Abstract Purpose This study focuses on the characterization and evaluation of innovative surface modifications of zirconia implants aimed at optimizing hard and soft tissue management. Methods The cytocompatibility of newly developed ceramic implant coatings was assessed. Five different surface types were investigated: uncoated zirconia (Zr), zirconia coated with pure titanium (ZrTi), zirconia coated with calcium phosphate (CaP), zirconia coated with hydroxyapatite (HA) and zirconia coated with calcium phosphate-hydroxyapatite (CaP/HA). Cytocompatibility was assessed using L929 mouse fibroblasts and MC3T3 pre-osteoblasts. Testing was performed in both direct and indirect cell contact with the materials. In the direct contact setup, cells were cultured for 24 h on the test surfaces, followed by live/dead staining and fluorescence microscopy. In the indirect setup, material extracts were prepared and cell viability was quantified after 72 h using lactate dehydrogenase (LDH) and cell proliferation (XTT) assays. Results All tested surfaces demonstrated good cytocompatibility without significant cytotoxic effects. Supplementary scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) analyses confirmed the successful application of the coatings and provided detailed insight into surface topography and elemental composition. Conclusion Calcium phosphate and hydroxyapatite-coated zirconia implants represent a promising biocompatible alternative to titanium-based surfaces, with the potential to improve tissue integration and long-term clinical outcomes in ceramic dental implantology.
This device-specific in vitro study compared workflow-level implant-position reproducibility under scanner-integrated artificial intelligence (AI)-based filtering and wired/wireless scanner-to-cradle conditions. A maxillary edentulous model with six implants was scanned using one Aoralscan Elite unit, one Aoralscan Elite Wireless unit, and one host computer. AI-based filtering enabled and disabled conditions were defined as AI-ON and AI-OFF, respectively. Five scans were acquired for each of the eight AI × communication-condition combinations: wired reference and Wireless 0.5, 2.5, and 5.0 m (40 datasets). After computer-aided design library matching and virtual-abutment replacement, datasets were registered using three reference bodies. Concordance was the percentage of the virtual-abutment surface area within a |deviation| of ≤ 50 μm of the reference. With AI-OFF, the median concordance was 53.1
Peri-implant soft tissue sealing depends on the coordinated behavior of epithelial cells and fibroblasts at the titanium abutment interface. However, their differential and potentially imbalanced responses on titanium may compromise formation of a stable biologic barrier. This study aimed to compare the behavior of human oral epithelial cells and fibroblasts on machined titanium and to determine whether UV photofunctionalization can rebalance their dynamics to promote a more favorable soft tissue environment. Machined titanium plates were used as model abutment surfaces, with or without UV photofunctionalization. Surface physicochemical properties were characterized by contact angle measurement and X-ray photoelectron spectroscopy. Human oral epithelial cells and fibroblasts were evaluated in monoculture, co-culture, and transmigration models. Cell attachment (WST-1, microscopy), proliferation (BrdU), collagen production, and adhesion (mechanical detachment assay) were assessed. Co-culture experiments quantified relative cell population dynamics, and titanium-to-titanium transmigration assays evaluated the ability of cells to colonize new surfaces. On untreated titanium, epithelial cells exhibited significantly greater proliferation, whereas fibroblasts demonstrated higher collagen production and stronger adhesion. UV photofunctionalization reduced surface carbon and converted titanium from hydrophobic to hydrophilic. UV treatment enhanced attachment and growth of both cell types, with a greater increase observed in fibroblasts, thereby reducing the epithelial growth advantage. Collagen production was further augmented in fibroblasts, while epithelial cells showed a more pronounced improvement in adhesion, narrowing the adhesion gap between the two cell types. In co-culture, the population imbalance was significantly diminished on UV-treated surfaces. In transmigration assays, fibroblasts showed minimal migration on untreated titanium but extensive migration and surface colonization on UV-treated titanium, whereas epithelial cells exhibited robust migration under both conditions with less relative enhancement by UV. UV photofunctionalization differentially modulates fibroblast–epithelial dynamics on titanium by enhancing fibroblast growth and migration while strengthening epithelial adhesion. By targeting the biologically limiting factors of each cell type, this compensatory effect rebalances cellular ecology at the interface. Collectively, these findings identify UV photofunctionalization as a rational surface-activation strategy with potential to create a smart titanium interface for promoting peri-implant soft tissue sealing.
