Implant Placement by Flapless Technique

Abstract

Denture or partial prosthesis replace the missing teeth and supporting oral tissues to restore the patient’s ability to eat, speak and improve appearance. Some patients are not satisfied with removable prosthesis treatment and if the numbers of remaining abutments are insufficient, it is not always possible to replace with fixed prosthesis. Over the past 30 years dental implants have undoubtedly been one of the most significant breakthroughs in dentistry.

INTRODUCTION

Dental implants replace missing tooth by a biocompatible screw like titanium objects that are surgically placed into maxilla or mandible.2 Dentistry is revolutionized by the success of Osseo integrated dental implants. The boon and proven milestone to dentistry is bran mark’s serendipitous work on osseointegration. Branemark advocated an unloaded healing time of 3-6 months to achieve predictable Osseo integration for dental implants.

To minimize the risk of implant failures after their placement, dental implants are kept traditionally load free for 3- 6months to establish Osseo integration before connecting the prosthesis superstructure. The aim is to bring the prosthesis at fixed interval gradually into occlusion depending on the bone quality, this in turn allows the bone to organise and remodel accordance to Wolff’s law.3

CASE -REPORT

A 40 years female patient reported to the department with the chief complaint of missing teeth in the Mandibular posterior region and wants replacement. Intraoral and extra oral examination was performed. Intraoral examination revealed missing 36, 46, 47 and root stump with 48 in the right posterior region which was advised for extraction .patient was motivated for implant treatment on right side of mandibular posteriors and fixed prosthesis on left side.

The different treatment options available to the patient were Removable prosthesis, fixed prosthesis, Implants.

As there is no presence of distal abutment, implant was the preferred option on the right side .The patient had good general and oral health with sufficient interarch space to accommodate the prosthesis. A preoperative investigation such as blood examination and panoramic radiograph was taken with the metal ball placed on the right posterior side to determine the implant length and diameter (figure-1). The patient was prepared for the surgical procedure with anaesthesia administered locally at the site of placement. The gingiva is punched out locally at implant sites according to position depth and angle of placement of implant drilling. The flapless implant site preparation was performed. Two bio horizon implants with a 3.5mm diameter were placed. The length of 10 mm and 12mm implants was placed at the distal most site of the dentulous area in the first and second molar region respectively. The angulation was confirmed radio graphically (figure-2, 3). Primary stability was achieved and confirmed by periapical and panoramic radiographs, the abutments were mounted on the implant at the implant level (figure-4).Impression was made for the fabrication of the prosthesis. Provisional restoration was placed out of occlusion. The hole present on the titanium abutment connects the prosthesis to facilitate occlusion and ease seating of the prosthesis.The cylinder is connected to the prosthesis in occlusion using glass inomer luting cement and finally the occlusion is checked once again (figure-6). The postoperative swelling and pain are limited and added advantage to flapless surgery.5

Advantages of flapless surgery less postoperative pain, minimal traumas to the bone around implant surface, less bone dentistry, less bleeding time, Maintenance of blood supply, no suturing, excellent soft tissue –implant seal is obtained. Under radiologic navigator this procedure must be done to ensure proper angulation and avoid perforation of bone plates.6

Conclusion: The flapless surgery is less invasive procedure with less postoperative pain, bone loss and improves implant anchorage. Flapless implant surgery is considered as the advanced procedure with less amount of reduction in crestal bone height and flapless technique compared to flap technique due to intact periosteum of the surrounding bone.

Figure-1:(preoperative panoramic radiograph)

Figure-2:(radiographic view of implant position)	Figure -3:(intraoral view of implant)

Figure-4:(intraoral view of abutment)

Figure-5(cast for fabrication of prosthesis)

Figure-6(intraoral view of permanent prosthesis)

REFERENCES