Histologic evaluation of implants following flapless and flapped surgery

A study in canines

William Becker, Ulf M E Wikesjö, Lars Sennerby, Mohammed Qahash, Philippe Hujoel, Moshe Goldstein, Ilser Turkyilmaz

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background: Flapless surgery requires penetration of the alveolar mucosa and bone without reflection of mucoperiosteal flaps. Do these techniques force gingival tissue or foreign materials into osteotomies? If so, do such tissues or materials interfere with osseointegration? A proof-of-principle study using a canine model attempted to answer these questions. Methods: Five young adult Hound Labrador mongrel dogs received implants with a moderately roughened surface by anodic oxidation using flapless or conventional one-stage (control) surgery in contralateral jaw quadrants. The implants were placed into the osteotomies, and the international stability quotient (ISQ) was recorded using resonance frequency analysis. These measurements were repeated following a 3-month healing interval when the animals were euthanized, and implants and surrounding tissues were retrieved and processed for histologic analysis. Results: The implants were stable upon insertion and demonstrated increased stability at 3 months without significant differences between surgical protocols. The histologic evaluation showed high bone-implant contact (flapless surgery: 54.7% ± 8.4%; control: 52.2% ± 13.0%; P >0.05) without evidence of gingival tissue or foreign body inclusions. There were no significant differences in marginal bone levels between the surgical protocols. Post-insertion and at 3 months, ISQ values depended on the amount of torque delivered. Immediately post-insertion, for every 1-unit increase in torque value, the ISQ increased by 0.3 (95% confidence interval: 0.1 to 0.4; P = 0.0043). Three months postoperatively, for every one-unit increase in torque the ISQ value decreased 0.2 (95% confidence interval: -0.4 to -0.1; P = 0.00 12). The effect of torque on ISQ values was independent of treatment effects and remained significant after adjustment for treatment. Conclusions: The results suggest that implants placed without flap reflection remain stable and exhibit clinically relevant osseointegration similar to when implants are placed with flapped procedures. Greater torque at implant placement resulted in less implant stability at 3 months.

Original languageEnglish (US)
Pages (from-to)1717-1722
Number of pages6
JournalJournal of periodontology
Volume77
Issue number10
DOIs
StatePublished - Jan 1 2006

Fingerprint

Torque
Canidae
Osseointegration
Osteotomy
Bone and Bones
Confidence Intervals
Newfoundland and Labrador
Foreign Bodies
Jaw
Young Adult
Mucous Membrane
Dogs
Therapeutics

Keywords

  • Dental implants
  • Histology
  • Osseointegration
  • Surgery

ASJC Scopus subject areas

  • Periodontics

Cite this

Becker, W., Wikesjö, U. M. E., Sennerby, L., Qahash, M., Hujoel, P., Goldstein, M., & Turkyilmaz, I. (2006). Histologic evaluation of implants following flapless and flapped surgery: A study in canines. Journal of periodontology, 77(10), 1717-1722. https://doi.org/10.1902/jop.2006.060090

Histologic evaluation of implants following flapless and flapped surgery : A study in canines. / Becker, William; Wikesjö, Ulf M E; Sennerby, Lars; Qahash, Mohammed; Hujoel, Philippe; Goldstein, Moshe; Turkyilmaz, Ilser.

In: Journal of periodontology, Vol. 77, No. 10, 01.01.2006, p. 1717-1722.

Research output: Contribution to journalArticle

Becker, W, Wikesjö, UME, Sennerby, L, Qahash, M, Hujoel, P, Goldstein, M & Turkyilmaz, I 2006, 'Histologic evaluation of implants following flapless and flapped surgery: A study in canines', Journal of periodontology, vol. 77, no. 10, pp. 1717-1722. https://doi.org/10.1902/jop.2006.060090
Becker W, Wikesjö UME, Sennerby L, Qahash M, Hujoel P, Goldstein M et al. Histologic evaluation of implants following flapless and flapped surgery: A study in canines. Journal of periodontology. 2006 Jan 1;77(10):1717-1722. https://doi.org/10.1902/jop.2006.060090
Becker, William ; Wikesjö, Ulf M E ; Sennerby, Lars ; Qahash, Mohammed ; Hujoel, Philippe ; Goldstein, Moshe ; Turkyilmaz, Ilser. / Histologic evaluation of implants following flapless and flapped surgery : A study in canines. In: Journal of periodontology. 2006 ; Vol. 77, No. 10. pp. 1717-1722.
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abstract = "Background: Flapless surgery requires penetration of the alveolar mucosa and bone without reflection of mucoperiosteal flaps. Do these techniques force gingival tissue or foreign materials into osteotomies? If so, do such tissues or materials interfere with osseointegration? A proof-of-principle study using a canine model attempted to answer these questions. Methods: Five young adult Hound Labrador mongrel dogs received implants with a moderately roughened surface by anodic oxidation using flapless or conventional one-stage (control) surgery in contralateral jaw quadrants. The implants were placed into the osteotomies, and the international stability quotient (ISQ) was recorded using resonance frequency analysis. These measurements were repeated following a 3-month healing interval when the animals were euthanized, and implants and surrounding tissues were retrieved and processed for histologic analysis. Results: The implants were stable upon insertion and demonstrated increased stability at 3 months without significant differences between surgical protocols. The histologic evaluation showed high bone-implant contact (flapless surgery: 54.7{\%} ± 8.4{\%}; control: 52.2{\%} ± 13.0{\%}; P >0.05) without evidence of gingival tissue or foreign body inclusions. There were no significant differences in marginal bone levels between the surgical protocols. Post-insertion and at 3 months, ISQ values depended on the amount of torque delivered. Immediately post-insertion, for every 1-unit increase in torque value, the ISQ increased by 0.3 (95{\%} confidence interval: 0.1 to 0.4; P = 0.0043). Three months postoperatively, for every one-unit increase in torque the ISQ value decreased 0.2 (95{\%} confidence interval: -0.4 to -0.1; P = 0.00 12). The effect of torque on ISQ values was independent of treatment effects and remained significant after adjustment for treatment. Conclusions: The results suggest that implants placed without flap reflection remain stable and exhibit clinically relevant osseointegration similar to when implants are placed with flapped procedures. Greater torque at implant placement resulted in less implant stability at 3 months.",
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