Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions

Application of a semi-active robotic system for implant placement in atrophic posterior maxilla: A retrospective case series

OBJECTIVE

The study aimed to evaluate the accuracy and safety of a semi-active robotic system for implant placement in atrophic posterior maxilla.

METHODS

Patients underwent robot-assisted implant placement in atrophic posterior maxilla were identified and included. Cone-beam computed tomography (CBCT) was performed before surgery. The virtual implant position and drilling sequences were planned in the robotic planning system. Patients with positioning marker took an intraoral scan. The preoperative CBCT and the intraoral scan were superimposed in the robotic software. After registration, the implant bed was prepared utilizing the robotic arm with 1 mm safety margin below the maxillary sinus floor. The transcrestal sinus floor elevation (TSFE) was performed by the dentist, followed by the implant placement with the robotic arm. A postoperative CBCT was taken and superimposed with the preoperative one to calculate the accuracy of implant placement. Complications and adverse events were recorded. Deviations between the implant platform and apex levels were analyzed using the paired t-test. P < 0.05 was considered statistically significant.

RESULTS

Twenty-seven implants of 20 patients were included. No intraoperative and postoperative complications were reported. The global, lateral and vertical platform deviations were 0.73 ± 0.27 mm, 0.35 ± 0.23 mm and 0.35 ± 0.57 mm, respectively. The global, lateral and vertical apex deviations were 0.77 ± 0.23 mm, 0.41 ± 0.20 mm and 0.34 ± 0.57 mm, respectively. There were significant differences between the global, lateral and vertical deviations between the implant platform and apex levels (P < 0.05, respectively). The angular deviation was 1.58 ± 0.76°.

CONCLUSIONS

High accuracy and safety for implant placement in atrophic posterior maxilla could be achieved using a semi-active robotic system, with the TSFE procedure performed by the dentist.

CLINICAL SIGNIFICANCE

This study provides significant evidence to support the application of semi-active robotic systems for implant placement in atrophic posterior maxilla.

Gingival color with implant-supported fixed prostheses (ISFP) and the impact on esthetic outcomes

OBJECTIVES

To: 1) analyze possible differences in the CIEDE2000 lightness, chroma and hue of the gingiva at the free gingival margin (FGM) and the middle zone of keratinized gingiva (MZ) between participants with an ISFP in the maxillary anterior region and participants with natural dentition and healthy gums; and 2) examine the perceptibility/acceptability of the differences in CIEDE2000 lightness, chroma and hue and in overall color, using the Euclidean and CIEDE2000 formulae.

METHODS

The L*, a* and b* color coordinates were measured in 60 adult participants (30 with an ISFP and 30 with healthy teeth and gums) using a Spectroshade™ Micro spectrophotometer. From these coordinates, the changes in lightness (ΔL'), chroma (ΔC') and hue (ΔH') CIEDE2000 between the participants with and without an ISFP were quantified. The one sample t-tests were used to test whether there were significant changes in lightness, chroma and hue between the participants with and without an ISFP, and effect size was assessed with Cohen's d. The authors examined the differences in CIEDE2000 lightness, chroma and hue, and the overall color differences between the participants in pairs (with ISFP-without ISFP), comparing results with the published perceptibility and acceptability thresholds.

RESULTS

Statistically significant differences were found (p < 0.05) between participants with and without an ISFP in all color attributes at both zones, with all color attributes observed to be lower in the gingiva of participants with an ISFP. In both gingival zones, the ISFP had a large effect on lightness (Cohen's d > 0.8) and a medium effect on hue (Cohen's d between 0.5 to 0.8). The mean gingival color difference of participants with and without an ISFP was 8.72 units in the MZ and 9.60 units at the FGM, using CIEDE2000.

CONCLUSIONS

CIEDE2000 lightness, chroma and hue are significantly lower in participants with an ISFP, both at the FGM and the MZ, with particularly marked differences in lightness. The average color difference between healthy gingiva next to natural teeth and the gingiva adjacent to an ISFP is clinically unacceptable.

CLINICAL RELEVANCE

Gingival color needs to be considered an indicator of success, given the potential unesthetic gray show-through of transmucosal abutments with ISFPs. Unacceptable color changes caused by poorly planned ISFPs can lead patients to demand treatment be repeated with more esthetic materials or mucogingival surgery to "camouflage" the discoloration.

An in vitro assessment of the accuracy of guided tilted and axial implant placement in the edentulous mandible

PURPOSE

To assess the precision of implant placement when comparing tilted orientations to axial orientations, utilizing a fully guided surgical protocol in an edentulous mandibular model.

MATERIALS AND METHODS

Fourteen rubber-coated mandibular models were scanned with fiducial markers using a commercial benchtop surface scanner, followed by cone beam computed tomography for implant planning through a dual-scan protocol. The models were randomly divided into control and experimental groups. In the control group, each model was planned for four axially oriented implants. Conversely, the experimental models were planned for two axially oriented implants near the lateral incisors and two posteriorly tilted implants at a 30-degree angle. A mucosal-supported, pin-retained surgical guide was designed and 3D-printed, facilitating the fully guided implant placement. All implants received scan bodies and were rescanned for evaluation of the trueness between the planned and the actual implant location using the implant planning software. Mixed model ANOVA was used to detect differences between groups with regards to angular deviation, offset at base, and offset at tip.

RESULTS

A total of 56 implants were placed across all models. Fourteen posterior implants in each group served as control and experimental conditions, while the remaining 28 anterior implants acted as secondary control. No significant differences were observed between the experimental and control groups in terms of angular deviation (p = 0.7001), offset at base (p = 0.6409), or offset at tip (p = 0.6931). Analysis comparing anterior implant deviations between groups and anterior to posterior implant deviations within the control arches also was not significant. However, secondary analysis revealed a significant difference between anterior and posterior implants within the experimental group for offset at base (p = 0.0087) and offset at tip (p = 0.0288).

CONCLUSIONS

Despite the limitations inherent to a benchtop study, the findings suggest that there are no statistically significant 3D deviations at the base or apex, nor in angular deviations, when comparing tilted and axial implant placements using a digital workflow and fully guided protocols in an edentulous model.

Accuracy of a Novel Robot-Assisted System and Dynamic Navigation System for Dental Implant Placement: A Clinical Retrospective Study

AIM

This clinical retrospective study aimed to compare the deviations in single-tooth implant placement using novel semi-autonomous robotic-assisted surgery system (sa-RASS) and dynamic navigation system (DNS) methods.

MATERIALS AND METHODS

A retrospective analysis of medical records from January to December 2023 was conducted to compare the implantation accuracy of the sa-RASS and DNS in partially edentulous patients using cone-beam computed tomography. Platform, apex, and angular deviations were measured and analyzed. The Kolmogorov-Smirnov test was used to check the data distribution, along with t-tests or Mann-Whitney U-tests, where appropriate.

RESULTS

Fifty-seven patients (57 implants) were analyzed: 29 (29 implants) in the sa-RASS group and 28 (28 implants) in the DNS group. The comparison of platform, apex, and angular deviation between the sa-RASS group and DNS group were 0.91 ± 0.46 mm vs. 1.26 ± 0.51 mm (p < 0.001), 1.06 ± 0.60 mm vs. 1.51 ± 0.56 mm (p < 0.001), and 3.07° ± 1.66° vs. 3.71° ± 1.64° (p > 0.05), respectively. In addition, there was no significant difference in the accuracy of different implant regions (premolar, molar, maxilla, and mandible) or implant length (p > 0.05).

CONCLUSIONS

In the present study, sa-RASS implant placement showed better positional accuracy than DNS implant placement in platform and apex deviation, although these improvements in accuracy may have limited clinical relevance, suggesting that the sa-RASS might be advantageous in dental implant surgery.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: ChiCTR2400085089.