Abstract Purpose To evaluate the 36-month survival and clinical outcomes of two-piece zirconia implants restored with screw-retained glass-ceramic crowns on PEKK abutments. Methods This prospective single-center clinical study evaluated implant survival as the primary outcome, with secondary outcomes including peri-implant soft tissue parameters, marginal bone level changes, and patient-reported outcome measures. Twenty-four patients received single CERALOG Hexalobe two-piece zirconia implants manufactured by ceramic injection molding (CIM) in healed sites. After 6-month submerged healing, implants were restored with provisional screw-retained crowns on PEKK abutments, followed by definitive lithium disilicate crowns (IPS e.max Press) on PEKK abutments secured with titanium abutment screws (25 Ncm). Clinical and radiographic examinations were performed at implant placement, re-entry, definitive loading, and at 12-, 24-, and 36-month follow-ups. Implant survival was analyzed using Kaplan–Meier estimates. Results Of 23 evaluable implants, nine failed within the first 12 months: six due to failed osseointegration (two at re-entry, three during provisional restoration, one after definitive loading) and three due to implant fracture (one during provisional restoration, two after definitive loading). Kaplan-Meier survival rate was 60.9% (95% CI; 41–81%) at 12 months. No additional failures occurred between 12 and 36 months. Peri-implant soft tissue parameters of surviving implants showed favorable trends (PPD: 2.7 ± 0.7 mm at 12 months, 2.0 ± 0.5 mm at 24 months, 1.9 ± 0.8 mm at 36 months; BOP: 26%, 21%, and 18%, respectively; MGI: 0.38 ± 0.36 at 12 months, 0.40 ± 0.76 at 24 months, 0.21 ± 0.48 at 36 months). At the implant level, peri-implant mucositis was diagnosed in 7 of 13 implants (53.8%) at 36 months; no peri-implantitis was observed throughout the observation period. Mean DIB was 1.9 ± 0.6 mm at definitive loading, 1.6 ± 0.5 mm at 24 months, and 1.5 ± 0.9 mm at 36 months. One abutment screw loosening at 24 months was successfully managed. Patients with surviving implants reported high satisfaction scores (overall satisfaction: 5.0 ± 0.0 at 36 months). Conclusions The 39.1% early failure rate within the first 12 months was followed by stable marginal bone levels through 36 months in implants that achieved successful osseointegration. However, peri-implant mucositis remained prevalent at 36 months, underlining the need for peri-implant maintenance. The early post-loading period represents the critical determinant of long-term implant survival in this system. Extended follow-up through 60 months is ongoing.
Abstract Purpose Conventional screw- and cement-retained single implant restorations are associated with biological and technical complications. Friction-retained conometric concepts have been proposed as an alternative; however, clinical evidence for single crowns, particularly from prospective multicenter studies, remains limited. This study evaluated the 1-year clinical performance of a conometric retention system for implant-supported single crowns. Methods This prospective multicenter study was conducted at nine clinical centers in Europe and North America. Subjects requiring single-tooth replacement in the maxilla or mandible received one implant restored with a prefabricated 5.9° conometric abutment and a titanium nitride–coated coping. All-ceramic crowns were extraorally bonded and seated without cement or screws. Radiographs were obtained at implant placement, delivery of the permanent restoration, and after 1 year. Primary outcomes were implant and prosthetic survival. Secondary outcomes included marginal bone level (MBL) changes, bleeding on probing, plaque, probing pocket depth, and complication rates. Descriptive statistics and confidence intervals were calculated. Results A total of 144 implants were included in the per-protocol analysis. Three implants failed after delivery of the permanent restoration, resulting in a 1-year implant survival rate of 96.7%. Of 131 restorations evaluated at 1 year, 4 showed irreversible loss of conometric retention and were classified as prosthetic failures. In total, 22 prosthetic complication events were recorded, including 18 reversible technical complications (12.5%) and 4 irreversible failures, corresponding to an overall complication rate of 15.3%. Mean MBL change was − 0.11 mm from implant placement to PR and − 0.02 mm from PR to 1 year. Conclusions Within the limitations of this 1-year analysis, the investigated conometric retention system demonstrated high implant and prosthetic survival rates and limited marginal bone changes. However, a clinically relevant incidence of technical complications, including irreversible loss of conometric retention, was observed during the first year of function. These findings suggest that the conometric concept may require careful case selection and clinical monitoring. Long-term follow-up is required to further evaluate the clinical stability and prosthetic reliability of this retention concept over time. Trial registration : ClinicalTrials.gov, ID, NCT04063878, August 20, 2019.
