Evaluation of Flapless Approach for Dental Implantation: A Prospective Clinical Study

Volume 10 , Issue 1 , April 2023 , Pages 27-34

Authors

Nuha S. Abdul-Qadir 1 ; Nzar A. Chawrash 1

1 University of Sulaimani

DOI logo 10.17656/sdj.10165

Keywords

Abstract

Objective: The present study aims to evaluate the dental implant flapless technique as a successful treatment option for implant patients by assessing marginal bone loss after 3 months and post-operative pain.
Methods: One hundred and twenty implants were placed in 40 patients. Two parameters were assessed post-operatively: marginal bone loss and pain; the difference in marginal bone loss (MBL) was measured based on an immediate post-operative OPG and another OPG taken three months after the surgery, and pain assessment was achieved using a 10-cm visual analog scale (VAS) post-operatively for five days. Descriptive and inferential statistics were used, and as most of the data were not normally distributed, Mann-Whitney test was used for comparing the groups.
Results: The present study's findings demonstrate that the average marginal bone loss (MBL) around the implant at three months using the flapless technique was 0.2± 0.1 mm. No implants failed to osseointegrate. There was no statistical MBL significance between male and female patients or between upper and lower jaw. This study shows significantly reduced post-operative pain in the flapless implant placement technique.
Conclusions: The flapless approach is predictable when patient selection, meticulous planning, and precise surgical protocols are followed.

