Computer-guided flapless transmucosal implant placement in the mandible: A new combination of two innovative techniques.

Objective: To assess whether computer-guided flapless transmucosal implant bed preparation without mucosal punching allows placement of dental implants in edentulous mandibles. Study design: Twenty patients with fully edentulous mandibles (11 male; 9 female) were included in the study. Each patient was scheduled to receive 4 screw-shaped Ankylos (Dentsply Friadent, Mannheim, Germany) implants in the interforaminal region. The StealthStation Treon navigation system (Medtronic, Minnesota, MN) was used for computer-guided drilling. Using conventional implant drills the mucosa was penetrated without flap elevation or mucosal punching. The study protocol did not allow direct visualization of the bone surface during surgery. Results: For 78 implants (97.5%) the preoperative plan could be transfered to the patient by intraoperative navigation with a mean deviation of 0.9 mm (Implant tip 0.8 ± 0.6 mm; coronal implant end 1.1 ± 0.7 mm) as measured by comparing pre- and postoperative computerized tomography images. Two implants (2.5 %) were not primarily stable and failed to osseointegrate. Conclusions: Computer-guided transmucosal interforaminal implant placement without mucosal punching is a precise and predictable procedure. It is, however, not yet suitable for all bone morphologies. Future developments may include miniaturization of hardware and simplification of the drilling procedure. [Copyright &y& Elsevier]