Skip to main content
Erschienen in: Oral and Maxillofacial Surgery 2/2023

29.03.2022 | Original Article

Does implant placement using a minimally invasive technique increase early failures among trainees at an academic center?

verfasst von: Brian R. Carr, Peter Rekawek, Joseph A. Gulko, John F. Coburn, William J. Boggess, Sung-Kiang Chuang, Neeraj Panchal, Brian P. Ford

Erschienen in: Oral and Maxillofacial Surgery | Ausgabe 2/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This study aims to identify whether dental implants placed using a flapless technique have a higher early failure rate, defined as failure within 6 months of placement, compared to implants placed with flap elevation when a surgical guide is not used.

Methods

A retrospective cohort study was conducted to evaluate implants placed with either flapless (FL) or mucoperiosteal flap (MF) surgery between 2006 and 2012 at the Philadelphia VA Medical Center (PVAMC). Implant status after FL or MF surgery was assessed using dental encounter and radiographs at subsequent follow-up appointments to assess for early implant failures within 6 months of implant placement.

Results

The FL technique was used to place 89 implants in 38 subjects, while the MF technique was used to place 381 implants in 139 subjects. Early failure occurred in 37 implants, of which 13 occurred in the FL group and 24 occurred in the MF group. FL surgery was found to be associated with a 265% increase in early implant failure (OR 2.653; 95% CL 1.287–5.469) and was statistically significant (p = 0.0064). Residents were over 200% more likely to have an early implant failure when using the FL technique (OR 2.314; 95% CL 1.112–4.816),

