| Objective:The objective of this systematic review and meta-analysis was to observe the differences between the implants being inserted by flapless or conventional flap surgery procedures.So we can provide guidance for clinical application.Methods:An electronic search of seven databases,including Pubmed,EMbase,Cochrane Library,Wanfang Med,CNKI,VIP and SinoMed,were performed.Human randomized controlled trials with data on comparison between the flapless and conventional flap procedures were included.After data extraction and quality evaluation of included trials,the RevMan5.3 software will be used to finish the meta-analysis.Results:25 studies,including 1592 patients and 1959 implants,were included.There were 795 patients and 966 implants in the experimental grou(Flapless,FL group),meanwhile 797 patients and 993 implants were included in the control group(Conventional Flap,CT group).The results of the meta-anaylsis showed that:(1)Compared with the CT group,the survival rate of the FL group was higher,with a significant difference [RR=1.10,95%CI(1.05,1.06),P=0.0003].(2)The heterogeneity of papers included about the duration of operating is pretty high so that we gave up doing meta-analysis,the data showed that the duration of FL group is shorter than that of CT group except Lindeboom's research.(3)According to the meta-analysis,the difference between the two procedures statistically affected the duration of postoperative pain[MD=-47.08,95%CI(-52.03,-43.56),P < 0.00001],and the difference was statistically significant.(4)The postoperative medication time presented a considerable heterogeneity among studies,the data of each research showed that the duration of medication in the FL group was decreased remarkably as compared with the CT group.(5)The meta-analysis showed that there are apparently significant effects of flapless surgery on the occurrence of postoperative pain in patients receiving implants(RR=0.39,95%CI(0.31,0.51),P<0.00001).(6)For postoperative edema,the two confounding factors did significantly influence on the outcome,difference between the two groups has statistical significance [RR=0.33,95%CI(0.25,0.44),P<0.00001]?postprocedure bleeding occurrence of the surgery with flapless technique were significantly lighter than that of traditional flapped surgery.Difference between the two groups has statistical significance [RR=0.30,95%CI(0.18,0.49),P < 0.00001] ?flapless procedure may influence bone recession.(9)Due to the high heterogeneity,the data of probing depth have not been combined,the data from each paper indicate that the flapless procedure can reduce the probing depth.Conclusion:This systematic review revealed that the flapless surgical procedure have a higher success rate and significantly reduced the duration of operation,postoperative pain time and postoperative medication time.Also,the occurrence of pain,edema and bleeding was significantly reduced.Moreover,bone absorption and depth of periodontal pocket were decreased.However,more high quality RCTs should be required to support the conclusion. |
PDF Full Text Request