title: Three-Year Outcome of Fixed Partial Rehabilitations Supported by Implants Inserted with Flap or Flapless Surgical Techniques.
abstract: OBJECTIVE
  The aim of this prospective clinical study was to evaluate the 3-year outcome of fixed partial prostheses supported by implants with immediate provisionalization without occlusal contacts inserted in predominantly soft bone with flap and flapless protocols.
  
  
  METHODS
  Forty-one patients partially rehabilitated with 72 NobelSpeedy implants (51 maxillary; 21 mandibular) were consecutively included and treated with a flapless surgical protocol (n = 20 patients; 32 implants) and flapped surgical protocol (n = 21 patients; 40 implants). Primary outcome measure was implant survival; secondary outcome measures were marginal bone resorption (comparing the bone levels at 1 and 3 years with baseline) and the incidence of biological, mechanical, and esthetic complications. Survival was computed through life tables; descriptive statistics were applied to the remaining variables of interest.
  
  
  RESULTS
  Eight patients with eight implants dropped out of the study. One implant failed in one patient (flapless group) giving an overall cumulative survival rate (CSR) of 98.6%. No failures were noted with the flapped protocol (CSR 100%), while for the implants placed with the flapless surgical technique, a 96.9% CSR was registered. The overall average marginal bone resorption at 3 years was 1.37 mm (SD = 0.94 mm), with 1.14 mm (SD = 0.49 mm) and 1.60 mm (SD = 1.22 mm) for the flap and flapless groups, respectively. Mechanical complications occurred in nine patients (n = 5 patients in the flapless group; n = 4 patients in the flap group). Implant infection was registered in three implants and three patients (flapless group), who exhibited inadequate oral hygiene levels.
  
  
  CONCLUSIONS
  Partial edentulism rehabilitation through immediate provisionalization fixed prosthesis supported by dental implants inserted through flap or flapless surgical techniques in areas of predominantly soft bone was viable at 3 years of follow-up. The limitations and risks of the "free-hand" method in flapless surgery should be considered when planning implant-supported fixed prosthetic reconstructions.
authors.affiliation: Department of Oral Surgery, Maló Clinic, Lisbon, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Maló
authors.affiliation: Research and Development Department, Maló Clinic, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: de Araújo Nobre
authors.affiliation: Department of Oral Surgery, Maló Clinic, Lisbon, Portugal.
authors.forename: Armando
authors.initials: A
authors.lastname: Lopes
mesh_terms: D016301:Alveolar Bone Loss; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants
keywords: Dental implants; fixed partial prosthesis; low-density bone; single teeth