Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques.

Objectives: The aim of this study was to compare the surgical and post-operative outcomes of a computer-aided implant surgery performed by bone- and mucosa-supported stereolithographic (SLA) guides against the standard technique.
Material and Methods: Multiple- and single-type SLA guides from two commercial manufacturers were produced and a total of 341 implants were placed to 52 patients using the standard technique (Control group), bone- (bone-supported guide [BSG] group) and mucosa-supported SLA guides (Flapless group) in 21, 16 and 15 patients, respectively. Surgical duration (min), number of analgesics (tablets) as well as hemorrhage, difficulty in mouth opening (or trismus) and other incidences were recorded. Pain and swelling was assessed using the visual analog scale (VAS). Parametric and non-parametric tests were used for statistical analysis (P<.05).
Results: The mean surgery duration (23.53+/-5.48 min) and the number of analgesics consumed (four tablets) in the Flapless group were lower than those in the control (68.71+/-11.4 min and 10 tablets) and BSG groups (60.94+/-13.07 min and 11 tablets, P<0.01). The change in pain scores (VAS) and the number of analgesics consumed in time were statistically significant (P<0.01 and 0.05, respectively) and the Flapless group reported a lower pain score than the BSG (P<0.01) and Control groups (P<0.001). The Flapless group experienced less hemorrhage (chi(2)=4.12, P=0.041 on the day of surgery) and fewer instances of trismus (chi(2)=6.91, P=0.031 the day after surgery). The differences in early-term failures were not statistically significant between the groups (log-rank test: P=0.782).
Conclusion: The use of mucosa-supported single SLA guides for flapless implant placement may help reduce the surgery duration, pain intensity, related analgesic consumption and most other complications typical in the post-implant surgery period. However, there are particular drawbacks in both guide types and further studies are required to confirm the prosthodontic conformity and long-term success of implants placed using computer-assisted techniques.