Narrative review regarding the applicability, accuracy, and clinical outcome of flapless implant surgery with or without computer guidance

Emitis Natali Naeini, Mandana Atashkadeh, Hugo De Bruyn, Jan D'Haese, Emitis Natali Naeini, Mandana Atashkadeh, Hugo De Bruyn, Jan D'Haese

Abstract

Background: The advent of computer-guided surgery removed the need for complex surgical interventions such as extensive flap elevations, second stage implant exposure, and complications usually associated with conventional protocols.

Purpose: (a) Analyze available literature reporting on applicability, accuracy, clinical outcome of flapless surgery with or without computer guidance. (b) Evaluate quality of studies, in terms of scientific level of evidence and ethical committee approval.

Materials and methods: A PUBMED search was performed in July 2018. A first search was based on a general search string limited to "Dental Implants" and "flapless surgery." A second search focused on accuracy of computer-guided surgery using search string "Surgery, Computer-Assisted" or "guided surgery," and "Dental implants." The following inclusion criteria were applied: (a) studies in English; (b) human studies (excluding cadaver); (c) systematic reviews; (d) systematic reviews with meta-analysis. Reviews not mentioning accuracy were excluded in search 2.

Results: Nine reviews included in total. Implant survival ranged between 89% and 100%. Early surgical and prosthetic complications reported in 9.1% to 36.4% of reviewed papers. Tooth-supported guides show more accuracy than bone or mucosa-supported guides. Fully guided surgery yields higher accuracy, with lower values for horizontal coronal, horizontal apical and angular deviation (1.00, 1.23, and 3.13°mm, respectively) than those placed with half guided surgery (1.44, 1.91, and 4.30 mm, respectively). Thirty-four of 71 human studies included in nine reviews, mentioned ethical committee approval or compliance with Declaration of Helsinki.

Conclusions: Guided flapless surgery is comparable to free-hand surgery in terms of implant survival, marginal bone remodeling, and peri-implant variables. Clinicians advised to take care in all steps of the protocol, and include safety margins around virtually planned implants. Regarding compliance with research ethics, we should question whether scientific reports of clinical trials performed without an ethical umbrella are trustworthy. Compliance of ethics standards is imperative for submitted research papers.

Keywords: accuracy; complications; computer-assisted; dental implants; research ethics.

Conflict of interest statement

The authors declare no potential conflict of interest.

© 2020 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
(A), Projection of the planned (green) and postoperative (red) implant position on the mesio‐distal plane (yellow) (left) and the planar view (right). (B), In plane implant calculations. Orthogonal projection of the postoperative (red) on the planned (green) position. a, shoulder point projection; b, tip point projection; c, angular deviation; d, depth deviation
FIGURE 2
FIGURE 2
Search process and generated outcome of search 1 focusing on the general aspects
FIGURE 3
FIGURE 3
Search process and generated outcome of search 2 focusing on accuracy

