Flapless Surgical Technique Research Articles

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

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

Three-Year Outcome of Fixed Partial Rehabilitations Supported by Implants Inserted with Flap or Flapless Surgical Techniques.

The aim of this prospective clinical study was to evaluate the 3-year outcome of fixed partial prostheses supported by implants with immediate provisionalization without occlusal contacts inserted in predominantly soft bone with flap and flapless protocols. Forty-one patients partially rehabilitated with 72 NobelSpeedy implants (51 maxillary; 21 mandibular) were consecutively included and treated with a flapless surgical protocol (n = 20 patients; 32 implants) and flapped surgical protocol (n = 21 patients; 40 implants). Primary outcome measure was implant survival; secondary outcome measures were marginal bone resorption (comparing the bone levels at 1 and 3 years with baseline) and the incidence of biological, mechanical, and esthetic complications. Survival was computed through life tables; descriptive statistics were applied to the remaining variables of interest. Eight patients with eight implants dropped out of the study. One implant failed in one patient (flapless group) giving an overall cumulative survival rate (CSR) of 98.6%. No failures were noted with the flapped protocol (CSR 100%), while for the implants placed with the flapless surgical technique, a 96.9% CSR was registered. The overall average marginal bone resorption at 3 years was 1.37 mm (SD = 0.94 mm), with 1.14 mm (SD = 0.49 mm) and 1.60 mm (SD = 1.22 mm) for the flap and flapless groups, respectively. Mechanical complications occurred in nine patients (n = 5 patients in the flapless group; n = 4 patients in the flap group). Implant infection was registered in three implants and three patients (flapless group), who exhibited inadequate oral hygiene levels. Partial edentulism rehabilitation through immediate provisionalization fixed prosthesis supported by dental implants inserted through flap or flapless surgical techniques in areas of predominantly soft bone was viable at 3 years of follow-up. The limitations and risks of the "free-hand" method in flapless surgery should be considered when planning implant-supported fixed prosthetic reconstructions.

Comparison Between Flapped and Flapless Implant Techniques by Measuring Crestal Bone Level: A Prospective Radiographical Trial

Background: Previously, the flapped dental implant surgery was the most common implant placement procedure. With the development of different implantation techniques, the flapless surgery is now available for implant placement. The aim of this study was to evaluate the effect of the flapless surgical technique for implant placement on bone level compared with the flapped surgery technique with the aid of panoramic imaging. Materials and methods: The study comprised 10 patients, 20 dental implants investigated, two implants placed for each patient (one implant placed with a flapped procedure and the other with a flapless surgical technique). Utilizing panoramic view pre- and post-surgical treatment, the crestal bone level at different intervals (1 week, 4 weeks and 12 week) has been compared. Results: When comparing flapped and flapless implant surgical procedures at different time intervals, the flapless surgical technique showed less bone level reduction, on the other hand no significant results obtained when comparing the surgical techniques in the maxillary and mandibular arches. Conclusion: Flapless implant placement provides less bone level reduction compared with the flapped technique.

Histopathological comparative analysis of peri-implant soft tissue response after dental implant placement with flap and flapless surgical technique. Experimental study in pigs.

The aim of this study was comparing the effect of flapless vs. flap technique of implant placement on inflammation degree of peri-implant soft tissue, through histopathological analysis. The experiment was conducted on five domestic pigs. Nine weeks after tooth extraction, implants were installed. Each animal received six implants in mandible. According to split-mouth design, randomly one side was used for flapless technique using mini-incision, while on the other side, flap was raised. After 7, 14, 21, 28, and 90 days, the experimental animals were sacrificed. Samples for histopathological analyzes were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The degree of inflammatory response in the peri-implant soft tissue was estimated through ordinal scores from 0 to 3. In the flap group Score 3 indicating high degree of inflammation was present from day 7 to day 21, in contrast to flapless group where Score 3 was not recorded during the entire follow-up. Three months after implantation, there were no signs of inflammation neither around flap nor around flapless implants. Flapless surgical implantation technique using mini-incision decreases peri-implant soft tissue inflammatory reaction compared with flap surgery.

