title: Radiographic evaluation of marginal bone levels during healing period, adjacent to parallel-screw cylinder implants inserted in the posterior zone of the jaws, placed with flapless surgery.
abstract: OBJECTIVE
  The purpose of this study was to compare changes at the marginal bone level adjacent to implants placed with flapless surgery and flap surgery during a stress-free healing period.
  
  
  METHODS
  Seven hundred and eighty-five implants were placed in 417 patients with a flapless approach and 459 implants were placed in 227 patients using flap techniques. The marginal bone level was determined radiographically, using digitized panoramic radiographs, at two time points: at implant placement (baseline) and after the healing period.
  
  
  RESULTS
  The median follow-up time was 0.5 years (SD, 1.2; range: 0.3-0.7). Implants placed with flapless surgery had a mean crestal bone loss of 0.5 mm (SD, 0.5; range: -0.7-2.4) and implants placed with flap surgery had a mean bone loss of 0.5 mm (SD, 0.7; range: -2.0-3.0) after healing. Differences in bone level changes between smokers and non-smokers were statistically significant for the flapless group (P<0.01).
  
  
  CONCLUSIONS
  A radiographic evaluation of marginal bone levels adjacent to implants showed comparable results for implants placed with flapless surgery and flap surgery. Appropriate case selection after virtual planning of the implant position and a sound surgical protocol is necessary for flapless surgery. Smoking habits may compromise the efficacy of flapless implant procedures.
authors.affiliation: Department of Prosthodontics, University Hospital Erlangen, Glückstr. 11, G-91054 Erlangen, Germany. Dr.A.Nickenig@t-online.de
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Nickenig
authors.forename: Manfred
authors.initials: M
authors.lastname: Wichmann
authors.forename: Karl Andreas
authors.initials: KA
authors.lastname: Schlegel
authors.forename: Emeka
authors.initials: E
authors.lastname: Nkenke
authors.forename: Stephan
authors.initials: S
authors.lastname: Eitner
mesh_terms: D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging* / Q000601:surgery*; D000704:Analysis of Variance; D001863:Bone Screws; D054893:Cone-Beam Computed Tomography; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D015921:Dental Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D012189:Retrospective Studies; D013499:Surface Properties; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
chemical_list: D015921:Dental Implants