{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:17Z","timestamp":1787028677213,"version":"build-2736575974"},"reference-count":47,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,5]],"date-time":"2020-07-05T00:00:00Z","timestamp":1593907200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical outcome and carried out 3D- cone-beam computerized tomography (CBCT) analysis of free-handed flaplessly placed one-piece maxillary MDIs by an experienced maxillofacial surgeon. Methods: Thirty-one patients suffering from an ill-fitting maxillary denture relating to compromised bone volume (as confirmed on CBCT), with a dentate mandible, were selected. They received 5\u20136 MDIs free-hand flaplessly placed and mentally guided with preoperative CBCT. Final connection and attachment activation took place six months later. After two years each implant was individually assessed with CBCT for perforations on eight sites. Implant survival, prosthetic failure, clinical stability and sinus\/nasal complaints were registered after three years. Results: 32\/185 (17.3%) MDIs failed during the provisional loading with non-activated attachments; 17 replacements in 10 patients were performed. Of the 170 actively loaded 170 MDIs, 82.3% survived and 27\/31 prostheses (87%) were fully functional. In total 98\/170 MDIs showed no perforation. Based on 1360 CBCT observations, 231 perforations (16.9%) were registered. Of most perforations 37 (25%) were observed at the apical tip and 37 were positioned (21%) into the sinus\/nasal cavity, although without clinical complaints. Conclusions: Given the compromised population, the minimally invasive procedure and the low treatment cost involved, a failure rate of 17% is substantial, however clinically acceptable given the critical bone condition. However, even in experienced surgical hands, freehanded and flapless placement yield a high risk for implant perforation, although this did not necessarily lead to complications.<\/jats:p>","DOI":"10.3390\/jcm9072120","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T09:49:11Z","timestamp":1594028951000},"page":"2120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Three-Dimensional Radiographic Outcome of Free-Handed Flaplessly Placed Mini Dental Implants in Edentulous Maxillae after 2-Years Function"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1307-8942","authenticated-orcid":false,"given":"Luc","family":"Van Doorne","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillo-Facial Surgery, Medical &amp; Cosmetic Treatments, Cosmipolis Clinic, Sint Claradreef 77, 8000 Brugge, Belgium"},{"name":"Department of Periodontology and oral implantology, Oral and Maxillo-Facial Surgery, Dental Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedram","family":"Gholami","sequence":"additional","affiliation":[{"name":"Department of Periodontology and oral implantology, Oral and Maxillo-Facial Surgery, Dental Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2404-0483","authenticated-orcid":false,"given":"Jan","family":"D\u2019haese","sequence":"additional","affiliation":[{"name":"Department Periodontology and Oral Implantology, Department of Maxillo-Facial Surgery, Institute of Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Hommez","sequence":"additional","affiliation":[{"name":"Department of Periodontology and oral implantology, Oral and Maxillo-Facial Surgery, Dental Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Meijer","sequence":"additional","affiliation":[{"name":"Department Periodontology and Oral Implantology, Department of Maxillo-Facial Surgery, Institute of Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0200-9546","authenticated-orcid":false,"given":"Hugo","family":"De Bruyn","sequence":"additional","affiliation":[{"name":"Department of Periodontology and oral implantology, Oral and Maxillo-Facial Surgery, Dental Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium"},{"name":"Department Periodontology and Oral Implantology, Department of Maxillo-Facial Surgery, Institute of Health Sciences, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,5]]},"reference":[{"key":"ref_1","first-page":"682","article-title":"Mini-Implants, Mega Solutions: A Case Series","volume":"25","author":"Kumari","year":"2016","journal-title":"J. Prosthodont. Implant. Esthet. Reconstr. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"826","DOI":"10.5005\/jp-journals-10024-1938","article-title":"Reasons for not using Implants to retain Complete Denture: Patients\u2019 Survey","volume":"17","author":"AlOtaibi","year":"2016","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/j.1741-2358.2009.00348.x","article-title":"Refusal of implant supported mandibular overdentures by elderly patients","volume":"28","author":"Ellis","year":"2011","journal-title":"Gerodontology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.sdentj.2010.07.006","article-title":"Dental patients\u2019 awareness and knowledge in using dental implants as an option in replacing missing teeth: A survey in Riyadh, Saudi Arabia","volume":"22","year":"2010","journal-title":"Saudi Dent. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"343","DOI":"10.11607\/jomi.6991","article-title":"Survival of Mini Dental Implants Used to Retain Mandibular Complete Overdentures: Systematic Review","volume":"34","author":"Jawad","year":"2019","journal-title":"J. Oral Maxillofac. Implant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jdent.2016.11.009","article-title":"Complete overdentures retained by mini implants: A systematic review","volume":"57","author":"Lemos","year":"2017","journal-title":"J. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1111\/joor.12053","article-title":"Patient satisfaction with mini-implant stabilised full dentures. A 1-year prospective study","volume":"40","author":"Tomasi","year":"2013","journal-title":"J. Oral Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.11607\/jomi.3222","article-title":"A 3-year follow-up study of overdentures retained by mini-dental implants","volume":"29","author":"Preoteasa","year":"2014","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_9","first-page":"45","article-title":"El-Sharkawy, Marginal bone loss around unsplinted mini-implants supporting maxillary overdentures: A preliminary comparative study between partial and full palatal coverage","volume":"44","author":"ELsyad","year":"2013","journal-title":"Quintessence Int."},{"key":"ref_10","first-page":"2","article-title":"Mini dental implants: A retrospective analysis of 5640 implants placed over a 12-year period","volume":"33","author":"Shatkin","year":"2012","journal-title":"Compend. Contin. Educ. Dent."},{"key":"ref_11","first-page":"92","article-title":"Mini dental implants for long-term fixed and removable prosthetics: A retrospective analysis of 2514 implants placed over a five-year period","volume":"28","author":"Shatkin","year":"2007","journal-title":"Compend. Contin. Educ. Dent. (Jamesburg N.J. 1995)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s10266-018-0343-8","article-title":"Open flap versus flapless placement of dental implants. A randomized controlled pilot trial","volume":"106","author":"Mishra","year":"2018","journal-title":"Odontology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lemos, C.A., Verri, F.R., Cruz, R.S., Gomes, J.M., Dos Santos, D.M., Goiato, M.C., and Pellizzer, E.P. (2018). Comparison between flapless and open-flap implant placement: A systematic review and meta-analysis. Int. J. Oral Maxillofac. Surg.","DOI":"10.1016\/j.ijom.2018.07.022"},{"key":"ref_14","first-page":"S111","article-title":"A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: A prospective multicenter study","volume":"7","author":"Glauser","year":"2005","journal-title":"Clin. Implant. Dent. Relat Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.joms.2003.08.017","article-title":"Computer-aided navigation in dental implantology: 7 years of clinical experience","volume":"62","author":"Ewers","year":"2004","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.ijom.2013.10.024","article-title":"Outcomes of implants placed with three different flapless surgical procedures: A systematic review","volume":"43","author":"Voulgarakis","year":"2014","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_17","first-page":"177","article-title":"Flapless versus open flap implant surgery in partially edentulous patients subjected to immediate loading: 1-year results from a split-mouth randomised controlled trial","volume":"4","author":"Cannizzaro","year":"2011","journal-title":"Eur. J. Oral Implant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/j.1600-0501.2012.02545.x","article-title":"Clinical advantages of computer-guided implant placement: A systematic review","volume":"23","author":"Hultin","year":"2012","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s10006-016-0568-z","article-title":"Experimental study on penetration of dental implants into the maxillary sinus at different depths","volume":"20","author":"Elhamruni","year":"2016","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1006\/ijom.2002.0485","article-title":"Rhino-sinusitis related to endosseous implants extending into the nasal cavity: A case report","volume":"33","author":"Raghoebar","year":"2004","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_21","first-page":"1","article-title":"The 2007 Recommendations of the International Commission on Radiological Protection","volume":"37","author":"Burns","year":"2007","journal-title":"Ann. ICRP"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/j.1440-1673.2007.01747.x","article-title":"New radiological typing system for rhinosinusitis and comparison with existing system: Initial finding","volume":"51","author":"Rustogi","year":"2007","journal-title":"Australas Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/S0901-5027(88)80047-X","article-title":"A classification of the edentulous jaws","volume":"17","author":"Cawood","year":"1988","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"43","DOI":"10.11607\/jomi.2014suppl.g1.3","article-title":"Systematic Review on Success of Narrow-Diameter Dental Implants","volume":"29","author":"Klein","year":"2014","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/clr.13342","article-title":"Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes","volume":"29","author":"Jung","year":"2018","journal-title":"Clin. Oral Implants Res."