***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: Recent empirical evidence supports the importance of adequate r and omization in controlled trials . Trials with inadequate allocation concealment have been associated with larger treatment effects compared with trials in which authors reported adequate allocation concealment . While that provides empirical evidence of bias being interjected into trials , trial investigators rarely document the sensitive details of subverting the intended purpose of r and omization . This article relates anonymous accounts run the gamut from simple to intricate operations , from transillumination of envelopes to search ing for code in the office files of the principal investigator . They indicate that deciphering is something more frequent than a rate occurrence . These accounts prompt some method ological recommendations to help prevent deciphering . R and omized controlled trials appear to annoy human nature -- if properly conducted , indeed they should PURPOSE To compare the efficacy of immediate functionally loaded implants placed with a flapless procedure ( test group ) versus implants placed after flap elevation and conventional load-free healing ( control group ) in partially edentulous patients . MATERIAL S AND METHODS Forty patients were r and omized : 20 to the flapless immediately loaded group and 20 to the conventional group . To be immediately loaded , implants had to be inserted with a minimum torque > 45 Ncm . Implants in the immediately loaded group were provided with full acrylic resin temporary restorations the same day . Implants in the conventional group were submerged ( anterior region ) or left unsubmerged ( posterior region ) and were left load-free for 3 months ( m and ibles ) or 4 months ( maxillae ) . Provisional restorations were replaced with definitive single metal-ceramic crowns 1 month postloading . Outcome measures were prosthesis and implant failures , biological and prosthetic complications , postoperative edema , pain , and use of analgesics . Independent sample chi2 tests , Mann-Whitney tests , t tests , and paired t tests were used with a significance level of .05 . RESULTS Fifty-two implants were placed in the flapless group and 56 in the conventionally loaded group . In the flapless group , 1 flap had to be raised to control the direction of the bur and 1 implant did not reach the planned primary stability and was treated as belonging to the conventional group . After 3 years no dropouts or failures occurred . There was no statistically significant difference for complications ; however , patients in the conventional group had significantly more postoperative edema and pain and consumed more analgesics than those in the flapless group . Osstell values were significantly higher at baseline in the flapless group ( P = .033 ) . When comparing baseline data with years 1 , 2 , and 3 within each group , mean Osstell values of the flapless group did not increase , whereas there were statistically significant increases in the Periotest values . CONCLUSIONS Implants can be successfully placed flapless and loaded immediately without compromising success rates ; the procedure decreases treatment time and patient discomfort The objective of this clinical study was to compare the survival rates of early loaded implants placed using flapless and flapped surgical techniques and to determine the bone density in the implant recipient sites using computerized tomography ( CT ) . The study population consisted of 12 patients who were referred implant placement . One group consisted of five patients referred for the placement of 14 implants and treated with a flapless procedure . The other group consisted of seven patients referred for the placement of 45 implants with a conventional flapped procedure . Patients were selected r and omly . CT machine was used for pre-operative evaluation of the jaw bone and the mean bone density value of each implant recipient site was recorded in Hounsfield units ( HU ) . All implants were placed using CT-guided surgical stents . The early loading protocol s included 2 months of healing in the m and ible and 3 months of healing in the maxilla . Single-implant crowns , implant-supported fixed partial dentures , and implant-retained over dentures were delivered to the patients . Of 59 implants placed , one was lost in the conventional flapped group within the first month of healing , meaning overall implant survival rate of 98.3 % average 9 months later . The highest average bone density value ( 801 + /- 239 HU ) was found in the anterior m and ible , followed by 673 + /- 449 HU for the posterior maxilla , 669 + /-346 HU for the anterior maxilla and 538 + /- 271 HU for the posterior m and ible . The results of this study show that the early loading of implants placed utilizing flapless surgical technique with CT-guided surgical stents may be possible BACKGROUND Regarding the Brånemark implant system , nonresorbable sutures have been advocated for reapproximation of the flaps . Fast-absorbable sutures are frequently used in oral surgery , which is convenient for both the patient and the surgeon . It would be advantageous if fast-absorbable sutures are suitable in implant surgery as well . PURPOSE The purpose of this study was to compare irradiated polyglactin 910 ( Vicryl Rapide , Ethicon GmbH , Norderstedt , Germany ) suture with a nonresorbable polyfilament suture ( Supramid , Schwarz , Resorba GmbH , Nürnberg , Germany ) used in oral implant surgery . MATERIAL S AND METHODS The study comprised 101 edentulous patients ( 52 females , 49 males ) who were provided with 350 Brånemark implants .  They were r and omized to receive either Vicryl Rapide suture ( n = 61 ) or 3 - 0 Supramid suture ( n = 40 ) . The patients were evaluated after 10 days and at the time of abutment surgery . Any wound complications and implant losses were recorded . RESULTS The implant failure rate at abutment surgery was low ( 1.2 % ) , and no difference was seen between the two suture groups . A higher incidence of complications ( mainly wound dehiscence ) was found in the absorbable suture group , especially when a continuous suture was used . CONCLUSIONS The results of this study indicate that it is possible to use irradiated polyglactin 910 sutures in oral implant surgery without affecting the rate of early implant failure . However , it is recommended to add interrupted " security sutures " if a continuous suture technique is used in combination with fast-absorption suture material AIM The aim of this controlled r and omized clinical trial was to evaluate the efficacy of a xenogeneic collagen matrix ( CM ) to augment the keratinized tissue around implants supporting prosthetic restorations at 6 months when compared with the st and ard treatment , the connective tissue autograft , CTG ) . MATERIAL S AND METHODS This r and omized longitudinal parallel controlled clinical trial studied 24 patients with at least one location with minimal keratinized tissue ( ≤1 mm ) . MAIN OUTCOME MEASURE The 6-month width of keratinized tissue . As secondary outcomes the esthetic outlook , the maintenance of peri-implant mucosal health and the patient morbidity were assessed pre-operatively and 1 , 3 , and 6 months post-operatively . RESULTS At 6 months , Group CTG attained a mean width of keratinized tissue of 2.75 ( 1.5 ) mm , while the corresponding figure in Group CM was 2.8 ( 0.4 ) mm , the inter-group differences not being statistically significant . The surgical procedure in both groups did not alter significantly the mucosal health in the affected abutments . There was a similar esthetic result and significant increase in the vestibular depth in both groups as a result of the surgery . In the CM group it changed from 2.2 ( 3.3 ) to 5.1 ( 2.5 ) mm at 6 months . The patients treated with the CM  referred less pain , needed less pain medication , and the surgical time was shorter , although these differences were not statistically significant when compared with the CTG group . CONCLUSIONS These results prove that this new CM was as effective and predictable as the CTG for attaining a b and of keratinized tissue PURPOSE The aim of this study was to compare the pain experienced after implant placement with 2 different surgical procedures : a flapless surgical procedure using an image-guided system based on a template and an open-flap procedure . MATERIAL S AND METHODS The study population consisted of 60 patients who were referred for implant placement . One group consisted of 30 patients who were referred for the placement of 80 implants and treated with a flapless procedure .  The other group consisted of 30 patients who were referred for the placement of 72 implants with a conventional procedure . Patients were selected r and omly . They were requested to fill out a question naire using a visual analog scale ( VAS ) to assess the pain experienced and to indicate the  number of analgesic tablets taken every postoperative day from the day of the surgery ( DO ) to 6 days after surgery ( D6 ) . RESULTS The results showed a significant difference in pain measurements , with higher scores on the VAS with open-flap surgery ( P < .01 ) . Pain decreased faster with the flapless procedure ( P = .05 ) . The number of patients who felt no pain ( VAS = 0 ) was higher with the flapless procedure ( 43 % at DO versus 20 % ) . With the flapless procedure , patients took fewer pain tablets ( P = .03 ) and the number of tablets taken decreased faster ( P = .04 ) . DISCUSSION Minimally invasive procedures may be requested by patients to reduce their anxiety and the pain experienced and thus increase the treatment acceptance rate . CONCLUSION With the flapless procedure , patients experienced pain less intensely and for shorter periods of time PURPOSE To evaluate the efficacy of flapless versus open flap implant placement in partially edentulous patients . MATERIAL S AND METHODS Forty patients with two separate edentulous areas characterised by residual bone at least 5 mm thick and 10 mm in height had these sites r and omised following a split-mouth design to receive at least one implant to each side after flap elevation or not . Implants were first placed in one site , and after 2 weeks in the other site freeh and . Implants inserted with a torque > 48 Ncm were immediately loaded with full occluding acrylic temporary restorations . Definitive single cemented crowns or screw-retained metal ceramic fixed dental prostheses were delivered after 2 months . Outcome measures were prosthesis and implant failures , complications , postoperative swelling and pain , consumption of analgesics , patient preference , surgical time , marginal bone level changes , and implant stability quotient ( ISQ ) values . RESULTS Seventy-six  implants were placed flapless and 67 after flap elevation . In the flapless group , four flaps had to be raised to control the direction of the bur , whereas one haemorrhage and one fracture of the buccal bone occurred in two patients of the flap elevation group . Four implants did not reach the planned stability ( three belonging to the flapless group ) and they were all immediately replaced by larger diameter ones . After 1 year , no drop-outs occurred . Two definitive bridges could not be placed when planned ( one in each group ) and two crowns had to be remade ( one in each group ) . Two implants failed in each group , all in different patients . There were no statistically significant differences for prosthetic and implant failures , complications , ISQ values and marginal bone levels between groups . However , flapless implant placement required significantly less operation time ( 17 minutes less , saving almost two-thirds of the time for implant placement ) , induced less postoperative pain , swelling , analgesic consumption and was preferred by patients . Mean ISQ values of both groups significantly decreased over time . CONCLUSIONS Implants can be successfully placed flapless and loaded immediately , reducing treatment time and patient discomfort AIM The aim of this study was to test a new collagen matrix ( CM ) aim ed to increase keratinized gingiva/mucosa when compared with the free connective tissue graft ( CTG ) . MATERIAL AND METHODS This r and omized longitudinal parallel controlled clinical trial studied 20 patients with at least one location with minimal keratinized tissue ( < or=1 mm ) . MAIN OUTCOME MEASURE The 6-month width of keratinized tissue . As secondary outcomes , the aesthetic outlook , the maintenance of periodontal health and the patient morbidity were assessed pre-operatively at 1 , 3 and 6 months . RESULTS At 6 months , the CTG attained a mean width of keratinized tissue of 2.6 ( 0.9 ) mm , while the CM was 2.5 ( 0.9 ) mm , these differences being insignificant . In both groups , there was a marked contraction ( 60 % and 67 % , respectively ) although the periodontal parameters were not affected . The CM group had a significantly lower patient morbidity ( pain and medication intake ) as well as reduced surgery time . CONCLUSIONS These results prove that this new CM was as effective and predictable as the CTG for attaining a b and of keratinized tissue , but its use was associated with a significantly lower patient morbidity OBJECTIVES To evaluate and compare the outcome of  dental implants  placed using a flapless protocol and immediate loading with a conventional protocol and loading after 6 weeks . MATERIAL S AND METHODS Fourteen patients with bilateral maxillary edentulous areas were treated using Straumann SLA-implants .  Using a r and omized split-mouth design , implants were placed in one side of the maxilla using a stereolithographic surgical guide for flapless surgery and immediately loaded on temporary abutments with a bridge ( test ) . Implants in the other side were placed using the conventional protocol and loaded after 6 weeks of healing ( control ) . Clinical and radiographic evaluation of peri-implant tissues was performed at time of implant surgery , and after 1 week , 6 weeks , 3 , 6 , 12 and 18 months . RESULTS A total of 70 implants were placed ( 3 
    Output:
    
On a patient , rather than per implant basis , implants placed with a flapless technique and implant exposures performed with laser induced statistically significantly less postoperative pain than flap elevation .
Sites augmented with soft tissues connective grafts showed a better aesthetic and thicker tissues .
Both palatal autografts or the use of a porcine-derived collagen matrix are effective in increasing the height of keratinised mucosa at the price of a 0.5 mm recession of peri-implant soft tissues .
There is limited weak evidence suggesting that flapless implant placement is feasible and has been shown to reduce patient postoperative discomfort in adequately selected patients , that augmentation at implant sites with soft tissue grafts is effective in increasing soft tissue thickness improving aesthetics and that one technique to increase the height of keratinised mucosa using autografts or an animal-derived collagen matrix was able to achieve its goal but at the price of a worsened aesthetic outcome ( 0.5 mm of recession ) .