Conclusions

Analysis revealed flapless implant placement was associated with higher early implant failure rates. In addition, early failures were more likely to occur when residents placed an implant using the flapless technique. While FL surgery can result in long-term success, it is a more technique-sensitive approach that requires greater clinical skill and stricter case selection to perform.
Literatur
2.
Zurück zum Zitat Kim JI, Choi BH, Li J, Xuan F, Jeong SM (2009) Blood vessels of the peri-implant mucosa: a comparison between the flap and flapless procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:508–512CrossRefPubMed Kim JI, Choi BH, Li J, Xuan F, Jeong SM (2009) Blood vessels of the peri-implant mucosa: a comparison between the flap and flapless procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:508–512CrossRefPubMed
3.
Zurück zum Zitat You TM, Choi BH, Li J, Xuan F, Jeong SM, Jang SO (2009) Morpho- genesis 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 107:66–70CrossRefPubMed You TM, Choi BH, Li J, Xuan F, Jeong SM, Jang SO (2009) Morpho- genesis 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 107:66–70CrossRefPubMed
4.
Zurück zum Zitat Van Steenberghe D, Glauser R, Blomback U, Andersson M, Schutyser F, Pettersson A et al (2005) A computed tomographic scan-derived customized surgical template and fixed pros- thesis for flapless surgery and immediate loading of implants in fully edentulous max- illae: a prospective multicenter study. Clin Implant Dent Relat Res 7(Suppl 1):111–120CrossRef Van Steenberghe D, Glauser R, Blomback U, Andersson M, Schutyser F, Pettersson A et al (2005) A computed tomographic scan-derived customized surgical template and fixed pros- thesis for flapless surgery and immediate loading of implants in fully edentulous max- illae: a prospective multicenter study. Clin Implant Dent Relat Res 7(Suppl 1):111–120CrossRef
5.
Zurück zum Zitat Marra R, Acocella A, Rispoli A, Sacco R, Ganz SD, Blasi A (2013) Full-mouth rehabilitation with immediate loading of implants inserted with computer-guided flap-less surgery: a 3- year multicenter clinical evaluation with oral health impact profile. Implant Dent 22:444–452CrossRefPubMed Marra R, Acocella A, Rispoli A, Sacco R, Ganz SD, Blasi A (2013) Full-mouth rehabilitation with immediate loading of implants inserted with computer-guided flap-less surgery: a 3- year multicenter clinical evaluation with oral health impact profile. Implant Dent 22:444–452CrossRefPubMed
6.
Zurück zum Zitat Barone A, Toti P, Piatelli A, Lezzi G, Derchi G, Covani U (2014) Extraction socket healing in humans after ridge preservation techniques: a comparison between flapless and flapped procedure in a randomized clinical trial. J Periodontol 85:14–23CrossRefPubMed Barone A, Toti P, Piatelli A, Lezzi G, Derchi G, Covani U (2014) Extraction socket healing in humans after ridge preservation techniques: a comparison between flapless and flapped procedure in a randomized clinical trial. J Periodontol 85:14–23CrossRefPubMed
7.
Zurück zum Zitat Lemos CAA, Verri FR, Cruz RS, Gomes JML, Dos Santos DM, Goiato MC, Pellizzer EP (2020) Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 49(9):1220–1231CrossRefPubMed Lemos CAA, Verri FR, Cruz RS, Gomes JML, Dos Santos DM, Goiato MC, Pellizzer EP (2020) Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 49(9):1220–1231CrossRefPubMed
8.
Zurück zum Zitat Chrcanovic BR, Albrektsson T, Wennerberg A. Flapless versus conventional flapped dental implant surgery: a meta-analysis. PLoS One 2014;9(6)e100624. Chrcanovic BR, Albrektsson T, Wennerberg A. Flapless versus conventional flapped dental implant surgery: a meta-analysis. PLoS One 2014;9(6)e100624.
9.
Zurück zum Zitat Sunitha RV, Sapthagiri E (2013) Flapless implant surgery: a 2-year follow-up study of 40 implants. Oral Surg Oral Med Oral Pathol Oral Radiol 116(4):e237–e243CrossRefPubMed Sunitha RV, Sapthagiri E (2013) Flapless implant surgery: a 2-year follow-up study of 40 implants. Oral Surg Oral Med Oral Pathol Oral Radiol 116(4):e237–e243CrossRefPubMed
10.
Zurück zum Zitat Lin GH, Chan HL, Bashutski JD, Oh TJ, Wang HL (2014) The effect of flapless surgery on implant survival and marginal bone level: a systematic review and meta-analysis. J Periodontol 85:e91-103CrossRefPubMed Lin GH, Chan HL, Bashutski JD, Oh TJ, Wang HL (2014) The effect of flapless surgery on implant survival and marginal bone level: a systematic review and meta-analysis. J Periodontol 85:e91-103CrossRefPubMed
11.
Zurück zum Zitat Albrektsson T, Zarb G, Worthington P, Eriksson AR (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1(1):11–25PubMed Albrektsson T, Zarb G, Worthington P, Eriksson AR (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1(1):11–25PubMed
