Outcomes of implants placed in sites of previously failed implants: a systematic review and meta-analysis

The survival rate of implants placed at sites of previous failures including the best treatment strategies remain unclear. This systematic review was performed to assess implant survival and peri-implant health for such cases, including subgroup analyses of immediate versus delayed implant placement and augmentation. Four electronic databases were searched. Meta-analyses including subgroup analyses were performed (PROSPERO CRD42024548610). Out of 1798 records identified, 24 studies were included. The 1-year implant survival rate after replacement was 96.7% (95% confidence interval (CI) 92.8-99.3%), with no significant difference between immediate and delayed placement (P = 0.31) or immediate and delayed augmentation (P = 0.85). Immediate augmentation showed higher overall implant survival (97.6%, 95% CI 93.4-99.9%) compared to delayed augmentation (91.7%, 95% CI 83.4-97.5%), although not statistically significant (P = 0.26). Peri-implant health outcomes, including marginal bone loss, were similar across subgroups. Second implant replacements had lower survival rates than first replacements. Replacement of the failed implant is an appealing treatment option for failed implants, although the implant survival is lower compared to initially placed implants. Immediate implant placement can be done if sufficient bone is present. If insufficient bone remains after removal, immediate augmentation followed by delayed implant placement is recommended.

Uncommon Presentation of a Symphyseal and Bilateral Mandibular Body Fracture From a Gunshot Injury: A Case Report and Literature Review

Mandibular fractures are one of the most common types of facial fractures and often result from trauma to the head and neck region. Understanding the mechanism-based factors resulting in different patterns of mandibular injury is important for their surgical management. This study reports a unique mandibular fracture whereby the symphysis and bilateral mandibular bodies were fractured following a gunshot wound to the maxillofacial region. A literature review of case reports on bilateral mandibular fractures highlights the uniqueness of the presented case and supplements the text as the initial management, treatment, and prognosis of the case are discussed.

Facilitated Alveolar Ridge Expansion Using Osseodensification: Achieving Implant Stability and Tissue Remodeling Without Grafting

Proper placement of dental implant restorations and their longevity are critical factors to consider before starting the treatment. It is essential for the implant to achieve primary stability upon insertion and undergo osseointegration during and after the healing process. Implant placement should follow prosthetically driven planning to ensure optimal outcomes. In cases of a narrow alveolar ridge, achieving mechanical stability poses a challenge while also preserving the buccal bone wall. A novel technique, osseodensification, has been introduced to address these issues by facilitating implant placement within a densified socket while also preserving the buccal bone wall through its ridge expansion techniques. This case presentation highlights using osseodensification for ridge expansion in low-density alveolar ridges. This technique preserves and increases the volume of the buccal bone wall while also reshaping the soft tissue above.

Indirect Restorations for Increasing the Vertical Dimension of Occlusion

OBJECTIVE

This article presents a clinical case of erosive tooth wear, in which the vertical dimension of occlusion (VDO) has been restored using defect oriented posterior onlays and anterior veneers respecting minimal invasive treatment approaches.

CLINICAL CONSIDERATION

A 44-year-old female with the history of bulimia nervosa and bruxism expressed the desire to improve the aesthetic appearance and reestablishment of function of her worn dentition. After a 3-month functional therapy to ease myofunctional problems using a Michigan splint, a diagnostic phase revealed the necessity for a full mouth prosthetic rehabilitation. A slight increase of the VDO of 1 mm at the incisal point was determined. Veneered lithium disilicate ceramic restorations of 0.3-0.5 mm in thickness were produced for the incisors and monolithic lithium disilicate restorations of 0.8-1.0 mm in thickness for posterior teeth.

CONCLUSIONS

Functional and aesthetic prosthodontic rehabilitation of severely worn teeth can be achieved satisfactory with minimal invasive procedures using defect oriented, indirect lithium disilicate ceramic restorations with increasing the VDO to its original state.

CLINICAL SIGNIFICANCE

Indirect, minimal invasive lithium disilicate ceramic restorations are suitable to restore the VDO of severe dental erosions.

Assessment of Subclinical Atherosclerosis in Patients with Psoriasis Using Echocardiographic Coronary Flow Reserve Parameters: A Systematic Review and Meta-Analysis

Aims/Background Psoriasis is a chronic inflammatory condition associated with an elevated risk of cardiovascular diseases including coronary artery disease (CAD). This study assessed coronary microvascular dysfunction (CMD) in psoriasis patients using echocardiographic coronary flow parameters, controlling for traditional cardiovascular risk factors and atherosclerosis, to fill gaps identified in previous research. Methods A comprehensive literature search was performed using multiple electronic databases for studies on echocardiographic coronary flow parameters in patients with psoriasis. The outcomes of interest included the coronary flow velocity reserve (CFVR), hyperemic diastolic peak flow velocity (DPFV), and baseline DPFV. Data were extracted and analyzed using RevMan 5.4 (Nordic Cochrane Center, Copenhagen, Denmark), with pooled standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Statistical significance was set at p < 0.05. Results Four studies involving 557 patients were included in this analysis. Pooled analysis revealed a significant reduction in CFVR in patients with psoriasis compared to controls (SMD: -0.71; 95% CI: -0.97, -0.45; p < 0.00001). Hyperemic DPFV was significantly reduced (SMD: -0.71; 95% CI: -1.30, -0.12; p = 0.02), whereas baseline DPFV showed no signficant difference (SMD: 0.20; 95% CI: -0.92, 1.32; p = 0.73). Conclusion Psoriasis was associated with reduced CFVR and hyperemic DPFV, suggesting early CMD. CFVR could aid in early CMD detection in psoriasis patients, informing cardiovascular risk management and potential anti-inflammatory treatment benefits. Systematic Review Registration PROSPERO: CRD42024574085.

Outcomes of Dental Implants in Routine Clinical Practice: A Retrospective Multicenter Study

Purpose: This study evaluated the clinical and radiographic outcomes of subjects rehabilitated with dental implants placed in daily practice. Materials and Methods: This retrospective multicentric case series study involved 339 patients (168 males, 171 females, mean age 54.0 ± 14.7 (standard deviation) years, range 28-81 years) treated in five private clinics, who received 651 implants between January 2019 and January 2023. The main outcomes were marginal bone loss (MBL) and implant survival rate. The effect of variables such as soft tissue status, crestal/subcrestal implant placement, immediate/delayed implantation, bone grafting/no graft, screwed, or cemented prosthesis were analyzed. Results: The implant survival rate was 99.9%, with only one implant failure observed in a 71-year-old female with subcrestal placement. Implants immediately placed in post-extraction sites had significantly greater MBL compared to delayed placements (p=0.0002). Subcrestally positioned implants showed significantly less MBL than crestal implants (p < 0.0001), while grafted and non-grafted sites showed similar results, and cemented prostheses demonstrated lower MBL compared to screwed prostheses (p < 0.0001). The prevalence of peri-implant mucositis was only 3.6% on implant basis. No intra-operative complications nor adverse events in the follow-up period were reported. Conclusion: Following current guidelines for implant therapy, consisting of proper diagnosis and personalised treatment plan and maintenance, and adhering to implant system manufacturer's recommendations, it is possible to achieve satisfactory clinical and radiographic outcomes in routine practice.

Accessory Mental Foramina in Dry Mandibles: An Observational Study Along with Systematic Review and Meta-Analysis

Background/Objectives: The mental foramen (MF) constitutes a passage for mental nerves and vessels, and it is a crucial anatomical landmark in the body of the mandible. The accessory mental foramen (AMF) is a small, addable foramen proximate to the MF, and it is mainly located posteriorly. The AMF is a rare anatomical variation in human mandibles that must be taken into consideration throughout dental and surgical operations. We aimed to assess the incidence and perform morphological and morphometric analyses of AMFs in the human dry mandibles of the Greek population, in addition to a relevant systematic review and meta-analysis of global data. Methods: We studied 114 human adult dry mandibles of unknown gender and age available from the Laboratory of Anatomy, Medical School, Democritus University of Thrace, Greece. We used the search term "accessory mental foramen" in the PubMed, Scopus, and Google Scholar databases to detect all publications of the last 50 years reporting the prevalence and morphology of AMFs in dry mandibles; the search ended on 13 January 2025. Quality assessments were performed using the relevant Joanna Briggs Institute tool. Data were synthesized with the random-effects REML model after Freeman-Tukey double arcsine transformationusing STATA 18. No external funding was received. The PROSPERO CRD is 42025638135. Results: According to our data, the MF was present in all observed mandibles, and it was bilateral. Nine AMFs (five right/four left; five round/four oval; six posterior/three anterior to the MF) were found in seven mandibles (five single and two double), and all were unilateral. AMFs presented a mean diameter of 0.96 ± 0.43 mm and mean distances of 4.12 ± 2.15 mm from the MF, 12.68 ± 4.10 mm from the alveolar ridge, and 11.92 ± 1.57 mm from the lower border of the mandible. Furthermore, 27 publications were included in the meta-analysis; the combined AMF prevalence was 6.1% (95% CI: 4.8-7.6%; I2 60%), the combined mean vertical axis was 1.18 ± 0.61 mm, and the combined mean distance from the MF was 3.64 ± 2.29 mm. Bilateral AMFs were detected in 2.1% of AMF cases. An oval shape was described in 37.3% of AMFs. No publication bias was detected. Conclusions: AMFs are not considered rare, and they are occasionally bilateral or even multiple in number. Moreover, they demonstrate considerable variation regarding their size, shape, anddistance from the MF, alveolar ridge, and lower border of the mandible. Dental surgeons must be aware of AMFs' anatomical variations during surgical and anesthetic planning in order to effectively prevent or mitigate the risk of postoperative complications, such as pain, anesthesia, injury, and other adverse outcomes.