Enhancing Implant Success in Mandibular Reconstruction: A Novel Approach Combining Implant-Retained Splint and Vestibuloplasty-A Case Series

Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation more difficult. This study introduces a novel approach combining vestibuloplasty with patient-specific implant-retained splints to enhance oral health and improve rehabilitation outcomes. Methods: Three patients underwent mandibular reconstruction with a free vascularized fibula flap (FFF). After 6 months of osseointegration, vestibuloplasty and soft tissue refinement were performed, with a split-thickness skin graft placed on the FFF periosteum. An implant-retained splint was secured to the abutments for two weeks to support soft tissue healing. Implant survival, bone loss, and peri-implant health were evaluated over a 2-year follow-up. Results: A total of 12 implants were placed, primarily in the neomandible (83.3%), with a 100% survival rate. Implant survival was assessed. Implant survival was assessed based on established criteria for clinical success, including stability, presence of pain, bleeding on probing (BOP), pocketdepth, bone loss and lack of peri-implant radiolucency. Functional outcomes included normal mouth opening, laterotrusion, and protrusion. Pocket depths ranged from 3 to 4 mm, except for one implant in cases 1 and 2. The mean BOP was 51.7%. Conclusions: This case series introduces a surgical technique that combines CAD/CAM and vestibuloplasty to optimize dental rehabilitation in mandibular FFF reconstructions, demonstrating safe thinning of soft tissues for improved oral hygiene and survival.

Minimally invasive myo-osseous chimeric DCIA-flap without crest, spine and skin to reconstruct composite defects of the mandible using virtual surgical planning and CAD/CAM technology

BACKGROUND

The medial approach for minimally invasive harvesting of a deep circumflex iliac artery (DCIA) flap is described for reconstruction of the jaw. The associated preservation of the crest of the ilium prevents the raising of the abdominal internal oblique muscle (IO) in a standard fashion. However, reconstructive surgery of composite mandibular defects includes bone and soft tissue. To achieve this goal, we combined this technique with a new perforator-based raising of the IO for reconstruction of intraoral soft tissue.

METHODS

In this study, we present eight cases of patients with composite mandibular defects who underwent the myo-osseous DCIA flap procedure with an IO perforator. Virtual surgical planning was employed to preplan the size and configuration of the graft. Cutting guides were made using CAD/CAM technology. The surgical procedure followed the described medial approach for minimally invasive harvesting, leaving the iliac crest, spine, and skin intact. In addition, we completely cut and isolated the IO with its sole attachment being the ascending branch of the DCIA. We used either a surgical guide with a slot to lead through both the transverse branch of the bone and the ascending branch of the IO or a surgical guide consisting of 2 parts.

RESULTS

In all instances, the flap successfully survived with a 100% success rate. There were no signs of infection, wound opening, or bleeding in either patient. Furthermore, the patients did not exhibit permanent complications related to the donor site. The internal oblique perforator flap exhibited remarkable integration in all patients and underwent rapid transformation. Notably, the flap developed keratinized mucosa (KM) that closely resembled the attached gingiva.

CONCLUSION

Our study demonstrated the effectiveness of a medial approach for harvesting a newly designed more flexible chimeric myo-osseous deep circumflex iliac artery flap. By incorporating virtual surgical planning and custom-made cutting guides for obtaining deep circumflex iliac artery flaps through the medial route along with an internal oblique perforator flap, we have established a highly promising method for the rehabilitation of patients with composite mandibular defects. This approach not only improves functional outcomes, but also enhances aesthetic results to maintain patients' quality of life.

D-arginine-loaded pH-responsive mesoporous silica nanoparticles enhances the efficacy of water jet therapy in decontaminating biofilm-coated titanium surface

Peri-implantitis, caused by bacterial biofilm on dental implants, leads to bone loss and tissue inflammation, ultimately causing oral health decline. Traditional methods to remove biofilm are ineffective in promoting reosseointegration on implant surfaces. This phenomenon can be attributed to two factors: incomplete removal of biofilm from hard-to-reach areas and alterations in the physicochemical properties of implant surfaces caused by decontamination procedures. To address this problem, we developed D-arginine-loaded chitooligosaccharide-capped pH-responsive mesoporous silica nanoparticles (Dar@MSN-COS) for improving the efficacy of decontamination of Water Jet (WJ). Dar@MSN-COS particles exhibit a targeted approach towards the extracellular polymeric substance (EPS) in order to disrupt the biofilm, and possess the capability to infiltrate confined areas between implant screws. Following this, the WJ treatment effectively removed residual biofilm and demonstrated improved cleaning efficacy. Furthermore, the decontamination of the Dar@MSN-COS combination with WJ promotes effective cell cytocompatibility on the titanium surface. The results of mechanistic experiments indicate that Dar@MSN-COS may act on biofilms by releasing a significant quantity of reactive oxygen species (ROS), suggesting it as a key contributing factor. In summary, our novel therapeutic protocol shows promise as an alternative solution for addressing the clinically complex aspects of peri-implantitis.

Microscale bone interlocking enhances osseointegration strength on the rough surface of 3D-printed titanium implants: experimental and finite element analysis

BACKGROUND

The advent of 3D-printing technology, which is capable of on-demand fabrication, has ushered in a new era for fixed implant prosthodontics. Over the past decade, immediately loaded 3D-printed titanium implants have demonstrated predictable clinical outcomes in human jaws, highlighting their superior osseointegration strength, which is attributed to their increased surface roughness. However, the biomechanical mechanisms underlying this enhanced osseointegration strength remain elusive, thereby impeding the standardization and broader clinical application of 3D-printed titanium implants.

METHODS

Experimental 3D-printed titanium implants were fabricated via selective laser melting (SLM), and conventional sandblasted and acid-etched titanium implants (CNC-SLA) served as the control group. Implant surfaces were characterized with scanning electron microscopy, surface profilometry, energy-dispersive X-ray spectroscopy, and a contact angle meter. Implants (n = 10) were surgically inserted into the femoral condyle of New Zealand rabbits. At weeks 1, 2, and 8, micro-CT and undecalcified histological sections were used to assess histological osseointegration (n = 6), whereas removal torque analysis was performed to evaluate osseointegration strength (n = 4). At week 8, microscale finite element analysis of different bone-implant interfaces was conducted to predict the peri-implant bone strain under multidirectional implant loading.

RESULTS

The surface roughness of the SLM implants was significantly greater than that of the CNC-SLA implants. Histological osseointegration assessments revealed equal levels of SLM and CNC-SLA implants at weeks 1, 2, and 8. Notably, after week 2, bone interlocking phenomenon appeared on the SLM implants. The removal torque for the SLM implants at week 2 were significantly greater (P < 0.05) than that for the CNC-SLA implants at the same time point and was comparable to the CNC-SLA implants at week 8 (P = 0.775). The removal torque for the SLM implants at week 8 was further increased. Microscale finite element analysis revealed that the rough surface of the SLM implants dispersed harmful strains at the bone-implant interface into the surrounding bone, thereby mitigating the risk of damage to the bone-implant interface.

CONCLUSIONS

The rough surface of 3D-printed titanium implants fosters microscale bone interlocking and alleviates peri-implant bone strain concentration, which is a promising biomechanical basis for osseointegration strength.

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.

Osseodensification technique in crestal maxillary sinus elevation-A narrative review

Osseodensification is a novel approach that has significantly advanced the field of implant dentistry, particularly in the context of transcrestal maxillary sinus floor elevation. This technique involves the use of specially designed burs that compact and densify bone along the osteotomy walls, thereby enhancing implant primary stability and facilitating osseointegration in low-density bone. This article reviews the historical evolution of implant site preparation, and the biomechanical, histological, and clinical evidence of osseodensification with a special focus on its application in sinus floor augmentation. The integration of this technique into contemporary practice represents a paradigm shift, offering a minimally invasive and efficient solution for addressing the challenges of posterior maxilla, with improved patient-reported outcomes and low complication rate. Three different protocols for sinus lift and implant placement using osseodensification burs are proposed based on available literature, and risk factors for Schneiderian membrane perforation based on residual bone height are discussed, along with implant-related outcomes and patient-reported outcome measures. The potential for osseodensification to become a standard practice in sinus floor augmentation is emphasized, highlighting key aspects such as surgical protocol and patient selection.

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.

