioning.Methods: This is a randomized controlled clinical study, which used CBCT imaging and flapless surgical technique to place implants in fresh extraction sockets. Accuracy measurements were done using BluSky®1software. A total of 22 patients were recruited according to inclusion and exclusion criteria. Results: The mean values at the implant shoulder for implants inserted using computer surgical guides and those inserted using free hand technique in the mesiodistal direction were 0.69 and 1.43mm, respectively. While in the buccolingual direction they were 0.96 and 1.34mm, respectively. At the implant apex in the mesiodistal direction, they were 1.26 and 2.35mm, respectively. While in the buccolingual direction, they were 1.64 and 1.70mm, respectively. For the angular deviation they were 1.57 and 3.18mm respectively in the mesiodistal direction. Whilein the buccolingual direction were 1.29 and 7.76mm, respectively.Conclusions: Accuracy of computer guided immediate implant insertion surpasses the freehand technique in the buccolingual direction in terms of placing Immediate Implants in fresh extraction sockets in maxillary estheticregion and thus the prosthetic aspect.

Mandibular bone height changes in two different design concepts of four implant assisted overdenture

Purpose: This comparative study was conducted to compare between two different design concepts of four implant assisted complete mandibular overdenture regarding the residual alveolar bone height changes.Materials and Methods: Ten healthy completely edentulous male patients were selected for this study. For each patient, a conventional complete denture was constructed. Each mandibular denture was duplicated to be used as a radiographic stent, then the CBCT surgical guide template was printed according to each design concept of 4-implant overdenture. The CBCT surgical guide templates were used for installing the implants according to flapless surgical technique followed by delayed loading. According to the two design concepts of the 4-implant overdenture used in this study, the patients were randomly classified into two equal groups: group [A]had two vertical canine implants with two axial 1st molar short implants (short design concept), and group [B]had two vertical canine implants with two distally inclined premolar implants (inclined design concept). Radiographic evaluations were performed immediately (T0), 6 months (T6), and 12 months (T12) respectively after picking up of the ball attachments.

CONSERVATIVE APPROACH FOR MANAGEMENT OF POSTERIOR ATROPHIC MAXILLA USING IMPLANT ASSISTED OVERDENTURE (CLINCAL TRIAL)

CONSERVATIVE APPROACH FOR MANAGEMENT OF POSTERIOR ATROPHIC MAXILLA USING IMPLANT ASSISTED OVERDENTURE (CLINCAL TRIAL) Nayrouz A. Metwally1* BDS,MSc, Ahmed M. Abdel-Hamid2 BDS,MSc,PhD, Ahmed M. Hommos3BDS,MSc,PhD, Nermeen A. Rady4 BDS,MSc,PhD ABSTRACT Introduction: Implant assisted prostheses provide a higher degree of patient satisfaction than traditional prostheses. However, severe atrophy of the edentulous maxilla and maxillary sinus pneumatization may reduce the available bone in the posterior region for a safe and reliable implant‑supported dental rehabilitation. Tilted implants in the anterior region of the maxilla were suggested to be useful in the treatment of posterior atrophic edentulous maxilla that allows the use of longer implants to gain more stability. This may preclude the use of conventional Implant overdenture abutments, requiring the use of divergence correcting attachments. Objectives: The aim of the present study was to clinically evaluate the effect of the use of Smart Box accompanied with OT Equator attachment in retaining the inclined implant assisted overdenture for atrophic maxilla. Materials and methods: Ten patients with posterior atrophic maxilla and partially dentate mandible with posterior occlusal stops were allocated for this study. For each patient, an implant assisted maxillary overdenture was fabricated using minimally invasive flapless surgical technique. Four implants were placed while the most anterior implants were axial and the most posterior implants divergent to 25 degrees using CAD/CAM surgical guide. The implants were loaded immediately by OT EQUATOR and smart box attachment retained maxillary overdenture. Each patient was evaluated clinically at the final prosthesis insertion (baseline), three, six and nine months post insertion. Modified gingival index (MGI), Clinical attachment Level (CAL) and Peri-implant probing depth (PIPD) are the clinical parameters that were evaluated. Results:MGI, CAL and PIPD revealed significant increase in both tilted and axial groups throughout the evaluation period intervals. Tilted implants group showed significantly greater increase in all parameters when compared with the axial group. Conclusions: Within the limitations of this study, it can be concluded that combination of axial and tilted implant assisted overdenture is a predictable treatment option in case of severely atrophic posterior maxillae.

