***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Osseointegrated dental implantation is traditionally performed by a flap approach that involves soft tissue flap reflection , but this technique is associated with several drawbacks . Conversely , the flapless method requires only minimal removal of soft tissue but is not suitable for all patients . The objective of this study was to compare the flapless ( FL ) method of implant placement with the traditional flap ( TR ) method with regard to achievement of success , change in bone level , and overall safety . PATIENTS AND METHODS In this single-center , open , retrospective , investigator-driven , nonr and omized , comparative study , patients were pre- or intraoperatively assigned to the FL or TR treatment . The primary success criteria were the absence of mobility , radiolucency , pain , and infection . RESULTS The  FL method was applied to 174 implants ( 46 % ) in 121 patients and the TR method to 203 implants ( 54 % ) in 98 patients . At visit 1 , implantation was rated successful in 171/174 ( 98.3 % ) implants with the FL method and in 200/203 ( 98.5 % ) with the TR method . Success rate remained constant until visit 2 . The difference between the 2 groups in the rate of success was not significant . Similarly , no significant difference was observed for mean time to last follow-up for success . CONCLUSIONS Based on pre- or intraoperative decision-making , patients eligible for FL surgery can benefit from a less straining procedure without affecting the high success rate of dental implant surgery . The FL approach is a predictable procedure when patient selection and surgical technique are appropriate Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results INTRODUCTION The two-stage surgical approach for implant placement first documented in 1977 by Brånemark , represents today the most used protocol for placing implants . AIM Aim of this prospect i ve case series study was to compare the clinical and radiological performance of 12 edentulous jaws treated with of a modified prosthetic and surgical protocol for 3D software planning , guided surgery , immediate loading of implants inserted in edentulous jaws and extraction sockets and restored with Cad-Cam Zirconia and titanium full arch frameworks . PATIENTS AND METHODS This work was design ed as a prospect i ve case series study . Twelve patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis .  A total of 72 implants , Nobel Replace Tapered Groovy ; Nobel Biocare AB , Goteborg , Sweden ) 26 of which were inserted in fresh extraction sockets , were inserted . Outcome measures were implants survival , radiographic marginal bone-levels and bone remodeling , soft tissue parameters and complications . RESULTS All patients reached 24 months follow-up , and no patients dropped out from the study . The cumulative survival rate was 100 % ; after 24 months mean marginal bone remodelling value was : 1.35 ± 0.25 , mean PPD value was 2.75 ± 0.40 mm and mean BOP value was 3.8 % ± 1.8 % . Only minor prosthetic complications were recorded . CONCLUSIONS These data seem to vali date this surgical and prosthetic protocol with valid results when applied in selected cases PURPOSE Although flapless computer-guided implant placement provides important benefits , deviations from the planned implant placement in the edentulous arch may pose significant risks . This study evaluated the reliability and accuracy of a flapless computer-guided surgical approach . MATERIAL S AND METHODS Computer-generated preoperative implant planning was compared to actual placement by cone-beam computerized tomography ( CBCT ) scanning of patients before and after surgery . A well-fitting complete denture or optimized prosthetic tooth arrangement was used and converted to a radiographic template . Prior to scanning , esthetics and functional aspects were checked clinical ly . The implant positions were virtually determined by the implant planning software relative to the bone structure and prospect i ve tooth position . After implant placement , new CBCT scans were obtained for each subject . Software was used to fuse the images of the planned and placed implants , and the locations and axes were compared . The normality of the data distribution was evaluated by the Kolmogorov-Smirnov test . Mean values were compared between groups based on the upper or lower jaws with the t test for independent sample s. The level of significance was fixed at 5 % . RESULTS Sixty-two implants were placed in edentulous arches with stereolithographic surgical guides in 14 patients .  Damage due to implant placement was not observed in any critical anatomical structure . Compared to the planned implants , placed implants showed mean and st and ard deviation linear measurements at the cervical , middle , and apical implant portions of 2.17 ( ± 0.87 ) , 2.32 ( ± 1.52 ) , and 2.86 ( ± 2.17 ) mm , for the maxilla , and 1.42 ( ± 0.76 ) , 1.42 ( ± 0.76 ) , and 1.42 ( ± 0.76 ) mm , for the m and ible , respectively . The angular deviations were 1.93 ( ± 0.17 ) and 1.85 ( ± 0.75 ) degrees for the maxilla and m and ible , respectively . The linear deviation differed significantlybetween the upper and lower jaws , but the angular deviation did not . CONCLUSION Flapless computer-guided surgery may be a viable treatment option for rehabilitating the edentulous arch Purpose . The aim of this study was to analyze the clinical and radiographic outcomes of 23 edentulous jaws treated with 3D software planning , guided surgery , and immediate loading and restored with CAD-CAM full arch frameworks . Material s and Methods . This work was design ed as a prospect i ve case series clinical study . Twenty patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis .  A total of 120 fixtures supporting 23 bridges were placed . 117 out of 120 implants were immediately loaded . Outcome measures were implants survival , radiographic marginal bone levels and remodeling , soft tissue parameters , and complications . Results . 114 of 117 implants reached a 30 months follow-up , and no patients dropped out from the study . The cumulative survival rate was 97.7 % ; after 30 months , mean marginal bone level was 1.25 ± 0.31 mm , mean marginal bone remodeling value was 1.08 ± 0.34 , mean PPD value was 2.84 ± 0.55 mm , and mean BOP value was 4 % ± 2.8 % . Only minor prosthetic complications were recorded . Conclusion . Within the limitations of this study , it can be concluded that computer-guided surgery and immediate loading seem to represent a viable option for the immediate rehabilitations of completely edentulous jaws with fixed implant supported restorations . This trial is registered with Clinical trials.gov NCT01866696 PURPOSE To evaluate the performance of a computer-aided three-dimensional planning protocol in combination with previously inserted reference mini-implants and CAD/CAM technology to restore completely edentulous patients . The study evaluated implant and superstructure survival in a prospect i ve clinical trial . MATERIAL S AND METHODS The plan protocol called for treatment of 35 patients who were edentulous in either arch .  Mini implants were used to establish a platform for computed tomography and fixation of the surgical template . The planning software based on three-dimensional simulation was used to plan ideal implant placement , digitally integrating the future prosthetic and anatomical situations to design the definitive superstructure . RESULTS A total of 35 patients , 20 with edentulous maxillae , 10 with edentulous m and ibles , and 5 patients with edentulism in both arches were treated . All patients received definitive prostheses on the day of surgery . The majority of patients treated in maxilla underwent a sinus graft procedure to achieve sufficient bone to place implants . A total of 40 superstructures were inserted and immediately loaded . Of the 240 inserted implants , 229 ( 95.4 % ) survived , with 146 ( 93.6 % ) and 83 ( 98.8 % ) implants in the maxillary and m and ibular arches , respectively . Of the 10 implants that failed in the maxilla , 9 occurred in patients with an augmented sinus . All definitive restorations demonstrated clinical ly acceptable fit . CONCLUSIONS When evaluating implant and superstructure survival , reference-based guided surgery seems to be a reliable treatment option for edentulous patients . The CAD/CAM superstructure , inserted and loaded immediately after guided implant insertion , demonstrated acceptable fit to the underlying implants Limited bone height restricts the use of long dental implants , so short implants may be selected in these situations . Recent reports on clinical results with short implants have been negative , however , and have suggested that indications for the use of these implants are limited . To verify these findings , a multicenter study of short ITI implants was carried out . In a 6-year period 253 short implants with a length of 6 mm were placed into 126 patients , who were followed up from 1 to 7 years . Altogether 7 implants were removed ; 6 of these were located in the maxilla and 1 in the m and ible . The quality of survival was comparable with the clinical results of longer implants from the same implant system . Although the clinical results of these short implants were favorable , it is recommended that they be used in combination with longer implants , especially when used in the less dense bone that is often seen in the maxilla BACKGROUND The introduction of digital planning programs has made it possible to place dental implants in preplanned positions and being immediately functionally loaded by using prefabricated prostheses . PURPOSE The aim of this multicenter study was to describe the 1-year results of digitally planned , immediately loaded edentulous maxillae . MATERIAL S AND METHODS A total of 312 implants ( Brånemark System , TiUnite RP , Nobel Biocare , Göteborg , Sweden ) in 52 patients from eight Sc and inavian clinics were digitally planned , surgically as well as prosthetically , by using the NobelGuide ( Nobel Biocare AB , Göteborg , Sweden ) and received prefabricated , immediately loaded fixed prosthetic constructions in the maxillae . Individual implant stability was manually tested at 1-year follow-up . RESULTS All patients received a Procera Implant Bridge ( Nobel Biocare AB ) ; however , in two cases , the bridges were reconstructed due to misfit . In five patients , difficulties in getting the surgical guide completely in position , and in five patients , getting the prostheses completely seated , were noted . All but four patients fulfilled the 1-year follow-up . Two implants were lost during the study period , result ing in a cumulative survival rate of 99.4 % . The mean marginal bone resorption from implant placement to the 1-year follow-up was 1.3 mm ( SD 1.28 ) . More than 2 mm of marginal resorption was noted in 19 % of the implants at this instant . The most frequently reported complications during the first year were gingival hyperplasia and prosthesis-related problems ( prosthesis screw loosening , occlusal fractures , and occlusal adjustments ) . CONCLUSION The 1-year results in this multicenter are promising regarding implant and bridge stability ; however , the study is planned to be running for at least 3 years PURPOSE The purpose of the current prospect i ve multicenter study was to evaluate the 5-year implant success and peri-implant conditions of smooth-surface Brånemark System implants when using a novel technique including a 1-stage surgical procedure with early loading in edentulous m and i 
    Output:
    
However , associated complications , such as implant loss , prosthesis or surgical guide fractures , and low primary stability , were often found , and there is a learning curve to achieve treatment success .