Influence of Implant Geometry on the Surface Strain Behavior of Peri-Implant Bone: A 3D Analysis

To ensure long-term implant success, it is crucial to understand the force transmission from the implant to the surrounding bone. In dentistry, bioengineering methods are applied to investigate these processes. The aim of this study was to analyze the influence of different implant geometries on the surface strain behavior of porcine mandibles under load using a 3D optical camera system in combination with digital image correlation. Four different implant types were subjected to a force of 200 N in three different loading directions (axial, non-axial 15°, and non-axial 30°). Under axial loading, parallel-walled implants exhibited lower surface strain values on the peri-implant bone compared with tapered implants. However, when subjected to non-axial loading, these parallel-walled implants showed a substantial relative increase in strain by approximately a factor of 2.96 compared with axial conditions. At a 30° non-axial angle, long, tapered implants with a smaller diameter (BLX 3.75) produced lower peri-implant bone strains than implants with larger diameters and shorter lengths, while short, tapered implants (BLT) demonstrated a lower relative increase in strain (factor ~1.49) from axial to non-axial loading. Under non-axial loading, long, tapered implants with a small diameter resulted in lower strains in the peri-implant bone compared with implants with a larger diameter and shorter length. It was found that non-axial loads lead to higher strains than axial loads. Therefore, the success of implantation could be significantly influenced by selecting an appropriate implant geometry and the correct angulation of the implant.

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.

The Modified Coronally Advanced Tunnel Technique for Coverage of Mucosal Recessions at Dental Implants

OBJECTIVES

To clinically evaluate the outcomes following surgical coverage of single peri-implant mucosal recessions in the aesthetic maxillary area by means of the modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG).

MATERIALS AND METHODS

Eleven systemically healthy non-smoking patients (8 females) each presenting a single peri-implant mucosal recession in the anterior maxillary region were consecutively treated with MCAT in conjunction with SCTG. In all cases, the facial recession was associated with an impaired aesthetic appearance. Before reconstructive surgery and at 12 months postoperatively, clinical and aesthetic parameters were assessed. The primary outcome variable was the mean mucosal recession coverage (MRC).

RESULTS

Healing was uneventful in all cases. At 12 months, statistically significant (p < 0.05) recession coverage (MRC 94.71%) and improvement of aesthetics (pink aesthetic score) was obtained at all implants. Complete RC was obtained in 10 out of the 11 patients (90.9%). The treatment was associated with a statistically significant gain of keratinized and attached mucosa (p < 0.05).

CONCLUSION

The present results demonstrate that single peri-implant mucosal recessions in the maxillary aesthetic area can be successfully treated with MCAT and SCTG.

Constructing an Injectable Multifunctional Antibacterial Hydrogel Adhesive to Seal Complex Interfaces Post-Dental Implantation to Improve Soft Tissue Integration

Soft tissue integration (STI) around dental implants determines their long-term success, and the key is to immediately construct a temporary soft tissue-like barrier to prevent bacterial invasion after implantation and then, promote STI. In response to this need, an injectable multi-crosslinked hydrogel (MCH) with abilities of self-healing, anti-swelling, degradability, and dry/wet adhesion to soft tissue/titanium is developed using gallic acid-graft-chitosan, oxidized sodium alginate, gelatin, and Cu2+ with water and borax solution as solvents, whose properties can be controlled by adjusting its composition and ratio. MCH can not only immediately build a sealing barrier to block the bacterial invasion in the oral simulation environment but also deliver outstanding antibacterial efficacy through the synergism of trapping bacteria and releasing bactericidal agents such as chitosan, gallic acid, aldehyde, and Cu2+. Moreover, MCH has an adjustable ROS-scavenging ability imparted by gallic acid, chitosan, and gelatin to reduce inflammation and can control the release of Cu2+. Based on these, it is believed that by injecting MCH around implants (percutaneous/transmucosal) after surgery, a universal non-aggressive strategy to promote STI can be developed for long-term implant success.

Unlocking Osseointegration: Surface Engineering Strategies for Enhanced Dental Implant Integration

Tooth loss is a prevalent problem faced by individuals of all ages across the globe. Various biomaterials, such as metals, bioceramics, polymers, composites of ceramics and polymers, etc., have been used for the manufacturing of dental implants. The success of a dental implant primarily depends on its osseointegration rate. The current surface modification techniques fail to imbibe the basics of tooth development, which can impart better mineralization and osseointegration. This can be improved by developing an understanding of the developmental pathways of dental tissue. Stimulating the correct signaling pathways through inductive material systems can bring about a paradigm shift in dental implant materials. The current review focuses on the developmental pathway and mineralization process that happen during tooth formation and how surface modifications can help in biomimetic mineralization, thereby enhancing osseointegration. We further describe the effect of dental implant surface modifications on mineralization, osteoinduction, and osseointegration; both in vitro and in vivo. The review will help us to understand the natural process of teeth development and mineralization and how the surface properties of dental implants can be further improved to mimic teeth development, in turn increasing osseointegration.

Global research interest and publication trends on guided surgery in implant dentistry: A metrics-based analysis

STATEMENT OF PROBLEM

Digital surgical guides improve precision by detailing the direction, position, and angle of implants, which reduces surgery time and complications. A bibliometric analysis of guided surgery in implant dentistry is lacking.

PURPOSE

The aim of this metrics-based analysis was to analyze the trends and key characteristics of articles related to guided surgery in implant dentistry.

MATERIAL AND METHODS

The search was conducted in February 2024 on the Web of Science. The main characteristics of the studies were extracted and analyzed. Collaborative networks were generated using the Vosviewer software program. Dimension was consulted to measure Altmetric data. Correlation among data was determined by using the Spearman test.

RESULTS

A total of 799 articles published between 1993 and 2023 were included. Most were case reports or series (n=26) using static guided surgery (n=672), primarily for dental implant placement (n=754). The studies typically employed a combination of cone beam computed tomography (CBCT) and digital scanning (n=316) for surgical planning. The most frequently used software program was coDiagnostiX (n=89), and the most commonly used guide type was the printed guide (n=161). The country with the most articles was the USA (n=137), though Europe stood out as the leading continent (n=398). The Vosviewer demonstrated strong collaborations among authors. According to Dimensions, significant mentions were identified in Mendeley, news outlets, and X.

CONCLUSIONS

An emerging trend in guided implant dentistry research was identified over the past 30 years through the use of software programs and 3D-printers for the fabrication of surgical guides. Europe showed the greatest interest in this topic, predominantly conducting research on static guided surgery for implant placement. Additional clinical studies and systematic reviews are needed.

Evaluation of accuracy of deep learning and conventional neural network algorithms in detection of dental implant type using intraoral radiographic images: A systematic review and meta-analysis

STATEMENT OF PROBLEM

With the growing importance of implant brand detection in clinical practice, the accuracy of machine learning algorithms in implant brand detection has become a subject of research interest. Recent studies have shown promising results for the use of machine learning in implant brand detection. However, despite these promising findings, a comprehensive evaluation of the accuracy of machine learning in implant brand detection is needed.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the accuracy, sensitivity, and specificity of deep learning algorithms in implant brand detection using 2-dimensional images such as from periapical or panoramic radiographs.

MATERIAL AND METHODS

Electronic searches were conducted in PubMed, Embase, Scopus, Scopus Secondary, and Web of Science databases. Studies that met the inclusion criteria were assessed for quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analyses were performed using the random-effects model to estimate the pooled performance measures and the 95% confidence intervals (CIs) using STATA v.17.

RESULTS

Thirteen studies were selected for the systematic review, and 3 were used in the meta-analysis. The meta-analysis of the studies found that the overall accuracy of CNN algorithms in detecting dental implants in radiographic images was 95.63%, with a sensitivity of 94.55% and a specificity of 97.91%. The highest reported accuracy was 99.08% for CNN Multitask ResNet152 algorithm, and sensitivity and specificity were 100.00% and 98.70% respectively for the deep CNN (Neuro-T version 2.0.1) algorithm with the Straumann SLActive BLT implant brand. All studies had a low risk of bias.

CONCLUSIONS

The highest accuracy and sensitivity were reported in studies using CNN Multitask ResNet152 and deep CNN (Neuro-T version 2.0.1) algorithms.

Positional accuracy during the sequence of static computer-assisted implant surgery in three alveolar ridge morphologies: An in vitro study

PURPOSE

This in vitro study aimed to assess the positional accuracy during the sequence of static computer-assisted implant surgery (sCAIS) according to the anatomical characteristics of the alveolar ridge.

MATERIAL AND METHODS

Maxillary bone models with six single tooth gaps including clinical scenarios of healed alveolar ridge (HR), single-rooted (SRS), and three-rooted socket (TRS) morphologies were used in this study. Positional deviations during implant placement procedures were evaluated after the pilot osteotomy (PD), final osteotomy (FD), and implant placement with respect to the pre-planned implant position by using a software package. ANOVA and post hoc analyses were performed.