Long-term clinical performance of flapless implant surgery compared to the conventional approach with flap elevation: A systematic review and meta-analysis.

BACKGROUNDThe conventional implant approach involves flap elevation, which may result in increased soft tissue and bone loss and postoperative morbidity. The flapless surgical technique, aided by three-dimensional medical imaging equipment, is regarded as a possible alternative to the conventional approach to alleviate the above issues. Several studies have been performed regarding the role of flapless implant surgery. However, the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.AIMTo compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.METHODSPubMed, EMBASE, Cochrane Central Register of Controlled Trials, and grey literature databases were searched from inception to 23 September 2019. Randomised controlled trials (RCTs) and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were included. Meta-analyses were conducted to estimate the odds ratios (ORs) or mean differences (MDs) and their 95% confidence intervals (CIs) between the long-term implant survival rate, marginal bone loss, and complication rate of the flapless and conventional groups. Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.RESULTSTen articles, including four RCTs and six cohort studies, satisfied the eligibility criteria and nine of them were included in the meta-analysis. There was no significant difference between the long-term implant survival rate [OR = 1.30, 95%CI (0.37, 4.54), P = 0.68], marginal bone loss [MD = 0.01, 95%CI (-0.42, 0.44), P = 0.97], and complication rate [OR = 1.44, 95%CI (0.77, 2.68), P = 0.25] after flapless implant surgery and the conventional approach. Moreover, subgroup analyses revealed that there was no statistically significant difference between the implant survival rate [guided: OR = 1.52, 95%CI (0.19, 12.35), P = 0.70]; free-hand: n = 1, could not be estimated), marginal bone loss [guided: MD = 0.22, 95%CI (-0.14, 0.59), P = 0.23; free-hand: MD = -0.27, 95%CI (-1.10, 0.57), P = 0.53], or complication rate [guided: OR = 1.16, 95%CI (0.52, 2.63), P = 0.71; free-hand: OR = 1.75, 95%CI (0.66, 4.63), P = 0.26] in the flapless and conventional groups either with use of the surgical guide or by the free-hand method.CONCLUSIONThe flapless surgery and conventional approach had comparable clinical performance over three years or more. The guided or free-hand technique does not significantly affect the long-term outcomes of flapless surgery.

Evaluation of Crestal Bone Resorption around Dental Implants in Flapped and Flapless Surgical Techniques Depending on Cone Beam CT Scan (Comparative Study)

Background: The long term survival of dental implants is evaluated by the amount of crestal bone loss around the implants. Some initial loss of bone around dental implants is generally expected. There is reason to believe that reflecting a mucoperiosteal flap promotes crestal bone loss in the initial phase after an implant has been inserted. The surgical placement of a dental implant fixture is constantly changing and in recent years, there has been some interest in developing techniques that minimize the invasive nature of the procedure, with flapless implant surgery being advocated. The purpose of this study was to compare the radiographic level of the peri- implant bone after implant placement between traditional flapped surgery and flapless approach depending on CBCT during 24 weeks healing period. Materials and Methods: A total of 25 Iraqi patients with an age ranged of 20-60 years who received 46 implants. Were randomized into two groups: control group which involved 27 implants inserted by conventional flapped surgical approach and study group which involved 19 implants inserted by flapless surgical approach. The bone level was measured by CBCT for each implant at buccal and palata/lingual sides at two times, immediately after implant placement (base line data), and after 24 weeks healing period. Results: There was no significant difference between study (flapless) and control (flapped) groups in the mean of total crestal bone resorption for buccal and palatal side after 24 weeks from implant placement (P= 0.393 for buccal side and P= 0.214 for palatal side). There was highly significant difference between buccal and palatal side regarding crestal bone loss around implants (P = 0.001) Conclusions: Bone resoption around dental implants placed with conventional flap surgery compared to flapless surgery does not seem to be influenced during the healing period before implant loading.

