INTRODUCTION:To compare the clinical, radiographic, and patient-reported outcomes of submerged and non-submerged healing modalities in the reconstructive surgical treatment of peri-implantitis, and to evaluate factors associated with treatment success. MATERIALS AND METHODS:Patient records from individuals treated for peri-implantitis with reconstructive surgical therapy were retrospectively analyzed. Implants were treated using either a non-submerged or submerged approach, with biomaterial application consisting of grafting alone or grafting combined with a collagen membrane. Clinical, radiographic, and patient-reported outcome measures (PROMs) were assessed. Treatment success was defined as absence of suppuration (SOP), absence of bleeding on probing (BOP) or bleeding at no more than one site, reduction in probing depth (PD), no additional marginal bone loss, and mucosal recession (MR) change of ≤ 1 mm. A cost-effectiveness analysis was additionally performed based on treatment success across predefined cost categories reflecting combinations of healing modality and biomaterial use. Data were analyzed using linear and generalized mixed models, and a generalized estimating equation model was applied for treatment success analysis. RESULTS:A total of 33 patients (53 implants) met the eligibility criteria and were included in the analysis. No significant differences in treatment success were observed between healing modalities (p > 0.05), although the submerged approach showed a tendency toward higher success rates across follow-up periods, irrespective of biomaterial use. Significant improvements over time were observed for clinical parameters, including plaque index (PI), BOP, PD, and SOP (p < 0.001). A significant group × time interaction was identified for PI, keratinized tissue height, and marginal bone level change (p < 0.05). PROMs revealed lower pain/discomfort and higher esthetic and satisfaction scores in the submerged group. Multivariate analysis identified history of periodontitis and baseline deepest PD as significant predictors of treatment success at 2 years postoperatively (p < 0.05). CONCLUSION:Over a 2-year follow-up, treatment success rates were comparable between submerged and non-submerged healing modalities following reconstructive surgical treatment of peri-implantitis, while submerged healing was associated with significantly better esthetic outcomes and higher patient satisfaction. History of periodontitis and greater baseline deepest PD were associated with less favorable treatment outcomes.
AIM:This study evaluated the efficacy of conventional flap and tunneling techniques for horizontal alveolar ridge augmentation using freeze-dried bone allograft (FDBA) particles combined with injectable platelet-rich fibrin (i-PRF). MATERIALS AND METHODS:Forty-five patients were randomly allocated to one of three groups (n = 15 each): conventional flap (CF), tunneling with membrane (TM), or tunneling without membrane (TnM). Preoperative ridge width was measured via cone beam computed tomography (CBCT). All augmentation procedures incorporated FDBA and i-PRF; an absorbable collagen membrane was applied in the CF and TM groups. Follow-up assessments, including CBCT imaging and histomorphometric analysis, were conducted 6 months postoperatively. For normally distributed data, ANOVA with Tukey's post hoc test and paired samples t-test were applied. Non-normally distributed data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-rank tests. RESULTS:Statistical analysis was performed on 43 patients. All groups demonstrated an increase in ridge width after 6 months. At the 2 mm level, the mean width gain was 1.28 mm (95% CI: 0.17 to 2.40) in the TM group, 2.85 mm (95% CI: 1.80 to 3.89) in the TnM group, and 1.95 mm (95% CI: 1.07 to 2.83) in the CF group. However, statistical analysis revealed no significant intergroup variation (p > 0.05). Histomorphometric assessments similarly demonstrated comparable outcomes across all groups, with no statistically significant differences observed (p > 0.05). CONCLUSION:Within the limitations of this study, the tunneling technique, regardless of membrane use, appears to be a clinically viable alternative to the conventional flap method for horizontal alveolar ridge augmentation. However, further studies with longer follow-up periods are required to substantiate these findings. TRIAL REGISTRATION:irct.behdasht.gov.ir identifier: IRCT 20101204005305N21.
OBJECTIVES:To assess the efficacy of non-pharmacologic interventions, specifically auditory distraction (music or comedy) and haptic distraction (stress-relief device), in maintaining hemodynamic stability during dental implant surgery. MATERIAL AND METHODS:This was a prospective, single-center, randomized trial. We included 150 patients getting single-tooth implants. Patients were split into three groups of 50. The Control group got standard care. The Auditory Distraction group listened to patient-selected Guzheng music or Xiangsheng comedy. The Haptic Distraction group used a stress-relief device. We recorded systolic and diastolic blood pressure and heart rate before and after surgery. We used paired t-tests and one-way ANOVA with Tukey's post hoc tests for analysis. RESULTS:Surgery increased blood pressure in all groups (p < 0.0001). The heart rate response was different between groups. The Control group had a significant increase in heart rate (p < 0.05). Both the Auditory and Haptic Distraction groups had lower heart rates after surgery (p < 0.05). There was no significant difference between the two interventions. CONCLUSIONS:Non-pharmacologic interventions may not fully prevent the rise in blood pressure from procedure-related BP elevation. However, these methods help stop the heart rate from rising due to physiological stress. Listening to familiar music or comedy, or using a simple stress-relief device, can help steady the heart during dental implant surgery. CLINICAL RELEVANCE:Auditory and haptic distractions are low-cost, non-invasive, and effective adjuncts for managing procedure-related physiological stress. By stabilizing heart rate, these interventions enhance patient safety and comfort, offering a viable alternative or supplement to pharmacological sedation in implant dentistry.