Management of a patient with ectodermal dysplasia with implant-assisted and implant-supported restorations: Sixteen years of clinical care

Ectodermal dysplasia, a disorder inherited through an X-linked recessive trait, is characterized by abnormalities in two or more structures that originate in the ectoderm. Dental manifestations include missing or malformed teeth. This clinical report details 16 years of interdisciplinary management, starting at age 7 and concluding after skeletal maturation, for a patient with ectodermal dysplasia. Initial treatment included an implant-assisted mandibular overdenture and a maxillary partial prosthesis to improve mastication, speech, and esthetics and to preserve alveolar bone. The prostheses were periodically adjusted to account for facial growth, and additional implants were placed after the completion of growth. The definitive rehabilitation involved maxillary and mandibular implant-supported fixed prostheses with a milled titanium thimble bar and single monolithic zirconia crowns.

Multimodality Imaging in the Diagnosis of Coronary Microvascular Disease: An Update

Coronary microvascular dysfunction (CMD) is characterized by structural and functional abnormalities in the coronary microvasculature which can lead to ischaemia and angina and is increasingly recognized as a major contributor to adverse cardiovascular outcomes. Despite its clinical importance, the diagnosis of CMD remains limited compared with traditional atherosclerotic coronary artery disease. Furthermore, the historical lack of non-invasive methods for detecting and quantifying CMD has hindered progress in understanding its pathophysiology and clinical implications. This review explores advancements in non-invasive cardiac imaging that have enabled the detection and quantification of CMD. It evaluates the clinical utility, strengths and limitation of these imaging modalities in diagnosing and managing CMD. Having improved our understanding of CMD pathophysiology, cardiac imaging can provide insights into its prognosis and enhance diagnostic accuracy. Continued innovation in imaging technologies is essential for advancing knowledge about CMD, leading to improved cardiovascular outcomes and patient care.

Symmetry-based analysis after surgical treatment of zygomaticomaxillary complex fractures using intraoperative cone-beam computed tomography: a retrospective case-control study

Zygomaticomaxillary fractures are among the most common fractures of the facial skeleton. Open reduction and internal fixation require radiographic control. Three-dimensional radiographs provide superior information on actual distances. The study aims to quantify and evaluate intraoperative reduction control by cone-beam computed tomography. The retrospective case-control study evaluates three-dimensional radiographs through linear measurements of defined skeletal landmarks from the median sagittal plane for symmetry. The study group received open reduction and internal fixation for zygomaticomaxillary fractures, and the control group consisted of a population without pathology of the midfacial region. The study group showed the same degree of symmetry as the control group. The mean absolute distance of all landmarks was 1.5 ± 1.3 mm in the study group and 1.0 ± 0.9 mm in the control group. There was a statistically significant likelihood of the right side being further away from the midline than the left. The study showed adequate reduction results of zygomaticomaxillary fractures. Moreover, the same degree of symmetry was ascertained compared to a control group. Intraoperative cone-beam computed tomography serves as a valid tool to check for immediate reduction control during surgery for zygomaticomaxillary fractures.

Multiscale Hierarchical Micro- and Nano-Surface Induced by High-Repetition-Rate Femtosecond Laser Promote Peri-Implant Osseointegration

Micro- and nanomorphological modification and roughening of titanium implant surfaces can enhance osseointegration; however, the optimal morphology remains unclear. Laser processing of implant surfaces has demonstrated significant potential due to its precision, controllability, and environmental friendliness. Femtosecond lasers, through precise optimization of processing parameters, can modify the surface of any solid material to generate micro- and nanomorphologies of varying scales and roughness. Inspired by the multiscale micro- and nanostructures of natural bone tissue, this study employed a high-repetition-rate femtosecond laser to fabricate three distinct micro- and nanomorphologies on titanium implant surfaces, characterized by low (LTi), medium (MTi), and high (HTi) roughness, exhibiting multiscale coexistence. Comprehensive characterization of the modified surfaces included analysis of morphology, roughness, wettability, and elemental composition. Furthermore, in vitro and in vivo experiments were conducted to evaluate osteogenic differentiation and osseointegration capabilities. Results revealed that the HTi surface, exhibiting high roughness, presents a multiscale hierarchical micro- and nanostructure composed of micrometer-sized spheres, submicrometer-sized corrugations, and nanometer-sized particles. In vitro studies demonstrated that the HTi surface promoted earlier adhesion, spreading, and enhanced osteogenic differentiation of osteoblasts, while in vivo studies indicated improved bone formation and osseointegration. In conclusion, multiscale hierarchical micro- and nanosurfaces with high roughness generated by high-repetition-rate femtosecond laser processing hold considerable promise for titanium implant applications.

Exploring the correlation of epidemiological and clinical factors with facial injury severity scores in maxillofacial trauma: a comprehensive analysis

Introduction

The Facial Injury Severity Scale (FISS) provides a numerical value based on individual fractures that can be a valuable tool for management of maxillofacial trauma patients. The aim of this study was to evaluate the association of epidemiological and clinical factors with facial fracture patterns and their correlations with FISS.

Methods

A retrospective study was conducted based on 511 medical records from a 4-year period of patients with facial trauma who underwent open reduction internal fixation (ORIF) under general anesthesia. Fracture patterns were categorized into 3 anatomic subunits: upper, middle and lower face. Single-unit and panfacial fractures groups were analyzed separately. Data regarding demographics, hospitalization, etiology of injury, fracture site and complications were collected. The overall risk of fracture within the viscerocranium requiring an ORIF was presented in graphical form.

Results

Single-unit fractures were more typical in younger patients. There was a significant association between FISS score and traumatic etiology, hospitalization time, length of surgery in each group (p < 0.001). For panfacial fractures, FISS >6 indicated prolonged surgery (>2 h) and hospitalization (>1 week).

Discussion

Despite the questionable clinical utility of FISS, classifying maxillofacial trauma can facilitate comprehensive treatment planning and multidisciplinary collaboration, particularly in complex cases such as panfacial fractures.

Zirconia Implants Indicated Better Stability After Exposure to Radioiodine-131 Therapy Used for Differentiated Thyroid Cancer

Background: Advancements in therapeutic approaches and standard medical interventions have significantly improved the prognosis of patients with differentiated thyroid cancer. However, uncertainties remain regarding the optimal timing and protocols for dental implant placement in patients undergoing radioiodine-131 (I-131) therapy. Debates continue about the potential effects of radiation on osseointegration dynamics and implant viability. This in vitro study assessed the impact of radiodiodine-131 (I-131) used for differentiated thyroid cancer on the structure of zirconia and titanium implants. Methods: A total of 60 implants were utilized, with distribution into two cohorts: titanium implants (Ti, n = 30) and zirconia implants (Zr, n = 30). Subsequently, the Ti and Zr implants were immersed in I-131 solution and retrieved at specified time intervals: 0, 6, 12, 24, 48 h, and 8 days post irradiation. The analyses used to characterize the structure of the implants were radioactivity, scanning electron microscopy, atomic force microscopy, roughness, and Vickers hardness assessment. Results: The findings indicate that the zirconia implants exhibited minimal ultra-structural topographic changes after irradiation. Notable topographical changes and debris deposition on zirconia surfaces became evident after 24 h, with cumulative effects observed after 192 h. The titanium implants, on the other hand, showed surface alterations beginning at 12 h of exposure. Significant changes, including erosive patterns and substantial debris deposits, occurred after 48 and 192 h, leading to increased surface roughness by 24 h. Implants exposed for 12 and 24 h formed a statistically significant group, indicating the onset of surface alteration accumulation. The erosion debris confirmed the surface alterations induced by radioiodine-131 exposure. Conclusions: Overall, the Zr implants demonstrated greater stability compared to the Ti implants following radioiodine-131 exposure.

CAD/CAM single prosthesis: A 25 years bibliometric assessment of prosthetic outcomes

Background

Computer-aided design and computer-aided manufacturing (CAD/CAM) single prostheses on teeth or implants are a viable option to restore edentulous spaces, using crowns. However, a comprehensive study that presents an overview of bibliometric factors related to the characteristics of this type of rehabilitation on teeth or implant is still lacking.

Objective

The purpose of this bibliometric study was to assess the review progress of papers in the field of CAD/CAM single prostheses regarding bibliometric parameters of year, framework material, technology, retention, and impression.

Material and methods

Four databases were assessed, and 5 bibliometric parameters were evaluated. An incidence rate ratio (IRR) was applied by using a multiple Poisson regression model (a = .05) to assess the association between single prostheses and each bibliometric parameter.

Results

A 25-year bibliometric research was carried out and 1019 studies were evaluated. Of these, 805 papers met the inclusion criteria. Over time, an upward trend was observed in the publication of articles on CAD/CAM single prostheses. Studies using only additive manufacturing had a higher IRR than papers that used both technologies (P = .016, IRR = 1.286). Aesthetic materials showed a higher IRR compared with studies that used titanium as framework material (P = .012, IRR = 1.258). Cemented prostheses (P < .001, IRR = 2.272) and both retentions systems (P = .005, IRR = 1.436) exhibited a higher IRR compared to screwed design. Scanning (P = .036, IRR = 1.107) had a higher IRR than hybrid method.

