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implants - internationalmagazine of oral implantology

clinical study _ flapless implant surgery I I 17implants4_2011 The presence of BOP is considered to be a readily available parameter that reflects peri-implant health (Heitz-Mayfield 2008). Its clinical impor- tance is not always equivocal and should be as- sessed cautiously in relation to additional parame- ters. The presence of BOP is generally considered to be a symptom of inflammation; nevertheless, the completeoppositewasalsofound.Langetal.(1990) in their thorough study demonstrated that the ab- senceofBOPisonlyclinicallymeaningfuliffoundin several consecutive measurements, i.e. negative prediction value of 98%. The presence of BOP had no clinical relevance (positive prediction value of 6%). The negative prediction value appears to be true in implantology too (Lang etal.1994; Becker & Gansky2007).Toconfirmaperi-implantinflamma- tion, measurement of matrix metalloproteinase ac- tivity (MMP-8/collagenase-2) would be necessary. Maetal.(2000)andXuetal.(2008)haveshownthat thisenzymeactivityallowsdistinctionbetweendis- eased and healthy tissues. _Conclusion In addition to peri-implant soft-tissue preserva- tion, minimally invasive implantation offers impor- tant advantages. This is particularly true for elderly, medically compromised patients, who typically present with limited bone availability and/or poor bonequalityinadditiontocongenitaloranti-coag- ulant-inducedbleedingdiathesis,aswellasgeneral medical contra-indications that make larger aug- mentative intervention quite challenging. In these patients, excellent results can be obtained using a minimally invasive, transgingival approach and pa- tient chewing comfort can be improved dramati- cally. As only the soft tissue the size of the implant diameter will be excised, the implant acts as a tam- ponadethatmayeffectivelydiminishbleedingfrom the bone and soft tissue. In early stages, the flapless technique was rec- ommended to inexperienced surgeons. It soon be- came clear that this type of surgery is technically very sensitive. Achieving success requires a much higher level of clinical experience than originally thought. Van de Velde et al. (2008) found no rela- tionship between surgical experience and precision using synthetic models. This finding has to be viewed with criticism because a successful mini- mally invasive surgery depends to a large extent on the correct assessment of the anatomical situation and this skill can be only obtained through long- term clinical experience. False assessment of the anatomic conditions may lead to bone perforation or false implant position. These severe complica- tions can only be avoided through long-term im- plantological practice. Dentalimplantologyhaschangedwiththeintro- duction of combined X-ray and DVT machines and easyaccesstoCT.Prospectiveplanningandthefea- sibilityof3-Dimplantsiteevaluationhaveledtoin- creasedpopularityofminimallyinvasiveimplantol- ogy(Sclar2007).Promisingresultswerereportedby recent studies that tested the transfer accuracy of planning with drilling templates manufactured us- ing various methods (Van Assche etal. 2010; Danza & Carinci 2010; Lomzynski & Mierzwinska-Nastal- ska 2010; Neugebauer et al. 2010). The number of patients treated using minimally invasive methods will undoubtedly increase in future. Thanks to exact planning before surgery and data transfer to suit- able templates, patients will have access to high quality solutions with minimal surgical interven- tion. In the hands of inexperienced dentists, who wouldblindlyrelyonplanningwithtemplates,plan- ning error when doing computer-assisted implan- tology may lead to disastrous results (Van Assche etal. 2010; Stoll 2010). Flapless implant insertion in this study demon- strated a success rate comparable to conventional implant surgery. Our results are congruent with the recentlypublishedrecommendationsoftheITICon- sensus Conference in September 2010 (Weber etal. 2010). The presented results demonstrated that flapless implant surgery is a predictable procedure. It has the advantages of preserving mucosal health arounddentalimplants.Thestatisticallyhigherrate of bleeding around Thommen implants is possibly associated with the shorter polished collar. The low positive prediction value of BOP must not be for- gotten.Overallgoodperi-implantsoft-tissuehealth conditions were found around all three implant types (Figs. 10–15). This study has confirmed that a band of keratinised gingival tissue around implants is not absolutely necessary but can minimise soft- tissue inflammation._ Editorial note: A list of references is available from the publisher. Dr Kai Höckl c/o KOSMedics Private Hospital forAesthetic Surgery and Laser Medicine,Prof Stoll & Partner Wilhelmstr.3 79098 Freiburg/Breisgau Germany kai.hoeckl@web.de _contact implants