INTRO:To compare clinical conditions and the implant marginal bone level after 1 year following placement of hybrid and moderate rough implants in the mandible of periodontally compromised patients using standardized radiographs. METHODS:In a multicenter study (three centers), thirty-nine periodontally compromised patients were randomly treated in a split-mouth study with both hybrid and moderate rough implants in the mandible at the premolar and molar site. In each patient, two tissue-level implants were inserted, and a healing cap was placed. After 3 months, the implants were restored with a FPD. The primary outcome consisted of radiographic assessments performed at 1-year follow-up. RESULTS:Thirty-six patients completed the study. Both types of implants showed a survival rate of 94.4% ± 3.8% (95% CI 87.0%-100%); all lost implants failed to achieve osseointegration. There is no significant difference found in the change of the bone level over time within the first year between the two groups (p = 0.25 for mesial pocket bone, p = 0.99 for distal pocket bone, p = 0.98 for mesial proximal bone and p = 0.68 for distal proximal bone). CONCLUSION:After one year, no statistically significant radiographic and clinical differences were observed between hybrid and moderately rough implants. However, peri-implant diseases often manifest after a longer period. This underscores the importance of extended follow-up. A subsequent evaluation is planned at the three-year mark.
AIM:To evaluate survival rates and identify temporally distinct risk factors for early and late failure of wide-diameter dental implants (≥ 5.0 mm) in a large real-world cohort using landmark analysis. MATERIALS AND METHODS:This retrospective cohort study analyzed 12 041 wide-diameter implants (≥ 5.0 mm), predominantly 5.0 mm, placed in 9247 patients at a single center between January 2014 and December 2023. Implant survival was defined as the fixture remaining in situ without clinical loss or replacement at the same site. Failures were classified as early (≤ 1 year) or late (> 1 year). Kaplan-Meier survival curves and a multivariable Cox proportional hazards model clustered by patient were generated. Schoenfeld residuals revealed time-varying effects for penicillin allergy, implant length, and kidney disease, prompting a landmark analysis at 365 days with separate multivariable logistic regression models for early and late failure. RESULTS:Overall implant survival was 97.5%. Kaplan-Meier estimates were 98.1% (95% CI: 97.9%-98.4%) at 1 year, 97.8% (95% CI: 97.5%-98.0%) at 3 years, and 97.6% (95% CI: 97.4%-97.9%) at 5 years. Of 301 failures, 225 (74.8%) were early and 76 (25.2%) were late. In the Cox model, short implants (≤ 8 mm; HR = 1.94, 95% CI: 1.43-2.62, p < 0.001), maxillary placement (HR = 2.13 vs. mandible, p < 0.001), male sex (HR = 1.39, p = 0.010), penicillin allergy (HR = 1.66, p = 0.014), and older age (HR = 0.84 per SD, p = 0.008) independently predicted failure; smoking was borderline (HR = 1.33, p = 0.065). Landmark analysis showed that early failure was driven by penicillin allergy (OR = 2.26, p < 0.001), maxillary placement (OR = 2.42, p < 0.001), male sex (OR = 1.40, p = 0.016), and short length (OR = 1.70, p = 0.007), whereas late failure was driven by short length (OR = 3.19, p < 0.001) and kidney disease (OR = 6.11, p = 0.003). CONCLUSIONS:Wide-diameter implants achieve excellent long-term survival. Early and late failures arise from distinct mechanisms: perioperative, anatomical, and sex-related factors predominate early, while short implant length and renal disease predominate late. These findings support tailored perioperative protocols, individualized risk stratification, and targeted long-term surveillance.