12.
Zurück zum Zitat Do TA, Le HS, Shen YW, Huang HL, Fuh LJ (2020) Risk factors related to late failure of dental implant—a systematic review of recent studies. Int J Environ Res 17(11):3931 Do TA, Le HS, Shen YW, Huang HL, Fuh LJ (2020) Risk factors related to late failure of dental implant—a systematic review of recent studies. Int J Environ Res 17(11):3931
13.
Zurück zum Zitat Golub LM, Lee HM, Greenwald RA, Ryan ME, Sorsa T, Salo T, Giannobile WV (1997) A matrix metalloproteinase inhibitor reduces bone-type collagen degradation fragments and specific collagenases in gingival crevicular fluid during adult periodontitis. Inflamm Res 46(8):310–319CrossRefPubMed Golub LM, Lee HM, Greenwald RA, Ryan ME, Sorsa T, Salo T, Giannobile WV (1997) A matrix metalloproteinase inhibitor reduces bone-type collagen degradation fragments and specific collagenases in gingival crevicular fluid during adult periodontitis. Inflamm Res 46(8):310–319CrossRefPubMed
14.
Zurück zum Zitat Cannizzaro G, Felice P, Leone M, Checchi V, Esposito M (2011) Flapless versus open flap implant surgery in partially edentulous patients subjected to immediate loading: 1-year results from a split-mouth randomised con- trolled trial. Eur J Oral Implantol 4(3):177–188PubMed Cannizzaro G, Felice P, Leone M, Checchi V, Esposito M (2011) Flapless versus open flap implant surgery in partially edentulous patients subjected to immediate loading: 1-year results from a split-mouth randomised con- trolled trial. Eur J Oral Implantol 4(3):177–188PubMed
15.
Zurück zum Zitat Wang F, Huang W, Zhang Z, Wang H, Monje A, Wu Y. Minimally invasive flapless vs. flapped approach for single implant placement: a 2-year randomized controlled clinical trial. Clin Oral Implants Res 2017;28 (6):757–64. Wang F, Huang W, Zhang Z, Wang H, Monje A, Wu Y. Minimally invasive flapless vs. flapped approach for single implant placement: a 2-year randomized controlled clinical trial. Clin Oral Implants Res 2017;28 (6):757–64.
16.
Zurück zum Zitat Katsoulis J, Avrampou M, Spycher C, Stipic M, Enkling N et al (2012) Comparison of implant stability by means of resonance frequency analysis for flapless and conventionally inserted implants. Clin Implant Dent Relat Res 14:915–923CrossRefPubMed Katsoulis J, Avrampou M, Spycher C, Stipic M, Enkling N et al (2012) Comparison of implant stability by means of resonance frequency analysis for flapless and conventionally inserted implants. Clin Implant Dent Relat Res 14:915–923CrossRefPubMed
17.
Zurück zum Zitat Rousseau P (2010) Flapless and traditional dental implant surgery: an open, retrospective comparative study. J Oral Maxillofac Surg 68:2299–2306CrossRefPubMed Rousseau P (2010) Flapless and traditional dental implant surgery: an open, retrospective comparative study. J Oral Maxillofac Surg 68:2299–2306CrossRefPubMed
18.
Zurück zum Zitat Campelo LD, Camara JR. Flapless implant surgery: a 10-year clinical retrospective analysis. Int J Oral Maxillofac Implants. 2002 Mar-Apr;17(2):271–6. Campelo LD, Camara JR. Flapless implant surgery: a 10-year clinical retrospective analysis. Int J Oral Maxillofac Implants. 2002 Mar-Apr;17(2):271–6.
19.
Zurück zum Zitat Eriksson AR, Albrektsson T (1983) Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent 50(1):101–107CrossRefPubMed Eriksson AR, Albrektsson T (1983) Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent 50(1):101–107CrossRefPubMed
20.
Zurück zum Zitat Chiapasco M, Zaniboni M (2009) Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res 20(Suppl 4):113–123CrossRefPubMed Chiapasco M, Zaniboni M (2009) Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res 20(Suppl 4):113–123CrossRefPubMed
21.
Zurück zum Zitat Venza I, Visalli M, Cucinotta M et al (2010) Proinflammatory gene expression at chronic periodontitis and peri-implantitis sites in patients with or without type 2 diabetes. J Periodontal 81:99CrossRef Venza I, Visalli M, Cucinotta M et al (2010) Proinflammatory gene expression at chronic periodontitis and peri-implantitis sites in patients with or without type 2 diabetes. J Periodontal 81:99CrossRef
22.
Zurück zum Zitat Al-Askar M, Ajlan S, Alomar N, Al-Daghri NM (2018) Clinical and radiographic peri-implant parameters and whole salivary interleukin-1b and interleukin-6 levels among type-2 diabetic and nondiabetic patients with and without peri-implantitis. Med Principles Pract 27:133CrossRef Al-Askar M, Ajlan S, Alomar N, Al-Daghri NM (2018) Clinical and radiographic peri-implant parameters and whole salivary interleukin-1b and interleukin-6 levels among type-2 diabetic and nondiabetic patients with and without peri-implantitis. Med Principles Pract 27:133CrossRef
23.