Influence of surgeon experience on the accuracy of implant placement via a partially computer-guided surgical protocol.

There is always a tension between allowing novice trainees to place implants independently and the need to achieve accurate functional and esthetic outcomes. The aim of this study was to measure the influence of surgeon experience on the accuracy of implant placement using a teeth-supported surgical guide via a partially guided surgical protocol. Twenty partially edentulous patients were randomly allocated to expert and novice surgeon groups. Implant drilling and placement for the two groups were performed through a flapless surgical technique using surgical guides following a partially guided surgical protocol. The study primary independent variable was the surgeon experience, while the outcome variable was the accuracy, which was measured based on the differences in implant angulations preoperatively and postoperatively. Two-way analysis of variance (ANOVA) was applied to find the influence of surgeon experience, implant size, and the interactive effect of surgeon experience and implant size on the angular deviation. A total of 40 implants were inserted in 7 men and 13 women. There was no significant difference (P = .453) in the mesiodistal deviation between the expert and novice groups. In a buccolingual direction, the expert group performed more accurate implant placement (3.7 ± 3.35) compared with the novice surgeons (8.5 ± 6.3). The level of surgeon experience affects the accuracy of implant placement using a teeth-supported surgical guide; therefore, the use of computer-guided surgery via a partially guided protocol does not completely compensate for the level of operator experience. However, such surgical guide might be used in a whole task training of novice surgeons, as it can bridge the gap between simulation training in vitro and freehand surgery in a clinical setting.

Survival of Mini Dental Implants Used to Retain Mandibular Complete Overdentures: Systematic Review.

To evaluate the survival rate of mini implants used to retain mandibular overdentures. An electronic search, supplemented by hand searching of the references, was conducted with no time or language restriction in October 2016 and updated in October 2017. The results were reviewed independently by the two authors. All randomized controlled trials, clinical trials, observational studies, and case series were included. The primary outcome measure was implant survival (months). The search retrieved a combined total of 391 articles. Following screening, 17 articles were included. A total of 1,715 mini implants were assessed in 475 patients. Follow-up periods ranged from 6 to 84 months (mean: 28.24 months). There were 75 failures in total. The overall survival rate was 95.63%. The majority of patients received four implants to retain their prostheses. Most studies used a flapless surgical technique, but there were vast differences in loading protocols and retention methods. Formal meta-analysis was not conducted due to the heterogeneity between studies. Based on the findings of this systematic review, mini dental implants exhibit excellent survival rates in the short to medium term. They appear to be a reasonable alternative treatment modality to retain mandibular complete overdentures from the available evidence.

Clinical research on a flapless surgical technique application of narrow implants.

The aim of the present study was to investigate the role of Axiom (implant diameter) ø2.8 mm narrow body implant in the clinical effect of minimally invasive implants in edentulous space.This study included 10 patients with 10 edentulous spaces less than 5 mm and received minimally invasive surgery with 10 Axiom ø2.8 mm narrow implants. Re-stabilization of all implants began 6 months after surgery to fix the partial denture. All cases were followed up for clinical and panoramic X-ray examinations.Imaging examination on these 10 pieces of narrow implants after 6 months showed that implant alveolar bone crest average absorption amount was 0.20 mm and no implant peripheral inflammation mucositis and denture with adjacent teeth gingival papilla between the fillings. All patients felt strong mastication and the reparation effect was more than up to expectation. No implant loosening and shedding were observed.Hence, <5 mm edentulous space by Axiom ø2.8 mm implant minimally invasive reparation can be used for aesthetic purposes.

