Flapless Dental Implant Surgery may Improve Hard and Soft Tissue Outcomes

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

Aim

:To compare the crestal bone level of flapless technique of dental implant placement with the flap technique.

Setting and Design

This Systematic review and Meta-analysis was conducted according to the Preferred Reporting Items For Systematic Review and Meta-Analyses (PRISMA) Guidelines and registered with PROSPERO.

Materials and Methods

Electronic search of Medline and Google scholar databases for articles from 2010 till March 2020 was performed. Studies comparing the crestal bone level with both the techniques were included. After the collection of data, the risk of bias was assessed for each study.

Statistical Analysis Used

Meta-analysis was executed using RevMan 5 software version 5.3.

Results

23 studies were included. Statistically significant difference in crestal bone level was found between flapless and flap surgery with mean difference of -0.14 (flapless placement versus flap surgery; 95% CI: -0.24 to -0.03; P = 0.01FNx01). The difference in crestal bone level between the 2 groups was not statistically significant with a mean difference of -0.05(Guided flapless placement versus flap surgery; 95% CI: -0.10 to 0.00; P=0.06). Meta-analysis of the freehand flapless surgery with flap surgery generated a mean difference of -0.20 which was found to be statistically significant (Freehand flapless placement versus flap surgery; 95% CI: -0.37 to -0.03; P=0.02FNx01).

Conclusions

Flapless placement of implant can positively influence crestal bone loss in comparison with conventional flap technique.

Sandblasted and Acid Etched Titanium Dental Implant Surfaces Systematic Review and Confocal Microscopy Evaluation

The field of dental implantology has made progress in recent years, allowing safer and predictable oral rehabilitations. Surely the rehabilitation times have also been reduced, thanks to the advent of the new implant surfaces, which favour the osseointegration phases and allow the clinician to rehabilitate their patients earlier. To carry out this study, a search was conducted in the Pubmed, Embase and Elsevier databases; the articles initially obtained according to the keywords used numbered 283, and then subsequently reduced to 10 once the inclusion and exclusion criteria were applied. The review that has been carried out on this type of surface allows us to fully understand the features and above all to evaluate all the advantages or not related. The study materials also are supported by a manufacturing company, which provided all the indications regarding surface treatment and confocal microscopy scans. In conclusion, we can say that, thanks to these new surfaces, it has been possible to shorten the time necessary to obtain osseointegration and, therefore, secondary stability on the part of implants. The surfaces, therefore, guarantee an improved cellular adhesion and thanks to the excellent wettability all the biological processes that derive from it, such as increases in the exposed implant surface, resulting in an increase in bone-implant contact (BIC).

Optimal number of implants for complete-arch implant-supported prostheses with a follow-up of at least 5 years: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Consensus is lacking regarding the optimal number of implants for supporting complete-arch prostheses with good survival rates and lower prosthetic complications and marginal bone loss.

PURPOSE

The purpose of this systematic review was to evaluate the influence of the number of implants used for complete-arch prostheses with at least 5 years of follow-up.

MATERIAL AND METHODS

A search was performed in the PubMed/MEDLINE, Scopus, and Cochrane Library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and was registered in The International Prospective Register of Systematic Reviews (CRD42016048468). The following was the population, intervention, comparison, outcome (PICO) question: Does the number of implants influence the longevity of complete-arch prostheses?

RESULTS

Nineteen studies including 1006 patients with a mean age of 61.44 years were selected for evaluation. The number of implants per jaw ranged between 2 and 9 in the maxilla, mandible, or both jaws. For implant survival rate in complete-arch prostheses with fewer than 5 implants per jaw, the pooled weighted event rate was 1.4% (I²=25.26%; P=.211) and 4.2% (I²=81.35%; P<.001) for complete arches with more than 4 implants per jaw. For the prosthesis survival rate, the pooled weighted event rate for a complete-arch with fewer than 5 implants per jaw was 1.5% (I²=0%; P=.677) and 9% (I²=17.33%; P=.304) for complete arches with more than 4 implants per jaw. For prosthesis complications for complete arches with fewer than 5 implants per jaw, the pooled weighted event rate was 19.9% (I²=93.5%; P<.001) and 24.5% (I²=88.89; P<.001) for complete arches with more than 4 implants per jaw. The mean marginal bone loss for complete arches with fewer than 5 implants per jaw was 1.22 ±0.49 mm (I²=99.46; P<.001) and 1.46 ±0.46 mm (I²=99.6; P <.001) for more than 4 implants per jaw.

CONCLUSIONS

The current systematic review indicated no relationship of the number of implants used to support a complete-arch prosthesis with implant survival rate, prosthesis survival rate, prosthesis complications, or marginal bone loss in studies with follow-up periods of between 5 and 15 years.

Flap Designs for Implant-Related Surgical Procedures: A Review

PURPOSE

The objective of this study was to compare the reliability and results of 2 flap techniques, flapless (FL) and full-thickness (FT) flap, during implant placement.

MATERIALS AND METHODS

Online and hand searches of the literature published were conducted to identify studies examining different flap techniques on clinical and histological outcomes. The search terms used, alone or in combination, were "flapless," "full-thickness flap," "crestal bone resorption," "gingival blood circulation," and "biological width."

RESULTS

Fifty studies were selected for comparison and to address the points highlighted in this study. Fourteen articles and 1 book were not directly related to flap design but were included for understanding the process of soft tissue healing. Five articles discussed the principles of oral surgery and flap design.

CONCLUSION

This review revealed that the FL technique might be more appropriate in immediate implant loading cases. This specific technique results in shallower biological width, reduced inflammation, less morbidity with guided implant placement, and better esthetics in comparison with the FT technique. The implant survival rates are not significantly different between the 2 flap techniques. With respect to crestal bone resorption in FL and FT, it is inconclusive, depending on the study type (human or animal).