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Evaluation of Outcomes of Dental Implants Inserted by Flapless or Flapped Procedure: A Meta-Analysis

Zhuang, Jiabao, BDS*; Zhao, Dan, DDS, PhD; Wu, Yaqin, MDS; Xu, Chun, DDS, PhD

doi: 10.1097/ID.0000000000000820
Meta-Analyses and Systematic Reviews

Purpose: The purpose of this meta-analysis was to evaluate the failure risk and marginal bone loss of dental implants inserted by flapless or flapped procedure.

Materials and Methods: Studies were identified by searching PubMed, Web of Knowledge, and the Cochrane Library within 10 years, along with a hand search of the reference lists of the retrieved articles.

Results: A total of 2717 articles were filtered after the searching strategy, and 31 studies were finally selected. Failure rate of dental implants was statistically affected by different insertion procedures (flapless or flapped) with a risk ratio (RR) of 1.70 (95% confidence interval [CI]: 1.13–2.55; P = 0.01; heterogeneity: I2 = 0.0%; P heterogeneity = 0.97). Subgroup analysis indicated that in the situation of immediate/early loading, the flapless procedure showed a higher risk of implant failure comparing with flapped procedure (RR = 2.24; 95% CI: 1.05–4.78; P = 0.04; heterogeneity: I2 = 0.0%; P heterogeneity = 0.91). Mean difference of marginal bone loss between the flapless group and the flapped group was −0.10 mm (95% CI: −0.18 to −0.02; P = 0.02; heterogeneity: I2 = 82%; P heterogeneity = 0.00).

Conclusions: This meta-analysis revealed that flapless procedure may increase the failure risk of the dental implants, especially in the situation of immediate/early loading. Nevertheless, flapless procedure showed a superiority in preserving bone tissues.

*Postgraduate Student, Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.

Resident, Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.

Professor, Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.

Reprint requests and correspondence to: Chun Xu, DDS, PhD, Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China, Phone: +86-21-53315691, Fax: +86-21-56389950, E-mail: imxuchun@163.com

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