The use of computer-guided surgery via a partially guided protocol does not completely compensate for the level of operator experience in implant placement

Purpose: There is always a tension between allowing novice trainees to place implantsindependently and the need to achieve accurate functional and esthetic outcomes. We aimed tomeasure the influence of surgeon experience on the accuracy of implants placed using a teethsupportedsurgical guide via a partially guided surgical protocol in a clinical setting.Materials and Methods: Twenty partially edentulous patients were randomly allocatedto expert and novice surgeon groups. Implant drilling and placement for the two groups wereperformed through a flapless surgical technique using surgical guides following a partially guidedsurgical protocol. The study primary independent variable was the surgeon experience, whilethe outcome variable was the accuracy, which was measured based on the differences in implantangulations pre- and postoperatively. Two-way analysis of variance (ANOVA) was applied to findthe influence of surgeon experience, implant size, and the interactive effect of surgeon experienceand implant size on the angular deviation.Results: A total of 40 implants were inserted in 7 males and 13 females. There was no significantdifference (p = 0.453) in the mesio-distal deviation between the expert and novice groups. In abucco-lingual direction, the expert group performed more accurate implant placement (3.7 ± 3.35)compared with the novice surgeons (8.5 ± 6.3). There was no effect for implant size and/or theinteraction effect on the degree of angular deviations.Conclusion: The level of surgeon experience affects the accuracy of implants placed using ateeth-supported surgical guide in a bucco-lingual direction; therefore, the use of computer-guidedsurgery via a partially guided protocol does not completely compensate for the level of operatorexperience. However, such surgical guide might be used in a whole task training of novice surgeons,as it can bridge a gap between simulation training in vitro and free-hand surgery in a clinical setting.

Effect of soft laser on osseointegrated dental implants supported maxillary overdenture

Background/ Aim: Many difficulties are encountered in providing a successful single complete denture treatment. Among these problems are the ways to provide comfort, function, proper esthetics and retention for the maxillary complete dentures in patients with opposing natural dentition. The aim of this study deals with successful rehabilitation of edentulous maxillary ridge (split-mouth technique) opposing a natural teeth prosthetically, retained with dental implants in the canine and posterior regions, using a flapless surgical technique, with an exposure of Low Level Laser Therapy (LLLT) after implant installment in order to evaluate its influence on the osseionegration, implant stability was evaluated using periotest at time of loading, 4 months and 6 months later to show the early success of dental implants placed into low- density bone. Also bone changes was evaluated by using digital periapical radiography with paralleling technique.Materials and methods: Following the split-mouth design, dental implants were inserted in the maxilla of 6 patients, the right side dental implants received LLLT ( laser side) with an output power of 0.5 UT and continuous mode was used to receive a total dose of 30 J per implant over 60 seconds, while the other side was the control side. The soft laser treatment was performed immediately after the surgery, 3 days and a week after surgery, then evaluated for stability during the follow-up period (at time of loading, 4 months and 6 months later) using periotest ,and further bone height changes using digital radiograph.Results: irradiated implants achieved a higher stability compared with control group during the entire follow-up period. At base line and after 4 months; there was no statistically significant difference between implant stability quotient (ISQ) values in the two sides. After 6 months; laser side showed statistically significantly higher mean ISQ values than control side.Conclusion: the present investigation demonstrated that 6 months after soft laser application significantly positively influenced implant stability and bone height around dental implants.

Open flap versus flapless placement of dental implants. A randomized controlled pilot trial.