Conclusions

The number of studies that reports CAD/CAM single crowns has increased over time. Likewise, as the volume of publications with aesthetic frameworks. Additive manufacturing has been increasingly present in the most publications assessed, as well as the use of intraoral scanners for impressions. Single prostheses cemented retained were most commonly found.

To evaluate the clinical efficacy of decompression for large cystic lesions in mandible by digital technology

OBJECTIVES

This study aimed to quantitatively evaluate the therapeutic effect of decompression on mandibular cystic lesions using three-dimensional volumetric analysis and investigate factors influencing volume reduction patterns.

METHODS

A retrospective cohort of 44 patients with mandibular cystic lesions, including 12 unicystic ameloblastomas (UAB), 12 odontogenic keratocysts (OKC), and 20 nonkeratinizing cysts (NKC), was analyzed. Volumetric measurements before and after decompression were obtained using Three- dimensional (3D) Slicer software and CBCT data. Outcome variables included absolute volume reduction (AVR), absolute speed of shrinkage (ASS), relative reduction in volume (RRV), and relative speed of shrinkage (RSS). Predictor variables were patient age, gender, presence of impacted teeth, mandibular ramus involvement, preoperative volume, and decompression duration. Statistical analyses were performed, with significance set at P ≤ 0.05.

RESULTS

Significant volume reductions were observed across all groups post-decompression (P < 0.01). Preoperative volume correlated positively with AVR and ASS (P < 0.05). Decompression duration was inversely related to RSS (P < 0.05) and positively related to RRV in OKC and NKC groups (P < 0.05). Other variables showed no significant associations (P > 0.05).

CONCLUSIONS

Decompression effectively reduces mandibular cystic lesion volume, with preoperative size and duration of decompression being key influencing factors. Three-dimensional volumetric analysis provides detailed, reliable evaluation of treatment efficacy, enhancing clinical monitoring and decision-making.

Dental Implant Rehabilitation of Posterior Maxillary Edentulism via Sinus Augmentation Using the Lateral Window Technique: A Retrospective Analysis of 289 Implants Followed Up for 15 Years

The aim of this study was to analyze the marginal bone loss and survival of implants in the augmented sinus area via the lateral window approach. The effect of sinus membrane perforation as well as splinting of the upper structure was analyzed. Two hundred and eighty-nine implants were placed in the sinus areas augmented with xenografts and collagen membranes in 101 patients. Clinical and radiographic data were obtained during recall visits. The Marginal Bone Loss (MBL) and Cumulative Survival Rate (CSR) were evaluated. The mean follow-up period was 12.4 years (range: 12 to 182 months). During the follow-up period, 19 implants were lost, yielding a 92.93% survival rate. No significant models for any of the covariates were found in terms of implant survival (p = 0.08). Similarly, no significant differences were observed between intact and perforated sinuses (p = 0.41) or between splinted or single standing implants (p = 0.11). The overall MBL reached 1.80 ± 0.56 mm at 15 years, and no significant differences were detected between any particular years (p = 0.12). Dental implant rehabilitation of the posterior maxilla via sinus augmentation using the lateral window technique is safe, effective and provides a high long-term implant survival with minimal prosthetic complications.

A comparative study of lumbar spine stabilization with 2-stage surgery and cement augmentation in osteoporosis patients: a randomized clinical trial

The biggest challenge for osteoporotic patients after spinal stabilization is screw loosening. Therefore, the present study was conducted with the comparative aim of stabilizing the lumbar spine with 2-stage surgery and cement augmentation in osteoporotic patients. 66 patients selected through convenience sampling and randomly assigned to two groups: CAPS and 2-stage surgery. In the CAPS group, lumbar spine fixation was performed in a single stage, accompanied by cement augmentation. In the 2-stage surgery group, spinal stabilization was conducted in 2 stages. In the first stage, pedicle screws were implanted, followed by the pedicle screw anchoring process 6 months later. fusion rate, screw loosening, pain levels (VAS), and patients' disability (ODI) were measured in each group. The fusion rate in the 2-stage Surgery group significantly increased. Screw loosening in the CAPS group showed a significantly higher difference. The rate of pain and disability in patients early postoperatively, in comparison to preoperative measures, significantly decreased in both groups. In the final follow-up, the CAPS group experienced a significant increase in pain and disability. The 2-stage Surgery stabilization, when compared to the CAPS technique, demonstrates superiority in enhancing the biomechanical stability of screws and achieving successful fusion.

In vivo bioengineered tooth formation using decellularized tooth bud extracellular matrix scaffolds

The use of dental implants to replace lost or damaged teeth has become increasingly widespread due to their reported high survival and success rates. In reality, the long-term survival of dental implants remains a health concern, based on their short-term predicted survival of ~15 years, significant potential for jawbone resorption, and risk of peri-implantitis. The ability to create functional bioengineered teeth, composed of living tissues with properties similar to those of natural teeth, would be a significant improvement over currently used synthetic titanium implants. To address this possibility, our research has focused on creating biological tooth substitutes. The study presented here validates a potentially clinically relevant bioengineered tooth replacement therapy for eventual use in humans. We created bioengineered tooth buds by seeding decellularized tooth bud (dTB) extracellular matrix (ECM) scaffolds with human dental pulp cells, porcine tooth bud-derived dental epithelial cells, and human umbilical vein endothelial cells. The resulting bioengineered tooth bud constructs were implanted in the mandibles of adult Yucatan minipigs and grown for 2 or 4 months. We observed the formation of tooth-like tissues, including tooth-supporting periodontal ligament tissues, in cell-seeded dTB ECM constructs. This preclinical translational study validates this approach as a potential clinically relevant alternative to currently used dental implants.

CBCT-Based Morphological Study of the Accessory Foramina of the Canalis Sinuosus: Prevalence, Morphological Variants, and Significance for Implant Surgery

Objective: The canalis sinuosus in the premaxillary region often has accessory canals palatal to the central and lateral incisors. These small anatomical structures are of increasing interest due to numerous case reports of postoperative complications following surgery in the upper anterior region. Methods: This study examined the number, position, and extent of the accessory foramina of the canalis sinuosus in 210 patients. Furthermore, this study examined the distances to neighboring teeth and to the buccal cortical bone in edentulous patients. Three-dimensional tomographic (CBCT) images were created with a resolution of 0.2 voxels and were evaluated using the Osirix MD 11.0 program. Results: The results showed a prevalence of 97% for accessory foramina, confirming them as a clear anatomical structure. Males had significantly more terminal openings of the canalis sinuosus than females, with clustering in the fourth to sixth decades of life. The foramina had a mean extension of 0.9 mm and a mean distance of 4.6 mm to adjacent teeth. Conclusions: This narrow position is particularly relevant for surgical procedures. Greater attention should be focused on larger foramina in implant planning, as postoperative complications are increasingly being described. Foramina and accessory canals should be detected in three-dimensional, navigated implant planning in order to minimize the risk of injury during oral surgery.

Effect of combining different 10-MDP-containing primers and cement systems on shear bond strength between resin cement and zirconia

PURPOSE

The longevity of zirconia restoration depends upon its esthetic, proper occlusion, marginal adaptation, and restoration retention. This study aimed to investigate the combination of 10-MDP-containing primers between the two commercial systems (Scotchbond Universal Plus Adhesive and Panavia V5) and airborne-particle abrasion on shear bond strength (SBS) between zirconia and resin cement.

METHODS

High translucency zirconia discs were sectioned and sintered according to the manufacturer's recommendations. The specimens were randomly applied with three different primers (Scotchbond Universal Adhesive, Tooth Primer, and Clearfil Ceramic Primer). Then, each group was bonded with Panavia V5 and RelyX™ Universal resin cements. Airborne-particle abrasion on the zirconia surfaces was also conducted using the manufacturer's bonding protocol for both resin cements. SBS was analyzed by a two-way ANOVA with Tukey's adjustment for multiple comparisons (α = 0.05).

RESULTS

Panavia V5 exhibited the highest SBS with Scotchbond Universal Adhesive (9.66±2.00 MPa) and Tooth Primer (8.47±2.08 MPa), respectively. As-sintered zirconia luted with primers and RelyXTM Universal resin cement exhibited lower SBS than that of Panavia V5. In regard to air-abrasion, air-abraded zirconia luted with Tooth Primer and Panavia V5 exhibited statistically significant higher SBS (29.26±3.26 MPa) than other groups (p<0.0001).

CONCLUSIONS

Combining primers from different adhesive cement systems may significantly enhance the bond strength. Zirconia luted with Scotchbond Universal Adhesive and Panavia V5 achieved the highest bond strength when combined with airborne-particle abrasion.

Occlusion and Biomechanical Risk Factors in Implant-Supported Full-Arch Fixed Dental Prostheses-Narrative Review

The biophysiological differences between teeth and dental implants and the issue of occlusal overload, although controversial, form the basis for the management of occlusion in implant-supported full-arch fixed dental prostheses (ISFAFDPs). Although there is currently a lack of scientific evidence on occlusal management, it is clear that the favorable prognosis of ISFAFDPs is linked to a correct understanding of the biomechanical principles involved. In the design of ISFAFDPs, the lack of proprioceptive feedback requires special attention to biomechanical factors: minimizing overloading complications and providing biomechanical stability are among the main goals of the occlusion. In ISFAFDPs, the occlusion must be decided on the basis of several factors that influence the loads on prosthesis and implants: each case must be evaluated individually and requires a personalized occlusion. The main aim of this narrative review is to provide an overview of the occlusal principles and materials that can be used in ISFAFDPs based on the data currently available in the literature. Practical clinical recommendations for the occlusion management of ISFAFDPs and a biomechanical risk score index to personalize implant-prosthetic treatment are proposed.

