Implantology offers a wide range of opportunities for the use of artificial intelligence (Al). If Al brings about advances in implantology that benefit patients and dentists, this is to be welcomed from an ethical point of view. This article examines the acceptability of Al applications in implantology based on four central principles of medical ethics that also apply to dentistry: autonomy, beneficence, non-maleficence, and justice. In this regard, both opportunities and risks arise from the use of Al. Ultimate human responsibility, data sovereignty, traceability and explainability of algorithms, fair and representative training data, and protection against deskilling can be identified as important preconditions for the ethically justifiable use of Al in implantology.
The digital implant workflow offers new possibilities for planning, impression-taking, and prosthetic restoration. However, it does not replace clinical expertise. Digital procedures allow for more accurate implant planning, better patient education, and more efficient communication between dental practices and laboratories. However, anatomical limitations, system-related inaccuracies, and the need for interdisciplinary coordination remain crucial factors in successful treatment. Clinical case studies illustrate the opportunities, challenges, and limitations of the digital implant workflow. Combining analog and digital procedures allows for flexible and patient-centered implant treatment. Digital tools should serve as support rather than as substitutes for clinical knowledge.
Modern digital technologies are increasingly being integrated into dental practice. They support clinicians and patients in various aspects of diagnostics, planning, and decision-making. In the implementation of digital workflows, various tools -such as intraoral scanners, CAD/CAM systems, facial scanners, and artificial intelligence (AI)-based planning software -are used to enhance efficiency, accuracy, and predictability, while facilitating communication between the dentist and dental technician. In the present case, a 68-year-old patient was rehabilitated with implant-supported removable dentures using a digital workflow. The process included digital planning, simulation, fabrication, and insertion of the prostheses, resulting in a precise and esthetically predictable outcome.
Algorithms, programs, and networks based on artificial intelligence (AI) are currently among the most important drivers of innovation in healthcare. In dentistry, AI-based algorithms emerged just over a decade ago, initially in dentomaxillofacial radiology, where the following applications were researched and implemented in everyday dental practice: improving radiologic image quality, automatically identifying teeth and implants (including their restorative status), diagnosing dental and oral pathologies, and localizing or segmenting anatomical landmarks and structures, for example, in the fields of orthodontics or oral surgery. Al is also a promoter of digital workflows in dentistry, particularly in oral implantology and prosthodontics, where it actively supports the planning, implementation, and monitoring of therapies. Exciting developments include speech recognition systems and visual language models (VLMs), which could significantly reduce and streamline the administrative burden in dental practices. The future use of virtual reality (VR), augmented reality (AR), and mixed reality (MR) in dental studies, or the active integration of this technology into the curriculum, also holds great promise for oral implantology, where complex surgical procedures can be trained and repeated virtually until both a suitable routine and practitioner expertise bare achieved to apply these techniques in real patients. Alongside all these possibilities, however, it is important to consider the risks associated with AI, such as deskilling and automation bias. Furthermore, the dental profession should actively participate in the discussion on the ethical use and regulation of this technology.
The rapid expansion of digital health data collected across national and institutional registries has opened new strategic avenues for innovation in medical and dental research. Registry-based clinical trials (RBCTs), which integrate large-scale datasets, represent a modern and promising methodologic concept designed to overcome key limitations of classic randomized controlled trials (RCTs). This perspective article introduces a methodologic framework that merges the external validity of clinical registries with the internal validity of traditional trial designs. It further provides a critical discussion of the future opportunities and challenges associated with RBCTs in dental research. RBCTs hold considerable potential to transform clinical research and may become an integral component of implant dentistry. Their influence extends far beyond academic inquiry, shaping clinical care pathways, healthcare systems, education, development in medical devices and pharmaceuticals, insurance structures, and regulatory decision-making. The major strength of RBCTs lies in the reliance on real-world data: They can substantially enhance recruitment efficiency while reducing the financial and logistical burden typically associated with classic clinical trial designs. Once established, registry infrastructures can continuously generate and support new research initiatives. As data volumes and quality continue to grow, so too will the scientific and clinical potential of registry-based trial methodologies. RBCTs will not replace traditional RCTs; rather, they should be considered a supplementary tool in clinical research.