The aim of this study was to compare the immediate postoperative period of participants rehabilitated with dental implants placed with a conventional technique or with a minimally invasive technique, without a mucoperiosteal flap elevation (flapless). Participants who needed implant placement were divided into two groups: one group was operated using a mucoperiosteal flap elevation (G_A), and the other with a flapless surgical technique (G_B). Objective clinical parameters including oral hygiene, mouth opening, inflammation (facial perimeter), surgical time and analgesic consumption, as well as subjective parameters of pain and degree of satisfaction with the procedure, were evaluated. 48 implants were placed in 30 participants (15 participants per group). Oral hygiene index, maximum interincisal opening, pain and analgesic consumption values had a significant difference between groups favoring the flapless technique at 24h and 7days but at the 15days' follow-up the differences were only significant for oral hygiene and pain (P<0.05); there were no statistically significant differences between groups in terms of facial perimeter values and surgical time (P>0.05). Average on the degree of satisfaction was of 2.6 (SD 0.8) for G_A and 3.6 (SD 1.02) for G_B (P=0.06). One implant placed in G_A (2.0%) failed before prosthetic loading due to mobility and pain at 3months' follow-up. Participants operated for implant placement with flapless surgical technique go through less postoperative discomfort. Both techniques show high success rates, but to perform a flapless technique patients must be properly selected.

New innovative method relating guided surgery to dental implant placement

IntroductionCompanies selling dental implant guided systems mostly offer similar surgical guides. The purpose of this paper is to present an innovative-guided surgery system which originality lies in its guidance device, and to report the author's experience in using this system for dental implant surgery. Technical protocolTwo parallel tubes on either side of the drilling axis guide the successive drills and the implant placement. As a result of the lateral guidance, there is no friction of the drills on the surgical guide, which would damage it or contaminate the drilling hole with particles torn out from the guide. No radiological guide is needed during the radiographic examination stage. No successive diameter reduction tubes are requested. This guide can be used for all brands of implants. DiscussionIn our experience, 67 implants (31 titanium and 36 zircon implants) were placed in 35 patients with guided surgery system. Multiple clinical cases were treated with this system: ‘one-stage’ or a ‘two-stage’ surgical protocol, with flap and flapless surgical techniques, and with delayed or immediate loading. Clinical cases treated revealed good implant placement with planning. The widely open design of this guide allows irrigation and practitioner's sight control under conditions comparable to those of operations performed without surgical guide. ConclusionThis dental implant guided system appears to be a significant advance in the field of implant surgical guides.

Macroscopic and microscopic evaluation of flapless alveolar perforations on experimental tooth movement.

Objective: The aim of this study was to evaluate a flapless surgical technique as an alternative to traditional alveolar corticotomy used to accelerate orthodontic tooth movement (OTM). Methods: To induce OTM in Wistar rats, 40 cN of orthodontic force were applied to the maxillary left first molars. Forty rats were distributed into control groups (CG1, CG3, CG7 and CG14) and experimental groups (n= 5), in which alveolar perforations were made using a spear-shaped guide bur (EG1, EG3, EG7, EG14). Euthanasia dates were set at 1, 3, 7 and 14 days, respectively, after tooth movement began. The amount of OTM was measured with a caliper, and osteoclasts present in the periodontal ligament of the mesial root of the moved tooth were counted by means of histological evaluation (tartrate-resistant acid phosphatase staining, TRAP). Results: Although there was no difference in the amount of OTM within subgroups of corresponding experimental periods (p> 0.05), when EG14 and CG14 were compared, a larger number of osteoclasts was counted in the experimental group (p< 0.00). Conclusion: The authors concluded that flapless cortical alveolar perforations led to more intense osteoclastic activity on the fourteenth day; nevertheless, no evidence of accelerated OTM could be noted.

Minimally invasive esthetic ridge preservation with growth-factor enhanced bone matrix.

