Accuracy of Computer-Assisted Flapless Implant Placement by Means of Mucosa-Supported Templates in Complete-Arch Restorations: A Systematic Review

Abstract

The aim of this study was to systematically review the current scientific literature regarding the accuracy of fully guided flapless implant positioning for complete-arch rehabilitations in edentulous patients and to assess if there was any statistically significant correlation between linear deviation at shoulder point, at apex point and angular deviation. The electronic and manual literature search of clinical studies was carried out using specified indexing terms. A total of 13 studies were eligible for qualitative analysis and 277 edentulous patients were rehabilitated with 1556 implants patients by means of fully guided mucosa-supported template-assisted flapless surgery. Angular deviation was 3.42° (95% CI 2.82-4.03), linear deviation at shoulder point 1.23 mm (95% CI 0.97-1.49) and linear deviation at apex point 1.46 mm (95% CI 1.17-1.74). No statistically significant correlations were found between the linear and angular deviations. A statistically significant correlation was found between the two linear deviations (correlation coefficient 0.91) that can be summarized by the regression equation y = 0.03080 + 0.8254x. Computer-assisted flapless implant placement by means of mucosa-supported templates in complete arch restorations can be considered a reliable and predictable treatment choice despite the potential effects that flapless approach could bring to the overall treatment.

Keywords: complete-arch; computer-guided-surgery; digital workflow; immediate loading.

Figure 1

Deviation of placed implants coordinates from 3D planned implants coordinates (a: linear deviation at shoulder point; b: linear deviation at apex point; c: angular deviation).

Figure 2

PRISMA flowchart.

Figure 3

Quality assessment of the included studies following the Cochrane Collaboration’s tool 2 for assessing risk of bias in randomized trials (green, low risk; yellow, unclear risk; red, high risk).

Figure 4

Quality assessment of the included studies following the Newcastle–Ottawa Scale for assessing the quality of nonrandomized trials. (Good quality: 3 or 4 *; Fair quality: 2 *; Poor quality: 0 or 1 *).

Figure 5

Boxplot for angular deviation of the included studies.

Figure 6

Boxplot for linear deviation at shoulder point of the included studies.

Figure 7

Boxplot for linear deviation at apex point of the included studies.

Figure 8

Regression equation (y = 0.03080 + 0.8254x, blue line) and confidence intervals (brown lines) assessing a statistically significant correlation between linear deviation at apex point and linear deviation at shoulder point.