RESULTS

A total of 90 implants were included in this study. Higher mean angular, crestal, and apical deviations were found after the PD and FD (3.5 ± 2.4°, 0.7 ± 0.3 mm, and 1.4 ± 0.8 mm versus 3.6 ±2.2°, 0.6 ± 0.3 mm, and 1.2 ± 0.6 mm) compared to IP (2.8 ± 1.6°, 0.7 ± 0.3 mm, and 1.2 ± 0.5 mm, p ≤ 0.004). Implants placed in TRS demonstrated higher mean angular, crestal, and apical deviations (4.0 ± 1.7°, 0.8 ± 0.3 mm, and 1.6 ± 0.5 mm) compared to implants placed in SRS (2.5 ± 1.2°, 0.7 ± 0.3 mm, and 1.1 ± 0.4 mm) or HR (2.0 ± 0.9°, 0.5 ± 0.3 mm, and 0.8 ± 0.4 mm, p < 0.001).

CONCLUSIONS

Positional deviations during sCAIS procedures are initiated with the first implant osteotomy and persist throughout the drilling sequence. However, deviations slightly decreased after implant placement. The alveolar ridge morphology is strongly associated with positional deviations. Higher deviations were observed in three-rooted and single-rooted sockets simulating an immediate approach compared to healed sites simulating a delayed protocol.

Nitrided Ti-6Al-4V: A Catalyst for Increase Mineralization and Osteogenic Marker Expression

Plasma nitriding is one of the surface modifications that show more effectiveness than other methods. In this study, the plasma-based ion implantation (PBII) technique was performed on the surface of titanium alloy (Ti-6Al-4V, Ti64) using a mixture of nitrogen (N2) and argon (Ar), resulting in a plasma-nitrided surface (TiN-Ti64). The surface composition of the TiN-Ti64 was verified through X-ray photoelectron spectroscopy (XPS). TiN-Ti64 demonstrated superior hydrophilicity compared with Ti64. TiN-Ti64 exhibited higher surface hardness than the original surface. The biological responses of primary human alveolar bone cells (hAVs) were observed on the TiN-Ti64, revealing greater activation of cell adhesion and spreading compared with Ti64 and the control group (glass coverslip). Moreover, the TiN-Ti64 significantly promoted cell proliferation compared with Ti64 and tissue culture plates. The mineralization of hAVs on the TiN-Ti64 showed a significant increase, almost 20% greater than that of Ti64. Furthermore, a significant upregulation of mRNA expression for osteogenic differentiation marker genes, including BMP2, OCN, OPN, and RUNX2, was observed in TiN-Ti64 compared with other conditions. In addition, the TiN-Ti64 exhibited antibiofilm activity against Streptococcus aureus. In conclusion, the TiN-Ti64, modified with the PBII technique utilizing a mixture of N2 and Ar, emerges as a promising alternative for surface modification in dental implant applications.

Horizontal Guided Bone Regeneration of the Posterior Mandible to Allow Implant Placement: 1-Year Prospective Study Results

OBJECTIVE

Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement.

MATERIALS AND METHODS

This open, prospective, single-cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post-GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health.

RESULTS

Of 45 patients evaluated 8 months post-GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: -1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and - 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health-related quality of life improved.

CONCLUSIONS

GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant-based tooth rehabilitation.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017).

Structure and composition of early biofilms formed on dental implants are complex, diverse, subject-specific and dynamic

Biofilm-associated peri-implant infections pose a major problem in modern medicine. The understanding of biofilm development is hampered by biofilm complexity and the lack of robust clinical models. This study comprehensively characterized the dynamics of early biofilm formation in the transmucosal passage of implant abutments in 12 patients. Biofilm structures and compositions were complex, diverse, subject-specific and dynamic. A total of 371 different bacterial species were detected. 100 phylogenetically diverse unnamed species and 35 taxonomically diverse disease-associated species comprised an average 4.3% and 3.1% of the community, respectively, but reached up to 12.7% and 21.7% in some samples. Oral taxa formed numerous positive associations and clusters and were characterized by a high potential for metabolic interactions. The subspecies diversity was highly patient-specific and species-dependent, with 1427 ASVs identified in total. The unprecedented depth of early biofilm characterization in this study will support the development of individualized preventive and early diagnostic strategies.

Analysis of trends in the context of implant therapy in a university surgical specialty clinic: a 20-year retrospective study

OBJECTIVES

To analyze the trends in the context of implant therapy in a 3-year patient population and compare it with data obtained over the last 20 years.

MATERIALS AND METHODS

All adult subjects who received treatment in the context of implant therapy between 2020 and 2022 were included in this retrospective study. Data regarding patient demographics, indications and location of implant therapy, implant characteristics, surgical techniques, complications, and early implant failures were recorded and compared to data obtained in the years 2002-2004, 2008-2010, and 2014-2016.

RESULTS

Between 2020 and 2022, n = 1555 implants were placed in n = 1021 patients. The mean age at implant placement was 59.9 + 15.1 years, demonstrating an increase over time in the age group 61-80 years of 23.1% and > 80 years of 3.2% (p < 0.0001). Single tooth gaps (48.9%) remained the main indication. The use of narrow diameters ≤ 3.5 mm increased (9.4% vs. 26.6%, p < 0.0001), while implant lengths > 10 mm decreased (45.7% vs. 23.5%, p < 0.0001). A reduction in more invasive techniques and an increase in computer-assisted implant surgeries (CAIS) of 19.5% was found.

CONCLUSIONS

The mean age of patients receiving dental implant therapy, with the use of narrow-diameter and shorter implants has progressively increased in the last 20 years. The observed trends suggest a transition from conventional to CAIS, accompanied by the introduction of minimally invasive surgical techniques.

CLINICAL RELEVANCE

The adoption of narrower and shorter implants, along with minimally invasive techniques and CAIS, enables clinicians to tailor treatment plans that accommodate the unique needs of aging patients and optimize clinical outcomes.

Patient Satisfaction and Quality of Life Outcomes Following Dental Implant Placement

Background

Dental implants have become a standard solution for the replacement of missing teeth, significantly influencing patient satisfaction and quality of life. This study aims to evaluate patient satisfaction and quality of life outcomes following dental implant placement.

Materials and Methods

A total of 150 patients who received dental implants were included in this study. Patient satisfaction was assessed using a validated questionnaire covering various aspects such as esthetics, function, and comfort. Quality of life was evaluated using the Oral Health Impact Profile (OHIP-14). Data were collected at baseline (prior to implant placement) and at a 6-month follow-up.

Results

Of the 150 patients, 135 (90%) completed the 6-month follow-up. The overall patient satisfaction score improved significantly from a baseline mean of 3.5 (SD = 1.2) to 8.2 (SD = 1.1) at the 6-month follow-up (P < 0.001). Similarly, the OHIP-14 score showed a significant reduction, indicating improved quality of life, from a baseline mean of 32.0 (SD = 5.3) to 14.5 (SD = 4.2) at the 6-month follow-up (P < 0.001). Subscales for pain, psychological discomfort, and social disability showed marked improvements.

Conclusion

Dental implant placement leads to a significant increase in patient satisfaction and quality of life. These findings underscore the importance of dental implants as a viable option for the restoration of missing teeth and the enhancement of overall oral health and well-being.

Comparison of osseointegration in commercial SLA-treated dental implants with different surface roughness: a pilot study in beagle dogs

PURPOSE

This pilot study investigated the effect of surface roughness on osseointegration by comparing two types of commercial SLA-treated dental implants with different surface roughness levels: moderately rough (Sa = 1 - 2 µm) and rough surfaces (Sa > 2 µm).

MATERIALS AND METHODS

Two implant groups were studied: TS (rough surface) and ADD (moderately rough surface) groups. Surface characteristics were analyzed using optical profilometry and SEM. In vitro studies using BRITER cells assessed cell adhesion, proliferation, and osteogenic differentiation through CCK-8 assay and qRT-PCR for osteopontin (OPN), osteocalcin (OCN), and alkaline phosphatase (ALP) expression. The in vivo study involved 12 implants (six per group) placed in mandibular defects of two beagle dogs. After 8 weeks, histomorphometric analysis evaluated bone to implant contact (BIC) and inter-thread bone density (ITBD). Statistical analysis used Student's t-test and two-way ANOVA for in vitro data, and Mann-Whitney U test for in vivo data.