Abstract Objectives The Pink Esthetic Score (PES) is widely used to assess peri-implant soft-tissue esthetics around single-tooth implant restorations; however, frontal-view assessment may incompletely capture three-dimensional peri-implant features such as buccolingual contour, emergence profile, and mucosal scarring. This study introduced the Extended Pink Esthetic Score (E-PES), a multidirectional assessment framework incorporating frontal, profile, and occlusal views. Materials and methods Thirty single-tooth implant restorations in the maxillary esthetic zone were evaluated using standardized photographs. Twenty blinded evaluators (five periodontists, five prosthodontists, five orthodontists, and five general practitioners) scored each case using two assessment systems. The traditional frontal-view assessment using the seven-variable PES, then the multidirectional E-PES assessment using frontal, profile, and occlusal views with nine variables. The E-PES retained the seven core PES variables, with emergence profile and mucosal scarring added to the variables to give a multidirectional view. Assessments were repeated after a three-week washout period with randomized image order. Reliability, agreement, and score-distribution analyses were performed. Results A total of 600 first-round assessments were completed for each scoring system and included in the paired frontal-view versus multidirectional score analysis. Original PES and multidirectional E-PES-compatible total scores averaged 9.98 ± 3.96 and 9.76 ± 3.52, respectively, yielding a small but statistically significant mean paired difference of 0.22 points ( P < 0.001). Scores differed in 442 of 600 paired assessments (73.67%). Agreement between frontal-view and multidirectional total scores remained excellent (ICC = 0.919; ICC = 0.958). The alveolar process/buccal contour parameter showed the greatest mean shift, decreasing from 1.31 ± 0.69 to 1.10 ± 0.74 ( P < 0.001). Inter-examiner reliability for multidirectional total scores was moderate at the individual-rater level (single-measure ICC = 0.633) and high at the group level (average-measure ICC = 0.972). Conclusions E-PES preserved the reliability of the original PES while identifying clinically relevant esthetic differences not fully captured by frontal-view assessment alone. Multidirectional evaluation particularly enhanced assessment of alveolar-process/buccal-contour morphology, supporting E-PES as a practical refinement of PES for more comprehensive peri-implant esthetic evaluation.