INTRODUCTION:The effects of self-reported penicillin allergy and alternative antibiotic regimens on implant outcomes remain poorly investigated. Therefore, the aim of this study was to evaluate the association between self-reported penicillin allergy and the use of alternative antibiotics with post-implant placement surgical complications, early implant failure, and preloading crestal bone loss (PLCBL). METHODS:This retrospective cohort study examined dental records of patients who received at least one dental implant. Patients who reported a penicillin allergy were identified as the exposed group, whereas patients without a reported penicillin allergy were selected as unexposed in a 1:2 exposed-to-unexposed ratio. Relevant patient- and implant-related factors were recorded. Implants were evaluated for postsurgical complications, PLCBL, and early failure. Data were analyzed using bivariate analyzes and mixed-effects regression models. RESULTS:A total of 179 subjects and 374 implants were evaluated. Early implant failure and surgical complications occurred in 6.1% and 8.0% of implants, respectively, while PLCBL was observed in 32.5% of implants. A higher prevalence of surgical complications and implant failure was observed among patients who reported a penicillin allergy compared with those without a reported allergy (p < 0.05). Implants prescribed azithromycin showed a higher prevalence of surgical complications, and those prescribed azithromycin or clindamycin had higher early failure rates compared with penicillin (p < 0.05). Regression analyzes showed that self-reported penicillin allergy was not independently associated with surgical complications, PLCBL, or early implant failure (p > 0.05). In exploratory multivariable analyzes, azithromycin and other alternative antibiotics were associated with higher odds of surgical complications compared with penicillin (p < 0.05). No significant associations were found between antibiotic type and PLCBL or early implant failure (p > 0.05). CONCLUSION:Self-reported penicillin allergy was not independently associated with early implant outcomes in this cohort. Certain alternative antibiotics were associated with a higher prevalence of early surgical complications, warranting further investigation in larger studies.
OBJECTIVE:This study aims to evaluate the application of an autonomous dental implant robot combined with osseodensification drills for transcrestal maxillary sinus floor elevation (ADIR-OD-TSFE) and simultaneous implant placement. The following parameters, such as maxillary sinus elevation volume (MSV), maxillary sinus elevation area (MSA), membrane elevation height (MEH), implant protrusion length (IPL), implant placement accuracy, intraoperative Schneiderian membrane perforation rate, and operative time, were evaluated. In addition, the force feedback characteristics associated with different maxillary sinus floor morphologies were preliminarily investigated. MATERIALS AND METHODS:This study enrolled patients treated at the Stomatological Hospital of Chongqing Medical University between January and November 2024, with a residual bone height (RBH) of 4.00-8.00 mm, who underwent simultaneous implant placement using ADIR-OD-TSFE. Postoperative CBCT scans were imported into the design software to evaluate implant placement accuracy. The software's AI segmentation function was used to calculate the sinus floor augmentation outcome immediately after surgery (P1) and at 6 months postoperatively (P2). Force feedback characteristics were analyzed for two sinus floor morphologies (flat and sloped). The total operative time for osteotomy, sinus floor elevation, and implant placement performed with robotic assistance was recorded; the surgeon's learning curve was plotted, and the intraoperative complications were documented. RESULTS:A total of 18 implants were placed, with 9 in flat sinus floors and 9 in sloped sinus floors. The mean preoperative RBH was 5.92 ± 1.01 mm. Schneiderian membrane perforation occurred in 1 case (5.6%). The mean surgery time was 25.5 ± 9.8 min, and the surgeon's learning curve plateaued as case numbers increased. The coronal global deviation (CG), apical global deviation (AG), and angular deviation (AD) were 0.69 ± 0.36, 0.76 ± 0.41, and 1.64° ± 0.91°, respectively. The maxillary sinus floor elevation volume was 351.54 ± 151.74 mm3 immediately after surgery (P1) and 253.68 ± 160.60 mm3 at 6 months postoperatively (P2). Force feedback analysis showed that the breakthrough force was higher in flat sinus floors (Ff0) than in sloped sinus floors (Fs0), with a mean difference of 6.86 N, a 95% CI of 0.82 to 12.90 N, and a large effect size (Hedges' g = 1.08). CONCLUSION:The ADIR-OD-TSFE technique is effective for sinus floor elevation and implant placement, with the learning curve improving as the surgeon's experience increases. It demonstrates high implant placement accuracy and maintains relatively stable bone augmentation outcomes at 6 months postoperatively. Flat sinus floors require significantly higher breakthrough forces compared to sloped sinus floors. Overall, the ADIR-OD-TSFE system proves to be a safe and clinically reliable approach.
OBJECTIVES:This multicenter prospective cohort study follows a 1-year period after a previously published randomized controlled trial, comparing the radiographic and clinical outcomes of implants placed with simultaneous guided bone regeneration (GBR) using bioceramic (BC) versus xenograft (BO). MATERIALS AND METHODS:Patients from the previous trial were recalled 1 year after crown delivery. The follow-up data focused on the buccal bone stability evaluated by CBCT and implant survival rate, Probing Depth (PD), Bleeding on Probing (BOP), Plaque Index (PI), and patient satisfaction through Oral Health Impact Profile-5 (OHIP-5). RESULTS:Out of 150 enrolled patients in a previous trial, a total of 97 patients completed the 1-year follow-up: 44 in the BC group and 53 in the BO group. The implant survival rate was 100% in both groups. Change in horizontal buccal bone thickness (△HBBT) at 1 year post-crown delivery versus immediately post-surgery was -0.28 ± 0.10 mm for the BC group and -0.91 ± 0.09 mm (mean ± standard error) for the BO group, with the BC group exhibiting less bone resorption along the implant than the BO group (p = 0.0000). No significant differences were observed in PI, BOP, or PD. Patient satisfaction remained high in both groups. CONCLUSIONS:GBR with bioceramic demonstrated stable radiographical bone on the buccal side of the implant 1 year after crown delivery.