New-Design Dental Implants: A 1-Year Prospective Clinical Study of 344 Consecutively Placed Implants Comparing Immediate Loading Versus Delayed Loading and Flapless Versus Full-Thickness Flap

This study compared the 1-year success rates of immediately loaded dental implants to delayed loaded implants, regardless of the surgical technique (flapless or conventional full-thickness flap) and regardless of extraction time. It also examined whether the surgical technique had an influence on the success rate of the immediately loaded implants. A total of 344 dental implants, some with a new expanded winged-thread design, were placed in 155 patients; 53% of the implants were immediately loaded. Of the immediately loaded implants, 68.9% were placed with a flapless surgical technique and 88% were placed in extraction sites. Pocket depth, mobility, bleeding on probing, presence of erythema, pain, or radiolucency around the implants, as well as clinical findings, were recorded. Implants were followed from placement through definitive restoration. Descriptive, univariate, and multivariate analyses using clustered marginal approach of the Cox proportional hazards model were applied. Of the 344 implants in the study, 10 (2.9%) failures were recorded, 7 of which were immediately loaded; however, there was no significant difference in failure rates between the immediate and delayed loading groups. Seven of the implants that failed were placed with a flapless (extraction site) technique; however, there was no significant difference in the failure rates between the flapless versus full-thickness flap technique in immediately loaded implants. The clinical success of immediately loaded implants after 1 year showed no difference from the success rate of delayed loaded implants. The implantation procedure (flapless versus conventional flap) or extraction time also had no influence on the success rate of the immediately loaded implants.

Implantologie dentaire assistée par ordinateur : intérêts de la navigation du système Robodent®

The use of the Robodent® passive robotic system improves the accuracy of implant placement and thus allows extending the field of indications for flapless surgical technique. Surgery can be performed with a greater operative safety and peroperative modification of the surgical protocol is possible.

Mini implants for definitive prosthodontic treatment: A systematic review

Mini implants are commonly used in orthodontics and for interim prosthodontic treatment, but evidence for their use in definitive prosthodontic treatment is not clear. This systematic review evaluated the mini-implant literature to analyze short-term (1 to 5 years), medium-term (5 to 10 years), and long-term (beyond 10 years) survival rates when used for definitive prosthodontic treatment. An electronic search of the English language literature for articles published between January 1974 and May 2012 was performed by using PubMed and Cochrane databases with predetermined inclusion criteria. Key terms included in the search were mini dental implants, narrow diameter implants, reduced diameter implants, small diameter implants, transitional implants, interim implants, and provisional implants. After a systematic filtering process, the selected articles were subjected to a detailed review, and the data collected were used to calculate the 1-year interval survival rate (ISR) and the cumulative survival rate (CSR). The electronic database search yielded 1807 titles. By scrutinizing the titles and abstracts with inclusion and exclusion criteria, the researchers identified 9 studies of mini implants for definitive prosthodontic treatment. Of the studies identified, 1 was a randomized controlled trial, 2 were prospective studies, and 6 were retrospective studies. The majority of mini implants were placed by using a flapless surgical technique in the mandibular anterior region to support an overdenture. The 1st year ISR was 94.7% and the CSR over a 9-year period, primarily attributed to data from 1 study, was 92.2%. Most implants were immediately loaded and almost all implant failures occurred during the first year after implant placement. For short-term survival, the first year ISR of 94.7% of mini dental implants appears encouraging, but the true 1-year survival rate is unknown, as the minimum follow-up period reported for several implants was less than a year. Insufficient information about failures after the first year makes it difficult to draw conclusions about the medium-term survival of these implants. Currently, there is no evidence for the long-term survival of mini implants.

Comparative radiographic and resonance frequency analyses of the peri-implant tissue after dental implants placement using flap and flapless techniques: An experimental study on domestic pigs