Extraction socket preservation procedures are critical to successful esthetic implant therapy. Conventional surgical approaches are technique sensitive and often result in alteration of the soft tissue architecture, which then requires additional corrective surgical procedures. This case series report presents the ability of flapless surgical techniques combined with a growth factor-enhanced bone matrix to provide esthetic ridge preservation at the time of extraction for compromised sockets. When considering esthetic dental implant therapy, preservation, or further enhancement of the available tissue support at the time of tooth extraction may provide an improved esthetic outcome with reduced postoperative sequelae and decreased treatment duration. Advances in minimally invasive surgical techniques combined with recombinant growth factor technology offer an alternative for bone reconstruction while maintaining the gingival architecture for enhanced esthetic outcome. The combination of freeze-dried bone allograft (FDBA) and rhPDGF-BB (platelet-derived growth factor-BB) provides a growth-factor enhanced matrix to induce bone and soft tissue healing. The use of a growth-factor enhanced matrix is an option for minimally invasive ridge preservation procedures for sites with advanced bone loss. Further studies including randomized clinical trials are needed to better understand the extent and limits of these procedures. The use of minimally invasive techniques with growth factors for esthetic ridge preservation reduces patient morbidity associated with more invasive approaches and increases the predictability for enhanced patient outcomes. By reducing the need for autogenous bone grafts the use of this technology is favorable for patient acceptance and ease of treatment process for esthetic dental implant therapy.

Effect of 2 Different Drilling Speeds on the Osseointegration of Implants Placed With Flapless Guided Surgery: A Study in Rabbits.

The aim of this study was to evaluate the influence of the drilling speed on bone healing and the osseointegration of implants placed with a guided flapless surgical technique in rabbit tibias. For the evaluation of bone healing, a total of 30 perforations (defects) were made in both tibias of 15 rabbits using 2 different drilling speeds (1500 rpm-control group; 50 rpm-test group). The regeneration of bone tissue in the surgical sites was evaluated at 0, 7, and 14 days. For the evaluation of implant osseointegration, another 15 rabbits underwent drilling in both tibias for implant placement. Thirty implants (3.75 × 10 mm) were placed to evaluate osseointegration at 4, 8, and 12 weeks after surgery. Both groups showed a progressive healing of the defect, which involved the complete closure of the perforation. The osseointegration occurred in all groups with no statistically significant differences in the assessment of the osseointegration between the groups. In the experimental models used, the drilling speed does not prejudice the pattern of bone healing and osseointegration of implants placed with guided flapless surgery.

Clips vs Resilient Liners Used With Bilateral Posterior Prefabricated Bars for Retaining Four Implant-Supported Mandibular Overdentures.

The objective of this research was to clinically compare peri-implant tissue health of bar-clips vs silicone-resilient liners used with bilateral posterior bars for retaining 4 implant-supported mandibular overdentures. Thirty completely edentulous male patients (mean age, 65 years) were randomly assigned into 2 equal groups. Each patient received 4 implants in the canine and first molar regions of the mandible using a flapless surgical technique. Mandibular overdentures were immediately connected to the implants with bilateral prefabricated instant adjusting bars. According to the method of retention to the bar, 1 group was retained with clips (GI), whereas the other group was retained with a silicone-resilient soft liner (GII). Peri-implant tissue health was evaluated clinically in terms of plaque scores (MPI), bleeding scores (MBI), probing depth (PD), and implant stability (IS). MPI, MBI, and PD were measured at mesial, distal, buccal, and lingual surfaces of each implant. Evaluations were performed 2 weeks (T0), 6 months (T6), and 12 months (T12) after overdenture insertion. Implants of GI with clips demonstrated significant increase in plaque, bleeding, and PD scores compared with those of GII with silicone-resilient liner at all observation times. Implants in GI demonstrated a significant decrease in implant stability compared with those of GII at T6 and T12 anteriorly and at T12 posteriorly. Resilient liners are considered better than bar-clips when used with bilateral posterior bars for retaining implant-supported mandibular overdentures in terms of peri-implant soft tissue health. Bilateral posterior ready-made bars cannot be proposed as a promising design for supporting implant-assisted mandibular overdentures.

