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A double-guide kit for preserving the keratinized mucosa in static guided complete arch implant surgery: A
Yifan Xu1, Kai Zhang2, Zhen Fan3
1PhD student, Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Oral Implantology, Shanghai Tongji Stomatological Hospital and Dental School, Tongji University, Shanghai, PR China.
Statement Of Problem:
A mucosa-supported guide for complete arch implant-supported prostheses has been widely used to enhance the accuracy of implant placement. However, the flapless surgical protocol involves a gingiva punch, inevitably leading to a decrease in keratinized mucosa width. Whether a novel double-guide kit will preserve keratinized mucosa is unclear.
Purpose:
The purpose of this prospective pilot clinical study was to evaluate a novel double-guide kit with the purpose of preserving keratinized mucosa in patients requiring complete arch implant-supported prostheses.
Material And Methods:
A total of 16 participants scheduled for complete arch implant-supported prostheses were enrolled and randomly allocated to the control or double-guide group. In the control group, a traditional 1-piece surgical guide with a flapless protocol was designed and used. The double-guide kit, comprising a fixation pin guide and a working guide, allowed the incision of the keratinized mucosa and elevation of a full-thickness flap. The width of keratinized mucosa was measured at 2 timepoint: before implant osteotomy and 3 months after implant placement. The accuracy of implantation was evaluated by superimposing presurgical design and postsurgical cone beam computed tomography (CBCT) scans. The t test and nonparametric test were used for the analysis of reduction volume and accuracy based on the data types (α=.05).
Results:
Eight participants (10 jaws and 61 implants) were assigned to the control group, and 8 participants (11 jaws and 57 implants) to the double-guide group. All implants integrated satisfactorily with no loss during the follow-up of 6 to 26 months. At 3 months postoperatively, the mean ±standard deviation reduction of keratinized mucosa width in the control group was 1.8 ±1.3 mm on the buccal side and 1.5 ±1.7 mm on the lingual side, while that in the double guide group was 0.6 ±1.3 mm on the buccal side and 0.5 ±1.0 mm on the lingual side, revealing a significant statistical difference (P<.05). The implant accuracy was also better in the double-guide group (P<.05).
Conclusions:
The novel double-guide kit significantly reduced keratinized mucosa damage compared with traditional guided implant procedures while ensuring precise implant placement; this should be advantageous for the long-term stability of complete arch implant-supported prostheses.
