Guided and conventional surgery for implant placement: clinical, radiographic, microbiological, imunoenzimatic and patient-centered evaluation

The objective was to compare implants installed with guided and conventional surgery, through tomographic, radiographic, immune-enzymatic, microbiological, and patient-centered evaluations.Twenty-nine 29 total edentulous patients were selected, and maxillary contralateral quadrants were randomly assigned to: Guided surgery (GS): flapless computer-guided surgery; Conventional surgery (CS): flap surgery with conventional planning. Tomography scans were performed at baseline and 10 days after the surgery to measurement deviations and radiographic evaluations were done at baseline, and after 6 and 12 months, for analysis of peri-implant bone level (PIBL). Peri-implant fluid and subgingival biofilm for the evaluation of bone markers and periodontal pathogens. The implants installed with GS showed less linear deviation at the apical point and the midpoint and less angular deviation (p<0.05). However, they presented a greater depth discrepancy in the positioning of the platform (p <0.05). Higher values of vertical PIBL were observed for GS group at baseline (p<0.05), while lower values of horizontal PIBL were observed for CS, independently of time-point evaluated (p<0,05). Bone markers, Tf and morbidity presented higher levels in CS (p<0.05). It can be concluded that the use of flapless GS for the installation of dental implants in maxillary total edentulous patients allows smaller linear and angular deviations, as well as less morbidity, than the conventional technique. However, PIBL was higher in GS and apparently the conventional technique led to a greater angiogenic and bone remodeling activity by the elevation of the levels of angiogenic, and bone markers.