Peri-implantitis is a major biological complication in implant dentistry, associated with bacterial biofilm formation and amplified by dysregulated host immune responses. Increasing evidence indicates that implant and abutment surface properties influence not only osseointegration but also microbial retention, soft-tissue sealing, and innate immune cell behavior. This narrative review aimed to summarize the current evidence on how dental implant nanotopography may affect peri-implantitis-related biological responses, with particular emphasis on innate immunity, region-specific peri-implant biointerfaces, and peri-implant tissue stability. Clinical, animal, and in vitro studies were reviewed to examine the pathogenesis of peri-implantitis, the roles of innate immune cells, the influence of implant and abutment surface topography on microbial and immune responses, and emerging nano-enabled strategies for the active regulation of peri-implant tissue responses. Peri-implantitis progression is shaped by the interplay among the disruption of transmucosal soft-tissue sealing, microbial invasion, implant- or abutment-derived foreign-body stimuli, and sustained dysregulated innate immune activation. Nanotopographic surfaces regulate epithelial and fibroblastic attachment, extracellular matrix organization, neutrophil and macrophage responses, and osteocyte network formation via mechanotransduction. The biological effects of nanotopography are design-dependent and are influenced by nanoscale geometry, size, hydrophilicity, and associated physicochemical properties, including surface chemistry, wettability, and charge. Additionally, anisotropic nanospike surfaces and nano-enabled biomolecule delivery technologies illustrate the future possibility of active nanointerface regulation beyond conventional surface modification, although intracellular delivery technologies currently remain conceptual for dental implant applications. Implant and abutment nanotopography may contribute to peri-implant tissue stability by coordinating soft-tissue sealing, microbial retention control, innate immune calibration, and bone-interface resilience. Although direct clinical evidence remains limited, region-specific and functionally active nano-biointerfaces may offer new opportunities to reduce susceptibility to peri-implant inflammatory tissue breakdown.
Zygomatic implants (ZIs) are indicated for severely atrophic maxillae where conventional implant (CI) placement is difficult. Although ZIs show favourable outcomes, factors influencing their survival remain unclear. This retrospective study evaluated implant- and patient-related factors associated with ZI survival in full-arch immediate-loading rehabilitation using the all-on-four concept combining ZIs and CIs. A total of 923 implants (323 ZIs and 600 CIs) placed in 203 patients between 2010 and 2021 were analysed. Cumulative survival rates were estimated using the Kaplan–Meier method, and intergroup comparisons were performed using the log-rank test. Cox proportional hazards regression analyses were performed to calculate hazard ratios (HRs). Statistical significance was set at p < 0.05. Cumulative survival rates at 3–13 years were 94.5
The aim of this study was to compare the failure loads and stress distribution of two different CAD-on systems used for implant-supported crowns. Implant-supported crowns were designed with CAD/CAM software (Cerec InLab V15.0) and fabricated using the CAD-on technique (n = 12 per group): Group ZF (zirconia core veneered with feldspathic ceramic) and Group ZL (zirconia core veneered with lithium disilicate ceramic). Following cementation onto titanium abutments, the restorations were subjected to failure load testing using a universal testing machine. Simultaneously, 3D models of FEA were generated to evaluate Von Mises, Maximum Principal, and Minimum Principal stress distributions across the restoration, implant, abutment, and supporting bone. The mean failure loads were compared using the independent samples t-test (p < 0.05). Group ZL exhibited significantly higher failure loads (4649.22 ± 733.42 N) compared to Group ZF (2085.91 ± 555.61 N) (p < 0.001). While stress concentrations were primarily located at the implant neck in both groups, the distribution on the abutments differed significantly. In Group ZF, delamination was the primary failure mode (100
Background Vertical bone augmentation in the posterior mandible presents significant challenges due to anatomical constraints and frequent deficiencies in soft tissue. Optimizing the soft-tissue phenotype prior to augmentation is critical to ensure stable wound closure and to provide the vascular support necessary for successful graft integration. This article introduces the pedicled masseter-buccinator periosteal flap, a novel technique that uses highly vascularized tissue to improve the quality and quantity of soft-tissue covering while also promoting graft survival.Case presentation A patient presented with an edentulous site in the left mandibular molar region, exhibiting a severe combined vertical and horizontal ridge deficiency. Panoramic radiography revealed a non-restorable implant and a hopeless tooth in the premolar area, resulting in an extensive defect at this site. Following removal of the implant and tooth, a large three-dimensional ridge defect was confirmed intraoperatively. After local decontamination, a pedicled masseter-buccinator periosteal flap was dissected from the inner aspect of the cheek. A partial-thickness flap, which included limited buccinator and masseter muscle fibers along with the periosteal layer was elevated. The flap was rotated mesially and sutured to the lingual periosteum to achieve stable soft tissue augmentation. Finally, the overlying primary mucoperiosteal flap was sutured, resulting in a double-layered tissue closure. Two months later, three-dimensional ridge augmentation in the left mandibular premolar-molar region was performed using the split-bone block technique with autogenous graft harvested from the ipsilateral mandibular retromolar area. After three months, two implants were inserted in combination with a Kazanjian vestibuloplasty. After three months of healing, the implants were uncovered, allowing completion of the prosthetic rehabilitation. Radiographic follow-up at two years showed stable peri-implant bone levels and clinical examination confirmed healthy and stable soft-tissue conditions.Conclusion The pedicled masseter-buccinator periosteal flap demonstrated to be a reliable and effective approach for soft tissue augmentation in the posterior mandible and support vertical bone grafting. Early clinical results indicate a high level of predictability with few complications making this technique a promising option in anatomically challenging cases.