BACKGROUND:This study aimed to evaluate the prevalence of peri-implant soft tissue deformities, including dehiscences (PSTDs) and deficiencies, around bone-level (BL) and tissue-level (TL) implants in the anterior maxilla, assess associated variables, and patient-reported outcomes (PROs). METHODS:Adults with implant-supported prostheses (ISPs) in the anterior maxilla were recruited. Clinical and digital assessments were performed, and related variables were analyzed. RESULTS:A total of 205 ISPs in 193 patients were evaluated. Mean follow-up after implant placement was 11.3 ± 1.4 years. PSTD prevalence was comparable between BL and TL implants (88.8% vs. 94.4%; p = 0.19), or when PSTD ≥ 1 mm (23.9% vs. 22.5%; p = 0.97). Similarly, 99.25% and 100% of BL and TL showed deformities, p = 1.00. Prevalence of prosthetic interface/abutment (12.7% vs. 2.5%) and implant shoulder exposure (4.2% vs. 0%), and overcontoured ISP (35.2% vs. 12.7%) was significantly higher in TL implants (p < 0.01). Greater papilla dimensions and lower volume deficiency (90.3% vs. 98.6%; p < 0.01) were observed around BL implants, while mucosal discoloration was similar between groups (16.4% vs. 15.5%; p > 0.05). Greater PSTD depth was associated with older age, reduced keratinized mucosa width (< 2 mm), wider implant diameter, prosthetic overcontouring, lower mucosal volume, and papilla deficiencies (p < 0.05). Wider prosthetic emergence angles were associated with reduced papilla dimensions (p < 0.05). Thin mucosa (< 2 mm) was associated with grayish mucosal discoloration (OR = 2.79). Despite these findings, OHIP-14 scores were low, and PROs were high, with no significant differences between groups. CONCLUSIONS:Prevalence of peri-implant soft tissue deformities in the anterior maxilla is high irrespective of implant type and is associated with age, soft tissue phenotype, mucosal volume, papilla deficiencies, wider implant diameters, and prosthetic overcontouring. However, this does not seem to have a measurable impact on patient perception.
OBJECTIVE:This study aimed to establish and validate a standardized, minimally invasive rat mandibular vertical bone augmentation model for evaluating the performance of digitally fabricated space-maintaining barrier membranes in guided bone regeneration (GBR). METHODS:Public single-cell RNA sequencing datasets were analyzed to compare the cellular microenvironment between the cranium and mandible. Three experimental models were established: cranial augmentation group (Crania group), mandibular augmentation group (Mandible group), and mandibular augmentation group with nutrient foramen preparation (Mandible +NF group). A circular retention form was prepared to fix hemispherical barrier membranes without screw fixation. Outcomes were assessed at 8 weeks via stereomicroscopy, micro-CT, and histology. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed to evaluate vertical bone augmentation, bone quality, survival rate, success rate (membrane retention), and body weight. RESULTS:The mandible presented a higher abundance of mesenchymal stem cells (MSCs) and osteoblasts than the cranium. ITT and PP analyses revealed that the Mandible group and Mandible + NF group achieved significantly higher vertical bone gain, bone volume to total volume ratio (BV/TV), and bone mineral density (BMD) than the Crania group, while additional NF preparation showed no enhanced osteogenic benefit. The Mandible group achieved the highest ITT survival rate (86.7%) and success rate (83.3%), whereas NF preparation increased surgical trauma and mortality. Mechanical analysis confirmed that circular retention alone ensured sufficient membrane stability in the mandibular model. CONCLUSION:A novel, minimally invasive, and highly reliable rat mandibular vertical bone augmentation model was successfully established. This model recapitulates the biological principles of clinical vertical GBR, presents favorable translational relevance, and serves as a low-cost, high-efficiency platform for the preclinical evaluation of GBR barrier membranes.