Clinical behavior and survival of CAD-CAM resin nanoceramic and polymer interpenetrating ceramic network material restorations on endodontically treated teeth: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Attempting to combine the mechanical and optical properties of ceramics and composite resins to mimic natural teeth has led to the emergence of resin nanoceramics and polymer interpenetrating ceramic network materials. Systematic reviews on the survival of these materials in endodontically treated teeth are lacking.

PURPOSE

This systematic review and meta-analysis assesses the survival of computer-aided design and computer-aided manufacturing (CAD-CAM) resin nanoceramics and polymer interpenetrating ceramic network material restorations on endodontically treated teeth and to describe the incidence of complications.

MATERIAL AND METHODS

The study was registered in the international prospective register of systematic reviews (PROSPERO) database and adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive search across 6 online databases was performed. Clinical studies which involved CAD-CAM manufactured resin nanoceramics and polymer interpenetrating ceramic network material restorations on endodontically treated teeth were included. Several investigators independently conducted the study selection, data extraction, and quality assessment processes. Risk of bias was assessed by using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Failure rates were analyzed using Poisson regression models to obtain summary estimates of 3- and 5-year survival proportions, which were pooled using a random-effects model. Subgroup analysis was performed for material type and restoration design (α=.05).

RESULTS

The search resulted in 250 studies after duplicate removal, and 11 articles were included in the final analysis. The meta-analysis of 289 restorations revealed an overall estimated failure rate of 3.44 (95% confidence interval [95% CI]: 2.67-4.21) per 100 restoration years, equivalent to a survival rate of 90.2% (95% CI: 88.1-92.3%) after 3 years and 84.2% (95% CI: 81.0-87.5%) after 5 years. A significantly lower (P<.001) failure rate was reported for polymer interpenetrating ceramic network material restorations (1.61, CI: 0.87-2.36) compared with resin nanoceramic restorations (5.97, CI: 3.52-8.41). Partial-coverage restorations (3.45, 95% CI: 1.98-4.92) had a significantly lower (P<.001) failure rate compared with 1-piece endodontic crowns (5.19, 95% CI: 2.75-7.64). Restoration debonding was the main reason for failure.

CONCLUSIONS

Endodontically treated teeth restored with CAD-CAM manufactured resin nanoceramic and polymer interpenetrating ceramic network material restorations have an acceptable survival rate and can be recommended as an alternative to conventional indirect restorative materials. Polymer interpenetrating ceramic network material restorations have a higher survival rate than resin nanoceramic restorations.

Three-dimensional in vivo and finite element analyses of peri-implant bone remodeling after superstructure placement

STATEMENT OF PROBLEM

Understanding the factors affecting loading-induced longitudinal peri-implant bone changes is crucial for successful implant-supported prosthetic treatment.

PURPOSE

The purpose of the study was to assess the biomechanical factors influencing 3-dimensional changes in the peri-implant bone volume and buccal bone thickness (BBT) with follow-up cone beam computed tomography (CBCT) images and finite element analysis (FEA).

MATERIAL AND METHODS

Twelve study participants received dental implants without bone augmentation, resulting in the evaluation of 22 posterior dental implants. Each participant underwent 3 separate CBCT scans: the first at 3 months after loading, followed by scans at 15 months and 27 months after loading. CBCT images were superimposed at each interval with an image-processing software program. The peri-implant buccal bone area was determined as the volume of interest (VOI), and volumetric change in VOI and changes in BBT at 2, 4, and 6 mm below the implant platform were measured. FEA was performed to examine the mechanical stimulation in the VOI with occlusal force data obtained from the Dental Prescale. Interobserver reliability was evaluated by 3 experienced prosthodontists and dentists experienced with dental implants. Linear regression analyses were performed to evaluate the relationship between variables.

RESULTS

Occlusal force and mechanical stimulation (strain energy density [SED]) in the VOI demonstrated a positive correlation; moreover, a positive correlation was observed between SED and bone volume loss in the VOI at 3 and 27months after loading. Similar correlations were observed with BBT, except at a depth of 6 mm under the implant platform. The interclass correlation coefficient values were 0.995 for volume and 0.982 for BBT, thereby indicating a high level of agreement among the observers' measurements.

CONCLUSIONS

This combined FEA and clinical study suggested that force-induced bone remodeling depends on the occlusal force in the early phases after superstructure placement.

Bone Resorption Assessment Following Zygomatic Implants Surgery over 10 Years of Follow-Up

The presence of sufficient bone volumes is one of the most important criteria for the success of oral implant osseointegration. Therefore, the rehabilitation of edentulous atrophic maxillae represents the greatest challenge in terms of oral rehabilitation. Techniques such as bone grafts, angled implants, short implants, tuberosity, and pterygoid implants may not always be a viable alternative in the subsequent rehabilitation of the posterior atrophic maxilla. A breakthrough occurred when Brånemark first introduced longer, custom-designed implants inserted into the zygomatic bone to support craniofacial prosthesis in the 1980s. When used in the treatment of atrophic jaws, zygomatic implants provide a safe and effective alternative, with stable long-term results. Objectives: We aimed to retrospectively evaluate zygomatic bone resorption ten years after the placement of zygomatic implants. Methods: A retrospective observational study was designed to evaluate bone resorption over ten years following the placement of zygomatic implants. In a study group of 50 patients, using Hounsfield scales, the area of the zygoma and its bone density were established and evaluated. The NewTom NNT Analysis software (NewTom®, Imola, Italy) was employed to trace the bone and implant limits on CBCT scans. Using this software, the three-dimensional information of the postoperative CBCT image was compared with the ten-year postoperative CBCT image, allowing for the assessment of the zygomatic bone resorption and bone density. Results: Highly significant statistical differences to an alpha level of 0.01 were identified between T0 (pre-op), T1 (12 months), and T2 (120 months) concerning zygomatic bone density, both in the first and in the second quadrants. The post hoc Bonferroni test revealed that significant statistical differences were observed between T0 and the remaining timepoints (T1 and T2), with the latter two exhibiting similar values. Conclusions: The evaluation of the resorption at the level of the zygoma, ten years after the placement of zygomatic implants, reveals that there are no significant losses between the initial and final controls. Therefore, it follows that this type of implant rehabilitation represents a viable alternative approach in patients with bone atrophy of the maxilla, offering a predictable therapeutic solution that enables immediate full function and excellent long-term success rates. However, we must not neglect the potential for future innovations in GBR involving the use of barrier membranes, either resorbable or non-resorbable, and even the application of titanium alveolar customized osteogenic scaffold, in conjunction with autologous bone grafts or biomaterials.

Budget Impact Analysis: Digital Workflow Significantly Reduces Costs of Implant Supported Overdentures (IODs)

BACKGROUND

For edentulism, an implant supported removable complete overdenture (IOD) is an attractive solution to restore patients' chewing capacity, aesthetics, and self‐esteem, however, treatment is expensive and time consuming.

PURPOSE/AIM

To estimate the decline in costs for digitally designed and CAD/CAM fabricated IODs (3D‐IODs) compared to conventionally fabricated IODs (C‐IODs) at comparable general health related quality of life (GHRQoL).

MATERIALS AND METHOD

A randomized crossover study enrolled 36 fully edentulous patients, in whom six maxillary implants were placed together with two mandibular implants, if not already present. At the start of the study, a set of C‐IODs and 3D‐IODs was fabricated for each patient. All patients wore each IOD‐type for 1 year: first the 3D‐IOD and the second year a C‐IOD, or vice versa. At all three‐time points patients general QoL was assessed using the EQ‐5D‐5L questionnaire as well as the SF‐36 from which the SF‐6D was obtained, to research the anticipation of no significant difference. To enable cost consequence analysis (CCA), both costs made within healthcare and patient costs were assessed. Subsequently, a budget impact analysis (BIA) was performed to demonstrate the potential savings.

RESULTS

No differences in general GHRQoL were seen between C‐IOD (M = 0.840, SD = 0.177) and 3D‐IOD (M = 0.837, SD = 0.156) (paired t‐test (N = 31): p = 0.880). With respect to the total costs for a complete IOD, however, the digital approach showed a reduction in initial total costs of 14.2% (€4700.33 vs. €4030.61: p < 0,001), in treatment time of 41.1% (309 vs. 182 min: p < 0.001), and in number of treatment sessions of 47.1% (5.68 vs. 3.0: p < 0.001). For repairs for an IOD in both the upper and lower jaw, the C‐IOD and 3D‐IOD scored similar for treatment time as well as additional costs.

CONCLUSION

Implementing a 3D workflow in the production of IOD's supplies patients with a high‐quality 3D‐IOD at lower costs.

TRIAL REGISTRATION

NL‐OMON44248 https://onderzoekmetmensen.nl/en/trial/44248.