Unknown dental implants without documentation are a common finding and are clinically relevant, especially in cases with prosthetic revisions, technical complications, and peri-implant diseases. This article outlines a manufacturer-independent strategy for identification, combining radiographic assessment (orthoradial periapical imaging, panoramic radiographs, and CBCT, when indicated) with a descriptive morphologic classification focusing on interface, collar, body, thread design, and apex. Digital resources such as visual databases, AI-based recognition tools, chairside apps, and professional communities are integrated with practical notes on image quality and data protection. A stepwise workflow for verification (instrument testing and radiographic matching) supports reliable treatment planning. Recent reviews report mean deep-learning accuracies around 90% to 92%, with selected studies achieving up to 95% under optimized conditions. Achieving a correct projection remains essential, as angulation errors distort measurements and obscure key features. The article concludes with case vignettes, MDR/UDI considerations, and practical recommendations.
PURPOSE:To investigate and compare the survival rate and the success rate of single-tooth implants placed and restored immediately after extraction in non-infected, acutely infected, and chronically infected sites in the maxillary anterior area. MATERIALS AND METHODS:Patients requiring a single-tooth replacement in the maxillary central incisor, lateral incisor, canine, or premolar region were included in the study. Implant sites were divided into three groups based on the presence or absence of an infection: group 1 (control)-non-infected sites (healthy periodontal and endodontic conditions); group 2 (test 1)-acutely infected sites (presence of a periodontal or endodontic or combined abscess and/or fistula); and group 3 (test 2)-chronically infected sites (presence of a periodontal pocket or a periapical lesion with no signs of acute inflammation). The applied protocol was as follows: flapless extraction, thorough debridement of the alveolus, immediate placement of the implant, placement of particulate graft material around the implant, resorbable membrane placement in the facial aspect of the implant for all those cases in which the buccal plate was compromised, and immediate placement of a screw-retained provisional FDP out of occlusion. The following periodontal and endodontic initial conditions were evaluated: gingival recession, probing depth, presence of an abscess and/or a fistula, reason for extraction, presence of a periapical lesion, alveolar buccal wall integrity, distance between the gingival margin (GM) and the alveolar bone crest midbuccally, and implant insertion torque. Implant conditions at the last follow-up included survival rate and marginal bone loss (MBL). Periodontal conditions such as recession, probing depth, and gingival index (GI) and the final esthetic results (pink esthetic score) were also evaluated. Statistical analysis was also performed. RESULTS:After a mean follow-up of 7 years (range 2 to 12 years), a total of 127 patients were treated and 143 single-tooth implants were placed and immediately restored with a provisional FDP. There were a total of 47 implants in group 1, 56 implants in group 2, and 40 implants in group 3. The survival rate for group 1 was 97.8%, 96.4% for group 2, and 95% for group 3, with no statistical difference between groups (P = .8). A total of five implants failed-one in group 1, two in group 2, and two in group 3-resulting in a cumulative implant survival rate of 96.5%. CONCLUSIONS:The results of this study showed a comparable implant survival rate for single-tooth implants placed and restored immediately in non-infected, acutely infected, and chronically infected sites.
Dental implantology has developed substantially over the last few decades thanks to technolog ic advances and scientific findings. With a documented long-term survival rate of over 90% after 10 years, implants are regarded as a reliable form of restoration. As a result of demographic devel opments and the longevity of implants, many patients now wear different systems from different generations. Combining these in the fabrication of new superstructures is a common but technically demanding procedure. Particular challenges arise from the heterogeneity of the implant-abutment connections, which differ in terms of fit, friction, load distribution, and soft tissue reaction. The choice between cemented, screw-retained, or combined luting solutions also requires a differen tiated clinical decision. In cases of limited technical possibilities, intraoral processing of existing components may be a necessary alternative. Despite the limited literature, clinical experience shows that careful planning, cross-system approaches, and complete documentation can achieve function al and esthetically satisfactory results, even in initially complex situations.