Flapless implant surgery has become very important issue during recent years, mostly thanks to computerization of dentistry and software planning of dental implants placements. The aim of this study was to compare flap and flapless surgical techniques for implant placement through radiographic and radiofrequency analyses. The experiment was made in five domestic pigs. Nine weeks following domestic pigs teeth extraction, implants were placed, on the right side using surgical technique flap, and flapless on the left side. Digital dental Xrays were applied to determine primary dental implant stability quality (ISQ). At certain intervals, not later than three months, the experimental animals were sacrificed, and just before it, control X-rays were applied to measure dental implants stability. Radiographic analysis showed that peri-implant bone resorption in the first 4 weeks following placement implants with flap and flapless surgical techniques was negligible. After the 3 months, mean value of peri-implant bone resorption of the implants placed using flap tehnique was 1.86 mm, and of those placed using flapless tehnique was 1.13 mm. In relation to the primary dental implant stability in the first and second week there was an expected decrease in ISQ values, but it was less expressed in the dental implants placed using the flapless technique. In the third week the ISQ values were increased in the dental implants placed by using both techniques, but the increase in flapless implant placement was higher (7.4 ISQ) than in flap implant placement (1.5 ISQ). The upward trend continued in a 4-week period, and after 3 months the dental implant stability values in the implants placed using flap technique were higher than the primary stability for 7.1 ISQ, and in the implants placed using flapless technique were higher comparing to the primary stability for 10.1 ISQ units. Based on the results of radiographic and resonance frequency analyses it can be concluded that the flapless technique in surgical implants placemat, leads to better results.

A CAD/CAM flapless surgical technique and immediate prosthesis: a clinical report

Background This article describes a clinical report with a new system for guided surgical treatment and immediate load prosthesis in the flapless surgical technique. Case report Based on a computed tomography (CT) of a 64 - year-old edentulous patient, the cross sections were reformatted and used to construct a virtual planning of the implants and a guide template in Dental Slice. Six dental implants were placed in the maxilla and mandible using a Slice Guide System. Following a 30-month in maxilla and 24-month in mandible healing period, the clinical and radiographic evaluation and computed tomography (CT) showed good clinical stability. The Slice Guide System proved satisfactory for the Flapless Surgical Technique in dental implants.

Healing of peri-implant tissues after flapless and flapped implant installation

The aim of this study was to investigate the consequences of different flapless procedures for the installation of dental implants on peri-implant bone response. After bilateral extraction of the mandibular second and third premolars and a 3-month healing period, 30 SLActive(®) implants were installed for 3 months in 10 Beagle dogs according to three different surgical approaches, i.e.: (1) flapped (F), (2) tissue punch flapless (P), and (3) direct flapless (DF). At harvesting, 29 implants were analysed. Micro-computed tomography and histomorphometrical evaluation (which also included the mobile implants) showed comparable results in bone volume (F=55 ± 9, P=51 ± 4, DF=54 ± 5) and crestal bone level (F=3420 ± 762, P=5358 ± 1681, DF=3843 ± 433). However, the implants inserted using the punch approach revealed a significantly lower first bone contact (F=3420 ± 762, P=5358 ± 1681, DF=3843 ± 433) and bone-to-implant contact percentage (F=70 ± 12, P=48 ± 23, DF=73 ± 12). Considering the gingival response, the barrier epithelium was also significantly deeper around the implants installed using the punch approach (F=1383 ± 332, P=2278 ± 1154, DF=1107 ± 300). The results indicate that a flapless surgical technique can be used for the installation of oral implants. In addition, using a tissue punch wider than the implant diameter should be avoided, as it can jeopardize the outcome of the implantation procedure.

Full-Mouth Implant-supported Rehabilitation with a Flapless Surgical Technique: A Treatment Approach using Computer-Assisted Oral Implant Surgery

Full-Mouth Implant-supported Rehabilitation with a Flapless Surgical Technique: A Treatment Approach using Computer-Assisted Oral Implant Surgery

Esthetic Rehabilitation of Maxillary Incisors in Conjunction with Flapless Surgical Techniques, an Implant Zirconia Crown, and Porcelain Veneers

ABSTRACT Esthetic replacement of a maxillary central incisor using a dental implant can be a challenging task. The hard and soft tissues must be managed in a way that minimizes the risk of tissue loss, while preserving and/or regenerating full interdental papillae. In order to achieve this, flapless surgical techniques have been developed. Advances in dental materials have led to the introduction of zirconia abutments and crowns that can be synergistically combined with other ceramic materials. This article describes a case in which a hopeless maxillary central incisor is replaced with an implant using flapless techniques, and restored with a customized zirconia abutment and crown. In addition, the remaining maxillary incisors were restored with feldspathic porcelain veneers to yield a highly esthetic result. CLINICAL SIGNIFICANCE This case demonstrates how a conservative multidisciplinary approach facilitates excellent results in an esthetically demanding area. Atraumatic surgical techniques can maintain the natural soft tissue architecture, while a detailed approach to provisional and final restorations allows for a highly esthetic smile. (J Esthet Restor Dent 21:294-303, 2009).