OBJECTIVES:This retrospective study evaluated the long-term effect of implant adjacency on the prognosis of adjacent natural teeth. MATERIALS AND METHODS:We included 345 patients who underwent posterior implant placement and prosthetic restoration between August 2007 and June 2025. In the experimental group, 502 implant-adjacent natural teeth were analyzed; contralateral teeth served as controls. Radiographic images and clinical records obtained at baseline (implant placement) and follow-up (minimum 24 months after prosthetic restoration; mean 70.98 months) were compared. Coronal status, pulpal status, and tooth survival were assessed, while periapical status was evaluated using the Periapical Index. RESULTS:Implant-adjacent teeth demonstrated significantly higher rates of coronal deterioration and periapical worsening than contralateral teeth, whereas changes in pulpal status did not differ significantly between groups. The survival rate of implant-adjacent teeth was significantly lower, with a 2.73-fold increased risk of extraction or loss. Subgroup analysis revealed that second molars exhibited a higher incidence of periapical deterioration, and mandibular premolars showed significantly reduced survival when implant-adjacent. CONCLUSION:Posterior implant restoration is associated with cumulative structural and radiographic alterations in adjacent natural teeth, which may compromise long-term tooth survival. The clinical success of posterior implant restoration should be evaluated by the preservation of structural and periapical integrity in adjacent teeth, not only implant survival.
OBJECTIVE:To compare the effect of deproteinized bovine bone matrix (DBBM) and horizontal platelet rich fibrin bone block (H-PRF-BB) in transcrestal sinus floor elevation (TSFE). MATERIALS AND METHODS:This retrospective study included 65 patients receiving 73 implants placed simultaneously with TSFE. Patients were divided into two groups: (1) the H-PRF-BB group (23 patients, 24 implants) and (2) the DBBM group (42 patients, 49 implants). Cone beam computed tomography (CBCT) was obtained pre-, immediate post-surgery and at the follow-up time. Residual bone height (RBH), height of the augmented bone above the apex of the implant (AH), and height of the elevated sinus floor (EH) were measured. The differences between the groups were analyzed using Welch's t-test or Mann-Whitney U test. The correlations between RBH0 and whether the implant apex was covered with bone were evaluated through Fisher's exact probability test. RESULTS:RBH preoperative (RBH0) and immediate postoperative (RBH1) exhibited no statistically significant difference between the two groups. The RBH at the follow up time (RBH2) in the H-PRF-BB group (11.46 ± 0.32 mm) was higher than that of the DBBM group (10.31 ± 0.30 mm), but without statistical significance. The bone height gained immediately after TSFE (EH1) was 6.39 ± 0.43 mm in the H-PRF-BB group and 5.65 ± 0.28 mm in the DBBM group (no statistical difference). Nevertheless, the bone height gained at the follow up time (EH2) was higher in the H-PRF-BB (5.39 ± 0.41 mm) group when compared to the DBBM group (4.04 ± 0.24 mm). The bone height change (ΔH) was minimal in the H-PRF-BB group (-1.02 ± 0.18 mm) compared to that in the DBBM group (-1.80 ± 0.23 mm). The mean AH immediately after surgery (AH1) was comparable in both groups, but was higher above the implant apex in the H-PRF-BB group (2.18 ± 0.28 mm) at the follow up time (AH2) when compared to the DBBM group (1.36 ± 0.16 mm). Lastly, the apex exposure rate was also lower in the H-PRF-BB group (12.5%) compared to the DBBM group (29.8%). CONCLUSION:H-PRF-BB showed better radiographic outcomes in TSFE compared to DBBM, with an elevated EH2 and AH2. The use of H-PRF-BB was found to reduce the height decrease over time and lessen implant exposure at the apex.
AIM:To compare one-year prosthetic, technical, and esthetic outcomes of screw-retained, implant-supported all-ceramic single crowns placed on two-piece zirconia (ZrO2) versus titanium implants. MATERIALS AND METHODS:In this randomized, prospective, multicenter clinical trial, patients received screw-retained, implant-supported all-ceramic single crowns placed either on a two-piece zirconia implant with a titanium base connection or on a titanium implant with a conventional titanium base (implant diameters: 4.1 mm). Restoration survival and technical complications were systematically recorded. Peri-implant soft-tissue parameters, including plaque index (PI), papilla bleeding index (PBI), and papilla index (PaI), were assessed at baseline and at the one-year follow-up. Baseline was set at three weeks after crown insertion. Statistical analyses were performed using descriptive statistics. Chi-square tests were used to compare outcomes between the zirconia and titanium implant groups, with the level of significance set at p < 0.05. RESULTS:A total of 117 implants were restored, and 112 restorations were available for analysis after one year of function. Restoration survival was 100% in both the zirconia and titanium implant groups. No statistically significant differences were observed between groups with regard to overall technical complication rates. Veneered zirconia crowns exhibited significantly higher complication rates compared with monolithic restorations, irrespective of the supporting implant material. Peri-implant soft-tissue parameters, including PI, PBI, and PaI, did not differ significantly between groups. CONCLUSION:Within the limitations of this prospective randomized clinical trial, restorations supported by zirconia implants with a screw-retained titanium base connection demonstrated short-term clinical performance comparable to that of restorations placed on titanium implants. Both groups showed a 100% restoration survival rate, with no significant differences in technical complications or peri-implant soft-tissue parameters. These findings should be interpreted considering the one-year follow-up, the study design primarily powered to detect differences in marginal bone loss, and the exclusive use of regular-diameter implants. Overall, the results support the favorable short-term clinical performance at 1 year. TRIAL REGISTRATION:The study is registered at the German Clinical Trial Register (https://drks.de/search/de/trial/DRKS00013209) as well as at the Federal Office of Public Health's (FOPH) portal for human research in Switzerland (kofam.ch).