RESULTS

Surface analysis revealed Sa values of 2.50 ± 0.27 µm for the TS group and 1.80 ± 0.06 µm for the ADD group. In vitro studies showed no significant differences in cell adhesion and proliferation between the groups (P > .05). However, gene expression patterns differed, with ADD group showing higher OPN expression (P < .001) and TS group showing higher ALP expression (P < .01). The in vivo study revealed no statistically significant differences in BIC and ITBD between the two groups (P > .05).

CONCLUSION

Surface roughness influenced osteoblast differentiation in vitro, but did not significantly affect osseointegration outcomes in vivo. Both moderately rough and rough surfaces appeared to support comparable levels of osseointegration. Larger studies are needed to confirm these findings and determine optimal implant surface characteristics.

Accuracy of a calibration method based on cone beam computed tomography and intraoral scanner data registration for robot-assisted implant placement: An in vitro study

STATEMENT OF PROBLEM

Robotic systems have shown promise for implant placement because of their accuracy in identifying surgical positions. However, research on the accuracy of patient calibration methods based on cone beam computed tomography (CBCT) and intraoral scanner (IOS) data registration is lacking.

PURPOSE

The purpose of this in vitro study was to develop a calibration method based on the registration of CBCT and IOS data of a robot-assisted system for implant placement, evaluate the accuracy of this calibration method, and explore the accuracy of robot-assisted surgery at different implant positions.

MATERIAL AND METHODS

Twenty standardized, polyurethane, partially edentulous maxillary typodonts were divided into 2 groups: one group used a calibration method based solely on CBCT data (CBCT group), and the other used a calibration method based on the registration of CBCT and IOS data (IOS group). Four implants were planned for each typodont in the right second premolar, left central incisor, left first premolar, and left second molar positions. The robot performed the osteotomies and implant placement step by step according to the preoperative plan. The operating software program automatically measured the deviation between the planned and actual implant position. Two-way analysis of variance (ANOVA) and the least significant difference (LSD) post hoc test (α=.05) were used to analyze differences between the test groups.

RESULTS

The angular deviation and 3-dimensional deviations at implant platform and apex between the 2 calibration methods did not significantly differ among the 4 implant positions (P>.05). The horizontal and depth deviations at the implant platform and apex levels between the 2 calibration methods did not significantly differ among the 4 implant positions (P>.05). In the anterior region (left central incisor), the CBCT group showed higher horizontal deviation at both the implant platform and apex compared with the IOS group (P<.05). Conversely, the IOS group had greater depth deviation at both the implant platform and apex than the CBCT group (P<.05). In the posterior region, with or without distal extension (right second premolar, left first premolar, and left second molar), no statistically significant differences were found between the 2 calibration methods (P>.05).

CONCLUSIONS

The calibration method that was based on the registration of CBCT and IOS data demonstrated high accuracy. No significant differences in the accuracy of the calibration methods for robot-assisted implant placement were found between the CBCT group and IOS group.

The Effect of Xanthohumol and Thymol on Candida albicans Filamentation and Its Impact on the Structure, Size, and Cell Viability of Biofilms Developed over Implant Surfaces

The aim of this in vitro study was to evaluate the effect of xanthohumol and thymol on the impact of Candida albicans on the structure, size and cell viability of subgingival biofilms formed on dental implant surfaces. The structure and microbial biomass of biofilms developed after 72 h, treated and untreated with both extracts, were compared by scanning electron microscopy (SEM) and confocal laser microscopy (CLSM). Quantitative polymerase chain reaction (qPCR) was used to quantify the number of viable and total microorganisms of each of the biofilm-forming strains in each condition. A general linear model was used to compare and validate the CLSM and qPCR results. The presence of xanthohumol and thymol during biofilm development inhibited the filamentous growth of C. albicans. The biofilm incubated with xanthohumol had significantly lower bacterial biomass and cell viability than the biofilm not exposed to the extract (p < 0.05). In contrast, these global parameters showed no differences when the biofilm was incubated with thymol. In the presence of xanthohumol, there was a decrease in counts and cell viability of Fusobacterium nucleatum, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans. Thymol treatment reduced the viability of F. nucleatum and P. gingivalis. The presence of these vegetable extracts during the development of a dynamic in vitro multispecies biofilm model inhibited the filamentous growth of C. albicans, partially reversing the effect that the fungus exerted on the structure, size and vitality of periodontopathogenic bacteria.

Primary Stability of Zirconia Dental Implants with Cylindrical and Tapered Designs Across Varying Bone Densities: An In Vitro Evaluation

Background: While titanium implants are widely recognized for their clinical success, zirconia implants have emerged as a metal-free alternative. This study aimed to evaluate the influence of zirconia implant macrogeometry and bone density on primary implant stability. Methods: Two types of zirconia implants were tested-the Neodent® Zi Ceramic Implant and the Straumann® PURE Ceramic Implant, that were placed into polyurethane foam blocks mimicking different bone densities (10 PCF, 15 PCF, 20 PCF, 30 PCF, and 40 PCF). Each implant type was inserted and removed multiple times, with primary stability measured using resonance frequency analysis via the Osstell® Beacon device. Statistical tests, including the Shapiro-Wilk test, t-tests, the Mann-Whitney U test, and the Kruskal-Wallis test, were applied, with significance set at 5% (p < 0.05). Results: The tapered Neodent® Zi Ceramic Implant consistently showed higher ISQ values across all foam densities compared to the Straumann® PURE Ceramic Implant (p = 0.035). Additionally, lower-density foams exhibited lower stability scores (p < 0.05). Conclusion: The study concludes that both the macrogeometry of zirconia implants and bone density significantly affect primary implant stability. Specifically, tapered implants demonstrated higher stability than cylindrical designs, suggesting that implant macrogeometry and bone density should be considered for optimal primary stability in clinical settings.

Non-surgical treatment of peri-implantitis

Treatment of peri-implantitis follows similar steps as the therapy of periodontitis. Non-surgical interventions, however, show limited success and in many cases, don't lead to a complete resolution of the local inflammation. The scientific literature was evaluated and based on the European Federation of Periodontology's S3-level guideline, recommendations for clinical practice are presented. Despite limitations in the success of this type of treatment, it is an important first step before surgical interventions and as such may help to improve overall treatment outcomes.

Early implant placement versus ridge preservation and delayed implant placement: Analysis of profilometric, clinician- and patient-reported outcomes from a two-centre RCT

OBJECTIVES

To compare early implant placement (EP) to alveolar ridge preservation and delayed implant placement (ARP/DP) in terms of contour changes, along with clinician- and patient-reported outcome measures (PROMs) until the delivery of the implant-supported restoration.

MATERIALS AND METHODS

Patients with a failing single tooth in the maxilla or mandible were recruited in two centres. After tooth extraction, patients were randomly assigned (1:1) to either EP or ARP/DP. At abutment connection and crown delivery, the buccal contour changes at 3 mm below the mucosal margin (primary outcome) along with clinician- (ease of treatment) and patient-reported outcomes were assessed using numeric rating scales and OHIP-14.

RESULTS

A total of 46 patients were analysed. The mean buccal contour at abutment connection decreased by -1.2 ± 0.6 mm in group EP and -1.6 ± 0.8 mm in group ARP/DP (estimated mean difference; 0.45 [95%CI, -0.02; 0.94]; p = .061) with no significant differences between the groups. ARP/DP was consistently easier than EP across all stages of the surgery (estimated mean difference; 2.0 [95%CI, 1.3; 2.7] p < .001): during flap elevation (EP: 4.8 vs. ARP/DP: 1.6), implant placement (EP: 5.7 vs. ARP/DP: 2.2) and wound closure (EP: 3.4 vs. ARP/DP: 1.6). Both interventions improved quality of life but patients who underwent ARP/DP were significantly more satisfied at the time of crown delivery (ARP/DP: 9.6 vs. EP: 9.1, p = .02).

CONCLUSIONS

EP and ARP/DP show no significant differences in buccal contour changes, aesthetics and patient-reported outcomes. However, ARP/DP is an easier procedure at all stages of the surgery compared to EP and could therefore be the preferred therapy for less experienced clinicians.

