title: Clinical outcomes in the presence and absence of keratinized mucosa in mandibular guided implant surgeries: a pilot study with a proposal for the modification of the technique.
abstract: OBJECTIVE
  To test the hypothesis of the outcome of complete arch flapless guided implant surgery mandibular rehabilitations in the presence or absence of a residual band of keratinized mucosa (KM) < 6 mm wide in the vestibular-lingual aspect, with and without a modification of the surgical protocol.
  
  
  METHODS
  Thirty-nine patients were included in this study (12 men and 27 women), with a mean age of 62.5 years (range, 42 to 79 years), divided into 3 groups of 13 patients according to the status of residual band of KM: group 1, KM < 6 mm rehabilitated through a modified guided surgical protocol with flap opening to preserve KM; group 2, KM ≥ 6 mm; and group 3, KM < 6 mm; patients from both groups 2 and 3 were rehabilitated through flapless guided implant surgery without modification of the protocol. Group 2 and 3 patients were age- and sex-matched with group 1. Outcome measures were clinical attachment loss (CAL) ≥ 2 mm after 1 year (backward conditional regression), incidence of dehiscences, dental plaque, bleeding, and implant infections. The level of significance chosen was 5%.
  
  
  RESULTS
  Thirty-nine patients with 156 implants were followed for 1 year, and no dropouts occurred. Absence of a residual band of KM ≥ 6 mm in the vestibular-lingual aspect was significantly associated with CAL (odds ratio, 39.1; P = .036) and dehiscences (P = .003).
  
  
  CONCLUSIONS
  Within the limitations of this study, the absence of a residual band of KM ≥ 6 mm wide in the vestibular-lingual aspect in patients rehabilitated in the complete edentulous mandible with flapless guided implant surgery may be associated with CAL and a higher incidence of dehiscences after 1 year of follow-up. This possible association needs to be confirmed in studies with stronger designs and longer follow-ups.
authors: Department of Oral Surgery, Malo Clinic, Lisbon, Portugal. research@maloclinics.com
authors: Paulo
authors: P
authors: Maló
authors: Mauricio
authors: M
authors: Rigolizzo
authors: Miguel de
authors: Md
authors: Nobre
authors: Armando
authors: A
authors: Lopes
authors: Enrico
authors: E
authors: Agliardi
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D003773:Dental Plaque / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology*; D005884:Gingival Hemorrhage / Q000209:etiology; D006801:Humans; D057893:Immediate Dental Implant Loading; D007575:Jaw, Edentulous / Q000534:rehabilitation / Q000601:surgery; D007633:Keratins; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D010347:Patient Care Planning; D057873:Peri-Implantitis / Q000209:etiology; D017622:Periodontal Attachment Loss / Q000209:etiology; D010865:Pilot Projects; D011183:Postoperative Complications; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D007633:Keratins