OBJECTIVE:This study aimed to compare the effect of PTFE tape wrapping and PTFE-coated titanium alloy screws on the removal torque after cyclic loading and on preload values under repetitive tightening. METHODS:A total of 60 titanium abutment screws were allocated to three surface-treatment groups (n = 20 each): untreated (Control), PTFE tape-wrapped (Wrap), and PTFE-coated (Coat). Within each group, 10 specimens underwent cyclic loading, whereas 10 were assigned to preload evaluation. Cyclic loading followed ISO 14801:2016. Screws were tightened to 30 N·cm, retightened after 10 min, and subjected to 300 000 cycles at 200 N using a fatigue testing machine (DYNA-MESS Prüfsysteme GmbH, Aachen, Germany). Removal torque was measured with a digital torque gauge (BTGE50CN, Tohnichi, Japan). For preload assessment, each specimen completed 10 tightening-loosening cycles at the same torque during which tensile force was recorded using a customized device. One representative screw per group was analyzed by SEM and micro-CT before and after loading to evaluate surface and structural changes. RESULTS:After cyclic loading, the removal torque did not differ significantly between the Control group (17.58 ± 1.85 N·cm) and the Wrap group (17.50 ± 1.77 N·cm), whereas the Coat group demonstrated significantly lower removal torque (14.71 ± 2.35 N·cm; p < 0.05). In the preload test, preload progressively decreased in the Control (-3.13 N per cycle) and Coat groups (-0.51 N per cycle), while the Wrap group showed a consistent increase with repeated tightening (+8.22 N per cycle). SEM revealed surface wear and partial loss of PTFE material after loading, particularly in the coated specimens. Micro-CT analysis showed no detectable differences in internal adaptation among groups before or after cyclic loading. CONCLUSIONS:PTFE tape wrapping increased preload during repeated tightening but did not improve removal torque after cyclic loading compared with those of untreated screws. Although PTFE-coated screws produced the highest initial preload, they were associated with reduced removal torque after loading. SEM analysis confirmed coating deterioration, whereas internal fit remained comparable across groups.
OBJECTIVE:The present study aimed to compare the clinical and radiographic performance of full-length implantoplasty (FLIP) versus partial-length implantoplasty (PLIP) for the supracrestal component as part of combined surgical therapy for peri-implantitis with a ≥ 3 mm depth at the intrabony component. MATERIALS AND METHODS:A single-center, prospective, randomized, controlled, two-arm comparative study was conducted to evaluate the extent of implantoplasty-limited to the supracrestal component (PLIP) or extending to both supracrestal and intrabony components (FLIP)-in the combined surgical management of peri-implantitis. Clinical and radiographic outcomes were assessed 1 year after surgery. Disease resolution was defined using a composite of clinical and radiographic criteria, although sample size was calculated for pocket depth reduction. Generalized estimating equations were applied to calculate unadjusted and adjusted odds ratios. RESULTS:A total of 33 patients (Nimplants = 40) completed the study. All evaluated clinical parameters in both groups showed statistically significant changes over the study period. A significant intergroup difference was observed for modified sulcus bleeding index (mSBI), favoring FLIP (p = 0.003). Marginal recession (MR) was significantly greater in the FLIP group compared with the PLIP group (p = 0.006) and was more pronounced in the posterior mandible (p = 0.002). No other clinical parameters differed significantly between groups. Regarding marginal bone level (MBL) gain, FLIP demonstrated a statistically significant advantage over PLIP in the adjusted model (p = 0.009). For the remaining radiographic variables, significant changes were observed at the 1-year follow-up assessment, but no significant intergroup differences were detected. Overall disease resolution was achieved in 77.5% of cases. The adjusted model showed no statistically significant difference between the tested groups (OR = 14; p = 0.13). Smoking was consistently associated with less favorable clinical and radiographic outcomes. No major postoperative complications were reported. CONCLUSION:Combined surgical therapy for peri-implantitis, including implantoplasty and regeneration of the intrabony component, is effective in arresting disease progression and restoring peri-implant health. Extending implantoplasty to the contained intrabony compartment appears to provide additional clinical and radiographic benefits. However, this advantage comes at the expense of increased mucosal recession, highlighting the need for careful case selection and patient counseling.
