title: Computer-guided flapless transmucosal implant placement in the mandible: a new combination of two innovative techniques.
abstract: OBJECTIVE
  To assess whether computer-guided flapless transmucosal implant bed preparation without mucosal punching allows placement of dental implants in edentulous mandibles.
  
  
  METHODS
  Twenty patients with fully edentulous mandibles (11 male; 9 female) were included in the study. Each patient was scheduled to receive 4 screw-shaped Ankylos (Dentsply Friadent, Mannheim, Germany) implants in the interforaminal region. The StealthStation Treon navigation system (Medtronic, Minnesota, MN) was used for computer-guided drilling. Using conventional implant drills the mucosa was penetrated without flap elevation or mucosal punching. The study protocol did not allow direct visualization of the bone surface during surgery.
  
  
  RESULTS
  For 78 implants (97.5%) the preoperative plan could be transfered to the patient by intraoperative navigation with a mean deviation of 0.9 mm (Implant tip 0.8 +/- 0.6 mm; coronal implant end 1.1 +/- 0.7 mm) as measured by comparing pre- and postoperative computerized tomography images. Two implants (2.5 %) were not primarily stable and failed to osseointegrate.
  
  
  CONCLUSIONS
  Computer-guided transmucosal interforaminal implant placement without mucosal punching is a precise and predictable procedure. It is, however, not yet suitable for all bone morphologies. Future developments may include miniaturization of hardware and simplification of the drilling procedure.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria. gert.wittwer@meduniwien.ac.at
authors.forename: Gert
authors.initials: G
authors.lastname: Wittwer
authors.forename: Wasiu Lanre
authors.initials: WL
authors.lastname: Adeyemo
authors.forename: Kurt
authors.initials: K
authors.lastname: Schicho
authors.forename: Natasha
authors.initials: N
authors.lastname: Gigovic
authors.forename: Dritan
authors.initials: D
authors.lastname: Turhani
authors.forename: Georg
authors.initials: G
authors.lastname: Enislidis
mesh_terms: D000368:Aged; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019232:Dental Restoration Failure; D005260:Female; D006801:Humans; D007575:Jaw, Edentulous / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome