Abstract Background Zygomatic implant (ZI) therapy has evolved over the past two decades into an established modality for the rehabilitation of the severely atrophic maxilla, avoiding extensive bone augmentation procedures. Aim While the efficacy of ZI therapy is well established, variability in its clinical implementation and remaining knowledge gaps continue to influence its application in clinical practice. Methods This critical review, based on a focused PubMed/MEDLINE search, synthesized higher‐level and long‐term evidence on surgical approaches, loading protocols, indications and outcomes, complications, prosthetic considerations, digital workflows, and current consensus recommendations. Results Current evidence demonstrates favorable long‐term survival across a broad range of ZI indications. The Quad Zygoma Protocol has further expanded graftless rehabilitation for the severely atrophic edentulous maxilla. Surgical approach selection should be guided by maxillozygomatic anatomy and prosthetically driven planning, while digital technologies have progressively shifted ZI surgery toward precision‐oriented workflows. Nevertheless, heterogeneous complication profiles, inconsistent definitions of treatment success, and limited reporting of patient‐reported and long‐term biological and prosthetic outcomes remain important limitations. Conclusions Contemporary ZI rehabilitation represents an established treatment modality for complex maxillary rehabilitation, with the current focus shifting from demonstrating efficacy toward improving treatment predictability and long‐term outcomes. Clinical Recommendations Appropriate case selection is fundamental to successful ZI rehabilitation. Surgical planning should integrate anatomical feasibility, implant emergence, and restorative design, while structured maintenance and patient compliance support long‐term success. Digital workflows can enhance surgical accuracy and reproducibility but require surgical experience and clinical judgment.
Abstract Objectives A limited number of randomized controlled trials have assessed the efficacy of platelet‐rich fibrin (PRF) therapy during oral surgical interventions in cigarette smokers. A systematic review of the currently available literature remains undocumented. The aim of this systematic review was to evaluate the clinical efficacy of adjunctive PRF therapy for enhancing wound healing and tissue regeneration and repair during oral surgical interventions in cigarette smokers. Materials and Methods The research question was: “In adult cigarette smokers undergoing OSI, does adjunctive PRF therapy, compared with non‐PRF or conventional comparator interventions, improve wound healing or tissue regeneration and repair?” A literature search was conducted in accordance with PRISMA guidelines. Indexed databases and Google Scholar were searched without time and language restrictions through June 2026. The risk of bias was assessed using the Cochrane Risk of Bias‐2 tool. The certainty of evidence for each clinical outcome was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Disagreements were resolved via discussion. Results Three randomized controlled trials reported in four publications were included. One trial was reported in two publications describing different outcomes and follow‐up periods. The number of participants in the individual trials ranged from 18 to 102 individuals. Sample‐size estimation was performed in two of the three trials. One trial, reported in two publications, evaluated socket preservation and reported short‐term soft‐tissue healing and postoperative pain outcomes as well as 6‐month radiographic and histologic outcomes. In general, all studies demonstrated that PRF improved healing. One study had a high risk of bias, and the remaining studies demonstrated some concerns. The certainty of evidence ranged from very low to moderate in the included studies. Conclusions The available evidence suggests that adjunctive PRF therapy promotes post‐extraction healing in cigarette smokers; however, its clinical efficacy remains inconclusive given the limited number of clinical trials, methodological heterogeneity, risk‐of‐bias concerns, and low‐to‐moderate certainty of evidence. Further well‐designed, adequately powered RCTs with standardized PRF protocols and long‐term follow‐up are warranted. Clinical Relevance The available evidence suggests that PRF may favor post‐extraction healing in cigarette smokers. Although a lower numerical occurrence of dry socket was reported in PRF‐treated sockets in one RCT, the current evidence is insufficient to establish a preventive effect. Overall, PRF appears promising; however, definitive clinical conclusions remain limited by the small number of trials, methodological limitations, and low‐to‐moderate certainty of evidence.
Abstract Background/Aim Peri‐implantitis represents a complex osteoimmune disorder characterized by dysregulated cellular ecosystems that drive chronic inflammation and accelerated peri‐implant bone loss. Materials and Methods This article was designed as a narrative scoping review to map and integrate the available evidence from transcriptomics, single‐cell RNA sequencing (scRNA‐seq), spatial transcriptomics, flow cytometry, and immunohistochemistry to construct a comprehensive cellular atlas of peri‐implantitis. Key Findings Current evidence suggests that peri‐implantitis lesions contain expanded and activated neutrophil, macrophage, T‐cell, and B‐lineage compartments, together with stromal and vascular cell populations that may contribute to inflammatory amplification and osteoclastogenic signaling. Reported features include CXCR2 + neutrophil subsets with NETosis‐associated activity, inflammatory macrophage states, altered Th17/Treg‐related immune responses, and expanded B‐cell/plasma‐cell compartments forming organized adaptive immune niches. Proposed molecular mechanisms include NF‐κB‐related inflammatory activation, CXCL13‐associated adaptive immune organization, NETosis‐related pathways, and RANKL‐mediated osteoclastogenic signaling. However, several of these pathways remain incompletely validated in human peri‐implantitis tissue. Critical knowledge gaps include limited direct evidence for NLRP3 inflammasome activation, uncharacterized type I interferon signaling, unresolved hierarchies of cellular RANKL sources, and limited functional data for rare immune populations. Conclusions The peri‐implantitis osteoimmune microenvironment constitutes a highly organized, self‐reinforcing inflammatory ecosystem. Progress toward precision therapeutic strategies requires spatial multiomics at subcellular resolution, longitudinal human studies, and functional ex vivo validation models to interrogate the self‐sustaining circuits identified here.
Abstract Objectives To update dental implant failure and survival estimates beyond 10 years and examine how success definitions and biological outcomes affect interpretation of long‐term performance. Materials and Methods Randomized controlled trials, prospective cohorts, and retrospective cohorts with at least 10 years of follow‐up were included. Failure proportions were pooled by study design using random‐effects models with clustering corrections and prediction intervals. Sensitivity analyses assessed influential studies, risk of bias, surface era, and clustering assumptions. Success, probing depth (PD), marginal bone loss (MBL), and peri‐implantitis were summarized descriptively. Results Thirty‐four studies including 7522 patients and 20 445 implants were analyzed. Pooled failure was 5.1% in prospective studies (95% CI, 3.0%–8.7%), 4.9% in retrospective studies (95% CI, 3.3%–7.1%), and 4.8% in randomized trials (95% CI, 3.2%–7.1%), corresponding to survival of approximately 94.9%, 95.1%, and 95.2%, respectively. Success averaged 85.1% across 14 studies, but definitions varied substantially. Descriptive means were 2.99 mm for PD, 1.30 mm for MBL, and 10.8% for implant‐level peri‐implantitis (range, 3.0%–39.9%). Conclusions Dental implants are highly durable in terms of retention, with approximately 95% survival after 10–25 years. However, high survival does not establish long‐term biological health or true treatment success: success rates were lower and definition‐dependent, and peri‐implant disease showed substantial variability. Retention is therefore a necessary but insufficient endpoint for judging long‐term implant therapy. Clinical Relevance Long‐term assessment should integrate biological, radiographic, technical, functional, and patient‐centered outcomes.
BACKGROUND:Extracellular vesicles (EVs), including exosomes, have emerged as fundamental regulators of cell-to-cell communication and are increasingly recognized for their therapeutic and diagnostic promise. While EV research has expanded remarkably over the past two decades, the discipline is rooted in a much longer history of observations, conceptual progress, and technological innovations that gradually transformed the comprehension of these nanosized particles. This review offers a historical perspective on the evolution of EV biology, underscoring the pivotal discoveries, researchers, and community-mediated initiatives that have shaped the contemporary domain. METHODS:A narrative review of the literature was conducted to assess major milestones in EV research, from the earlier descriptions of cell-free particulate material to modern progress in EV biology, standardization, and translational medicine. Particular emphasis was placed on landmark investigations that redefined the biological importance of EVs and on the development of international frameworks that enhanced reproducibility and methodological rigor. RESULTS:Early studies characterized EV-like particles as sedimentable plasma components or cellular waste, culminating in Peter Wolf's description of "platelet dust" in 1967. Subsequent research by Crawford, Johnstone, Stahl, Raposo, Ratajczak, and others established EVs as bioactive structures contributing to vesicle biogenesis, antigen presentation, and horizontal gene transfer of genetic information. Progress in particle characterization, molecular profiling, and imaging approaches further demonstrated EVs as intricate carriers of proteins, lipids, metabolites, and nucleic acids capable of mediating diverse physiological and pathological mechanisms. In parallel, the establishment of the International Society for Extracellular Vesicles (ISEV) and the successive MISEV guidelines offered a pivotal foundation for standardization, transparency, and reproducibility across the discipline. CONCLUSION:The history of EV research reflects a remarkable transition from observations of poorly understood extracellular particles to the recognition of EVs as key modulators of biological communication and potential therapeutic systems. As technological capabilities, standardization efforts, and translational applications continue to advance, EVs are poised to play an increasingly important role in the future of precision medicine.