References

    1. Meijer HJ, Raghoebar GM, Van't Hof MA, Geertman ME, Van Oort RP. Implant‐retained mandibular overdentures compared with complete dentures; a 5‐years' follow‐up study of clinical aspects and patient satisfaction. Clin Oral Implants Res. 1999;10:238‐244.
    1. Laurell L, Lundgren D. Marginal bone level changes at dental implants after 5 years in function: a meta‐analysis. Clin Implant Dent Relat Res. 2011;13:19‐28.
    1. Holm‐Pedersen P, Lang NP, Muller F. What are the longevities of teeth and oral implants? Clin Oral Implants Res. 2007;18(Suppl 3):15‐19.
    1. Pjetursson BE, Tan K, Lang NP, Bragger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res. 2004;15:667‐676.
    1. Simonis P, Dufour T, Tenenbaum H. Long‐term implant survival and success: a 10‐16‐year follow‐up of non‐submerged dental implants. Clin Oral Implants Res. 2010;21:772‐777.
    1. Sclar AG. Guidelines for flapless surgery. J Oral Maxillofac Surg. 2007;65:20‐32.
    1. Rousseau P. Flapless and traditional dental implant surgery: an open, retrospective comparative study. J Oral Maxillofac Surg. 2010;68:2299‐2306.
    1. 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;111:41‐46.
    1. Staffileno H. Significant differences and advantages between the full thickness and split thickness flaps. J Periodontol. 1974;45:421‐425.
    1. Rocci A, Martignoni M, Gottlow J. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: a retrospective 3‐year clinical study. Clin Implant Dent Relat Res. 2003;5(Suppl 1):29‐36.
    1. Becker W, Goldstein M, Becker BE, Sennerby L. Minimally invasive flapless implant surgery: a prospective multicenter study. Clin Implant Dent Relat Res. 2005;7(Suppl 1):S21‐S27.
    1. Becker W, Goldstein M, Becker BE, Sennerby L, Kois D, Hujoel P. Minimally invasive flapless implant placement: follow‐up results from a multicenter study. J Periodontol. 2009;80:347‐352.
    1. Brodala N. Flapless surgery and its effect on dental implant outcomes. Int J Oral Maxillofac Implants. 2009;24(Suppl):118‐125.
    1. 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;21:298‐304.
    1. Naeini EN, Dierens M, Atashkadeh M, De Bruyn H. Long‐term clinical outcome of single implants inserted flaplessly or conventionally. Clin Implant Dent Relat Res. 2018;20:829‐837.
    1. Jacobs R, Adriansens A, Verstreken K, Suetens P, van Steenberghe D. Predictability of a three‐dimensional planning system for oral implant surgery. Dentomaxillofac Radiol. 1999;28:105‐111.
    1. Van de Velde T, Glor F, De Bruyn H. A model study on flapless implant placement by clinicians with a different experience level in implant surgery. Clin Oral Implants Res. 2008;19:66‐72.
    1. D'Haese J, Ackhurst J, Wismeijer D, De Bruyn H, Tahmaseb A. Current state of the art of computer‐guided implant surgery. Periodontol. 2017;73:121‐133.
    1. Jung RE, Schneider D, Ganeles J, et al. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2009;24(Suppl):92‐109.
    1. Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2014;29(Suppl):25‐42.
    1. Buser D, Halbritter S, Hart C, et al. Early implant placement with simultaneous guided bone regeneration following single‐tooth extraction in the esthetic zone: 12‐month results of a prospective study with 20 consecutive patients. J Periodontol. 2009;80:152‐162.
    1. Buser D, Wittneben J, Bornstein MM, Grutter L, Chappuis V, Belser UC. Stability of contour augmentation and esthetic outcomes of implant‐supported single crowns in the esthetic zone: 3‐year results of a prospective study with early implant placement postextraction. J Periodontol. 2011;82:342‐349.
    1. Schneider D, Marquardt P, Zwahlen M, Jung RE. A systematic review on the accuracy and the clinical outcome of computer‐guided template‐based implant dentistry. Clin Oral Implants Res. 2009;20(Suppl 4):73‐86.
    1. D'Haese J, Vervaeke S, Verbanck N, De Bruyn H. Clinical and radiographic outcome of implants placed using stereolithographic guided surgery: a prospective monocenter study. Int J Oral Maxillofac Implants. 2013;28:205‐215.
    1. Verhamme LM, Meijer GJ, Berge SJ, et al. An accuracy study of computer‐planned implant placement in the augmented maxilla using mucosa‐supported surgical templates. Clin Implant Dent Relat Res. 2015;17:1154‐1163.
    1. Verhamme LM, Meijer GJ, Boumans T, Schutyser F, Berge SJ, Maal TJ. A clinically relevant validation method for implant placement after virtual planning. Clin Oral Implants Res. 2013;24:1265‐1272.
    1. Weigl P, Strangio A. The impact of immediately placed and restored single‐tooth implants on hard and soft tissues in the anterior maxilla. Eur J Oral Implantol. 2016;9(Suppl 1):S89‐S106.