},{"key":"ref_26","first-page":"646","article-title":"Br\u00e4nemark System Implants in the posterior Maxilla: Clinical Study of 660 Implants Followed for 5 to 12 Years","volume":"15","author":"Bahat","year":"2000","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_27","first-page":"703","article-title":"Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: A 7-year retrospective study","volume":"19","author":"Vigolo","year":"2004","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_28","first-page":"547384","article-title":"An Overview of the Mechanical Integrity of Dental Implants","volume":"2015","author":"Rittel","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_29","first-page":"1","article-title":"A systematic review of implant-supported overdentures in the edentulous maxilla, compared to the mandible: How many implants?","volume":"7","author":"Raghoebar","year":"2014","journal-title":"Eur. J. Oral Implant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1111\/jcpe.12625","article-title":"Maxillary overdentures supported by four or six implants in the anterior region: 5-year results from a randomized controlled trial","volume":"43","author":"Slot","year":"2016","journal-title":"J. Clin. Periodontol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/clr.13403","article-title":"Four or six implants in the maxillary posterior region to support an overdenture: 5-year results from a randomized controlled trial","volume":"30","author":"Slot","year":"2019","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1111\/joor.12557","article-title":"Maxillary implant-supported overdentures opposed by (partial) natural dentitions: A 5-year prospective case series study","volume":"44","author":"Boven","year":"2017","journal-title":"J. Oral Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jmbbm.2015.05.014","article-title":"On the mechanical integrity of retrieved dental implants","volume":"49","author":"Rittel","year":"2015","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1111\/j.1600-0501.2011.02410.x","article-title":"How successful are small-diameter implants? A literature review","volume":"23","author":"Sohrabi","year":"2012","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1111\/ger.12066","article-title":"Clinical response of edentulous people treated with mini dental implants in nine dental practices","volume":"32","author":"Mundt","year":"2015","journal-title":"Gerodontology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1111\/clr.12660","article-title":"Patient satisfaction and prosthetic aspects with mini-implants retained mandibular overdentures. A 5-year prospective study","volume":"27","author":"Elsyad","year":"2016","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_37","first-page":"303","article-title":"Implant treatment in edentulous maxillae: A 5-year follow-up report on patients with different degrees of jaw resorption","volume":"10","author":"Jemt","year":"1995","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/j.1600-0501.2007.01423.x","article-title":"A model study on flapless implant placement by clinicians with a different experience level in implant surgery","volume":"19","author":"Glor","year":"2008","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.ejrad.2008.06.002","article-title":"Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications","volume":"71","author":"Loubele","year":"2009","journal-title":"Eur. J. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/j.1600-0501.2008.01538.x","article-title":"Treatment outcome of immediately loaded implants installed in edentulous jaws following computer-assisted virtual treatment planning and flapless surgery","volume":"19","author":"Komiyama","year":"2008","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"205","DOI":"10.11607\/jomi.2618","article-title":"Clinical and Radiographic Outcome of Implants Placed Using Stereolithographic Guided Surgery: A Prospective Monocenter Study","volume":"28","author":"Vervaeke","year":"2013","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.11607\/jomi.7480","article-title":"Influence of surgeon experience on the accuracy of implant placement via a partially computer-guided surgical protocol","volume":"34","author":"Marei","year":"2019","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"671","DOI":"10.11607\/jomi.6029","article-title":"Thermal Changes During Guided Flapless Implant Site Preparation: A Comparative Study","volume":"33","author":"Sannino","year":"2018","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1111\/cid.12511","article-title":"Incidental findings of implant complications on postimplantation CBCTs: A cross-sectional study","volume":"19","author":"Clark","year":"2017","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40729-019-0157-7","article-title":"Influence of exposing dental implants into the sinus cavity on survival and complications rate: A systematic review","volume":"5","author":"Ragucci","year":"2019","journal-title":"Int. J. Implant. Dent."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Chrcanovic, B.R., Albrektsson, T., and Wennerberg, A. (2014). Flapless versus conventional flapped dental implant surgery: A meta-analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0100624"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.oooo.2013.01.021","article-title":"Influence of anatomical location on CT numbers in cone beam computed tomography","volume":"115","author":"Oliveira","year":"2013","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/7\/2120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:47:42Z","timestamp":1760176062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/7\/2120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,5]]},"references-count":47,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["jcm9072120"],"URL":"https:\/\/doi.org\/10.3390\/jcm9072120","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,5]]}}}