Dental implantology faces both functional and esthetic challenges in cases of severely atrophic jaws. This article presents an interdisciplinary treatment concept involving simultaneous vertical and horizontal hard and softtissue augmentation combined with immediate implantation and provisionalization. Using digital planning and backward-planning strategies alongside patient-specific smile design, precise implant positioning was achieved. While the maxilla was converted into an FP-1 design through augmentation, the nonaugmented mandible was restored using an FP-3 concept. This clinical approach demonstrates that a functionally and esthetically high-quality rehabilitation achievable even in complex defect situations through the application of modern materials, digittools, and surgical precision. Immediate loading proved to be an effective method for reducing treatment duration.
The All-on-X concept is becoming increasingly popular, especially among anxious patients who prefer a quick, fixed restoration. But how should a dentist react when the patient in question still has a number of teeth with a prognosis of "worth preserving" and/or is fundamentally critical of serial extractions? This article presents the case of a patient who was recommended an All-on-X concept by the initial dentist, even though the patient wanted to retain most of his teeth. The specific example of this case is used to explain, step by step, the conditions under which teeth with questionable prognoses can-and should-be preserved and which professional and ethical aspects guide the treatment. At the center of the analysis is an evaluation according to the ethical principles of Beauchamp and Childress, based on "respect for patient autonomy," "nonmaleficence," "beneficence," and "justice." This article invites critical debate and shows that exciting and fruitful points of discussion can arise precisely in the challenging border area of established care concepts, individual patient wishes, and normative aspects.
The challenge of obtaining precise digital impressions for multiple implants in full-arch edentulous cases significantly restricts their routine clinical use. Although traditional impression-taking methods and intraoral scanning with standard cylindrical scan bodies have shown similar accuracy for single implants and short-span scenarios, ensuring a proper fit for one-piece full-arch restorations is a more demanding process. Maintaining scanning accuracy over longer distances, combined with the absence of stable morphologic reference points and the limitations of current scan technologies, poses a significant challenge. To overcome these challenges, modified scan bodies with an extended design have been developed and have shown promising results. This report describes a clinical case that illustrates the treatment protocol for full-arch intraoral scanning of multiple implants in the maxilla, emphasizing the cooperation between the dental office and laboratory to develop a treatment solution for a fixed, screw-retained implant restoration based on digital technologies and new scan flags.
Dental implants can be inserted using either a manual ratchet or a surgical motor, but it is unclear whether this parameter may impact implant angulation. Using a model representing a mandible with an edentulous space spanning both premolars and the first molar, implant placement was per formed in polyurethane foam blocks representing four different bone qualities. Standardized x-rays in the buccolingual and mesiodistal directions were made with the final drill and the dental implant in place. Angular changes were calculated by subtracting the deviation of the drill and implant rela tive to a vertical plane defined by the bone blocks. Statistical analysis was based on intraclass cor relation coefficients, Shapiro-Wilk tests, Levene's test, ANOVA, and Tukey's honest differences test with the level of significance set at alpha = .05. Mean deviations ranged from 0.86 to 3.79 degrees, with a clear trend towards greater deviation in the mesiodistal direction as compared to the buccolingual direction. ANOVA did not indicate significant differences for measurements made in the buccolingual direction; but for measurements made in the mesiodistal direction, both bone quality (P = .028) and implant insertion method (P = .001) had a significant effect. Lower deviations were recorded in bone quality IV as compared to bone quality I (P = .029) and with manual implant insertion as compared to motorized insertion (P = .001). Based on the presented findings, the process of implant insertion can lead to deviations even when using a non-cutting, tapered implant placed into a parallel-walled osteotomy. Manual insertion using a ratchet seemed to cause less deviations as compared to using a surgical motor, especially in the mesiodistal direction.
The present practice concept describes the decision-making process between three approaches to peri-implantitis therapy: reconstructive, resective, and explantation. Regenerative therapy is favored if complete bony regeneration up to the implant shoulder is possible. A proposed decision tree takes into account defect-specific and patient-specific factors. Defect-specific factors, such as implant pos ition and defect anatomy, are analysed first. RP1 defects have the highest regeneration potential, while RP3 defects are usually not regenerable. Patient-specific factors, such as smoking or diabetes, influence the long-term prognosis. Resective therapy is suitable forsupracrestal pockets but requires precise incision and bone preparation. Explantations are often unavoidable, and they considerably reduce bone availability. 3D diagnostics are recommended to accurately assess the defect morph ology. Long-term aftercare is crucial to ensure successful treatment. New technologies could facili tate treatment in the future, especially in cases of incomplete regeneration.
