Considerations for Incision and Flap Design With Implant Therapy in the Esthetic Zone

Enhancing early-stage healing responses through the modified "Poncho" technique in customized titanium mesh-mediated bone regeneration: A soft tissue management approach-case series

RATIONALE

Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified "Poncho" technique (MPT), integrated with customized titanium mesh-mediated bone regeneration, and investigates the healing quality during the initial stages of an incision.

PATIENT CONCERNS

The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection.

DIAGNOSIS

All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration.

INTERVENTIONS

The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry's healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique's performance in early wound closure.

OUTCOMES

The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry's healing index increased from 3 ± 0.47 to a final value of 4.69 ± 1.06, indicating substantial improvement in healing over time.

LESSONS

The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.

Flap versus Flapless Immediate Implants with Bone Augmentation: A Novel Study

Background

This study aimed to equate implants placed using a traditional flap elevation technique with implants placed using a flapless process regarding bone healing and success in clinical conditions.

Materials and Methods

Sixty subjects were included in this research work. The participants were randomly divided into two groups. Patients in group A underwent implant placement with the flap elevation technique. Similarly, group B patients underwent implant placement without flap reflection. Parameters such as plaque index, wound healing index, crestal bone loss, and radiograph were considered to estimate the effectiveness of the two techniques.

Results

Plaque indexes were improved in both groups. The modified gingival index also improved in all the phases of healing. The flapless method showed a better crestal bone.

Conclusion

It can be concluded that this study showed that with the right augmentation techniques, implants could be successfully performed immediate extraction sockets, both with and without elevation of the mucoperiosteal flap.

Do different incision techniques for implant surgery affect gingival papilla height around dental implants? A retrospective study of 115 cases

BACKGROUND

Surgical incision designs are considered closely correlated to gingival papilla of dental implants. This study aims to explore whether different incision techniques for implant placement and second stage surgery affect gingival papilla height.

METHODS

Cases using different incision techniques (intrasulcular incisions or papilla sparing incisions) between November 2017 and December 2020 were selected and analyzed. A digital camera was used to capture images of gingival papilla at different time points. Ratio of papilla height to crown length using different incision techniques were measured and statistically compared.

RESULTS

A total of 115 papillae (68 patients) were eligible according to the inclusion/exclusion criteria. The average age was 39.6 years. Decreased postoperative papilla height were observed after implant placement surgery in all groups without statistical difference. However, for second stage surgery, intrasulcular incisions lead to more atrophy in gingival papilla compared to papilla sparing incisions.

CONCLUSIONS

Selection of incision techniques in implant placement surgery does not significantly affect papilla height. For second stage surgery, intrasulcular incisions significantly leads to more papilla atrophy compared with papilla sparing incisions. Trial registration KQCL2017003.

Clinical study of dynamic real-time navigation assisted immediate implant without flapping in the esthetic zone

OBJECTIVE

The purpose of this study is to investigate the clinical effect of Dynamic real-time navigation to assist immediate implant without flapping in the esthetic zone.

METHODS

Eight patients who underwent immediate implantation in the aesthetic area were included. A total of 11 implants were implanted using dynamic real-time navigation system combined with non-flap technology. Clinical indicators including implant deviation, initial stability, alveolar bone absorption, implant success rate, pink esthetic score (PES), Papilla index score (PIS), and the thickness of labial side bone plate of the implant were recorded.

RESULTS

The deviation between the actual implant position and the preoperative design was (0.76±0.08) mm at the top, (1.11±0.18) mm at the root, (0.90±0.16) mm at the depth, and (1.48±0.91)°at the Angle. ISO values of all implants were greater than 59. PES was greater than 8. PIS index was 2 or 3. The average alveolar bone absorption was (0.34±0.09) mm and the thickness of bone plate on the lip of implant was greater than 1.6 mm. The success rate of implantation was 100%.

CONCLUSION

The use of dynamic real-time navigation assisted non-flap implantation in the aesthetic area can effectively reduce implant deviation and improve the aesthetic effect.

Comparison of general and aesthetic effects between flapless and flap techniques in dental implantation: a meta-analysis of randomized controlled trials

Background

Information about the aesthetic effects of flapless in implant surgeries is scant. Differences of the survival rate (SR) and crestal bone loss (CBL) between the two techniques were also controversial. Thus, this review was aimed to compare the general and aesthetic effects of flapless and flap approaches in implant surgeries.

