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

Abstract

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.

Postsurgical oral symptoms after insertion of one or two implants for mandibular overdentures: short-term results of a randomized clinical trial

“…Moreover, postoperative pain or discomfort may affect daily activities such as oral hygiene, eating or conversation, and difficulty using a removable prosthesis during the surgical healing period. Therefore, there is a need to assess the impacts of the implant insertion surgery and the associated bone and soft tissue injuries that lead to postoperative inflammation, edema, and pain in the short term [ 5 ].…”

Dimensional changes of buccal bone plate in immediate implants inserted through open flap, open flap and bone grafting and flapless techniques: A cone‐beam computed tomography randomized controlled clinical trial

“…Among human studies on bone radiographic changes around post-extraction implants that have implemented CBCT measurements, only a few have been randomized controlled trials (Paknejad, Akbari, Aslroosta, Panjnoush, & Hajheidary, 2017). There is a lack of high-quality research that investigates dimensional alveolar bone changes and the efficiency of different wound healing strategies or concomitant regenerative techniques for immediate post-extraction implants (Clementini et al, 2015;Esposito, Maghaireh, Grusovin, Ziounas, & Worthington, 2012;Lee, Park, Koo, Seol, & Lee, 2019;Llamas-Monteagudo, Girbes-Ballester, Vina-Almunia, Penarrocha-Oltra, & Penarrocha-Diago, 2017). Similarly, there are a lack of controlled clinical trials investigating the potential correlation between marginal gap dimensions and dimensional changes in the buccal alveolar ridge (Chen & Buser, 2014;Lee, Chiu, Chuang, Tarnow, & Stoupel, 2014).…”

The Anatomical Conditions of the Alveolar Process of the Anterior Maxilla in Terms of Immediate Implantation—Radiological Retrospective Case Series Study

“…The flapless implants are provided in various regions of a jaw, in various time algorithms, or in guided or free-hand procedures. All these variables have a significant impact on the conditions and goals of the procedure and should be recognized and taken into account at the planning stage [ 10 , 15 , 20 , 21 , 22 , 29 , 30 , 32 , 46 ]. Current literature describes bony conditions for immediate implants [ 20 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 ].…”

“…It is the result of successful osseointegration. The shape, material and surface of the implant used are important, as well as the technique of implant cradle preparation [ 4 , 20 , 26 , 32 , 46 , 47 , 48 ]. The variability of local soft and hard tissue conditions found in the cases of immediate implant insertion in the aesthetic region of the maxilla may result in different levels of difficulty and predictability of the treatment.…”