الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This trial was conducted on patients of both genders; who complain from missing
maxillary posterior teeth. Patients were recruited from the outpatient clinic of Alexandria
Main University Hospital and operated in the Oral and Maxillofacial Surgery Department,
Faculty of Dentistry, Alexandria University.
The aim of this study was to evaluate of efficiency of guided flapless technique for
dental implant placement in maxillary posterior area in controlled type 2 diabetic patients.
While the secondary objective was to compare of guided flapless technique versus
conventional technique in controlled type 2 diabetic patients.
Patients enrolled in the study were selected after fulfilling the following criteria, and
signing an Informed Consent form before undergoing the procedure to ensure and confirm
their understanding of the outcome of the procedure and the risks they might be subjected to
during the intervention
Eligible patients were allocated randomly into 2 equal groups with ten patients in each
according to the surgical technique operated to them. group A (Study group), Ten patients
with controlled type 2 diabetes mellitus had received dental implants in maxillary posterior
area by guided flapless techniques. While group B (Control group), Ten patients with
controlled type 2 diabetes mellitus had received dental implants in maxillary posterior area by
conventional surgical techniques.
Pre surgical assessments of the patients were done including history taking, clinical and
radiographic examinations. Also HbA1c lab testing was done for all patients and the results
must be ≥ 6.5% and < 7%.
Summary, Conclusions and Recommendations
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Then fabrication of the computerized surgical guide stent was done by taking impression
from the patients. The missing tooth was waxed-up on the stone model considering the optimal
position for rehabilitation, as well as retentions over all the other teeth of the dental arch. The
whole structure was transformed into a clear acrylic resin tomographic guide. Four to six
perforations distributed along the guide will be performed with spherical hand piece burs (Jet
Burs, Kerr), and the holes will be filled with radiopaque material (Gutta-Percha Points,
Dentsply Maillefer). Tomographic guides will be then clinically tested and adjusted.
Briefly, the scanning was first performed with the tomographic guide positioned on the
mouth of the patient for selecting the length and diameter of implant. Then, the tomographic
guide was scanned alone. Thus, patient and guide images can be combined on a computer
with the reference of the radiopaque markers. All CBCT scans were taken in the same
scanner. Files in Digital Imaging and Communications in Medicine (DICOM) format were
converted and imported to an open source planning software (DDS-PRO).
The virtual planning of the implant was performed considering bone availability and
optimal position for rehabilitation in each case. The virtual planning was sent to a prototyping
center to stereo-lithographic surgical guide manufacture, in which the 3D resin impression of
the guide was carried out.
In group A (flapless technique): after adaptation of the computerized surgical guide
stent, a rotary tissue punch with a speed not exceeding 35 rpm was used to make a circular cut
in the soft tissue at the crest of the alveolar bone at the site of the implantation, the circular
soft tissue cut was removed using tissue forceps, the steps of implant placement was carried
out according to the manufacturer‟s protocol.
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The implant primary stability (base line) was measured with a dedicated instrument
(Osstell Mentor®). This portable device emitted magnetic pulses to a small magnet (Smart
peg®) screwed directly onto the implant; the magnet started to vibrate, and the probe listened to
the tone and translate it to an implant stability quotient (ISQ) value. For each implant, ISQ
values (scaled 1 – 100) were measured from the four sites (mesial, distal, buccal, and palatal
sites). The mean of all measurements were rounded to a whole number and regarded as the
mean ISQ of the implant and lastly, the cover screw was inserted into the implant and tightened.
While in group B (conventional flap technique): a pyramidal mucoperiosteal incision
was done using blade no. 15, including both sides of the proposed implant site, reflection of
the mucoperiosteal flap from the bone surface as accurate as possible to avoid damaging the
periosteium. After adaptation of the computerized surgical guide, the implant site was
prepared and the implant was inserted in place. The implant stability (primary stability) was
measured with an instrument (osstell mentor®). Lastly, the cover screw was inserted into the
implant and tightened and the mucoperiosteal flap was repositioned over the alveolar bone
and sutured using 3/0 Prolene * suture material.
All patients were recalled after 1 week, 4 months and 8 months for clinical and
radiographic assessment.
Clinical evaluation included Postoperative pain which was recorded for each patient after
1, 3, 7 days postoperatively through a 10-point Visual Analogue Scale (VAS) from 0 to 10.
Then Postoperative swelling was recorded for each patient after 1, 3, 7 days postoperatively
through a 10-point scale with 4 parameters. - None (no swelling), mild (intraoral, localized to
the treated area), moderate (extra oral swelling localized to the treated area), and severe (extra
oral swelling extending beyond the treated area). Finally the Implant stability was measured
immediately postoperative (primary stability) and after 4 months by implant stability meter
(Osstell™) with Smart peg.
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While radiographic evaluation was done immediate postoperative (base line), after 4
months (crown placement) and 8 months. CBCT was requested in order to evaluate crestal
bone loss. For measuring the crestal bone loss, mesial and distal crestal bone levels were
calculated from the reconstructed corrected sagittal views by drawing a line parallel to the
implant serration extending from the crestal bone to the apical end of the implant. Average
readings of the two sides at each interval were calculated and tabulated for statistical analysis