This prospective multi-centre cohort study aims to evaluate the trueness and safety of implant placement using a Dynamic Navigation System (DNS) for implant bed preparation. A total of 109 dental implants were inserted using a DNS for implant bed preparation in 76 patients by five experienced surgeons in four study centres. Before implantation, a preoperative CBCT scan was performed for each patient. This was subsequently aligned with an intraoral scan. After digital planning of the implant position, a holding tray for the intra-oral marker was designed and printed with a 3D printer. Procedure duration as well as adverse events were recorded. After implant bed preparation with DNS, the implants were placed in a freehand manner. Postoperative surface scans were superimposed onto the pre-operative planning data to evaluate the angular and spatial deviations. Descriptive statistics were followed by a one-sided, one-sample t-test to compare the data with performance goals extracted from literature-based benchmark data from freehand surgery. The overall mean angular deviation was 3.37°±2.01° with a minimum of 0.20° and a maximum of 11.10°. The mean mesiodistal and orovestibular deviation at implant tip was 1.18 ± 0.66 mm. 3D deviation at implant base showed a mean ± SD of 1.24 ± 0.65 mm. No Serious Adverse Device Effects (SADE) were reported. The angular and mesiodistal, and orovestibular deviations were significantly better than the performance goals from freehand surgery (P<.001). The mean VAS was of 87.5 ± 14.3. The study-related DNS demonstrates trueness, safety and surgeon satisfaction.
PURPOSE:Optimized surface properties are a pivotal factor for dental ceramic implants and overall implant success. After grit-blasting and spray-coating Aluminum Toughened Zirconia (ATZ) ceramic samples with a glass solder, the biological cell response was examined and compared to uncoated and solely grit-blasted samples of the same ceramic. METHODS:In this study, a silica-based glass solder was evaluated for cytocompatibility, osteogenic differentiation, and hemocompatibility using L929 mouse fibroblasts and human dental pulp cells (HDPCs). RESULTS:No toxic effects were observed for either coated or uncoated ATZ samples in direct or indirect tests, as assessed by live/dead staining. Differentiation and viability assays with HDPCs and L929 mouse fibroblasts showed no toxicity, and osteogenic differentiation was not impaired by the coating. Hemocompatibility testing with human whole blood revealed similar results for coated and uncoated ceramic specimens, with no hemolysis or adverse effects on standard hematological parameters. CONCLUSIONS:The glass solder coating was cytocompatible and hemocompatible under the tested in vitro conditions and did not impede osteogenic differentiation. These findings indicate that it can serve as a suitable substrate for the proliferation and spreading of L929 fibroblasts and HDPCs, with potential benefits for improving dental ceramic implant surfaces.