Zirconia implants and peek restorations for the replacement of upper molars

BackgroundOne of the disadvantages of the zirconia implants is the lack of elasticity, which is increased with the use of ceramic or zirconia crowns. The consequences that could result from this lack of elasticity have led to the search for new materials with improved mechanical properties.Case presentationA patient who is a 45-year-old woman, non-smoker and has no medical record of interest with a longitudinal fracture in the palatal root of molar tooth 1.7 and absence of tooth 1.6 was selected in order to receive a zirconia implant with a PEEK-based restoration and a composite coating. The following case report describes and analyses treatment with zirconia implants in molars following a flapless surgical technique. Zirconia implants are an alternative to titanium implants in patients with allergies or who are sensitive to metal alloys. However, one of the disadvantages that they have is their lack of elasticity, which increases with the use of ceramic or zirconia crowns. The consequences that can arise from this lack of elasticity have led to the search for new materials with better mechanical properties to cushion occlusal loads. PEEK-based restoration in implant prosthetics can compensate these occlusal forces, facilitating cushioning while chewing.ConclusionThis procedure provides excellent elasticity and resembles natural tooth structure. This clinical case suggests that PEEK restorations can be used in zirconia implants in dentistry.

Clinical parameters of implants placed in healed sites using flapped and flapless techniques: A systematic review.

BackgroundDental implant placement using flapless surgery is a minimally invasive technique that improves blood supply compared with flapped surgery. However, the flapless technique does not provide access to allow bone regeneration.ObjectivesThe aim of this systematic review was to evaluate the clinical parameters following implant surgery in healed sites, using two procedures: flapped vs. flapless surgery.Material and MethodsA detailed electronic search was carried out in the PubMed/Medline, Embase and Cochrane Library databases. The focused question was, “How do flapped and flapless surgical techniques affect the clinical parameters of dental implants placed in healed sites?”. All the studies included with a prospective controlled design were considered separately, depending on whether they had been conducted on animals or humans. The following data were recorded in all the included studies: number of implants, failures, location (maxilla, mandible), type of rehabilitation (partial or single), follow-up and flap design. The variables selected for comparison in the animal studies were the following: flap design, gingival index, mucosal height, recession and probing pocket depth. In humans studies the variables were as follows: flap design, plaque index, gingival index, recession, probing pocket depth, papilla index and keratinized gingiva.ResultsTen studies were included, six were experimental studies and four were clinical studies. Studies in animals showed better results using the flapless technique in the parameters analyzed. There is no consensus in the clinical parameters analyzed in human studies, but there is a trend to better results using flapless approach.ConclusionsThe animal studies included in the present review show that implants placed in healed sites with a flapless approach have better clinical parameters than the flapped procedure in a short-term follow-up. In human studies, there is no consensus about which technique offer better results in terms of clinical parameters. Therefore, more research in humans is required in order to overcome the limitations and contrast these results. Key words: Clinical parameters, gingival recession, probing depth, dental implants, flap, flapless.

A Comparative Study between Flapped and Flapless Surgical Techniques in Dental Implant Stability According to Resonance Frequency Analysis

Background: Recent implant surgical approach aims to cause less trauma, invasiveness and pain as much as possible and to reduce patient and surgeon discomfort, time of surgery and time needed for functional implant loading. Flapless surgical techniques considered recently as one of the most popular techniques that may achieve these aims especially enhancing osseointegration and subsequently implant stability within less time than the traditional flapped surgical technique. So this study aimed to make a comparison between flapped and flapless surgical techniques in resulted implant stability according to resonance frequency analysis RFA and in duration of surgical operation. Materials and methods: A total of 26 patients with 41 implants (one implant in the study group failed so it was excluded from the statistical analysis) were randomized into two groups: control group which involved 20 implants inserted by conventional flapped surgical approach and study group which involved 20 implants inserted by flapless surgical approach. Estimation of alveolar bone was done for study group by bone (ridge) mapping procedure. Duration of surgical operation for each implant, Implant stability was measured at three time intervals (at surgery, two months and three months after surgery). Results: After three months interval of surgery the mean implant stability of the study (flapless) group achieved significant higher implant stability than control (flapped) group (P< 0.05) and the difference in measured implant stability was (5.05) implant stability quotient(ISQ). The time of surgical operation for implants in the study group significantly was less than that of control group (P< 0.01). Conclusions:implants placed with flapless surgical technique can produce high implant stability in shorter time and consume prominently shorter time for surgical operation compared to those placed with conventional flapped technique.