Van de Velde Tommie, Glor Fadi, De Bruyn Hugo
Department of Periodontology and Oral Implantology, University of Ghent, Ghent, Belgium.
Clin Oral Implants Res. 2008 Jan;19(1):66-72. doi: 10.1111/j.1600-0501.2007.01423.x. Epub 2007 Oct 22.
Some implant companies advocate that flapless surgery is easy to perform and beneficial for aesthetics and patients morbidity. However, studies objectively analyzing the position in the bone of implants installed with this approach are lacking. This in vitro model study was performed to analyse deviations in position and inclination of implants placed with flapless surgery compared with the ideally planned position and to examine whether the outcome is affected by experience level.
Identical radio-opaque resin models were developed with a silicon lining mimicking the soft tissues and six edentulous single tooth spaces. Eighteen clinicians (six periodontists, six general dentists and six students) drilled four implant sites each (Straumann AG, Basel, Switzerland) with a flapless approach. Corresponding CT-scan images of the models were available. A virtual implant program (Simplant, Materialise NV, Leuven, Belgium) was used to plan the ideal position and to compare this with the implant angulation and position of the test implants.
There were no significant differences between the experience groups for all parameters except for global deviations between dentist and students, angle deviations between dentists and students and horizontal deviations between specialists and students. In incisor sites, specialists and students deviated significantly more in global deviation and depth than dentists. In premolar and molar sites, there were no significant differences except for horizontal deviations between specialists and dentists in molar sites. As a consequence of the malpositioning, perforations were seen in 59.7% (43/72) of the implant occasions when the artificial mucosa was removed from the model.
The three-dimensional location of implants installed with flapless approach differs significantly from the ideal, although neighbouring teeth were present and maximal radiographical information was available. Within the limitations of this in vitro model study it seems necessary to point out that these deviations would in a clinical situation lead to complications such as loss of implant stability, aesthetical and phonetical consequences. The outcome is not influenced by the level of experience with implant surgery. This points out that more precise measurements of soft tissue in situ or additional use of guiding systems are recommendable.
一些种植体公司主张，不翻瓣手术操作简便，有利于美观，且对患者发病率有益。然而，缺乏对采用这种方法植入的种植体在骨内位置进行客观分析的研究。本体外模型研究旨在分析与理想规划位置相比，不翻瓣手术植入的种植体在位置和倾斜度上的偏差，并研究结果是否受经验水平的影响。
使用硅树脂衬里模拟软组织和六个无牙单牙间隙，制作了相同的不透射线树脂模型。18名临床医生（6名牙周病医生、6名普通牙医和6名学生）采用不翻瓣方法在每个模型上钻出四个种植位点（瑞士巴塞尔的Straumann AG公司生产）。模型有相应的CT扫描图像。使用虚拟种植程序（比利时鲁汶的Materialise NV公司的Simplant）规划理想位置，并将其与测试种植体的角度和位置进行比较。
除了牙医和学生之间的总体偏差、牙医和学生之间的角度偏差以及专家和学生之间的水平偏差外，所有参数在经验组之间没有显著差异。在前牙位点，专家和学生在总体偏差和深度上的偏差明显大于牙医。在双尖牙和磨牙位点，除了磨牙位点专家和牙医之间的水平偏差外，没有显著差异。由于位置不当，当从模型中移除人工黏膜时，在59.7%（43/72）的种植情况下出现了穿孔。
尽管存在邻牙且有最大的影像学信息，但不翻瓣方法植入的种植体的三维位置与理想位置有显著差异。在本体外模型研究的局限性内，似乎有必要指出，这些偏差在临床情况下会导致诸如种植体稳定性丧失、美学和语音方面的后果等并发症。结果不受种植手术经验水平的影响。这表明建议对软组织进行更精确的原位测量或额外使用导向系统。