The Rehabilitation of Partially Edentulous Maxilla With Unilateral Zygomatic Implants: A Retrospective Study up to 23 Years Follow-Up

OBJECTIVES

This retrospective study aimed to evaluate the clinical outcomes associated with zygomatic implant (ZI) rehabilitation in partially atrophic edentulous maxillae over a mean follow-up period of more than 10.3 years.

METHODS

All consecutive patients underwent ZI rehabilitation between 1999 and 2020, with a minimum follow-up period of 3 years. The primary outcome was the implant survaival rate. Secondary outcomes included the prosthesis success rate, complications, and Oral Health-Related Quality of Life.

RESULTS

Of the 21 patients, treated with 27 ZIs and 48 conventional implants (CIs), 9 (42.9%) were females. The mean follow-up was 10.3 ± 5.7 years (range 3.2-23.4). ZI and CI survival rates were 100% and 97.9%, respectively, with one CI that failed. Eleven patients received 12 CIs placed in the pterygoid and tuberosity region. Most of the implants (81.33%) were immediately loaded, with 17 patients (80.9%) receiving 21 acrylic bridges. Of the total of 26 definitive prosthesis, the success rate was 96.1%. Local inflammation (n = 2) and soft tissue recession (n = 1) were reported as complications, occurring at a mean follow-up of 4.5 and 3.2 years, respectively. The mean score of the OHIP-14 questionnaire was 1.19 ± 1.99.

CONCLUSIONS

Unilateral ZI rehabilitation was a predictable option for patients with partially atrophic edentulous maxilla who have experienced previous graft or implant failures, or who require immediate loading. Splinting the ZI with CI for restoration appeared to be essential in unilateral ZI treatment. Complications were infrequent and could be managed effectively, with patient-reported outcomes indicating normalization in quality of life.

Long-Term Survival of Implants Placed in Earlier Failed Implant Sites

Dental implant therapy is generally successful. However, when such therapy fails, considerations for implant replacement must be carefully considered. The survivability of implants placed into previously implanted sites must be considered. Appraisal of early implant loss versus late implant loss is important in presurgical planning for implant replacement. This review highlights the factors that can impact the success of implant reimplantation.

Survival and Success of 3D-Printed Versus Milled Immediate Provisional Full-Arch Restorations: A Retrospective Analysis

OBJECTIVE

To evaluate and compare the survival rates of 3D-printed and chairside milled resin polymethylmethacrylate (PMMA) immediate temporary provisional full-arch implant restorations using prosthetic survival as the primary outcome.

MATERIALS AND METHODS

Records of 335 routine patients receiving 443 temporary six-implant retained maxillary or mandibular prosthetic restorations between January 2019 and January 2022 at a private clinic (Dr Sobczak Clinical Centre, Radosc, Poland) were considered for this retrospective analysis. The analysis compared prosthetic and implant failure rates between printed and milled restorations as primary and secondary outcomes, respectively. Patient-related and treatment-related characteristics between groups were compared using the Chi-square test and Mann-Whitney U-test, respectively. Group-specific cumulative prosthetic survival was qualitatively and quantitively compared using Kaplan-Meier, generalized linear mixed models and univariate cox proportional hazard analyses. Prosthetic survival was set into context to implant survival using Chi-square tests. A multivariable cox proportional hazards model with frailty was used to identify confounding factors affecting prosthetic survival.

RESULTS

Prosthetic failure rates of milled and printed temporary restorations were 13.01% and 11.25% over the average follow-up period of 307.7 ± 115.5 days, respectively. The corresponding 180-day cumulative prosthetic survival rates were 92.4% and 93%. Hazard ratios for the prosthetic failure of milled and printed restorations did not show a statistical difference (p = 0.794). Implant failure rates in restorations that experienced prosthetic failure (17.31%) were higher compared to restorations without failures (5.63%), with a 3.2 times significantly higher odds of failure for a prosthesis experiencing implant loss (p = 0.003). Gender, presence of teeth at treatment baseline, smoking, and bone augmentation were identified as confounding factors impacting prosthetic survival.

CONCLUSION

Chairside 3D-printed restorations may represent an equivalent treatment modality to established chairside milled restorations for immediate full-arch therapy. Provisional prosthetic survival may impact implant survival and treatment success.

Outcomes of bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with two prosthetic techniques: A 1-year randomized clinical trial

STATEMENT OF PROBLEM

Providing a definitive restoration with an emergence profile matching that of the contralateral or extracted tooth should result in an esthetic peri-implant soft tissue contour. Whether a custom healing abutment improves the outcome of a bio-copied definitive restoration compared with a stock abutment is unclear.

PURPOSE

The purpose of this 1-year randomized clinical trial was to evaluate the peri-implant soft and hard tissues related to bio-esthetic single implant-supported restorations having a contralateral tooth-matching restorative emergence profile after peri-implant soft tissue conditioning with either custom or stock healing abutment for patients indicated for immediate implant placement.

MATERIAL AND METHODS

Twenty-four participants indicated for immediate implant placement in the maxillary esthetic zone received bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with either a custom healing abutment (n=12) or a stock healing abutment (n=12). The pink and white esthetic score (PES-WES) was evaluated 6 and 12 months after implant placement. Peri-implant bone changes were measured with cone beam computed tomography (CBCT) scans at the same intervals.

RESULTS

The PES-WES showed significant difference between the 2 groups at 6 and 12 months. The CBCT scans did not show significant difference between the 2 groups.

CONCLUSIONS

The use of the bio-esthetic concept for immediate single implant placement achieved successful esthetic restorations after conditioning the peri-implant tissues using either custom or stock healing abutments. However, the use of custom healing abutments was associated with higher PES-WES values in comparison with the use of stock healing abutments.

Influence of Implant Surfaces on Peri-Implant Diseases - A Systematic Review and Meta-Analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to evaluate the current literature on the effect of implant surface characteristics on peri-implant marginal bone levels (MBL), soft tissue periodontal parameters, peri-implantitis, and implant failure rates.

MATERIALS AND METHODS

Randomized controlled trials were searched in electronic databases. Risk of bias within the selected studies was assessed using the Risk of Bias Tool 2. Meta-analyses were performed using Review Manager software for studies with similar comparisons reporting same outcome measures.

RESULTS

Ten randomized control trials were included in the present review. The primary outcome of changes in peri-implant MBL favoured implants with machined surfaces, however, the difference was not statistically significant (P = .18). The changes in probing pocket depths significantly favoured the use of machined surfaces (P = .01), while the implant failure rates favoured roughened surface implants. However, the difference was not statistically significant (P = .09).

CONCLUSION

Machined surface implants were favoured in terms of lesser peri-implant MBL, though the difference was not significant. The analysis also demonstrated limited favourable outcomes in terms of periodontal parameters for machined surfaces, with slightly significantly better outcomes in terms of probing pocket depths. However, rough surface implants tended to display a lower implant failure.

Three Factors for Long-Term Dental Implant Success: Up to 40-year Follow-up

This article provides clinicians with 3 main factors that relate to long-term success. Long term in this article represents the lifespan of the patient, often requiring more than 40 years of function on the implant restoration. Literature is reviewed and used to provide evidence for these recommendations. Cases are presented to demonstrate these critical factors.

Treatment Outcomes of Four-Implant-Retained Maxillary Palateless Overdenture: A 5-Year Observational Study

INTRODUCTION

Palateless overdentures (PLODs) provide advantages of improved taste perception and retention over conventional dentures. We aimed to evaluate 5-year outcomes of four implant maxillary PLODs.

METHODS

In this prospective observational study, edentulous participants were enrolled. A new conventional maxillary denture was prepared followed by implant placement and insertion of four implant retained maxillary PLOD. Oral health quality of life was assessed using the 49-item Oral Health Impact Profile (OHIP-49) at multiple intervals over 5 years along with biological and mechanical outcomes.

RESULTS

Nine patients were evaluated at year 5. The mean age was 68 years, and six of the nine patients were males. The cumulative survival rate of implants was 100% while the implant success rate was 86%. Nylon retentive replacement was the most common encountered complication noted approximately four times per patient over 5 years. From a mean OHIP-49 severity score of 71.2 at baseline, severity scores decreased to 23.9 (p < 0.001) at year 1, denoting a clinically meaningful and statistically significant improvement in oral health quality of life. The lowered OHIP-49 severity scores remained stable throughout 5 years of follow-up.

CONCLUSION

Four implant supported maxillary overdenture appears to have good patient perceived, biological and mechanical outcomes over 5 years. Fully powered studies are needed to replicate these findings.

A Multicenter Study of Factors Related to Early Implant Failures-Part 1: Implant Materials and Surgical Techniques

BACKGROUND

Dental implant materials, designs as well as general concepts for surgical techniques have evolved during the last decades. It has been validated that primary stability followed by bone apposition around implants is crucial for implant survival as most implant failures occur during the first year. However, new implant materials and different micro and macro designs have improved implant survival in more challenging clinical conditions. Therefore, clinical research with large patient groups is needed to investigate the effects of different implant designs and surgical protocols with the aim to improve early implant outcomes.

PURPOSE

The purpose of the study is to investigate the clinical use of dental implant materials, designs, and surgical techniques related to early implant complications and failures.

MATERIALS AND METHODS

All patients who had received implant surgery in 2007 and 2017 at three specialist centers in Sweden were identified using charge codes. Data were retrieved from a dental record system as well as from digital and analog registries on implant surgeries. Information on anamnestic data, bone status, implant materials and designs, surgery techniques, and early implant failures and complications during the first year was compiled and analyzed. Descriptive statistics were used for comparison of the time cohorts. The data were statistically analyzed with a multivariable logistic regression model with a significance level of p < 0.05 using early implant failures and complications as the dependent variables.

