Clinical and biological concept of application of surgical navigation template using flapeless technique

Abstract

Introduction. Currently, the direction of minimally invasive surgical interventions in surgical dentistry is relevant to reduce the time of postoperative rehabilitation. Detachment of the mucoperiosteal flap during dental implantation leads, depending on the extent of the defect, to a hematoma, which increases the risk of complications (suture dehiscence, wound infection). Because of this, treatment tactics have been developed that allow dental implantation to be performed using surgical navigation templates using a flapless technique. However, despite the obvious effectiveness and efficiency of the method, there are few experimental studies to substantiate the flapless technique of dental implantation.Purpose: clinical substantiation of the effectiveness of the use of flapless navigation techniques for dental implantation Materials and methods: the clinical study included 40 patients with secondary partial edentia. The patients were divided into two groups: the main and control groups. A life history was collected, as well as a history of the development of the present disease. The patients underwent dental implantation surgery in the area of the lateral groups of teeth. In the main group, dental implantation was carried out using a navigation template with a complete protocol and the use of a “flapless” technique; in the control group, dental implantation was carried out with a full-thickness incision and detachment of the mucoperiosteal flap. The evaluation criteria were clinical parameters of healing in the early postoperative period, the height of the soft tissues around the dental implant in the late postoperative period (CBCT, probing), as well as the presence of complications (mucositis, peri-implantitis). The data was entered into a table for further statistical analysis.Results. In the control group, the average height of the formed gingival cuff was 1,55±0,43 mm, 95% CI (1,34–1,75), with primary healing the average height was 1,64±0,44 mm, 95% CI (1,31–1,98), with secondary healing the average height is 1,46±0,43 mm, 95% CI (1,17–1,75). In the main group, the average height of the formed gingival cuff was 2,42±0,45 mm, 95% CI (2,21–2,62), with primary healing the average height was 2,40±0,45 mm, 95% CI (2,17–2,63), with secondary healing mean height 2,50±0,53 mm, 95% CI (1,19–3,81). In the control group, the average loss of marginal bone tissue was 1,27±0,47 mm, 95% CI (1,05–1,49), with primary healing the average loss was 0,96±0,29 mm, 95% CI (0,73–1,18), with secondary healing the average loss is 1,53±0,44 mm, 95% CI (1,23–1,82). In the main group, the average loss of marginal bone tissue was 0,50±0,31 mm, 95% CI (0,35–0,65), with primary healing the average loss was 0,48±0,33 mm, 95% CI (0,31–0,65), with secondary healing the average loss is 0,63±0,12 mm, 95% CI (0,35–0,92). Comparison of the main and control groups in terms of the height of the formed gingival cuff showed a statistically significant difference (p<0,001). This indicator differs significantly between groups with primary (p=0,0004) and secondary wound tension (p=0,004). In the early period, in the control group of 20 patients, 8 (40%) had mucositis, 2 (10%) had peri-implantitis, in the main group 3 (15%) had mucositis. In the late period, in the control group, 7 (35%) had mucositis, 1 (5%) had peri-implantitis, in the main group, 2 (10%) had mucositis. A comparison of the main and control groups in terms of the presence of pain, as well as the presence of complications in the early and late periods, showed a significant difference. In the control group, 60% of patients felt pain, and in the main group, 15% (p=0,009). The presence of complications in the early period was observed in 50% in the control group and in 15% in the main group (p=0,042). In the late period, the proportion of complications decreased and amounted to 40% in the control group and 10% in the main group (p = 0,03). The groups differ in the proportion of primary and secondary healing, so in the main group 85% of patients had primary healing, and in the control group patients with secondary healing of 55% predominated (p = 0.02). Comparison of the study and control groups in terms of loss of marginal bone tissue showed a statistically significant difference (p<0,001).Conclusion. The use of a flapless navigation technique can reduce the likelihood of complications in the early and late postoperative periods, while predictably controlling the height of the gingival cuff.