COMMENTARY. esthetic rehabilitation of maxillary incisors in conjunction with flapless surgical techniques, an implant zirconia crown, and porcelain veneers

COMMENTARY. <scp>esthetic rehabilitation of maxillary incisors in conjunction with flapless surgical techniques, an implant zirconia crown, and porcelain veneers</scp>

A preliminary report of patients treated with early loaded implants using computerized tomography‐guided surgical stents: flapless versus conventional flapped surgery

The objective of this clinical study was to compare the survival rates of early loaded implants placed using flapless and flapped surgical techniques and to determine the bone density in the implant recipient sites using computerized tomography (CT). The study population consisted of 12 patients who were referred implant placement. One group consisted of five patients referred for the placement of 14 implants and treated with a flapless procedure. The other group consisted of seven patients referred for the placement of 45 implants with a conventional flapped procedure. Patients were selected randomly. CT machine was used for pre-operative evaluation of the jaw bone and the mean bone density value of each implant recipient site was recorded in Hounsfield units (HU). All implants were placed using CT-guided surgical stents. The early loading protocols included 2 months of healing in the mandible and 3 months of healing in the maxilla. Single-implant crowns, implant-supported fixed partial dentures, and implant-retained over dentures were delivered to the patients. Of 59 implants placed, one was lost in the conventional flapped group within the first month of healing, meaning overall implant survival rate of 98.3% average 9 months later. The highest average bone density value (801 +/- 239 HU) was found in the anterior mandible, followed by 673 +/- 449 HU for the posterior maxilla, 669 +/-346 HU for the anterior maxilla and 538 +/- 271 HU for the posterior mandible. The results of this study show that the early loading of implants placed utilizing flapless surgical technique with CT-guided surgical stents may be possible.

CAD/CAM-guided implant surgery and fabrication of an immediately loaded prosthesis for a partially edentulous patient

The treatment planning, placement, and restoration of dental implants for the partially edentulous patient can be challenging. Anatomical limitations can make implant location difficult to determine. The use of CT scans and surgical planning software to produce a CAD/CAM surgical template, as well as the use of a flapless surgical technique, can make implant placement more predictable, safer, and easier for patients. The article describes a computer-guided surgical technique for the partially edentulous patient, with a restoration fabricated prior to implant placement, for immediate loading.

A Computed Tomographic Scan–Derived Customized Surgical Template and Fixed Prosthesis for Flapless Surgery and Immediate Loading of Implants in Fully Edentulous Maxillae: A Prospective Multicenter Study

Based on three-dimensional implant planning software for computed tomographic (CT) scan data, customized surgical templates and final dental prostheses could be designed to ensure high precision transfer of the implant treatment planning to the operative field and an immediate rigid splinting of the installed implants, respectively. The aim of the present study was to (1) evaluate a concept including a treatment planning procedure based on CT scan images and a prefabricated fixed prosthetic reconstruction for immediate function in upper jaws using a flapless surgical technique and (2) validate the universality of this concept in a prospective multicenter clinical study. Twenty-seven consecutive patients with edentulous maxillae were included. Treatments were performed according to the Teeth-in-an-Hour concept (Nobel Biocare AB, Göteborg, Sweden), which includes a CT scan-derived customized surgical template for flapless surgery and a prefabricated prosthetic suprastructure. All patients received their final prosthetic restoration immediately after implant placement, that is, both the surgery and the prosthesis insertion were completed within approximately 1 hour. In the 24 patients followed for 1 year, all prostheses and individual implants were recorded as stable. The present prospective multicenter study indicates that the prefabrication, on the basis of models derived from three-dimensional oral implant planning software, of both surgical templates for flapless surgery and dental prostheses for immediate loading is a very reliable treatment option. It is evident that the same approach could be used for staged surgery and in partial edentulism.

An immediately loaded CAD/CAM-guided definitive prosthesis: A clinical report

Dental implants have had a major impact on the treatment of edentulous patients. Fixed complete dentures have allowed removable complete dentures to be replaced with fixed prostheses. A new treatment modality using immediately loaded implants placed with a CAD/CAM surgical template using a flapless surgical technique, then loaded with a prefabricated restorative prosthesis, is presented. This report describes the Teeth-in-an-Hour (Nobel Biocare, Yorba Linda, Calif) treatment provided for a patient.