RESULTS

For 2007, 799 patients with 2473 implants were identified. For 2017, 1076 patients with 2287 implants were identified. However, 74 (3.7%) patients were excluded, mainly due to lack of data. Differences were observed when comparing the two cohorts. In 2017, fewer preoperative antibiotics were prescribed, more incidences of exposed implant threads were reported, more non-submerged implant surgeries were performed, shorter implant lengths were used, more implants were placed in augmented bone, and tapered implants with a variable design were used. Implants of commercially pure titanium (CP Ti) Grades 1-4 with moderately and minimally rough surfaces were used in 2007, whereas CP Ti Grade 4 and alloy titanium zirconium (TiZr) with moderately rough surfaces were used in 2017. Significantly higher number of implant failures were reported in 2017 at the implant level: 56 (2.4%) in 2017 compared to 26 (1.1%) in 2007. Eleven variables were shown to increase the risk of failure including exposed implant threads OR 3.56 (1.60, 7.91) p = 0.0018 and increased number of implants per patients 1.26 (1.14, 1.39) p < 0.001 analyzed at the patient level. Nine variables were shown to increase the risk of early implant complications, including exposed implant threads OR 4.52 (2.60, 7.87) p < 0.001, sinus membrane perforations OR 8.14 (2.46, 26.93) p < 0.001, and no prescription of preoperative antibiotics OR 4.52 (2.60, 7.87) p < 0.001 analyzed at the patient level.

CONCLUSIONS

This study reports on changes in implant materials, designs, and surgical techniques between 2007 and 2017. Significantly higher numbers of implant failures and complications were reported in 2017. Factors related to early implant complications and failures were identified.

Long-Term Clinical and Radiographic Outcomes of Hydrophilic Implants: A 10-Year Study in a Specialist Private Practice

AIM

To report the 10-year clinical and radiographic outcomes of implants placed in grafted (GBR) and non-grafted (no-GBR) sites in a Swiss specialist private practice using hydrophilic implants with a low surface roughness flange.

METHODS

Fifty consecutively enrolled patients received 159 hydrophilic implants with a low surface roughness flange. A first re-evaluation was performed 1 year after delivery of restoration (T1). An additional examination was performed at the 10-year follow-up (T2) including the assessment of clinical (i.e., periodontal/peri-implant pockets probing depths (PPD) (mm), full-mouth bleeding score (%), implant survival rate, mid-buccal keratinized mucosa (KM) width in mm, and peri-implant phenotype), and radiographic (i.e., marginal bone level change [ΔMBL]) outcomes. Biological, mechanical and technical complications were also recorded.

RESULTS

Out of the initial cohort, 22 patients (9/40.9% male and 13/59% female) and 63 implants (47 with GBR, 16 without GBR), could be re-examined at T2. Overall, ΔMBL (T2-T1) was -0.56 ± 0.96 mm. In the GBR group, ΔMBL were significantly higher at the distal sites compared to the no-GBR group (-0.75 ± 1.17 mm vs. -0.12 ± 1.29 mm, p = 0.045), however, in the GBR group MBL started at a higher level at T1 but were similar with the no-GBR group at T2. Implant survival was 100% with only very few technical complications (6.3%). Mean PPD amounted to 3.84 ± 1.00 mm with significantly higher values in the GBR group (3.98 ± 1.08 mm vs. 3.45 ± 0.60 mm; p = 0.016). Nineteen implants (30.1%) were diagnosed with peri-implant health while 44 (69.9%) presented with peri-implant mucositis.

CONCLUSION

Within the limitations of this study, favorable clinical and radiographic conditions were recorded around hydrophilic implants with a low surface roughness flange placed in pristine and augmented bone after 10 years in function.

Dynamic navigation-guided robotic placement of zygomatic implants

OBJECTIVES

To assess the feasibility and accuracy of a new prototype robotic implant system for the placement of zygomatic implants in edentulous maxillary models.

METHODS

The study was carried out on eight plastic models. Cone beam computed tomographs were captured for each model to plan the positions of zygomatic implants. The hand-eye calibration technique was used to register the dynamic navigation system to the robotic spaces. A total of 16 zygomatic implants were placed, equally distributed between the anterior and the posterior parts of the zygoma. The placement of the implants (ZYGAN®, Southern Implants) was carried out using an active six-jointed robotic arm (UR3e, Universal Robots) guided by the dynamic navigation coordinate transformation matrix. The accuracy of the implant placement was assessed using EvaluNav and GeoMagicDesignX® software based on pre- and post-operative CBCT superimposition. Descriptive statistics for the implant deviations and Pearson's correlation analysis of these deviations to force feedback recorded by the robotic arm were conducted.

RESULTS

The 3D deviations at the entry and exit points were 1.80 ± 0.96 mm and 2.80 ± 0.95 mm, respectively. The angular deviation was 1.74 ± 0.92°. The overall registration time was 23.8 ± 7.0 min for each side of the model. Operative time excluding registration was 66.8 ± 8.8 min for each trajectory. The exit point and angular deviations of the implants were positively correlated with the drilling force perpendicular to the long axis of the handpiece and negatively correlated with the drilling force parallel to the long axis of the handpiece.

CONCLUSION

The errors of the dynamic navigation-guided robotic placement of zygomatic implants were within the clinically acceptable limits. Further refinements are required to facilitate the clinical application of the tested integrated robotic-dynamic navigation system.

CLINICAL SIGNIFICANCE

Robotic placement of zygomatic implants has the potential to produce a highly predictable outcome irrespective of the operator's surgical experience or fatigue. The presented study paves the way for clinical applications.

Managing Mandibular Osteoradionecrosis

OBJECTIVE

Mandibular osteoradionecrosis (MORN) is a morbid complication of head and neck radiation therapy. Recent advances in surgical and medical therapies underscore the need for a shift in traditional treatment paradigms and a disease grading system that can guide appropriate management.

DATA SOURCES

Pubmed/MEDLINE.

REVIEW METHODS

We conducted a detailed review of publications related to MORN, specifically focusing on its staging and management techniques. Articles meeting inclusion criteria were synthesized into a final narrative review.

CONCLUSION

There has been a paradigm shift away from hyperbaric oxygen therapy in the management of MORN. Growing evidence for the efficacy of pentoxifylline and tocopherol in early-stage disease and novel surgical techniques to manage moderate and late-stage disease warrant an updated staging stratification which is proposed.

IMPLICATIONS FOR PRACTICE

This review summarizes the clinical efficacy of established and novel therapeutic modalities currently available in treating MORN, emphasizing the significant advances achieved over the last decade. It introduces a contemporary staging and treatment algorithm which incorporates traditional, evidence-supported surgical and medical management with effective early intervention strategies.

Outcome of Single Dental Implants Over 38-40 Years: A Long-Term Follow-Up Study

INTRODUCTION

This is a comprehensive, long-term follow-up study of single-implant treatments. At the Brånemark Clinic in Gothenburg, Sweden, during the period of 1982-1985, 16 patients received single-tooth implants.

OBJECTIVE

This study evaluates the survival rate of the implants after nearly four decades, focusing on the biological and technical complications.

METHODS

Of the original 16 patients with a total of 23 implants, 13 patients with 18 implants were available for the follow-up and were included in the study. Clinical and radiographic examinations were performed on these patients.

RESULTS

The cumulative survival rates were 95.6% for the implants and 60.9% for the implant-supported crowns after 38-40 years in function. The marginal bone level changes were 0.9 ± 1.0 mm (range, -0.5─3.0 mm) over the follow-up period. The frequency of biological complications was low; although mucositis was common, no cases of peri-implantitis were observed. The mean plaque index was 16.9% ± 11.6% (range, 1%─34%) and the mean probing depth around the implants was 3.8 ± 2.2 mm (range, 0.0─7.0 mm). Few technical complications were observed, although many of the original implant-supported crowns had been replaced for esthetic reasons.

CONCLUSION

The findings emphasize the importance of long-term follow-up in implant dentistry, particularly for younger patients, to improve understanding of potential complications and the longevity of treatment outcomes. Overall, single-tooth implants have a favorable long-term prognosis, though crown replacement may eventually be necessary.

Clinical Outcomes of Bone-Level and Tissue-Level Short Implants Placed in Posterior Maxilla: A Case-Control Study

INTRODUCTION

Short implants are today a reliable, minimally invasive option for the rehabilitation of the posterior maxilla. However, maintaining marginal bone stability remains a crucial factor for long-term success, particularly in the case of short implants. The present multicenter prospective case-control study aimed to compare the clinical outcomes of bone-level and tissue-level short implants in the posterior maxilla, focusing on implant survival and peri-implant marginal bone stability over 1 year of function.

METHODS

Fifty-nine patients who met specific inclusion criteria were enrolled and treated by three clinical centers with a total of 74 short implants, either bone-level (7 mm in length, placed 1 mm sub-crestally) or tissue-level (5 or 6.5 mm in length). The primary outcome was physiological bone remodeling (PBR) measured via radiographs at baseline (T0), prosthesis delivery (T1), and 12 months post-loading (T2). Statistical analysis was performed to evaluate differences in PBR between groups, with multivariate analysis assessing the influence of various patient and site-specific factors.

