Short-term postoperative discomfort in patients receiving flapless contra open implant surgery

Alexander Aizenberg, Jesper Jansson, Peter Abrahamsson

Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malm? University, Malm?, Sweden.
Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden.

DOI: 10.4236/ojst.2013.35050                

Abstract

Purpose: The aim of this pilot study was to evaluate subjective and objective findings on short-term post-operative discomfort in patients receiving flapless implant surgery compared to traditional open flap surgery. Materials and Methods: A two-centre, prospective survey study was conducted, using a customized questionnaire. Between December 2010 and January 2012, 20 patients were consecutively included. Eleven received conventional open-flap surgery and nine received flapless surgery. Inflammatory signs, analgesic consumption and sleeping difficulties were evaluated up to seven days postoperatively. A clinical examination was made one week postoperatively. Results: Significantly less experienced swelling was noted 24 hours after flapless surgery compared to open flap surgery for patients receiving four implants or more, and at three days postoperatively for patients receiving single implants. No difference concerning sleeping difficulties, pain or analgesic consumption was found. Clinical examination one week postoperatively showed no differences in wound gaps, redness of the mucosa, or presence of pus between the groups. Conclusions: In conclusion, flapless surgery seems to have a limited effect on postoperative comfort and short-term post-operative signs of soft tissue healing compared to open flap surgery. There is a need for larger randomized trials for evaluating differences in postoperative discomfort between the two surgical techniques.