Abstract Purpose This study aimed to develop a machine learning model capable of preoperatively predicting three-dimensional implant placement errors at the implant apex in static-guided surgery and to identify the clinical features associated with placement accuracy. Methods Clinical data partially derived from a previous observational study were analyzed. In total, 181 patients and 480 implants placed using fully static-guided surgery were included in this study. The outcome variable was defined as three-dimensional implant placement error at the implant apex relative to the preoperative simulation, dichotomized as less than 0.5 mm or ≥ 0.5 mm. Twenty-one clinical and radiographic factors previously suggested to influence the placement accuracy were used as explanatory variables. The feature importance was evaluated using three gradient boosting decision tree models. Furthermore, a stacking model combining multiple classifiers was constructed, and the classification performance was assessed using ten-fold cross-validation. Results The feature importance analysis identified 12 features associated with implant placement errors. The stacking model demonstrated superior classification performance compared to individual classifiers. The true positive rate was 0.73, false negative rate was 0.27, false positive rate was 0.14, and true negative rate was 0.86. Conclusions The proposed stacking model correctly classified 86% of cases with implant placement error less than 0.5 mm and 73% of cases with implant placement error of ≥ 0.5 mm. These findings suggest that the proposed model may support the preoperative evaluation of implant placement accuracy in static-guided surgeries.
Abstract Purpose Long-term dental implant success depends on a biologic “race to the surface,” in which osteogenic cells, peri-implant soft-tissue cells, and bacterial pathogens compete for early dominance at the implant–tissue interface. Because implant surface design is often optimized for one objective at the expense of another (e.g., micro-roughness to accelerate osteoconductivity but with increased plaque-retention risk; relatively smooth transmucosal surfaces to discourage bacterial attachment despite uncertainty regarding optimal soft-tissue integration), strategies that enhance peri-implant health without forcing topographical trade-offs are needed. Ultraviolet (UV) photofunctionalization—by removing storage-acquired hydrocarbons (“biological aging”) and converting surfaces to a high-energy, superhydrophilic state—has been proposed as a chairside, topography-preserving approach to improve interfacial biology. This systematic review evaluates whether UV photofunctionalization of titanium and zirconia surfaces provides clinically relevant advantages for (1) reduction of bacterial attachment and biofilm formation, (2) peri-implant soft-tissue responses relevant to mucosal sealing, and (3) human clinical outcomes. Methods After systematic literature search, screening and full-text evaluation, a total of 34 articles, including 9 bacterial/biofilm, 13 soft-tissue (1 overlapping between bacterial and soft-tissue), and 13 clinical studies were selected. Findings were synthesized qualitatively with attention to protocol heterogeneity (UV wavelength band, exposure duration, device configuration, and material and surface types). Results Across experimental models, UV photofunctionalization most consistently reduced early bacterial attachment and/or early biofilm accumulation across several titanium surface topographies, supporting an early anti-adhesive and biofilm-suppressive phenotype. Soft-tissue studies generally demonstrated enhanced fibroblast/epithelial attachment, spreading, and functional behaviors relevant to sealing on both titanium and zirconia, although the optimal underlying topography for soft-tissue integration remains unresolved. Clinically, the most consistent signal was accelerated and enhanced implant stability development, while selected studies also suggested favorable trends in peri-implant soft-tissue parameters and/or crestal bone maintenance. However, clinical outcomes remained variable and were limited by heterogeneity in UV protocols, surface systems, endpoints, and follow-up duration. Conclusions UV photofunctionalization can be conceptualized as a surface-agnostic physicochemical reactivation technology: a topography-preserving enhancement that restores high surface energy and favorable surface chemistry without altering the underlying surface architecture. Current evidence for this concept is strongest for titanium, whereas supportive evidence for zirconia is emerging primarily from soft-tissue and interface-focused models. This interface-first, positive-sum strategy may allow clinicians to select zone-specific topographies (e.g., smooth transmucosal regions and rough endosteal regions) while maximizing soft-tissue affinity and suppressing early colonization. Although current clinical evidence most strongly supports accelerated osseointegration/stability development, further longitudinal studies with standardized peri-implant health, microbiologic, and mucosal inflammatory endpoints are needed to clarify the long-term translational impact of UV photofunctionalization on peri-implant disease prevention. Graphical abstract