RESULTS

The final analysis included 58 patients who were treated with a total of 71 short implants, comprising 36 tissue-level and 35 bone-level implants (one patient dropped out as he did not attend follow-up visits on time). All implants were rehabilitated with fixed, screwed prosthetics after 5 months, with no recorded complications up to 1 year of loading. Stability was similar between the two implant types at T0 and T1, with no significant differences in insertion torque and implant stability quotient (ISQ). Multivariate analysis revealed a significant positive correlation between insertion torque and ISQ at T0, as well as with bicortical engagement of the implant apex with the sinus floor. Tissue-level implants demonstrated significantly lower peri-implant bone remodeling (PBR) compared to bone-level implants at both T1 (0.11 ± 0.27 mm vs. 0.34 ± 0.35 mm, p = 0.004) and T2 (0.30 ± 0.23 mm vs. 0.55 ± 0.42 mm, p = 0.003). Multivariate analysis showed a significant positive correlation between PBR (T0-T1) and thin vertical mucosal thickness (≤ 2 mm) at T0 in both tissue-level and bone-level implants. Additionally, PBR (T1-T2) in both groups significantly correlated with the use of short prosthetic abutments (≤ 2 mm) and, only in bone-level implants, with crown emergence angles > 30°.

CONCLUSION

Both tissue-level and bone-level short implants are effective options for implant-supported rehabilitation in the posterior maxilla. Tissue-level short implants offer superior marginal bone stability compared to bone-level implants placed subcrestally, suggesting their favorable use in clinical practice.

Successful treatment of adult cherubism with a 60 mg denosumab 6-monthly regimen

Cherubism is a rare autosomal dominant skeletal dysplasia, affecting the maxilla and/or mandible. The condition typically has childhood onset, followed by progression until puberty, with subsequent regression. Cherubism lesions share histological features with giant cell tumor of bone, where high-dose monthly denosumab is an effective medical treatment. Therefore, high-dose denosumab has also been trialed in children with cherubism with positive outcomes. However, the role of denosumab in adult cherubism, particularly a lower dose and frequency, has not been established. We present the case of a 60-year-old man with cherubism, reviewed for a new 39 × 21 mm left mandibular lesion. The patient had multiple surgeries up to the age of 30 for tumors in the right maxilla and mandible. Given the impact of further surgery on his appearance and quality of life, the patient was referred to Endocrinology for consideration of medical therapy. His bone turnover markers were slightly elevated with normal calcium, phosphate, 25-OH vitamin D, and parathyroid hormone levels. A bone density scan showed lumbar spine osteopenia. He was commenced on 60 mg denosumab 6-monthly with excellent clinical and radiological responses over the next 30 months. The most recent CT mandible showed a sustained reduction in the lesion size, measuring 36 × 18 mm, with osteoid formation and improvement in cortical thinning. Surgery is no longer indicated. No adverse effects from denosumab were reported in the patient. This is the first study to report the efficacy and safety of a low-dose denosumab regimen in the management of cherubism. This treatment approach was able to prevent major surgery and minimize denosumab-related adverse effects. While the optimal treatment duration remains unclear, the patient will continue with 60 mg denosumab 6-monthly in the short-term given the favorable response. In summary, a low-dose denosumab regimen should be considered for patients with cherubism, particularly those with contraindications or preferences to avoid surgery.

The Effect of Patient-associated Factors on Long-Term Survival of Dental Implants

Dental implant therapy has developed over the past half century to have documented successful outcomes in most patients who receive treatment. The long-term survival of dental implants depends upon a variety of factors including patient, surgeon, restorative dentist, and materials-related factors. The impact of patient-associated factors may impact significantly on the success of dental implants including diabetes mellitus, medications, smoking, parafunctional habits, oral hygiene, head and neck radiation, and the use of bisphosphonates, antiangiogenic, and antiresorptive medications.

Effectiveness of immediate implant placement into defective sockets in the esthetic zone: A systematic review and meta-analysis

STATEMENT OF PROBLEM

A defective socket is common after tooth extraction in the esthetic zone, but whether an implant can be immediately placed in a defective socket is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to summarize relevant studies within the last 20 years on implant survival and changes in soft and hard tissues after immediate implant placement in esthetic areas with socket defects.

MATERIAL AND METHODS

A search was conducted for the relevant studies in the PubMed/Medline, the Cochrane Library, Web of Science, and Embase databases from January 2000 to March 2022. The literature review, data retrieval, and judgment whether the included studies had a risk of bias were handled independently by 2 reviewers, and a single-arm meta-analysis was performed using a statistical software program.

RESULTS

A total of 23 studies evaluating the immediate implant placement of 630 implants (9 studies without a flap and 14 studies with a flap) were included. A 98.1% implant survival rate (95% confidence interval (CI): 96.2%, 100.0%) was determined. Marginal bone loss (MBL) at 6, 12, and ≥24 months were 1.03 mm (95%CI: 1.02, 1.03), 0.72 mm (0.72, 0.73), and 1.15 mm (1.14, 1.16). Gingival recession at 12 months was 0.25 mm (95%CI: 0.17, 0.33). The pink esthetic score (PES) were 12.34 (95%CI: 12.16, 12.52) at 12 months and 12.58 (12.39, 12.76) at ≥24 months.

CONCLUSIONS

Current evidence shows that immediate implant placement into defective sockets in esthetic areas is feasible. Immediate implant placement can have a relatively good therapeutic effect in terms of implant survival rate, MBL, gingival recession, and PES.

Predictors of Mortality in Acute Myocardial Infarction Patients With Systemic Lupus Erythematosus

Introduction Acute myocardial infarction (AMI) remains a leading cause of mortality globally, with systemic lupus erythematosus (SLE) posing additional risks for adverse outcomes. Methods This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020 to investigate predictors of mortality among hospitalized AMI patients, stratified by SLE status. Results A total of 81,935 patients were included, with variables analyzed using multivariate logistic regression. Among SLE patients, being female, aged ≥65 years, and having a prolonged hospital stay >5 days were associated with higher mortality. Elective admissions were protective while non-Hispanic Black SLE patients showed reduced odds of mortality compared to their non-Hispanic White counterparts. Among non-SLE patients, predictors of increased mortality included being non-Hispanic Black and having prolonged hospital stays. Private insurance coverage was associated with lower mortality in this group. Conclusion These findings highlight critical patient- and hospital-related factors influencing mortality in AMI patients with and without SLE. Targeted strategies focusing on early recognition, effective interventions, and reducing healthcare disparities are essential to improve outcomes in this population.

Evaluating diagnostic uncertainty and the role of surgical management in cherubism: a review of nine cases

OBJECTIVE

Cherubism is a rare genetic disorder characterized by bilateral proliferative lesions of the mandible and maxilla. Diagnosis is complex and conservative management is favored; however, aggressive cases often require surgical intervention. This study aims to enhance understanding of diagnostic challenges and surgical strategies to address functional and aesthetic concerns.

STUDY DESIGN

Nine patients diagnosed with cherubism from 2010 to 2024 were included. Patients were graded from I to VI. Clinical presentation, radiographic and histopathologic data, and treatment courses were documented. Outcomes included symptom resolution, functional and aesthetic results.

RESULTS

Mean age at consultation was 8.1 ± 3.4 years. All patients had mandibular involvement; six had maxillary involvement. Genetic testing identified a SH3BP2 mutation in one patient. Two Grade VI cases presented with respiratory and ophthalmic symptoms. Seven patients underwent surgical debulking. Patients with Grade VI cherubism underwent multiple debulking procedures and one received adjuvant denosumab therapy. Surgical outcomes were favorable, with improved facial symmetry in all patients and significant improvement in proptosis and respiratory symptoms in severe cases.

CONCLUSIONS

Cherubism is a rare disease that requires an individualized management approach. Surgical management is effective in aggressive cases involving rapidly expanding lesions, impending pathologic fracture, and severe psychosocial distress. Denosumab is a promising adjuvant therapy for enhancing surgical outcomes.

Randomized, Placebo-Controlled Pilot Study of Naproxen During Dental Implant Osseointegration

OBJECTIVES

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed following the placement of dental implants, but the effects of these drugs on the osseointegration process are poorly understood. We designed a randomized, placebo-controlled pilot study to quantitatively assess the effect of NSAIDs during early implant osseointegration.

MATERIALS AND METHODS

Subjects receiving a maxillary dental implant were randomized to take naproxen or placebo for 7 days after the surgery. Implant osseointegration was quantified using Resonance Frequency Analysis device. Implant-Stability-Quotient (ISQ) measurement was performed at the time of surgery and at follow-up visits 1, 4, and 16 weeks after surgery. Periapical radiographs were taken to measure the marginal bone level. Separately, a questionnaire of NSAIDs usage was provided to subjects presenting with early implant failure.

RESULTS

After 4 weeks, ISQ values increased modestly ( + 1%) in subjects receiving naproxen whereas subjects receiving placebo had a much larger increase in ISQ value (+41%). We observed 55% more marginal bone loss at 4 weeks, and 52% at 16 weeks in the naproxen group compared to the placebo group. These results were not found to have statistically significant between groups (p ≥ 0.05). These effect sizes and variance were used to conduct a power analysis to determine the necessary sample size for future studies. Furthermore, our separate questionnaire study revealed that 68% of our patients with early failed dental implants reported a history of NSAIDs usage after the surgery.