Keywords

Postoperative Discomfort; Flapless Surgery; Guided Implant Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Branemark, P.I., Hansson, B.O., Adell, R., Breine, U., Lindstrom, J., Hallen, O., et al. (1977) Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scandinavian Journal of Plastic and Reconstructive Surgery Supplementum, 16, 1-132.
[2]	Al-Khabbaz, A.K., Griffin, T.J. and Al-Shammari, K.F. (2007) Assessment of pain associated with the surgical placement of dental implants. Journal of Periodontology, 78, 239-246. doi:10.1902/jop.2007.060032
[3]	Brand, H.S., Gortzak, R.A., Palmer-Bouva, C.C., Abraham, R.E. and Abraham-Inpijn, L. (1995) Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment. International Dental Journal, 45, 45-48.
[4]	Hashem, A.A., Claffey, N.M. and O’Connell, B. (2006) Pain and anxiety following the placement of dental implants. The International Journal of Oral & Maxillofacial Implants, 21, 943-950.
[5]	Komiyama, A. (2010) Evaluation of computer-assisted virtual treatment planning and template-guided surgery in dental implant treatment. Larserics Digital Print AB, Sundbyberg, pp. 1-68.
[6]	Campelo, L.D. and Camara, J.R. (2002) Flapless implant surgery: A 10-year clinical retrospective analysis. The International Journal of Oral & Maxillofacial Implants, 17, 271-276.
[7]	Komiyama, A., Klinge, B. and Hultin, M. (2008) Treatment outcome of immediately loaded implants installed in edentulous jaws following computer-assisted virtual treatment planning and flapless surgery. Clinical Oral Implants Research, 19, 677-685. doi:10.1111/j.1600-0501.2008.01538.x
[8]	Cannizzaro, G., Leone, M., Consolo, U., Ferri, V. and Esposito, M. (2008) Immediate functional loading of implants placed with flapless surgery versus conventional implants in partially edentulous patients: A 3-year randomized controlled clinical trial. International Journal of Oral & Maxillofacial Implants, 23, 867-875.
[9]	Malo, P. and Nobre, M. (2008) Flap vs. flapless surgical techniques at immediate implant function in predominantly soft bone for rehabilitation of partial edentulism: A prospective cohort study with follow-up of 1 year. European Journal of Oral Implantology, 1, 293-304.
[10]	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 prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: A prospective multicenter study. Clinical Implant Dentistry and Related Research, 7, S111-S120. doi:10.1111/j.1708-8208.2005.tb00083.x
[11]	Ozan, O., Turkyilmaz, I. and Yilmaz, B. (2007) A preliminary report of patients treated with early loaded implants using computerized tomography-guided surgical stents: Flapless versus conventional flapped surgery. Journal of Oral Rehabilitation, 34, 835-840. doi:10.1111/j.1365-2842.2007.01772.x
[12]	Brodala, N. (2009) Flapless surgery and its effect on dental implant outcomes. The International Journal of Oral & Maxillofacial Implants, 24, 118-125.
[13]	Fortin, T., Bosson, J.L., Coudert, J.L. and Isidori, M. (2003) Reliability of preoperative planning of an image-guided system for oral implant placement based on 3-dimensional images: An in vivo study. The International Journal of Oral & Maxillofacial Implants, 18, 886-893.
[14]	Kim, J.I., Choi, B.H., Li, J., Xuan, F. and Jeong, S.M. (2009) Blood vessels of the peri-implant mucosa: A comparison between flap and flapless procedures. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 107, 508-512. doi:10.1016/j.tripleo.2008.08.003
[15]	Sclar, A.G. (2007) Guidelines for flapless surgery. Journal of Oral and Maxillofacial Surgery, 65, 20-32. doi:10.1016/j.joms.2007.03.017
[16]	Orentlicher, G., Goldsmith, D. and Horowitz, A. (2010) Applications of 3-dimensional virtual computerized tomography technology in oral and maxillofacial surgery: Current therapy. Journal of Oral and Maxillofacial Surgery, 68, 1933-1959. doi:10.1016/j.joms.2010.03.013
[17]	Hammerle, C.H., Stone, P., Jung, R.E., Kapos, T. and Brodala, N. (2009) Consensus statements and recommended clinical procedures regarding computer-assisted implant dentistry. The International Journal of Oral & Maxillofacial Implants, 24, 126-131.
[18]	Schneider, D., Marquardt, P., Zwahlen, M. and Jung, R.E. (2009) A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. Clinical Oral Implants Research, 20, 73-86. doi:10.1111/j.1600-0501.2009.01788.x
[19]	Misir, A.F., Sumer, M., Yenisey, M. and Ergioglu, E. (2009) Effect of surgical drill guide on heat generated from implant drilling. Journal of Oral and Maxillofacial Surgery, 67, 2663-2668. doi:10.1016/j.joms.2009.07.056
[20]	Eli, I., Schwartz-Arad, D., Baht, R. and Ben-Tuvim, H. (2003) Effect of anxiety on the experience of pain in implant insertion. Clinical Oral Implants Research, 14, 115-118. doi:10.1034/j.1600-0501.2003.140115.x
[21]	Conrad, S.M., Blakey, G.H., Shugars, D.A., Marciani, R.D., Phillips, C. and White, R.P. (1999) Patients’ perception of recovery after third molar surgery. Journal of Oral and Maxillofacial Surgery, 57, 1288-1294. doi:10.1016/S0278-2391(99)90861-3
[22]	Van Gool, A. (1977) Clinical consequences of complaints and complications after removal of the mandibular third molar. International Journal of Oral Surgery, 6, 29-37. doi:10.1016/S0300-9785(77)80069-0
[23]	Berge, T.I. and Gilhuus-Moe, O.T. (1993) Perand postoperative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon. Acta Odontologica Scandinavica, 51, 389-397. doi:10.3109/00016359309040590
[24]	Valmaseda-Castellon, E., Berini-Aytes, L. and Gay-Escoda, C. (2001) Inferior alveolar nerve damage after lower third molar surgical extraction: A prospective study of 1117 surgical extractions. Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 92, 377-383. doi:10.1067/moe.2001.118284
[25]	Valmaseda-Castellon, E., Berini-Aytes, L. and Gay-Escoda, C. (2000) Lingual nerve damage after third lower molar surgical extraction. Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 90, 567-573. doi:10.1067/moe.2000.110034
[26]	Lindeboom, J.A. and van Wijk, A.J. (2010) A comparason of two implant techniques on patient-based outcome measures: A report of flapless vs. conventional flapped implant placement. Clinical Oral Implants Research, 21, 366-370. doi:10.1111/j.1600-0501.2009.01866.x
[27]	Misch, K. and Wang, H.L. (2008) Implant surgery complications: Etiology and treatment. Implant Dentistry, 17, 159-168. doi:10.1097/ID.0b013e3181752f61
[28]	Ellies, L.G. and Hawker, P.B. (1993) The prevalence of altered sensation associated with implant surgery. The International Journal of Oral & Maxillofacial Implants, 8, 674-679.
[29]	Bartling, R., Freeman, K. and Kraut, R.A. (1999) The incidence of altered sensation of the mental nerve after mandibular implant placement. Journal of Oral and Maxillofacial Surgery, 57, 1408-1412. doi:10.1016/S0278-2391(99)90720-6
[30]	Van Steenberghe, D., Lekholm, U., Bolender, C., Folmer, T., Henry, P., Herrmann, I., et al. (1990) Applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: A prospective multicenter study on 558 fixtures. The International Journal of Oral & Maxillofacial Implants, 5, 272-281.
[31]	Tong, D.C. and Rothwell, B.R. (2000) Antibiotic prophylaxis in dentistry: A review and practice recommenddations. The Journal of the American Dental Association, 131, 366-374.
[32]	Capuzzi, P., Montebugnoli, L. and Vaccaro, M.A. (1994) Extraction of impacted third molars: A longitudinal prospective study on factors that affect postoperative recovery. Oral Surgery, Oral Medicine, Oral Pathology, 77, 341-343. doi:10.1016/0030-4220(94)90194-5
[33]	Siddiqi, A., Morkel, J.A. and Zafar, S. (2010) Antibiotic prophylaxis in third molar surgery: A randomized double-blind placebo-controlled clinical trial using split-mouth technique. International Journal of Oral and Maxillofacial Surgery, 39, 107-114. doi:10.1016/j.ijom.2009.12.014