Abstract Purpose Accurate assessment of the distance between dental implants and the mandibular canal is essential for preventing nerve injury. Although cone-beam computed tomography (CBCT) is widely used for implant planning, its accuracy in resolving submillimeter distances remains uncertain. This study evaluated the measurement accuracy of CBCT for assessing distances below 1.0 mm. Methods A custom phantom enabling 0.0–1.0 mm implant–canal distances in 0.1-mm increments was developed. CBCT images were acquired at varying distances, positional shifts (X, Y, Z), and tube voltages. Five dentists involved in implant treatment measured the implant–canal distances using medical-grade and general-purpose monitors. Measurement error and contributing imaging factors were statistically analyzed. Results CBCT did not reliably distinguish distances ≤ 0.4 mm, with the greatest instability observed at 0.3 mm (interquartile range = 0.121). Although a linear trend was observed from 0.1 to 0.4 mm, variability exceeded clinically acceptable limits. For distances ≥ 0.5 mm, reproducibility was high, but CBCT consistently underestimated the true gap by 0.2–0.3 mm. The central field of view produced the most stable measurements, whereas accuracy decreased with off-center positioning. Tube voltage and monitor type had minimal influence on measurement accuracy. Conclusions CBCT cannot accurately identify implant–canal distances ≤ 0.4 mm, which may directly affect clinical risk assessment. Even for distances ≥ 0.5 mm, CBCT underestimates the true distance by 0.2–0.3 mm. These findings provide practical guidance for setting safe margins in implant planning and postoperative evaluation.
Abstract Purpose To systematically review the efficacy and safety of resorbable scaffolds for bone augmentation of alveolar bone defects. Methods A specific PICO question was formulated: In partially or fully edentulous patients requiring alveolar ridge augmentation (P), how do resorbable scaffolds (I), compared with non-resorbable devices (e.g., titanium meshes) or conventional bone augmentation techniques (C), perform in terms of clinical outcomes including bone gain, implant loss and success, and complication rates (O)? A PubMed/MEDLINE electronic search was conducted to identify clinical studies published until December 2025. No restrictions on publication date were imposed, and only studies published in the English language were considered. Selected studies were all studies on humans using resorbable devices for alveolar ridge augmentation; in vivo and in vitro studies were excluded. Study characteristics, operative techniques, materials, and clinical outcomes including complications, bone augmentation techniques, implant stability, survival and success rates were extracted and analyzed. Resorbable materials evaluated included polylactide (PLA), polycaprolactone (PCL), Polylactic Acid-Polyglycolic Acid (PLGA), and beta-tricalcium phosphate (β-TCP). Results A total of 3704 articles were found, but only 7 studies met the pre-established inclusion criteria and were considered suitable for analysis. These studies included 39 patients and 45 edentulous ridges. Implant loss was only reported in one study. Complications occurred in three studies, with graft loss in 5 cases. Primary implant stability values averaged 35Ncm. Degradation time is an important determinant, but remains insufficiently studied/evaluated in the included evidence base. Conclusions Resorbable scaffolds seem to represent viable alternatives to conventional bone grafting approache. Customized scaffolds may offer additional esthetic advantages. However, larger randomized controlled trials with longer follow-up periods and standardized outcome measures—including CBCT-based volumetric and linear bone gain, clearly defined complication categories, and implant-related outcomes such as stability, survival, and success—are required to enable robust evidence-based clinical recommendations.