Zurück zum Zitat Halpern LR, Adams DR (2021) Medically complex dental implant patients: controversies about systemic disease and dental implant success/survival. Dent Clin North Am 65(1):1–19CrossRefPubMed Halpern LR, Adams DR (2021) Medically complex dental implant patients: controversies about systemic disease and dental implant success/survival. Dent Clin North Am 65(1):1–19CrossRefPubMed
24.
Zurück zum Zitat Eber RM. Increasing levels of smoking may increase the relative risk of dental implant failure. J Evid Based Dent Pract. 2020 Dec;20(4):101493. Eber RM. Increasing levels of smoking may increase the relative risk of dental implant failure. J Evid Based Dent Pract. 2020 Dec;20(4):101493.
25.
Zurück zum Zitat Chrcanovic BR, Albrektsson T, Wennerberg A (2015) Smoking and dental implants: a systematic review and meta-analysis. J Dent 43(5):487–498CrossRefPubMed Chrcanovic BR, Albrektsson T, Wennerberg A (2015) Smoking and dental implants: a systematic review and meta-analysis. J Dent 43(5):487–498CrossRefPubMed
26.
Zurück zum Zitat Wang F, Wang Q, Zhang J (2021) Role of dynamic navigation systems in enhancing the accuracy of implant placement: a systematic review and meta-analysis of clinical studies. J Oral Maxillofac Surg 79(10):2061–2070CrossRefPubMed Wang F, Wang Q, Zhang J (2021) Role of dynamic navigation systems in enhancing the accuracy of implant placement: a systematic review and meta-analysis of clinical studies. J Oral Maxillofac Surg 79(10):2061–2070CrossRefPubMed
27.
Zurück zum Zitat Van Doorne L, De Kock L, De Moor A, Shtino R, Bronkhorst E, Meijer G, De Bruyn H. Flaplessly placed 2.4-mm mini-implants for maxillary overdentures: a prospective multicentre clinical cohort study. Int J Oral Maxillofac Surg. 2020 Mar;49(3):384–391. Van Doorne L, De Kock L, De Moor A, Shtino R, Bronkhorst E, Meijer G, De Bruyn H. Flaplessly placed 2.4-mm mini-implants for maxillary overdentures: a prospective multicentre clinical cohort study. Int J Oral Maxillofac Surg. 2020 Mar;49(3):384–391.
28.
Zurück zum Zitat Arisan V, Karabuda CZ, Ozdemir T (2010) Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res 21:980–988PubMed Arisan V, Karabuda CZ, Ozdemir T (2010) Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res 21:980–988PubMed
29.
Zurück zum Zitat Sunitha RV, Sapthagiri E (2013) Flapless implant surgery: a 2-year follow-up study of 40 implants. Oral Surg Oral Med Oral Pathol Oral Radiol 116:e237–e243CrossRefPubMed Sunitha RV, Sapthagiri E (2013) Flapless implant surgery: a 2-year follow-up study of 40 implants. Oral Surg Oral Med Oral Pathol Oral Radiol 116:e237–e243CrossRefPubMed
30.
Zurück zum Zitat Wood DL, Hoag PM, Donnenfeld OW, Rosenfeld LD (1972) Alveolar crest reduction following full and partial thickness flaps. J Periodontol 42:141–144CrossRef Wood DL, Hoag PM, Donnenfeld OW, Rosenfeld LD (1972) Alveolar crest reduction following full and partial thickness flaps. J Periodontol 42:141–144CrossRef
31.
Zurück zum Zitat De Bruyn H, Atashkadeh M, Cosyn J, van de Velde T (2011) Clinical outcome and bone preservation of single TiUnit implants installed with flapless or flap surgery. Clin Implant Dent Relat Res 13:175–183CrossRefPubMed De Bruyn H, Atashkadeh M, Cosyn J, van de Velde T (2011) Clinical outcome and bone preservation of single TiUnit implants installed with flapless or flap surgery. Clin Implant Dent Relat Res 13:175–183CrossRefPubMed
32.
Zurück zum Zitat Covani U, Cornelini R, Barone A (2008) Buccal bone augmentation around immediate implants with and without flap elevation: a modified approach. Int J Oral Maxillofac Implants 23:841–846PubMed Covani U, Cornelini R, Barone A (2008) Buccal bone augmentation around immediate implants with and without flap elevation: a modified approach. Int J Oral Maxillofac Implants 23:841–846PubMed
33.
Zurück zum Zitat Van de Velde T, Sennerby L, De Bruyn H (2010) The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial. Clin Oral Implants Res 21:1223–1233CrossRefPubMed Van de Velde T, Sennerby L, De Bruyn H (2010) The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial. Clin Oral Implants Res 21:1223–1233CrossRefPubMed
Metadaten
Titel
Does implant placement using a minimally invasive technique increase early failures among trainees at an academic center?
verfasst von
Brian R. Carr
Peter Rekawek
Joseph A. Gulko
John F. Coburn
William J. Boggess
Sung-Kiang Chuang
Neeraj Panchal
Brian P. Ford
Publikationsdatum
29.03.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Oral and Maxillofacial Surgery / Ausgabe 2/2023
Print ISSN: 1865-1550
Elektronische ISSN: 1865-1569
DOI
https://doi.org/10.1007/s10006-022-01057-y

Weitere Artikel der Ausgabe 2/2023

Oral and Maxillofacial Surgery 2/2023 Zur Ausgabe

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.