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IntroductionFlapless surgery for implant placement has been gaining popularity among implant surgeons1.Flapless implant surgery has numerous advantages, including the preservation of circulation, soft

tissue architecture, and hard tissue volume at the site, as well as decreased surgical time, improvedpatient comfort, and accelerated recovery2. Various methods exist for gaining access to the alveolarridge. Theuse of a tissue punch has been proposed3, whereas othermade a hole in the gingival tissueusing drills instead of a tissue punch4. Drilling through the mucosa without removing a core of softtissue may simultaneously cut the gingival tissue and the bone. This method could result in largeragged wounds, increasing the risk of impaired healing and significant scarring and entrapment ofsoft tissues in the implant site1. A study1 supports the use of a tissue punch slightly narrower than theimplant itself to obtain better perimplant tissue healing around flapless implants.Although flaplessimplant surgery has numerous advantages, the approach also has some drawbacks, including theinability to save the keratinized mucosa. In regions were the amount of keratinized tissue is deficient,use of gingival punch is not indicated5.Aim of this study is show a novel technique for flapless implant surgery, using dedicated rotarydevices, designed to save keratinized mucosa.Patients and methods

Eleven consecutive patients were enrolled for this study, 8 F, 3 M, 35-72 yo, mean 62. Inclusioncriteria were patient age>18, willing and able to give informed consent, willing to participate in thestudy, absence of systemic or local controindication for implant placement; 2) Treatment plan thatincluded implant positioning on both side of maxilla or mandible; 3) Abundant bone (>7mm width,>12 mm height, measured by CT scans) 4) presence of a band of keratinized mucosa larger than 5mm. Exclusion criteria were patients with uncontrolled diabetes and those on oral or IV

bisphosphonates, history of alcoholism or drug abuse, uncontrolled metabolic disease, transplantpatient on immunosuppressant therapy, uncompensated systemic disease, mental illness, receivedradiation therapy to surgical site, pregnancy.Surgery was performed with hand punch 4 mm in diameter on one side (Gima SpA, Gessate, MI,Italy), while on the other the new devices (Surgical Kit for non-invasive implant surgery, AvimaticSrl, Bagnolo Cremasco, CR, Italy) were used. The tested surgical kit was made of three rotaryinstruments, 1) Disc Blade 2) Cup Blade 3) Flat blade. The sides were choosen using a random

technique (Random number generator, Graphpad, www graphpad.com). Tissue Level 4.1 or 4.8Straumann Implants were used, 10 or 12 mm of lenght (Straumann AG, Basel, Switzerland).Clinical data were collected before, during and after surgery, at 1 week, 1 month and 3 months recall

before placement of final prosthesis, and included patients discomfort, surgical time, radiographicappearance, quality and quantity of keratinized mucosa, probing depth and bleeding on probing.ResultsAll patients completed the study. 28 implants were placed, 15 with the tested device and 13 withtissue punch. The results were analyzed using non-parametric statistics (Mann-Whitney testGraphpad InStat) and showed that, 3 months after surgery the experimental sites had significant morekeratinized mucosa than control sites. Probing depth, bleeding on probing, surgical time, x-rayevaluation and patient discomfort did not show significant differences.DiscussionBased upon data of this study, the tested devices look promising for flapless surgical implant

positioning. The use of these rotary blades allow the surgeon to save almost all the keratinized tissue,

and even to move it slightly in the preferred position. The section of all fibrous tissue beforeosteotomy could prevent entrapment of soft tissues in the implant site.ConclusionThe tested devices could be useful in minimally invasive implant surgery. Further studies are neededin order to evaluate their possible use, even in presence of a band of keratinized tissue smaller thanimplant diameter.

ITI Research Competition

ITI World Symposium, Geneva, April 15-17, 2010

Patient n11. M.L., 35 yo F,36 & 46, 2 StraumannStandard Implant 4.8x10 mmWN

P value is 0,0158,considered significant.

References1) Lee DH, Choi BH, Jeong SM, Xuan F, Kim HR, Mo DY: Effects of soft tissue punch size on thehealing of peri-implant tissue in flapless implant surgery. Oral Surg Oral Med Oral Pathol OralRadiol Endod 2010;109: 525-530

2) Sclar AG. Guidelines for flapless surgery. J Oral Maxillofac Surg 2007;65:20-32.3) Campelo LD, Camara JRD. Flapless implant surgery: a 10-year clinical retrospective analysis.Int J Oral Maxillofac Implants 2002;17:271-6.4) Becker W, Goldstein M, Becker BE, Sennerby L, Kois D, Hujoel P. Minimally invasive flaplessimplant placement: follow-up results from a multicenter study. J Periodontol 2009;80:347-52.5) Rotter BE: Emergence profile consideration for implant surgery. Oral Maxillofacial Surg Clin

North Am 8; 413,1996.

Tested rotary devices

A new technique for flapless implant surgeryPresenter: Manuele Leoni, Modena, Italy leoni.manuele@libero.it

Co-Authors: Pio Bertani, Piero Zoppi, Paolo Generali

mailto:leoni.manuele@libero.itmailto:leoni.manuele@libero.it