Flapless versus Conventional Flapped Dental Implant Surgery: A Meta-Analysis

Abstract

The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 23 publications. The I2 statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used for random-effects model or fixed-effects model, when indicated. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. Sixteen studies were judged to be at high risk of bias, whereas two studies were considered of moderate risk of bias, and five studies of low risk of bias. The funnel plots indicated absence of publication bias for the three outcomes analyzed. The test for overall effect showed that the difference between the procedures (flapless vs. open flap surgery) significantly affect the implant failure rates (P = 0.03), with a RR of 1.75 (95% CI 1.07–2.86). However, a sensitivity analysis revealed differences when studies of high and low risk of bias were pooled separately. Thus, the results must be interpreted carefully. No apparent significant effects of flapless technique on the occurrence of postoperative infection (P = 0.96; RR 0.96, 95% CI 0.23–4.03) or on the marginal bone loss (P = 0.16; MD −0.07 mm, 95% CI −0.16–0.03) were observed.

Dental implants inserted in fresh extraction sockets versus healed sites: A systematic review and meta-analysis

“…First of all, all confounding factors may have affected the long-term outcomes and not just the fact that implants were placed in fresh extraction sockets patients or in healed sites, and the impact of these variables on the implant survival rate, postoperative infection and marginal bone loss [105][106][107][108][109][110][111] is difficult to estimate if these factors are not identified separately between the two different procedures in order to perform a meta-regression analysis. The lack of control of the confounding factors limited the potential to draw robust conclusions.…”

Flapless Dental Implant: Contemporary Trends in Literature Coverage

“…Nevertheless this approach will be promising future for esthetic zone areas without any intervention for alveolar bone exposure or soft tissue reflection. Recent studies reported identified risk factors for flapless implant surgeries such as type 4 bone, smoking, periodontal disease, the immediate loading only in the flapless group in some studies is a confounding factor, the use of grafts, the use or not use of surgical guides, different prosthetic configurations, and the insertion of implants from different brands and surface treatments [23][24][25][26].…”

Comparison Between Flapped and Flapless Implant Techniques by Measuring Crestal Bone Level: A Prospective Radiographical Trial

“…To ensure less trauma during surgical placements of dental implants, and less surgical time, a flapless technique can be used with the aid of a surgical stent but it requires a good bone quality 10 . It is regarded as a blind procedure and the operator cannot evaluate the alveolar bone quality 4 ; therefore, it needs an advanced clinical experience and surgical judgment 8,11,12 .…”

“…The disadvantages of the flapless surgical technique include inability to visualize anatomical landmarks, thermal damage due to reduction of coolant irrigation during preparing the socket, and mal-posed angle of dental implants 8,11,12 . The advantages of the flapped surgical procedure are: it provides good access to the implant site, allows good visualization to anatomical landmarks, and allows bone graft placement, when required 8,11,12 .…”

“…The advantages of the flapped surgical procedure are: it provides good access to the implant site, allows good visualization to anatomical landmarks, and allows bone graft placement, when required 8,11,12 .…”