CONCLUSION

In conclusion, this pilot study provides effect sizes and sample size estimates for future studies to definitively determine recommendations regarding NSAID usage following dental implant surgery. Nonetheless, our study did not observe any statistically significant differences in ISQ value or marginal bone loss after up to 16 weeks of follow-up between subjects from naproxen and placebo groups.

Effect of different wound closure interventions on the clinical outcomes following immediate implant placement in the aesthetic area: A network meta-analysis based on thirty-four studies

OBJECTIVE

The purpose of this study was to systematically compare and assess the effect of various wound closure interventions on the clinical outcomes following immediate implant placement (IIP) in the esthetic zone.

DATA

Studies comparing the clinical effect of different interventions in the process of wound closure in IIP were included.

SOURCES

A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of science, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang Database.

STUDY SELECTION

A total of 34 studies involving 1213 implants and eight interventions were included in the network meta-analysis (NMA). The agreement between reviewers reached a kappa value of 0.84. In terms of reducing marginal peri-implant recession (MPR), as the primary outcome, NMA showed that connective tissue graft (CTG) [MD = -0.44, 95 % CI (-0.56, -0.33)], collagen matrix (CM) [MD = -0.32, 95 % CI (-0.46, -0.17)] and CGF [MD = -0.11, 95 %CI (-0.16, -0.06)] showed significant less MPR than the control group, and CTG [MD = -0.33, 95 %CI (-0.46, -0.20)] and CM [MD = -0.20, 95 %CI (-0.36, -0.05)] were also associated with less MPR compared to concentrate growth factor (CGF). The optimal intervention to prevent MPR was CTG. Among the secondary outcomes, CTG was determined as the optimal intervention to increase gingival thickness (GT), CGF ranked as the promising intervention to reduce marginal bone loss (MBL) and improve pink aesthetic score (PES).

CONCLUSION

The use of CTF could enhance soft tissue stability by minimizing MPR and increasing GT in the process of wound closure in IIP, and CGF could better prevent MBL and improving PES. However, the findings related to CGF were based on a limited number of studies.

CLINICAL SIGNIFICANCE

CTG and CGF ought to be worthy of clinical promotion to intervene wound closure of IIP in esthetic area, with the ability of improving the peri-implant soft and hard tissues. However, clinicians should still consider the specific clinical situation when selecting the most appropriate intervention or alternative materials.

Immediate implant placement in the premolar maxillary area: a cone-beam computed tomography study

PURPOSE

This research aimed to investigate potential factors associated with the risk of perforation of the labial bone plate, nasal floor, or maxillary sinus floor during immediate implant placement (IIP) in the maxillary premolar area, utilizing a cone-beam computed tomography (CBCT) virtual study.

METHODS

CBCT exams from 179 eligible participants, encompassing 716 teeth, were included. Implants were virtually positioned in 2 orientations: along the long axis of the tooth (the prosthetically-driven position) and in an optimal position relative to adjacent anatomical structures (the bone-driven position). Binary logistic regression analysis was employed to assess potential associations between perforation or invasion and various covariates, including sex, age, tooth region, the distance from the tooth apex to the nasal floor or maxillary sinus floor, the angle between the prosthetically- and bone-driven positions (implant-line A angle [ILAA]), and the labial concavity angle (LCA).

RESULTS

The mean ILAA was 18.3°±8.0°, and the angle was significantly larger for the second premolar compared to the first premolar. The mean minimum implant length was 13.0±2.1 mm, with a bone anchorage of 4 mm. The incidence of perforation was 84.1% for the prosthetically-driven position and 40.5% for the bone-driven position. Factors associated with a higher risk of cortical bone wall perforation or invasion of the 2-mm safety margin from surrounding anatomical structures (in the bone-driven position) included female sex, older age, shorter distance from the tooth apex to the nasal cavity/maxillary sinus, and smaller LCA.

CONCLUSIONS

A high prevalence of cortical bone wall perforation or invasion of the 2-mm safety margin is anticipated when performing IIP in the maxillary premolar region.

A Retrospective Cohort Study on Scan Quality of Implant Scanbodies Matched With CAD Libraries

PURPOSE

To assess the effect of scanbody (SB)-type, edentulous site, and restoration-type on the scan quality of SBs used in the treatment of short-span edentulism.

MATERIALS AND METHODS

The cohort consisted of SBs with different specifications connected to bone-level implants for intraoral digitalization in the fabrication of fixed restorations. SBs matched with library CAD files for digital implant position transfer into dental CAD software were enrolled in the study group. Intraoral implant digital records were categorically evaluated to assess the quality of SB scans. In statistical analyses, the chi-squared test was used to describe the clinical variables, and logistic regression models were constructed to reveal the association between the clinical variables and SB scan quality.

RESULTS

A total of 243 SBs were eligible for scan quality evaluation. Scan quality did not differ statistically (p > 0.05) in the SB reference area, while texture in the representation of SB was significantly affected (p < 0.05) by the variables SB-type and edentulous-site. Cylindrically designed SBs without specific geometrical features presented remarkably higher risks for reduced scan quality in SB representation.

CONCLUSION

SBs successfully aligned with library CAD files based on a software algorithm may not consistently present similar scan quality. Intraoral scanning of a SB is highly vulnerable with regard to scan deterioration in texture and geometry.

The Psychophysical Assessments of Tactile, Temperature and Electrical Perception for Implants With Metal Prosthetic Surfaces

Tactile function and thermal perception are 2 primary functions of oral structures. Implants without periodontal ligaments and pulp might fail to sense tactile and temperature changes. This study aimed to investigate implants' tactile, thermal, and electrical perception by detailed psychophysical assessments. A total of 48 patients with single implant restoration were recruited. Mechanical (5 intensities), cold (4 temperatures), and electrical stimulation were, respectively, applied to implants and natural teeth, and the psychophysical results were recorded with a visual analog scale and compared between implants and natural teeth. For tactile perception, at low and medium forces, implants were significantly poorer than natural teeth (P ＜ .01), but at the largest force, there were no significant differences (P > .05). Regarding thermal perception, thermal changes on implants could be detected although the signals were weaker when compared with natural teeth (P ＜ .01). Implants were less sensitive to electrical stimulation than natural teeth (P ＜ .01). Even though there is no periodontium and pulp, dental implants could perceive the mechanical, thermal, and electrical stimulation weakly.

Survival of dental implants placed in a postgraduate educational setting: a retrospective cohort study

INTRODUCTION

Dental implant treatment can still fail due to various factors. The aim of this retrospective cohort study was to assess the influence of operator experience in a postgraduate educational setting, as well as patient, implant, and surgical risk factors on the incidence of the dental implant failure.

METHODS

The dental records of 1049 implants with a mean follow-up of 794.70 days were analysed. Variables included operator experience (year of specialty study) and clinic-pathological patients' related variables. Clinic-pathological associations were explored and a Cox regression model accounted for implant survival factors.

RESULTS

Multivariate analysis revealed that a history of periodontitis and smoking were the only factors with independent prognostic value, with hazard ratios of 2.0 (95 % CI: 1.0-4.0, p = 0.048) and 1.9 (95 % CI: 1.0-3.6, p = 0.039) respectively. Conversely, despite implant treatment delivered by early career students had a higher failure rate (5.6 %) compared to advanced career students (3.7 %), this difference was statistically significant only in the univariate analysis.

CONCLUSION

Periodontitis and smoking are independent prognostic variables, with career level potentially biasing complex case allocation to advanced students. Targeted educational interventions, including virtual reality and artificial intelligence, should be emphasized in student training. University-based implant trials must consider operator career stage.

CLINICAL SIGNIFICANCE

The study underscores the importance of operator experience in dental implant success. It highlights that while clinical experience influences outcomes, factors like a history of periodontitis and smoking are independent predictors of implant failure. These findings emphasize the need for targeted educational interventions to improve clinical training and patient outcomes.

A 10-year Retrospective Clinical Study to Identify Risk Indicators for Peri-Implant Bone Loss and Implant Failure

AIM

To evaluate long-term survival and success of dental implants and evaluate indicators affecting the long-term outcome.

MATERIALS AND METHODS

Implant survival, success and crestal bone loss (BL) over time were evaluated. For covariates at patient level, Kaplan-Meier estimates of implant survival were compared between groups with the log-rank test. Observed mean bone loss (MBL) was plotted as a function of time. Cumulative frequencies of BL were plotted for different post-op times. Uni- and multivariate analysis was performed. Simple linear mixed and multiple linear mixed models for BL at 1, 5 and 10 years were fitted.

RESULTS

407 patients (221 women, 186 men; mean age 64.86 years (range 28-92, SD 10.11)), with 1482 implants, responded. Absolute implant survival was 94.74%; MBL was 0.81 mm (SD 1.58, range 0.00-17.00) after an average follow-up of 10.66 years (range 10-14, SD 0.87). Implant survival was influenced on implant level by smoking, implant width and early bone loss (EBL) > 0.5 mm; on patient level by a history of periodontitis. Indicators influencing MBL after the 1st year were abutment height, type of surgery and implant width, while after 5 and 10 years of function were abutment height, EBL > 0.5 mm and smoking.

CONCLUSION

Implant survival was significantly affected by a history of periodontitis on patient level and by smoking, implant width and EBL > 0.5 mm on implant level. Late bone loss was significantly affected by abutment height, EBL > 0.5 mm and smoking.

TRIAL REGISTRATION

B670201524796.