    1. Cosyn J, Hooghe N, De Bruyn H. A systematic review on the frequency of advanced recession following single immediate implant treatment. J Clin Periodontol. 2012;39:582‐589.
    1. Voulgarakis A, Strub JR, Att W. Outcomes of implants placed with three different flapless surgical procedures: a systematic review. Int J Oral Maxillofac Surg. 2014;43:476‐486.
    1. Lin GH, Chan HL, Bashutski JD, Oh TJ, Wang HL. The effect of flapless surgery on implant survival and marginal bone level: a systematic review and meta‐analysis. J Periodontol. 2014;85:e91‐e103.
    1. Moraschini V, Velloso G, Luz D, Barboza EP. Implant survival rates, marginal bone level changes, and complications in full‐mouth rehabilitation with flapless computer‐guided surgery: a systematic review and meta‐analysis. Int J Oral Maxillofac Surg. 2015;44:892‐901.
    1. 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;86:185‐191.
    1. Al‐Ekrish AA. Radiology of implant dentistry. Radiol Clin N Am. 2018;56:141‐156.
    1. Carbajal Mejia JB, Wakabayashi K, Nakano T, Yatani H. Marginal bone loss around dental implants inserted with static computer assistance in healed sites: a systematic review and meta‐analysis. Int J Oral Maxillofac Implants. 2016;31:761‐775.
    1. Pozzi A, Polizzi G, Moy PK. Guided surgery with tooth‐supported templates for single missing teeth: a critical review. Eur J Oral Implantol. 2016;9(Suppl 1):S135‐S153.
    1. Laleman I, Bernard L, Vercruyssen M, Jacobs R, Bornstein MM, Quirynen M. Guided implant surgery in the edentulous maxilla: a systematic review. Int J Oral Maxillofac Implants. 2016;31(Suppl):s103‐s117.
    1. Sanz M, Naert I. Biomechanics/risk management (working group 2). Clin Oral Implants Res. 2009;20(Suppl 4):107‐111.
    1. Sicilia A, Botticelli D. Computer‐guided implant therapy and soft‐ and hard‐tissue aspects. The third EAO consensus conference 2012. Clin Oral Implants Res. 2012;23(Suppl 6):157‐161.
    1. Vercruyssen M, Jacobs R, Van Assche N, van Steenberghe D. The use of CT scan based planning for oral rehabilitation by means of implants and its transfer to the surgical field: a critical review on accuracy. J Oral Rehabil. 2008;35:454‐474.
    1. Raico Gallardo YN, da Silva‐Olivio IRT, Mukai E, Morimoto S, Sesma N, Cordaro L. Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta‐analysis. Clin Oral Implants Res. 2017;28:602‐612.
    1. Bover‐Ramos F, Vina‐Almunia J, Cervera‐Ballester J, Penarrocha‐Diago M, Garcia‐Mira B. Accuracy of implant placement with computer‐guided surgery: a systematic review and meta‐analysis comparing cadaver, clinical, and in vitro studies. Int J Oral Maxillofac Implants. 2018;33:101‐115.
    1. D'Haese J, Van De Velde T, Komiyama A, Hultin M, De Bruyn H. Accuracy and complications using computer‐designed stereolithographic surgical guides for oral rehabilitation by means of dental implants: a review of the literature. Clin Implant Dent Relat Res. 2012;14:321‐335.
    1. Jeremy Howick IC, Glasziou Paul, Greenhalgh Trish, Heneghan Carl, Liberati Alessandro, Moschetti Ivan, Phillips Bob, and Thornton Hazel. The Oxford levels of evidence 2. 2011.
    1. Mischkowski RA, Zinser MJ, Neugebauer J, Kubler AC, Zoller JE. Comparison of static and dynamic computer‐assisted guidance methods in implantology. Int J Comput Dent. 2006;9:23‐35.
    1. Van Assche N, van Steenberghe D, Guerrero ME, et al. Accuracy of implant placement based on pre‐surgical planning of three‐dimensional cone‐beam images: a pilot study. J Clin Periodontol. 2007;34:816‐821.
    1. van Steenberghe D, Naert I, Andersson M, Brajnovic I, Van Cleynenbreugel J, Suetens P. A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report. Int J Oral Maxillofac Implants. 2002;17:663‐670.
    1. Kalt G, Gehrke P. Transfer precision of three‐dimensional implant planning with CT assisted offline navigation. Int J Comput Dent. 2008;11:213‐225.
    1. Ruppin J, Popovic A, Strauss M, Spuntrup E, Steiner A, Stoll C. Evaluation of the accuracy of three different computer‐aided surgery systems in dental implantology: optical tracking vs. stereolithographic splint systems. Clin Oral Implants Res. 2008;19:709‐716.
    1. Sarment DP, Sukovic P, Clinthorne N. Accuracy of implant placement with a stereolithographic surgical guide. Int J Oral Maxillofac Implants. 2003;18:571‐577.
    1. Kuhl S, Zurcher S, Mahid T, Muller‐Gerbl M, Filippi A, Cattin P. Accuracy of full guided vs. half‐guided implant surgery. Clin Oral Implants Res. 2013;24:763‐769.

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