Clinical and radiological evaluation of soft tissues and bone level in implant supported rehabilitations performed with flapless computer-guided implantology. A prospective clinical study

Purpose: A prospective cohort study was designed to analyze the marginal bone resorption and soft tissue healing around implants in fixed partial rehabilitations. Materials and methods: Forty patients (20 males and 20 females) were recruited from 2017 to 2022. A total of 59 partial rehabilitations supported by 129 implants, 62 in the maxilla and 67 in the mandible, were performed with flapless computer-guided surgery. The mean follow-up was 48 ± 15 months (range 18–72 months). The observed outcomes were implant success/survival/failure, prosthetic survival/failure, soft tissue health and biological complications. Results: Considering the implants (129) and the patients involved in the study: ten patients (24 implants) were considered as drop-outs and 7 implants were lost; therefore, a total of 98 implants were analysed, thus resulting in a survival rate of 93.33% . The mean marginal bone loss (MBL) was 0.72 ± 0.91 mm, with a mean probing depth (PD) of 3.16 ± 1.24 mm. Ø 4.2 implants had lower MBL and a lower percentage of bleeding on probing (BOP) despite being the most represented sample overall. Mucositis occurred in 8 cases of 98 surviving implants (8.2 %), corresponding to 7 rehabilitations out of 43 (16.28 %). Additionally, 5 cases of peri-implantitis were observed (6.1 %) in 5 rehabilitations out of 43 (11.6 %). Conclusions: Within the limits of this prospective study, it can be affirmed that the use of computer-guided surgery represents a feasible therapeutic alternative. Overall, this study reinforces the role of computer-guided surgery as a reliable treatment modality that may improve patient outcomes and contribute to the refinement of future minimally invasive implant protocols. Further research is needed to identify potential sources of errors and strive to improve the overall accuracy of the procedures . Clinical Significance: This study provides clinically relevant insights into marginal bone resorption and soft tissue healing around implants in fixed partial rehabilitations performed with guided flapless surgery. The findings may help clinicians optimize implant placement protocols and improve long-term outcomes in minimally invasive procedures. Trial registration: The protocol was approved by the ethics committee of ASST Santi Paolo e Carlo in Milan Area 1 (protocol number 1361 dated July 12, 2017) and retrospectively registered at ClinicalTrials.gov.