INTRODUCTION:Peri-implantitis, characterized by inflammatory bone loss, is a leading cause of dental implant failure. Current regenerative strategies face limitations due to the persistent inflammatory microenvironment. Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have emerged as promising acellular therapeutics with dual osteogenic and immunomodulatory capacities, offering a novel approach to address the complexity of peri-implant bone defects. METHODS:This narrative review synthesizes preclinical evidence on MSC-EVs for peri-implant bone regeneration. It examines methods for EV isolation from various sources. Furthermore, it analyzes advanced engineered delivery systems, such as peptide-functionalized implant surfaces and bioactive scaffolds, designed to enhance local retention and therapeutic efficacy. RESULTS:MSC-EVs orchestrate bone regeneration through multifaceted mechanisms. They directly stimulate osteogenesis by transferring pro-osteogenic miRNAs and proteins, activating key pathways like PI3K/AKT and Wnt/β-catenin. Crucially, they modulate the osteoimmune environment by reprogramming macrophages toward a reparative M2 phenotype, suppressing pro-inflammatory Th1/Th17 responses, and expanding regulatory T cells (Tregs). Concurrently, MSC-EVs inhibit bone resorption by favorably modulating the RANKL/OPG balance and directly interfering with osteoclast differentiation. They also promote neovascularization, a critical factor for healing in ischemic zones. Preclinical models demonstrate that localized delivery via engineered systems significantly enhances osseointegration, bone-implant contact, and regeneration of functional bone-vessel units. CONCLUSION:MSC-EVs represent a promising and multifaceted therapeutic strategy for bone regeneration in peri-implantitis, simultaneously targeting inflammation, bone resorption, and osteogenesis. While robust preclinical evidence supports their role in halting bone loss and promoting structured regeneration, successful clinical translation requires further standardization, optimization of delivery, and validation in human trials.
OBJECTIVES:This retrospective study compared the clinical and radiographic outcomes of a stepwise modified transcrestal sinus floor elevation (SM-TSFE) with the lateral sinus floor elevation (LSFE) for simultaneous implant placement in sites with 3-5 mm of residual bone height (RBH). MATERIALS AND METHODS:A total of 149 patients with 3-5-mm RBH underwent simultaneous implant placement using either SM-TSFE (n = 69) or LSFE (n = 80). The follow-up period ranged from 6 months to 8 years. Evaluated clinical outcomes included implant survival rates, sinus membrane perforation, and postoperative complications. Radiographic assessments included preoperative RBH, marginal bone loss (MBL), and vertical bone height changes. RESULTS:Cumulative implant survival rates were comparable between SM-TSFE (91.30%) and LSFE (93.75%) groups (p = 0.537). However, the SM-TSFE group demonstrated a significantly lower sinus membrane perforation rate (7.24%) compared to the LSFE group (18.75%; p = 0.047). Multivariate analysis identified maxillary sinus septa as the strongest risk factor for perforation (p = 0.002). Regarding implant failure, TiUnite surface (p = 0.035) and membrane perforation (p = 0.039) were significant risk factors, while higher marginal bone height (MBH) was identified as a protective factor (p = 0.003). Both groups exhibited comparable MBL at 2 years post-loading (p > 0.05). CONCLUSION:In sites with 3-5 mm of RBH, SM-TSFE provides implant survival rates comparable to LSFE over the observation period but offers a significant safety advantage due to a substantially lower rate of sinus membrane perforation.
OBJECTIVE:To investigate for the first time the difference in Yes-associated protein (YAP) gene expression and protein levels in the peri-implant crevicular fluid of healthy osseointegrated titanium implants and those showing early signs of peri-implantitis before loading; and to investigate the immunomodulatory effect of titanium on YAP expression by comparing YAP protein levels around healthy implants with those in the gingival crevicular fluid of healthy teeth. MATERIALS AND METHODS:Sixty-six systemically healthy individuals were recruited. Fold change in YAP gene expression was evaluated by q-PCR, and YAP protein level was measured by ELISA in clinical conditions of peri-implant health (n = 22) and peri-implantitis (n = 22) before insertion of implant-supported prosthesis to avoid the effect of loading on mechanosensitive YAP. The level of YAP protein was measured in healthy periodontal tissues (n = 22) in the absence of traumatic occlusion and compared with healthy peri-implant environment. RESULTS:Statistical analysis revealed that YAP gene expression relatively increased by 35% in the presence of peri-implantitis with a non-significant p-value of 0.938. YAP protein levels pairwise comparison between the studied groups was statistically significant with p-value < 0.005. The least value of YAP was in healthy periodontium, followed by healthy peri-implant tissue and finally a remarkable increase in the presence of peri-implantitis. Gender was a significant predictor of YAP, with higher levels in females in the presence of implants. CONCLUSION:YAP is a recent biomarker that can predict the presence of inflammation in the peri-implant environment. YAP protein levels are the highest in the presence of titanium implants and early clinical and radiographic signs of peri-implantitis. Studying the YAP-related osteoimmunology of the peri-implant environment offers new insights into a better understanding of the osseointegration process and titanium-induced peri-implantitis.