Development of an Angular Stiffness Sensor to Measure Dental Implant Stability In Vitro

This investigation aims to develop an angular stiffness sensor intended for measuring dental implant stability in bone. The sensor hardware included a tiny eccentric motor and an accelerometer to measure a flex constant of an implant with its abutment. The sensor software included a mechanics-based model to convert the flex constant to angular stiffness at the implant/abutment junction to indicate the stability. The sensor's accuracy and effectiveness are demonstrated through use of Sawbones slab models that mimic a mandibular premolar section. The models include a Branemark Mk III implant inserted into Sawbones slabs of 5 different densities with a locator abutment. An incremental insertion torque was first recorded while the implant was placed in the Sawbones models. Then benchtop experiments were conducted to measure resonance frequencies and angular stiffness. Results indicated that angular stiffness increased with Sawbones density, showing high correlation with the measured resonance frequency (R=0.977) and the incremental insertion torque (R=0.959). Finally, accuracy of the angular stiffness sensor is calibrated in light of the resonance frequency. Angular stiffness scores 99% and 95% accuracy for Sawbones models mimicking medium cancellous bones with and without a cortical layer, respectively.

Multi-Scale Characterization of Conventional and Immediate Dental Implant Systems

We hypothesized that the different post-implantation healing stages between the conventional and immediate implantations produce different amounts and tissue composition of the peri-implant bone. Thus, the objective of the current study was to examine whether the stability of dental implant systems is associated with characteristics of the interfacial bone area at different post-implanation healing periods. Mandibular molars were extracted from each beagle dog. After 10 weeks post-extraction, a screw-type titanium dental implant was placed in the molar location following a conventional dental implant (Con) procedure. Simultaneously, mandibular premolars were extracted and the same type of dental implant was placed in the distal site of the extracted premolar root following an immediate dental implant (Imm) procedure. The implant stability quotient (ISQ) values were not significantly different between Con and Imm groups at 0-, 3-, and 6-weeks post-implantation. However, 3D micro-computed tomography and 2D histological images confirmed that the Imm system had more gaps between the bone and implant than the Con system. On the other hand, the nanoindentation modulus value at the bone-implant interface was significantly higher for the Imm group than the Con group at both 3 weeks and 6 weeks post-implantation. The current results from multi-scale characterization suggest that the higher interfacial bone quality of the Imm system, despite its earlier post-implantation stage, plays a crucial role in maintaining stability comparable to that of the Con system.

Simple-Challenging-Difficult (SCD) Difficulty Classification for Vertical Bone Augmentation

OBJECTIVE

To propose a new difficulty classification for vertical bone augmentation (VBA) based on different defect morphologies.

OVERVIEW

VBA procedures for dental implant placement present significant biological and technical challenges. Among the various techniques, guided bone regeneration (GBR) provides an optimal balance between the anticipated bone gain and the likelihood of postoperative complications. Understanding the specific configuration of defects and adjacent bone peaks is essential for tailoring treatment strategies and improving outcomes. The proposed Simple-Challenging-Difficult (SCD) difficulty classification was based on defect morphology (V-shaped, U-shaped, VV-shaped), including defect size (Height: < 5 mm, 5-8 mm, and > 8 mm), proximity of neighboring bony walls (Width: < 10 mm, 10-20 mm, and > 20 mm), as well as predictability of treatment outcomes.

CONCLUSIONS

The proposed difficulty classification for VBA serves as a guide for selecting the most appropriate GBR treatment modality and sequence for safe and predictable management of VBA in implant therapy. In addition, when determining the preferred treatment, it is again essential to consider site-specific and patient-related factors alongside the clinician's surgical experience and skill.

CLINICAL SIGNIFICANCE

Identifying defect patterns and bone peak structures is crucial, and the proposed classification assists in decision-making in VBA treatment.

Efficacy of immediate loading compared to conventional loading in implant-supported removable prostheses: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to evaluate the efficacy of two different loading methods in implant-supported removable prostheses (partial dentures and full-maxillary dentures).

METHODS

As of August 2023, three electronic databases and nine oral implant-related journals had been searched. Only randomised controlled trials (RCTs) that compare immediate loading with conventional loading in implant-supported removable prostheses were included. The primary outcome was the implant survival rate. At the same time, a meta-analysis of bone-level changes was performed. Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to evaluate the risk of bias in the included trials.

RESULTS

A total of 16 RCTs were included, including 543 participants with 1595 implants. The included trials compared immediate loading and conventional loading in implant-supported removable prostheses. Regarding implants as the statistical unit, the immediate loading group had a statistically significant lower survival rate (RR = 0.950; 95% confidence interval [CI], (0.926, 0.974); P = 0.027; I² = 47%). When patients were regarded as statistical units, a statistically significant lower survival rate was also observed in the immediate loading group (RR = 0.929; 95% CI, (0.897, 0.961); P = 0.590; I² = 0%). When we analysed the bone level changes, a statistically significant decrease was observed in bone level in the immediate loading group compared with the conventional loading group (weighted mean difference [WMD] = -0.127; 95% CI, (-0.195, -0.059); P < 0.00001).

CONCLUSION

Lower implant survival rates and a decrease in marginal bone level was observed compared to immediate loading with conventional loading.

Assessment of Bone Loss Around Platform-Switching Subcrestal Implants: A Quasi-Experimental Study

INTRODUCTION

Replacement of lost teeth with implants is a well-known and accepted worldwide treatment. A healthy amount of bone surrounding the implant plays a vital role in osseointegration and is required for implant success. This study aimed to evaluate the efficacy of single-crown rehabilitation of subcrestal implants in terms of bone loss (BL) and overall success.

MATERIALS AND METHODS

Twenty healthy patients requiring implant placement to replace single hopeless teeth or extracted teeth were recruited for this prospective study. In these 20 patients, the implants were placed at the subcrestal level. Bone levels around the implant placement (T0) and one year after loading (T1) were estimated in this study. A paired t-test was used for intra-group comparisons, multivariate linear regression analysis was conducted to analyze the effect of independent variables on BL, and a correlation test was used to correlate various variables. Statistical significance was maintained at a p value of 0.05.

RESULTS

The outcomes demonstrated statistically significant BL at the mesial and distal sides of the subcrestal implants at one-year follow-up (p<0.05). Age and sex were not significantly correlated with BL in any region (p>0.05). Brushing frequency, probing depth (PD), and bleeding index (BI) showed statistically significant effects on BL (p<0.05). A weak correlation was observed between age and other variables, with age and mesial BL showing a low correlation of 0.016.

CONCLUSION

Within the parameters of this prospective study, it could be proposed that subcrestal implants caused significant BL. The PD, BI, and brushing frequency were significant predictors of BL.

Enhancing early-stage healing responses through the modified "Poncho" technique in customized titanium mesh-mediated bone regeneration: A soft tissue management approach-case series

RATIONALE

Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified "Poncho" technique (MPT), integrated with customized titanium mesh-mediated bone regeneration, and investigates the healing quality during the initial stages of an incision.

PATIENT CONCERNS

The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection.

DIAGNOSIS

All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration.

INTERVENTIONS

The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry's healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique's performance in early wound closure.

OUTCOMES

The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry's healing index increased from 3 ± 0.47 to a final value of 4.69 ± 1.06, indicating substantial improvement in healing over time.

LESSONS

The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.

The past forty-three years of dental implantology literature. A global mapping and scientometric analysis

PURPOSE

The aim of this research is to make a scientometric analysis of the dental implantology literature and to present the results in a more understandable way to the reader by visualizing them with maps.

METHODS

The dental implantology literature was accessed through the Web of Science database. Scientometric data was obtained with Citespace 6.1 software, co-citation, clustering analysis, citation burst, and mapping analyzes were performed. Scimago Graphica software was used for additional visualizations.

RESULTS

A total of 35,704 articles were included in the analysis. There were 88,616 authors, 72,333 institutes, 142 countries/regions, and 3,265 journals contributing to the dental implantology literature. The United States was first with 7,334 publications and 225,868 citations. The literature between 1980 and 2023 was divided into 19 different clusters, and the literature between 2000 and 2023 was divided into 16 different clusters.

CONCLUSIONS

Key themes in the field include the use of autogenous bone, advancements in implant surface technology, and the use of platform switching and intraoral scanners. Emerging topics of interest include esthetic considerations in the treatment of the anterior region, stress distribution, the use of zirconia, and the impact of implant treatment on oral health-related quality of life. With similar scientometric analysis studies to be done in the future, the progress of the literature can be followed on the basis of evidence.

