Flapped versus flapless surgery and delayed versus immediate loading for a four mini implant mandibular overdenture: a RCT on post-surgical symptoms and short-term clinical outcomes.

Leles, Cláudio Rodrigues; de Paula, Marcella Silva; Curado, Thalita Fernandes Fleury; Silva, Jésio Rodrigues; Leles, José Luiz Rodrigues; McKenna, Gerald; Schimmel, Martin (2022). Flapped versus flapless surgery and delayed versus immediate loading for a four mini implant mandibular overdenture: a RCT on post-surgical symptoms and short-term clinical outcomes. Clinical oral implants research, 33(9), pp. 953-964. Wiley-Blackwell 10.1111/clr.13974

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OBJECTIVE

This factorial randomized clinical trial tested the effects of the surgical approach (flapped - FPS versus flapless - FLS surgery) and loading protocol (delayed - DL versus immediate - IL) for treatment with a four mini implant mandibular overdenture.

MATERIAL AND METHODS

A total of 296 one-piece titanium-zirconium mini implants were inserted in 74 patients (IL/FLS=17; IL/FPS=18; DL/FLS=20; DL/FPS=19). Outcomes included patient's perceived surgical burdens, clinical time, implant survival, and post-surgical symptoms and complications, assessed immediately after surgery, in the 7-day and 6-week follow-ups.

RESULTS

Perceived surgical burdens were relatively low, higher for females, and no difference was found between flapped and flapless surgery. Surgical time was lower for flapless surgery. Overall symptoms were mild after 24 hours, and higher for females. Less symptoms were recorded for the flapless surgery compared to the flapped for the delayed loading patients, and flapless surgery was associated with lower risk of bleeding. No early implant failure was observed until the 6-week follow-up. Delayed was associated with discontinuous use of the prosthesis and poor function. Lower complaint rates were observed for immediate loading regardless of the surgery protocol.

CONCLUSIONS

Mini implants for mandibular overdenture is a feasible option regardless of surgical access and loading protocol, with high safety and predictable survival rates, and low incidence of post-insertion complications. Flapless surgery requires less clinical time and result in easier intraoral prosthetic incorporation of attachments compared to flapped surgeries. Immediate loading did not increase the risk of early implant failure when satisfactory primary stability was achieved.

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