Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Janina Golob Deeb, Sompop Bencharit, Christopher A. Loschiavo, Matthew Yeung, Daniel Laskin, George R. Deeb

Abstract

Introduction

A major advantage of guided implant surgery using 3D printed guides is the ability to do accurate surgery flapless. A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2 mms of keratinized tissue surrounding the implant.

Materials and Methods

A retrospective analysis included 27 maxillary and 27 mandibular implant sites treatment planned for implant guided surgery using 3shape Implant Studio. Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. ANOVA (p<0.05) and correlation coefficients were used to determine statistical difference in keratinized tissue among sites.

Results

There was no statistical difference either between the width in buccal keratinized tissue in the maxillary anterior (4.06+/-1.42mm) and posterior areas (4.93+/-2.54mm) (p=0.293) or between the amount of buccal and lingual keratinized tissue in the mandible, p=0.995. The keratinized tissue width in the maxillary buccal area was significantly different (4.48+/-2.04mm) from in the mandibular posterior buccal (1.98+/-1.41mm) and lingual areas (1.98+/-1.23mm), (p<0.001). Over 77% of maxillary implant sites had >3mm of gingiva and just over 20% had sufficient gingiva in the mandible.

Conclusions

Adequate keratinized tissue was found in most of the planned maxillary implant sites whilethe majority of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.

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