References

  1. Oshida Y, Tuna EB, Aktören O, Gençay K. Dental implant systems. Int J Mol Sci. 2010;11(4):1580-678.
  2. Divakar TK, Gidean Arularasan S, Baskaran M, Packiaraj I, Dhineksh Kumar N. Clinical evaluation of placement of implant by flapless technique over conventional flap technique. J Maxillofac Oral Surg. 2020;19(1):74-84.
  3. Naeini EN, Atashkadeh M, De Bruyn H, D'Haese J. Narrative review regarding the applicability, accuracy, and clinical outcome of flapless implant surgery with or without computer guidance. Clin Implant Dent Relat Res. 2020;22(4):454-67.
  4. Doan N, Du Z, Crawford R, Reher P, Xiao Y. Is flapless implant surgery a viable option in posterior maxilla? A review. Int J Oral Maxillofac Surg. 2012;41(9):1064-71.
  5. Sclar AG. Guidelines for Flapless Surgery. J Oral Maxillofac Surg. 2007;65(7 SUPPL.):20-32.
  6. Jeong SM, Choi BH, Kim J, et al. A 1-year prospective clinical study of soft tissue conditions and marginal bone changes around dental implants after flapless implant surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(1):41-6.
  7. Rousseau P. Flapless and traditional dental implant surgery: an open, retrospective comparative study. J Oral Maxillofac Surg. 2010;68(9):2299-306.
  8. Wood DL, Hoag PM, Donnenfeld OW, Rosenfeld LD. Alveolar crest reduction following full and partial thickness flaps. J Periodontol. 1972;43(3):141-4.
  9. Morad G, Behnia H, Motamedian SR, Shahab S, Gholamin P, Khosraviani K, et al. Thickness of labial alveolar bone overlying healthy maxillary and mandibular anterior teeth. J Craniofac Surg. 2014;25(6):1985-91.
  10. Vohra F. Al-Kheraif AA, Almas K, Javed F. Comparison of crestal bone loss around dental implants placed in healed sites using flapped and flapless techniques: a systematic review. J Periodontol. 2015;86(2):185-91.
  11. Khojasteh A, Motamedian SR, Sharifzadeh N, Zadeh HH. The influence of initial alveolar ridge defect morphology on the outcome of implants in augmented atrophic posterior mandible: an exploratory retrospective study. Clin Oral Implants Res. 2017;28(10):e208-e217.
  12. Khojasteh A, Hassani A, Motamedian SR, Saadat S, Alikhasi M. Cortical Bone Augmentation Versus Nerve Lateralization for Treatment of Atrophic Posterior Mandible: A Retrospective Study and Review of Literature. Clin Implant Dent Relat Res. 2016;18(2):342-59.
  13. Hosseinpour S, Ghazizadeh Ahsaie M, Rezai Rad M, Baghani MT, Motamedian SR, Khojasteh A. Application of selected scaffolds for bone tissue engineering: a systematic review. Oral Maxillofac Surg. 2017;21(2):109-129.
  14. Motamedian SR, Tabatabaei FS, Akhlaghi F, Torshabi M, Gholamin P, Khojasteh A. Response of dental pulp stem cells to synthetic, allograft, and xenograft bone scaffolds. Int J Periodontics Restorative Dent. 2017;37(1):49-59.
  15. Eroglu CN, Ertugrul AS, Eskitascioglu M, Eskitascioglu G. Changes in the surface of bone and acid-etched and sandblasted implants following implantation and removal. Eur J Dent. 2016;10(1):77-81.
  16. Cecchinato D. Lops D, Salvi GE, Sanz M. A prospective, randomized, controlled study using OsseoSpeedTM implants placed in maxillary fresh extraction socket: soft tissues response. Clin Oral Implants Res. 2015;26(1):20-7.
  17. Khorsand A, Rasouli-Ghahroudi AA, Naddafpour N, Shayesteh YS, Khojasteh A. Effect of micro thread design on marginal bone level around dental implants placed in fresh extraction sockets. Implant Dent. 2016;25(1):90-6.
  18. Bayounis AM, Alzoman HA, Jansen JA, Babay N. Healing of peri-implant tissues after flapless and flapped implant installation. J Clin Periodontol. 2011;38(8):754-61.
  19. Ozan O, Turkyilmaz I, Yilmaz B. A preliminary report of patients treated with early loaded implants using computerized tomography-guided surgical stents: Flapless versus conventional flapped surgery. J Oral Rehabil. 2007 34:835-40.
  20. Sunitha RV, Sapthagiri E. Flapless implant surgery: a 2-year follow-up study of 40 implants. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(4):e237-43.
  21. Fortin T, Bosson JL, Isidori M. Blanchet E. Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants. 2006;21(2):298-304.
  22. You TM, Choi BH, Li J, Xuan F, Jeong SM, Jang SO. Morphogenesis of the peri-implant mucosa: a comparison between flap and flapless procedures in the canine mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(1):66-70.
  23. Brodala N. Flapless surgery and its effect on dental implant outcomes. The Int J Oral Maxillofac Implants. 2009;24 Suppl:118-25.
  24. Romero-Ruiz MM, Mosquera-Perez R, Gutierrez- Perez JL, Torres-Lagares D. Flapless implant surgery: A review of the literature and 3 case reports. J Clin Exp Dent. 2015;7(1):146-52.
  25. Hahn J. Single-stage, immediate loading, and flapless surgery. J Oral Implantol. 2000;26(3):193-8.
  26. Campelo LD, Camara JR. Flapless implant surgery: a 10-year clinical retrospective analysis. Int J Oral Maxillofac Implants. 2002;17(2):271-6.
  27. Abd El-Ghaffar Y, Temerek A, Hammad H, Fahd A. Flapless dental implant surgery as a successful patient relevant treatment option: a 5-year retrospective clinical and radiographic evaluation. Egypt Dent J. 2019:65(1):197-204.
  28. Jeong SM, Choi BH, Li J, Kim HS, Ko CY, Jung an JH. et al. Flapless implant surgery: experimental study. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, and Endod. 2007;104(1):24-8.
  29. Poshiya A, William A, Thakkar R, Sadek F, Shingala A. Advantage of flapless implant surgery in the healing of peri-implant tissue. J Adv Med Dent Sci Res. 2021;9(4):24-7.
  30. Lombardi T, Berton F, Salgarello S, Barbalonga E, Rapani A, Piovesana F et al. Factors influencing early marginal bone loss around dental implants positioned subcrestally: a multicenter prospective clinical study. J Clin Med. 2019;8(8):1168.
  31. Kim JI, Choi BH, Li J, Xuan F, Jeong SM. Blood vessels of the peri-implant mucosa: a comparison between flap and flapless procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 ;107(4):508-12.
  32. Galindo-Moreno P, León-Cano A, Ortega-Oller I, Monje A, O' Valle F, Catena A. Marginal bone loss as success criterion in implant dentistry: beyond 2 mm. Clin Oral Imp Res. 2015;26(4):28-34.
  33. Chen CH, Wang L, Tulu US, Arioka M, Moghim MM, Salmon B, Chen CT. Hoffmann W, Gilgenbach J. Brunski JB, Helms JA. An osteopenic/osteoporotic phenotype delays alveolar bone repair. Bone. 2018;112(1):212-9.
  34. Khorshidi H, Lavaee F, Ghapanchi J, Golkari A, Kholousi S. The relation of pre-operative stress and anxiety on patients' satisfaction after implant placement. Dent Res J (Isfahan).2017;14(5):351-5
  35. Al-Khabbaz AK, Griffin TJ. Al-Shammari KF. Assessment of pain associated with the surgical placement of dental implants. J Periodontol. 2007;78(2):239-46.
  36. Lindeboom JA, Van Wijk AJ. A comparison of two implant techniques on patient-based outcome measures: a report of flapless vs. conventional flapped implant placement. Clin Oral Implants Res. 2010;21(4):366-70.
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