Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI.
J Periodontol. 2013 Dec;84(12):1747-54. doi: 10.1902/jop.2013.120575. Epub 2013 Jan 24.
Implant therapy is a highly predictable treatment option; however, insufficient data exist to show whether flapless implant surgery provides better esthetic outcomes and less bone loss than implant surgery with a flap approach.
In this randomized, controlled study comparing the flapless and traditional flap protocol for implant placement, 24 patients received a single implant in the anterior maxillary region. A cone beam computed tomography-aided surgical guide was used for implant placement surgery for both groups. Implants were restored using a one-piece, screw-retained ceramic crown at 3 months. Radiographic and clinical measurements were assessed at baseline (implant placement) and at 3 (crown placement), 6, 9, and 15 months. Clinical parameters evaluated were plaque index, gingival index, papillary index (PPI) (0 = no papilla, 1 = less than half, 2 = more than half but not complete, 3 = complete fill, and 4 = overfill), marginal tissue levels, biotype, width of keratinized tissue, and soft tissue thickness.
Implant success rate was 92% in both groups. Mean PPI values for the flap control group and flapless test group were 2.38 ± 0.51 versus 2.31 ± 0.48 at crown placement (P = 0.68) and 2.52 ± 0.52 versus 2.64 ± 0.54 at 15 months (P = 0.42), respectively. PPI increased over time in both groups, although the flapless group had a significantly larger change in PPI from crown placement to 6 and 9 months (P <0.01). Crestal bone levels in the flap group were more apical in relation to the implant platform than those in the flapless group for the duration of the study. No differences among groups were noted for all other measurements.
Both flapless and flap implant placement protocols resulted in high success rates. A flapless protocol may provide a better short-term esthetic result, although there appears to be no long-term advantage.
种植体治疗是一种高度可预测的治疗选择；然而，目前还没有足够的数据表明无瓣种植手术是否比有瓣种植手术提供更好的美学效果和更少的骨丢失。
在这项比较无瓣和传统瓣种植体放置方案的随机对照研究中，24 名患者在前上颌区域接受了单个种植体。两组均采用锥形束计算机断层扫描辅助手术导板进行种植体放置手术。两组均在 3 个月时采用一体式、螺丝固位陶瓷冠进行修复。在基线（种植体放置）和 3 个月（冠放置）、6 个月、9 个月和 15 个月时评估影像学和临床测量结果。评估的临床参数包括菌斑指数、牙龈指数、乳头指数（PPI）（0 = 无乳头，1 = 不到一半，2 = 超过一半但不完全，3 = 完全充盈，4 = 充盈过度）、边缘组织水平、生物型、角化组织宽度和软组织厚度。
两组种植体成功率均为 92%。瓣对照组和无瓣试验组的平均 PPI 值分别为冠放置时的 2.38 ± 0.51 与 2.31 ± 0.48（P = 0.68）和 15 个月时的 2.52 ± 0.52 与 2.64 ± 0.54（P = 0.42）。两组的 PPI 值均随时间增加，但无瓣组从冠放置到 6 个月和 9 个月时 PPI 值的变化显著更大（P <0.01）。在整个研究期间，瓣组的牙槽嵴骨水平相对于种植体平台更向根尖方向。组间其他测量值无差异。
无瓣和有瓣种植体放置方案均取得了较高的成功率。无瓣方案可能提供更好的短期美学效果，尽管长期似乎没有优势。