Antral membrane balloon technique versus Densah bur in crestal sinus lift with simultaneous implant placement: a randomized clinical trial

BACKGROUND

The posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement.

MATERIALS AND METHODS

This randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed.

RESULTS

All dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05).

CONCLUSION

Both techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density.

TRIAL REGISTRATION

This study was registered in Clinical-Trials.gov PRS ( https://register.

CLINICALTRIALS

gov ) under identification number NCT05922592 on 28/06/2023.

Single Dental Implant Restoration: Cemented or Screw-Retained? A Systematic Review of Multi-Factor Randomized Clinical Trials

Background: Dental implant rehabilitation has significantly advanced prosthodontics by providing a reliable, long-lasting solution for missing teeth. This systematic review compares the clinical, technical, and biological outcomes of cemented versus screw-retained single dental implant restorations based on randomized clinical trials (RCTs). Materials and Methods: This review included recent human and in vitro studies focusing on the keywords “cemented vs. screw-retained” and “dental implant”. Eight studies met the inclusion criteria, which investigated parameters, including implant survival rate, bleeding on probing (BOP), probing depth, plaque index, marginal bone loss (MBL), cytokine concentrations, mechanical complications, esthetic outcomes, patient satisfaction, treatment time, and technical failures. Results: The primary outcomes, BOP and MBL, did not statistically differ between cemented and screw-retained implants (p-values for MBL and BOP are 0.5813 and 0.8093, respectively). The reviewed studies, including RCTs, split-mouth studies, and clinical evaluations, demonstrated comparable clinical, technical, and biological outcomes between the two restoration methods. Conclusions: Screw-retained and cemented dental implant restorations exhibit similar clinical, technical, and biological outcomes. Screw-retained restorations offer advantages such as retrievability, ease of repair, and predictable passive fit, while cemented restorations provide superior esthetics. The risk of peri-implant complications due to residual cement in cemented restorations must be considered. Future research should explore long-term stability and the impact of different prosthetic protocols on peri-implant health.

Inter- and intraindividual variability in virtual single-tooth implant positioning

OBJECTIVES

The purpose of this prospective study was to determine the inter- and intraindividual variability in virtual single-tooth implant positioning based on the level of expertise, specialty, total time spent, and the use of a prosthetic tooth setup.

MATERIALS AND METHODS

Virtual implant planning was performed on matched pre- and post-extraction intraoral scans (IOS), and cone-beam computed tomography scans of 15 patients. Twelve individual examiners, involving six novices and experts from oral surgery and prosthodontics positioned the implants, first based on anatomical landmarks utilizing only the post-extraction, and second with the use of the pre-extraction IOS as a setup. The time for implant positioning was recorded. After 1 month, all virtual plannings were performed again. The individual implant positions were superimposed to obtain 3D deviations using a software algorithm.

RESULTS

An interindividual variability with mean angular, crestal, and apical positional deviations of 3.8 ± 1.94°, 1.11 ± 0.55, and 1.54 ± 0.66 mm, respectively, was found. When assessing intraindividual variability, deviations of 3.28 ± 1.99°, 0.78 ± 0.46, and 1.12 ± 0.61 mm, respectively, were observed. Implants planned by experts exhibited statistically lower deviations compared to those planned by novices. Longer planning times resulted in lower deviations in the experts' group but not in the novices. Oral surgeons demonstrated lower crestal, but not angular and apical deviations than prosthodontists. The use of a setup only led to minor adjustments.

CONCLUSIONS

Substantial inter- and intraindividual variability exists during implant positioning utilizing specialized software planning. The level of expertise and the time invested influenced the deviations of the implant position during the planning sequence.

Jaw osteoporosis: Challenges to oral health and emerging perspectives of treatment

Osteoporosis is a prevalent bone metabolic disease that poses a significant challenge to global human health. Jaw osteoporosis, characterized by microstructural damage of the jaw resulting from various factors, is one of the common manifestations of this condition. Recent studies have demonstrated that jaw osteoporosis has multifaceted effects on oral health and can negatively impact conditions such as periodontitis, oral implantation, orthodontic treatment, and wound healing. However, there are still some limitations in the conventional treatment of osteoporosis. For instance, while bisphosphonates can enhance bone quality, they may also lead to osteonecrosis of the jaw, which poses a potential safety hazard in oral diagnosis and treatment. In recent years, considerable attention has been focused on improving the pathological condition of jaw osteoporosis. Treatment strategies such as gut microbial regulation, extracellular vesicles, molecular targeted therapy, herbal medicine, mechanical stimulation are expected to enhance efficacy and minimize adverse reactions. Therefore, understanding these effects and exploring novel treatments for jaw osteoporosis may provide new insights for oral health maintenance and disease treatment. This article reviews the impact of jaw osteoporosis on oral health and describes the limitations associated with current methods. It also discusses emerging perspectives on treatment, offering a comprehensive overview of the challenges and future directions in managing jaw osteoporosis.

Occlusal Changes Following Single Dental Implant Placement in the Posterior Region of Jaws: A Systematic Review and Meta-Analysis

Inserting a single implant in the posterior region is one of the most common procedures for replacing a missing posterior tooth. However, the impact of implant location on bite force distribution and occlusal forces remains unclear. To investigate the occlusal changes following single-implant crown placements in the posterior region, a systematic review and meta-analysis was conducted. A comprehensive search was performed across seven databases using Boolean operators and MeSH keywords. The study adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and minimize bias. Six studies met the inclusion criteria. The meta-analysis revealed that single-implant crown placements significantly alter the distribution of bite and occlusal forces over time. The mean differences (MDs) in relative occlusal forces (ROF, μm) between implants and controls at two weeks, three months, six months, 12 months, 24 months, and 36 months were -6.31 μm, -1.53 μm, -2.09 μm, -0.10 μm, 2.91 μm, and 7.01 μm, respectively. The overall effect of the meta-analysis was -0.71 μm, although this was not statistically significant (P = 0.54). Subgroup analysis showed considerable heterogeneity between different time periods (P < 0.00001, I² = 89.8%). Additionally, a significant increase in the distribution of bite force (N) was observed post-implantation, with an MD of 1.00 N (0.86, 1.15) and high statistical significance (P < 0.00001). These findings indicate that single-implant crown placement in the posterior region leads to significant shifts in the distribution of both biting forces (N) and ROF (μm) over time.

Simulating the Entire Clinical Process for an Implant-Supported Fixed Prosthesis: In Vitro Study on the Vertical Implications of Implant-Abutment Connections and Rotational Freedom

OBJECTIVES

The aim of this in vitro study was to investigate whether and to what extent different scenarios of rotational freedom in different IAC designs affect the vertical dimension of a three-part fixed partial denture (FPD). At the same time, the experimental setup should simulate all clinical and laboratory steps of the implementation of such an FPD as accurately as possible.

MATERIAL AND METHODS

Twenty identical pairs of jaw models were fabricated from aluminum, each lower-jaw model holding two implants with conical or flat IACs. Three impressions of each model were taken to fabricate stone casts and three-unit FPDs. Three assembly scenarios were compared for the vertical position stability they offered for these FPDs, differing by how the sequential implant components (impression posts > laboratory analogs > abutments 1 > abutments 2) were aligned with the positional index of the IAC. In this way, a total of 60 stone casts and FPDs were fabricated and statistically analyzed for changes in vertical dimension (p < 0.05).

RESULTS

Regardless of whether a conical/flat IAC was used (p > 0.05), significantly greater mean changes in vertical dimension were consistently (all comparisons p < 0.0001) found in a "worst-case scenario" of component alignment alternating between the left- and right-limit stop of the positional index (0.286/0.350 mm) than in a "random scenario" of 10 dentists and 10 technicians with varying levels of experience freely selecting the alignment (0.003/0.014 mm) or in a "best-case scenario" of all components being aligned with the right-limit stop (-0.019/0.005 mm).

CONCLUSIONS

The likelihood of integrating a superstructure correctly in terms of vertical dimension appears to vary considerably more with assembly strategies than with IAC designs. Specifically, our findings warrant a recommendation that all implant components should be aligned with the right-limit stop of the positioning index.

Ceramic conversion treated titanium implant abutments with gold for enhanced antimicrobial activity

INTRODUCTION

Peri-implantitis is an inflammatory process around dental implants that is characterised by bone loss that may jeopardize the long-term survival of osseo integrated dental implants. The aim of this study was to create a surface coating on titanium abutments that possesses cellular adhesion and anti-microbial properties as a post-implant placement strategy for patients at risk of peri-implantitis.

