Zygomatic implants have emerged as a promising surgical technique to rehabilitate severe atrophic maxilla and maxillectomy. However, this implant design lacks an appropriate standard test protocol. This study aimed to simulate and evaluate zygomatic implants under compressive and lateral loads using finite element analysis, following the current ISO parameters for dental implants, employing different cylindrical holders. These holders simulate the bone configuration of clinical scenarios of the zygoma anatomic-guided approach (ZAGA) and maxillectomy rehabilitation with zygomatic implants. Six three-dimensional models were generated and subjected to a 150 N compressive load at a 40° angle. In the next step, a simultaneous 50 N lateral load was applied. Von Mises stress data and contour plots were collected and analyzed. Von Mises peak stresses increased by more than 100% when a lateral load was applied. Data demonstrated the influence of the setup support and lateral load on the implant components’ peak stress values.

With increasing life expectancy and an aging global population, the demand for orthopedic and dental implants is increasing. Recently developed, citric-acid-based anodization processes facilitate the production of more bioactive oxide layers by incorporating important bone minerals such as Ca, P, and Mg and forming bone-like crystalline compounds such as carbonated apatite on titanium implant materials. The primary goal of the present study was to evaluate the applicability of these anodization processes to solid and 3D-printed titanium alloy substrates. The anodized oxides produced on each solid or 3D-printed lattice substrate revealed multi-scaled surface roughness profiles as evidenced by scanning electron microscopy, optical microscopy, and surface roughness analyses. Additionally, each oxide group was shown to incorporate substantial amounts of Ca, P, and Mg bone-mineral dopants and form AB-type carbonated apatite, as shown using a combination of energy-dispersive spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, and attenuated total reflectance-Fourier transform infrared spectroscopy analyses. Finally, each oxide group showed sustained Ca, P, and Mg ion release during an inductively coupled plasma spectroscopy dissolution assessment, and demonstrated early apatite-forming ability during simulated body fluid bioactivity testing. The findings of this study show much promise for the applicability of these novel oxide coatings to a wide variety of future titanium implant applications.

Objective The present retrospective diagnostic accuracy study aimed to evaluate the performance of an AI-based system for automated detection of teeth, caries, implants, restorations, and fixed prostheses on bitewing radiographs. Methods A total of 407 bitewing radiographs from 315 adult patients were analyzed using an AI system developed by VELMENI Inc. and compared with reference annotations on individual tooth-level provided by two oral and maxillofacial radiologists. