FLAPLESS GUIDED SURGERY IN THE ATROPHIC POSTERIOR MANDIBLE: SAFETY LIMITS FOR IMPLANT PLACEMENT NEAR THE MANDIBULAR CANAL

Abstract

Flapless guided surgery has been widely used in contemporary implant dentistry due to its ability to provide greater surgical predictability and lower postoperative morbidity. However, in patients with an atrophic posterior mandible, the proximity between the residual alveolar crest and the mandibular canal represents a significant challenge for the safe placement of dental implants. This study aimed to analyze the scientific evidence published over the last ten years regarding safety limits for implant placement near the mandibular canal in flapless guided surgeries performed in the atrophic posterior mandible. An integrative literature review was conducted using the PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library databases. After applying the eligibility criteria, seven studies were selected for the final sample. The results demonstrated that guided surgery associated with three-dimensional planning significantly improves surgical accuracy and reduces the risk of anatomical complications. Nevertheless, linear and angular deviations between virtual planning and the final implant position may still occur, justifying the maintenance of safety margins in relation to the mandibular canal. The available evidence indicates that an approximate distance of 2 mm between the implant apex and the mandibular canal remains the most prudent and scientifically supported recommendation. It is concluded that flapless guided surgery is a safe and predictable alternative for rehabilitation of the atrophic posterior mandible, provided that it is associated with careful planning and respect for established anatomical limits.