Abstract Purpose This randomized controlled trial aimed to evaluate the clinical and histological efficacy of autogenous demineralized dentin matrix (DDM) compared with deproteinized bovine bone mineral (DBBM) for alveolar ridge preservation (ARP), with a specific focus on dimensional stability and remodeling dynamics over a 6-month follow-up period. Methods Fifty patients requiring single-tooth extraction were randomized to receive ARP with either DDM (test group, n = 25) or DBBM (control group, n = 25). Dimensional changes were assessed by CBCT at baseline, 3 months, and 6 months. Histomorphometric analysis was performed on bone core biopsies harvested at 6 months. Results Fifty patients were enrolled and randomly assigned to the test (DDM, n = 25) or control (DBBM, n = 25) group. At 3 months post-surgery, the test group exhibited significantly greater horizontal bone resorption at the mid-socket level (50%) compared with the control group (p = 0.006). However, at 6 months, no statistically significant differences were observed between the two groups regarding horizontal width reduction at any level (coronal, middle, apical) or vertical height reduction (p > 0.05). Histomorphometric analysis at 6 months revealed active new bone formation and good integration of graft particles in the DDM group, confirming its biodegradability and osteoconductive potential. Conclusions Although autogenous DDM exhibited a faster remodeling rate and dimensional contraction in the early healing phase (3 months), it achieved long-term (6-month) dimensional stability comparable with that of the gold-standard xenograft. Furthermore, histological evidence of superior tissue integration suggests that DDM is a biologically viable and cost-effective alternative for alveolar ridge preservation.
Abstract Background Autogenous bone (AB) is considered the gold standard for alveolar bone grafting, but its limitations have prompted the development of synthetic alternatives. The Shell technique provides a stable framework for bone augmentation. However, few studies have directly compared different graft materials under intraoral-like conditions, especially in mandibular models. This study aimed to quantitatively compare the osteogenic capacity of four graft materials—autogenous bone (AB), β-tricalcium phosphate (β-TCP), octacalcium phosphate collagen composite (OCPC), and atelocollagen absorbable sponge (AAS)—using a rat mandibular shell model that simulates intraoral conditions. Methods Cortical bone blocks were harvested from the mandibular body of 36 male Wistar rats, and mandibular reconstruction was performed using the Shell technique with cortical bone plates. Four graft materials, particulate AB, β-tricalcium phosphate (β-TCP), octacalcium phosphate collagen composite (OCPC), and Atelocollagen Absorbable Sponge (AAS), were evaluated. Each postoperative cohort consisted of 12 rats in total (n = 3 per group × 4 groups), and histological and histomorphometric analyses were performed at 8, 12, and 16 weeks postoperatively. Results AB generated significantly more new bone than the other materials at all time points. OCPC induced moderate limited regeneration until later stages, while β-TCP and AAS resulted in limited bone growth. The mandibular model effectively simulated oral anatomy and provided reliable structural support throughout the procedure. Conclusions AB showed better osteogenic capacity than synthetic and composite materials. Use of the mandibular Shell technique with a rat model of mandibular defects proved useful for evaluating bone grafts under clinically relevant conditions.
Abstract Purpose To retrospectively evaluate biological and technical complication rates of implant-supported fixed complete dentures (IFCDs) in edentulous jaws and to identify factors associated with complications over long-term follow-up. Methods Between 2003 and 2023, 91 IFCDs supported by 498 implants were placed in 72 patients. Mean observation period was 6.8 years (0.5–17). Biological and technical complications were compared between materials. Time until first complication was estimated using Kaplan–Meier analysis and risk factors for recurrent complications were assessed through multivariable Andersen–Gill Cox regression. Results Seven IFCDs failed, corresponding to a cumulative overall IFCD survival of 92.3%. Twenty-one of 498 implants (4.2%) were explanted. Overall prosthesis survival of resin veneered (RV) and ceramic veneered (CV) IFCDs did not differ (p = 0.85), whereas veneer fracture–free survival was significantly higher for CV IFCDs (p = 0.0094). In total, 169 complications were recorded, including recurrent events, whereas 49.5% of prostheses remained complication-free. Technical complications predominated, with veneer fractures representing the most frequent event. Biological complications such as peri-implantitis and implant loss occurred less frequently. Compared to base metal alloy–ceramic IFCDs, titanium–resin IFCDs exhibited a significantly higher overall complication risk (HR 4.25, p = 0.0015), particularly for veneer fractures (HR 7.11, p = 0.0029). Conclusions Within the limitations of this long-term retrospective cohort study, IFCDs demonstrated high prosthesis and implant survival rates, but a considerable number of predominantly technical complications. The choice of framework and veneering material appears to influence long-term complication risk and should be carefully considered during treatment planning. Graphical abstract