MATERIALS AND METHODSMETHODS

Titanium alloy Grade V stubs were coated with gold particles and then subjected to ceramic conversion treatment (CCT) at 620 °C for 3, 8 and 80 h. The surface characteristics and chemistry were assessed using scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and X-ray diffraction (XRD) analysis. The leaching profile was investigated by inductively coupled plasma mass spectroscopy (ICP-MS) for all groups after 7, 14 and 28 days in contact with distilled water. A scratch test was conducted to assess the adhesion of the gold coating to the underlying titanium discs. Two bacterial species (Staphylococcus aureus (SA) & Fusobacterium nucleatum (FN)) were used to assess the antibacterial behaviour of the coated discs using a direct attachment assay test. The potential changes in surface chemistry by the bacterial species were investigated by grazing angle XRD.

RESULTS

The gold pre-coated titanium discs exhibited good stability of the coating especially after immersion in distilled water and after bacterial colonisation as evident by XRD analysis. Good surface adhesion of the coating was demonstrated for gold treated discs after scratch test analysis, especially titanium, following a 3-hour (3 H) ceramic conversion treatment. All coated discs exhibited significantly improved antimicrobial properties against both tested bacterial species compared to untreated titanium discs.

CONCLUSIONS

Ceramic conversion treated titanium with a pre-deposited gold layer showed improved antimicrobial properties against both SA and FN species than untreated Ti-C discs. Scratch test analysis showed good adherence properties of the coated discs the oxide layer formed is firmly adherent to the underlying titanium substrate, suggesting that this approach may have clinical efficacy for coating implant abutments.

Implant Health in Treated Periodontitis Patients: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this meta-analysis was to evaluate the role of a history of periodontitis on implant failure. The two main judgment criteria studied are peri-implantitis and the survival rate. The two secondary judgment criteria studied are the mean pocket depth and the mean peri-implant bone loss.

METHODS

An electronic search was performed via five databases (MEDLINE, Embase, ScienceDirect, LILACS and the Cochrane Library) and was supplemented by manual searching. The search was undertaken in June 2024.

RESULTS

Of 10 775 potentially eligible articles, 8 were included in the qualitative analysis and 10 in the quantitative synthesis.

CONCLUSIONS

This meta-analysis suggests that a history of periodontitis has a significant impact on the rate of peri-implantitis, survival rate, mean bone loss and pocket depth.

Influencing Factors Regarding the Severity of Peri-Implantitis and Peri-Implant Mucositis

The scientific literature is increasingly focused on peri-implant mucositis and peri-implantitis, which are biological outcomes of dental implant treatment.

BACKGROUND/OBJECTIVES

The present study aimed to evaluate the two most critical complications of dental implantation, peri-implant mucositis and peri-implantitis, through the prism of different influencing factors.

METHODS

We followed 40 patients, with a total number of 92 dental implants, divided into three age groups: under 35 years, between 35 and 55 years, and older than 55 years. Patients were also divided into groups according to the time since implant placement: 1-3 years, 4-7 years, and more than 7 years. The patients were examined, and periodontal pocket depth, peri-implant pocket depth, Löe-Silness gingival index, mucosal thickness, and keratinized mucosal width were recorded; bone resorption was measured on radiographs using a 2D image analysis method; and a questionnaire was also conducted.

RESULTS

Bone resorption was highest in the 35-55 age group (3.09 ± 0.04 mm) and for implants placed 4-7 years ago (3.39 ± 0.12 mm). Females had a mean bone resorption of 3.4 ± 0.15 mm and males of 2.45 ± 0.07 mm. Statistically, there was a significant difference only in the Löe-Silness index: the 35-55 age group had the highest values (p = 0.04).

CONCLUSIONS

There were no statistically significant differences between the time since implant placement and the degree of bone resorption, nor between sexes. Peri-implant inflammation may occur at any age, regardless of the lifetime of the implants.

Bactericidal Effect of Different Photochemical-Based Therapy Options on Implant Surfaces-An In Vitro Study

Objectives: Photochemical systems are frequently recommended as an adjuvant treatment option in peri-implantitis therapy. The aim of the present study was to evaluate the efficacy of these treatment options, as well as a novel curcumin-based option, in a biofilm model on implants. Methods: Eighty dental implants were inoculated with an artificial biofilm of periodontal pathogens and placed in peri-implant pocket models. The following groups were analyzed: I, photodynamic therapy (PDT); II, PDT dye; III, curcumin/DMSO + laser; IV, curcumin/DMSO only; V, dimethyl sulfoxide (DMSO) only; VI, photothermal therapy (PTT); VII, PTT dye; VIII, control. After treatment, remaining bacterial loads were assessed microbiologically using quantitative real-time polymerase chain reaction analysis. Results: The PDT, PTT, and DMSO treatment methods were associated with statistically significant (p < 0.05) improvements in germ reduction in comparison with the other methods and the untreated control group. The mean percentage reductions were as follows: I (PDT) 93.9%, II (PDT dye) 62.9%, III (curcumin/DMSO + laser) 74.8%, IV (curcumin/DMSO only) 67.9%, V (DMSO) 89.4%, VI (PTT) 86.8%, and VII (PTT dye) 66.3%. Conclusions: The commercially available PDT and PTT adjuvant treatment systems were associated with the largest statistically significant reduction in periopathogenic bacteria on implant surfaces. However, activation with laser light at a suitable wavelength is necessary to achieve the bactericidal effects. The use of curcumin as a photosensitizer for 445 nm laser irradiation did not lead to any improvement in antibacterial efficacy in comparison with rinsing with DMSO solution alone.

Electric Current Application on Dental Implant Biofilms: Review

The prevalence of complications due to the presence of biofilms in dental implant surfaces and their relationship with peri-implant diseases, namely peri-implantitis, remain difficult problems to overcome. The information available about the application of electric current on dental implant biofilms; its parameters, namely current level, voltage and exposure time; and related effects are still not enough to understand which individual mechanisms are caused by this technique, culminating in the decrease or eradication of the biofilm. The purpose of this narrative review, based on a systematic search, is to understand the effect of electric current directly applied to biofilms present in dental implants and which parameters are used. For the systematic search, electronic databases including MEDLINE/PubMed, Scopus, and Web of Science, up to and including November 2023, were searched. Seven studies were included. A 12-item checklist was used to assess their methodological quality. All studies used direct/constant electric current; however, that use was not achieved by the same protocol/set-up. Parameters such as current, voltage, resistance, and actuation time were different in all studies. Monospecies and multi-species biofilm were used in the substrate made of titanium. The results indicate that the use of constant and alternating electric current directly applied to dental implant's surfaces is a promising way to treat problems related to biofilms and peri-implant diseases. Future trials, namely in vivo tests, are necessary to reveal all the potential of this treatment.

A Post-Implanto-Prosthetic Rehabilitation Study Regarding the Degree of Improvement in Patients' Quality of Life: A Before-After Study

BACKGROUND

Implant-prosthetic rehabilitation has the ability to improve the quality of life of patients, because, in addition to the role of restoring masticatory function, they also have many other benefits, such as restoring aesthetics or improving speech. This study aimed to analyze whether patients' quality of life was improved by implanto-prosthetic rehabilitation and which were the most important aspects.

MATERIALS AND METHODS

In this before-after study, we applied the Oral Health Impact Profile (OHIP-14) questionnaire to analyze the degree to which complex implanto-prosthetic rehabilitation led or not to an increase in patients' quality of life. The present study was carried out at the level of a private medical center in a city in the central region of Romania and included patients who visited this medical center between January and June 2022 and who benefited from a complex implanto-prosthetic rehabilitation, with the total number of patients eligible for inclusion in the study being 116.

RESULTS

Overall, an improvement in quality of life after implant-prosthetic rehabilitation was found. Patients' gender, age, or educational level did not significantly influence their responses. The network analysis offered an overview (intuitive visual representation) of the similarities but also the differences in the OHIP-14 item relationships in both situations: before and after oral rehabilitation.

CONCLUSIONS

A better understanding of how patients perceive implanto-prosthetic rehabilitation and the aspects that influence this perception can lead to an improvement in their quality of life, increasing the addressability of this type of medical procedure.