Computer guided flapless vestibular to lingual trans-alveolar implant insertion for All on four implant prosthesis in case of severely atrophied mandible: A short term clinical and radiographic study

Abstract

Aim: This short-term investigation aimed to study the outcomes of computer guided flapless vestibular to lingual implant insertion for All on four implant prosthesis in case of severely atrophied mandible.Material and methods: Six (3 men and 3 women) edentulous patients (mean age of 59 years) with atrophied mandibles received four implants using the computer guided flapless surgical protocol and a stereolithographic surgical guide. The posterior implant was installed in bicuspid region lingual to mental foramen and inclined in buccolingual trans-alveolar direction to engage the lingual cortical plate. Fixtures were loaded by the old denture the same day of implant placement. Plaque and bleeding scores, probing depth, fixture mobility and loss of bone around implants were measured at baseline (immediately after loading), 6 and 12 months thereafter. Results:There was a significant increase in plaque scores, probing depth and resorption of bone with passage of time. gingival scores and stability of the implants did not change with time. Premolar implants showed significant higher plaque scores, probing depth and marginal loss of bone compared to canine implants. Two posterior implants were lost resulting in survival rate of 91.6% after one year. Conclusion:Within the limits of this study, it could be concluded that computer guided flapless vestibular to lingual trans-alveolar posterior implant insertion for All on four implant prosthesis in case of severely atrophied mandible is a predictable and reliable method as it was associated with favourable clinical and radiographic peri-implant outcomes after one year.