Brian R Carr1, Peter Rekawek2, Joseph A Gulko3, John F Coburn4, William J Boggess5, Sung-Kiang Chuang6,7,8, Neeraj Panchal9,10,6, Brian P Ford6. 1. Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. brian.carr@utsouthwestern.edu. 2. Department of Oral and Maxillofacial Surgery, New York University Langone Medical Center and Bellevue Hospital Center, New York, NY, USA. 3. Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA. 5. Department of Craniofacial and Oral and Maxillofacial Surgery, Sanford Health, Fargo, ND, USA. 6. Department of Oral and Maxillofacial Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA. 7. Brockton Oral and Maxillofacial Surgery Inc, Brockton, USA. 8. Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA, USA. 9. Penn Presbyterian Hospital, Philadelphia, USA. 10. Philadelphia Veteran's Affairs Medical Center, Philadelphia, USA.
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.
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.