OBJECTIVES:To investigate the differential effects of primary (PPT) and odontogenic (OPT) pathological Schneiderian membrane thickening on outcomes of transcrestal sinus floor elevation (TSFE) with simultaneous implant placement. MATERIAL AND METHODS:This prospective cohort study enrolled 89 patients (123 implants), divided into normal, PPT, and OPT groups. All patients underwent TSFE with simultaneous implant placement. The Schneiderian membrane perforation, early implant failure, postoperative complications, and implant stability quotient (ISQ) value were recorded. Cone beam computer tomography was obtained preoperatively, immediate postoperatively, and 6 months postoperatively to perform linear measurements including Schneiderian membrane thickness (SMT), residual bone height (RBH), sinus floor elevation height (SFEH), endo-sinus bone gain (ESBG), and graft material resorption height (GMRH). RESULTS:No early implant failure or postoperative complications were observed, and no significant difference in ISQ values was found among the three groups (p = 0.116). The OPT group had a significantly higher membrane perforation rate (30.4%) than the normal (9.5%) and PPT (7.7%) groups (p = 0.023), lower ESBG (2.88 ± 1.59 mm vs. normal 4.02 ± 1.63 mm, p = 0.015), and higher GMRH (2.98 ± 1.84 mm vs. normal 1.37 ± 1.15 mm/PPT 1.41 ± 1.26 mm, p < 0.001). PPT showed no significant differences in ESBG/GMRH versus normal (p > 0.05). CONCLUSIONS:Our results demonstrate that neither primary nor odontogenic pathological Schneiderian membrane thickening influences the early success rate of implants placed simultaneously with transcrestal sinus floor elevation. Nevertheless, odontogenic pathological Schneiderian membrane thickening significantly increases the incidence of Schneiderian membrane perforation and decreases the formation of new bone.
AIM:To evaluate the clinical and radiographic outcomes of transcrestal sinus floor elevation (TSFE) with simultaneous implant placement in sites with residual bone height (RBH) of 3-5 mm. MATERIALS AND METHODS:This retrospective cohort study included patients who underwent TSFE with simultaneous implant placement between December 2017 and September 2023. According to the intraoperative bone grafting status, patients were divided into two groups: the non-grafting group and the grafting group (Bio-Oss Collagen). Patient medical histories were collected, and radiographic parameters were measured at the following timepoints: preoperative (T0), immediate postoperative (T1), healing phase (T2, 4-6 months postoperatively), and follow-up period (T3, 1-6 years postoperatively). Implant survival rate, complication-free survival rate, incidence of sinus membrane perforation (SMP), endo-sinus bone gain volume (ESBGV), endo-sinus bone gain height (ESBGH), marginal bone loss (MBL), apical bone height (ABH), and mean cost of treatment were evaluated. A linear mixed model (LMM) regression was employed to identify key determinants influencing endo-sinus bone augmentation following TSFE. RESULTS:Sixty-six dental implants placed in 57 patients were included (non-grafting group: 26 implants in 21 patients; grafting group: 40 implants in 36 patients). After the 1- to 6-year follow-up, the survival rate of implants was 100% in two groups (p > 0.05) and complication-free survival rate was 84.85% at implant level (non-grafting group: 80.77%, grafting group: 87.50%; p > 0.05) and 82.46% at patient level (non-grafting group: 76.19%, grafting group: 86.11%; p > 0.05). The incidence of SMP was 11.54% and 10.00% in non-grafting and grafting groups, respectively (p > 0.05). ESBGV, ESBGH, and ABH were significantly greater in the grafting group compared to the non-grafting group (p < 0.05). No significant differences in MBL were found (p > 0.05). The total treatment cost was significantly lower in the non-grafting group than in the grafting group (p < 0.05), whereas no significant difference was found in retreatment costs between the groups (p > 0.05). The LMM regression results showed that the core determinant of ESBGV was postoperative maxillary sinus augmentation volume (p < 0.05). CONCLUSION:Within the limitations of this study, TSFE with simultaneous implant placement demonstrated medium- to long-term stable clinical and radiographic outcomes in the posterior atrophic maxilla ridges with RBH ranging from 3 to 5 mm regardless of bone grafting. While the grafting strategy significantly enhanced endo-sinus bone augmentation, the non-grafted approach was associated with significantly lower overall treatment costs.