The diagnosis of a missing maxillary anterior tooth is frequently made during routine clinical exam inations of adolescent patients (eg, agenesis of the lateral incisors, trauma to the anterior teeth, dis placed canines). In the context of treatment planning, the fundamental question arises regarding the short-and long-term management of these spaces. One option is to open the space for a prosthetic restoration by using a dental implant or a bridge. This often leads to the question of how to manage the space from the end of orthodontic treatment until implant placement can occur. To bridge this interim period, adhesive bridges or removable dentures are typically used. This article presents a third option-the temporary restoration of a missingtooth using a mini implant (pediatric implant)- which proves to be a highly recommended therapeutic alternative. This method effectively achieves the dual goals of providing a fixed and esthetically high-quality interim solution and preserving the alveolar bone.
Natural healing after tooth extraction leads to alveolar resorption that requires augmentation procedures outside the bony envelope to provide sufficient bone to support implant placement (whether early or late) in a prosthodontically correct position. The clinical concept presented in this article aims at maintaining the postextraction alveolar crest dimensions to facilitate late implant placement in a prosthodontically correct position without additional lateral augmentation procedures. Material-related aspects, surgical procedures, and the issue of infected alveoli are discussed.
Platelet-rich fibrin (PRF) is an autologous blood concentrate system that is gained from patients' own peripheral blood by centrifugation. The role of PRF gained increasing importance in different indications in the field of regenera-tive medicine, making it an attractive and promising tool for preparing the implantation bed and the insertion of den-tal implants. This guideline evaluates the clinical efficacy of PRF for applications in the field of dental implantology compared with an adequate control group. Ultimately, it provides clinicians with an evidence-based decision-making tool to recommend clinically effective, sustainable, and safe care options for affected patients. A systematic research was conducted in multiple medical digital libraries to outline the most relevant published clinical studies. Two recom-mendations concerning the treatment of extraction sockets were subsequently developed based on the synthesized evidence. First, the use of solid PRF matrix in freshly extracted sockets improves socket healing and can be applied to support socket regeneration by means of open wound healing. Second, the use of solid PRF for socket/ridge preser-vation supports bone volume preservation and can be recommended as an alternative treatment option. The results further showed only a few clinical studies evaluating other indications, such as sinus lift, immediate implantation, or the treatment of peri-implant diseases. Therefore, no evidence-based recommendation could be developed for these indications. The present clinical guideline is the first of its kind worldwide, outlining clinical recommendations for the use of PRF in dental implantology. Further studies are needed to gain clinical evidence and allow the development of further recommendations in future.
Vitamin D is important for bone metabolism and the osseointegration of dental implants. It regulates calcium and phosphate homeostasis, promotes osteoblast differentiation, and influences the immune response. A vitamin D deficiency can significantly delay implant healing and increase the risk of peri-implantitis. Preoperative screening of vitamin D levels is particularly useful in high-risk patients. An adjusted supplementation can improve bone healing and implant stability. In addition, a cell-based ex vivo osteoblast model is discussed as an alternative method for assessing bone quality, as it reflects biologic activity more accurately than radiologic procedures. Multicenter studies are required to standardize supplementation protocols and develop a vitamin D risk algorithm for optimized implant therapy.
Local anesthesia represents a cornerstone in implantology as an effective method for pain management. This article explores the historical development, mechanisms of action, and application techniques of local anesthetics, with a particular focus on distinguishing between primary and secondary anesthetic procedures, including their respective advantages and limitations. Current trends such as preemptive analgesia and buffering of local anesthetics, aimed at improving efficacy in challenging clinical scenarios, are also discussed. The article highlights specific challenges in implantology such as selecting the appropriate technique for implant placement in the posterior mandible, addressing anatomical variations, and the impact of these on success rates. This comprehensive review provides an up-to-date overview of local anesthesia and offers practical insights for dental practitioners and implantologists.
