Title Survivability of Flapless Dental Implant Surgery Comparing: 3D Guided Navigation and Freehand Techniques
Clinical Question When performing flapless dental implant surgery on an edentulous or partially edentulous patient is the survivability of 3D guided surgery greater than the survivability of the freehand (non-guided) surgery technique?
Clinical Bottom Line Both the freehand and 3D guided flapless dental implant surgeries performed well, showing exceptional survivability rates, however freehand technique resulted in greater survivability than the 3D guided technique.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24290308Voulgarakis/2013n= 3911 (1267 Patients, 3911 Implants)Systematic review of randomized and non randomized trials
Key resultsThe reviewed studies provide variable ranges of average survivability up to 100% for both techniques. The free hand method showed the greatest success rate with a low of 98% survivability, while the guided surgery with 3D Navigation had a low of 89%.
Evidence Search "Flapless surgery"[All Fields] AND "dental implants"[All Fields] AND "outcome"[All Fields]
Comments on
The Evidence
Validity: Out of 235 studies the authors trimmed out 212 ending with only 23. There was a disparity in the number of studies for each technique with only 2 studies on the freehanded and 17 for the 3D guided techniques. Perspective: The comparative abundance of applicable studies for the 3D guided technique may be due to study sponsorship by guide manufactures. In addition the lower survivability rates for the 3D guided surgeries may be due to guide failures while the higher rates for free handed techniques may be due to operator experience and case selection in addition to other factors.
Applicability The review's analysis of guided vs non guided surgery is applicable because the surgical guide manufacturer's would like 3D guides to become the standard of care while on the other hand the professional judgement of many practitioners may differ from that of the guide manufacturer. The review points out that statistically the difference in survivability between the two methods is negligible, and thus practitioners should feel free to use their professional judgement as to the best method for each individual case.
Specialty (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords flapless surgery; minimally invasive procedure; guided surgery; 3D navigation; 3D planning; dental implants
ID# 2858
Date of submission 04/01/2015
E-mail rudin@livemail.uthscsa.edu
Author Josh Rudin
Co-author(s) e-mail
Faculty mentor Concepcion Barboza, DDS
Faculty mentor e-mail BarbozaArgue@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available