Materials and methods

Following the principals of PRISMA, literature databases were searched for the eligible randomized controlled trials (RCTs) comparing the clinical performances of flap and flapless techniques. After that, relevant data of selected studies were pooled and analyzed to compare SR, bleeding on probing (BOP), probing depth (PD), visual analogue scale (VAS), papillae presentation index (PPI), keratinized mucosa (KM) width and CBL between the two techniques.

Results

Fourteen RCTs were included. No significant difference was found in SR (RR = − 0.01, 95% confidence interval (CI) (− 0.05, 0.04)), BOP (OR = 0.40, 95% CI (0.15, 1.02)), KM width (WMD = − 0.42, 95% CI (− 1.02, 0.17)) between two groups. Subgroup analysis revealed that the difference of CBL was insignificant in two groups (WMD = − 0.13, 95% CI (− 0.63, 0.38)). However, flap techniques would lead more peri-implant PD (WMD = − 0.37, 95% CI (− 0.51, − 0.23)). Subgroup analysis also indicated lower VAS scores in flapless group after 1 day (WMD = − 1.66, 95% CI (− 2.16, − 1.16)) but comparable pain experience after 3 days (WMD = − 0.59, 95% CI (− 1.33, 0.16)). Mean difference of PPI (WMD = 0.32, 95% CI (0.28, 0.35)) between the two groups was significant.

Conclusions

The flapless procedure showed a superiority in preserving gingival papillae, reducing postoperative pain and peri-implant PD compared to the flap procedure, while exhibiting comparable effects on SR, BOP, KW width changes and CBL. Flapless technique is more recommended at the ideal soft and hard tissue implanting sites.

Immediate implant placement combined with maxillary sinus floor elevation utilizing the transalveolar approach and nonsubmerged healing for failing teeth in the maxillary molar area: A randomized controlled trial clinical study with one-year follow-up

BACKGROUND

In previous studies, immediate implant placement in molar sites has been widely applied.

PURPOSE

To study the clinical effect and feasibility of immediate implant placement combined with maxillary sinus floor elevation utilizing the transalveolar approach and nonsubmerged healing for failing teeth in the maxillary molar area.

MATERIAL AND METHODS

Patients who required implantation surgry to replace a failing tooth in the maxilla molar region were selected. Patients were randomized into two groups: immediate implant placement combined with maxillary sinus floor elevation utilizing the transalveolar approach and nonsubmerged healing (test group) or delayed implant placement combined with maxillary sinus floor elevation utilizing the transalveolar approach and nonsubmerged healing (control group). The outcome criteria were the success rates of implants, Cone Beam Computer Tomography (CBCT) data and results of the subjective satisfaction survey performed with a visual analog scale (VAS).

RESULTS

All implants had good initial stability after implantation. The survival rate of implants was 100% at 1-year follow-up. At the time of permanent restoration, the differences in average horizontal shrinkage of alveolar bone (W1) on the buccal side between the test group (0.65 ± 0.12 mm) and the control group (1.23 ± 0.32 mm) were statistically significant (P < .0001); however, no statistically significant difference (P = .515) was observed on the palatal side (0.3 ± 0.10 mm vs 0.28 ± 0.08 mm). The difference in vertical resorption of alveolar bone (H1) on the buccal side between the test group (0.60 ± 0.18 mm) and the control group (1.53 ± 0.19 mm) was statistically significant (P < .0001), but no statistically significant difference (P = .190) in the reduction of palatal alveolar bone (0.24 ± 0.12 mm vs 0.29 ± 0.13 mm) was observed. After 1-year loading, no statistically significant difference (P > .05) in vertical or horizontal changes (W2, H2) were identified in the test group or control group. Patient satisfaction in both groups was similar (8.36 ± 1.01 vs 8.14 ± 1.35), and the difference between groups was not statistically significant (P = .638).

CONCLUSION

Immediate implant placement combined with maxillary sinus floor elevation utilizing the transalveolar approach and nonsubmerged healing is feasible for the maxillary molar area, and the clinical effect is satisfactory.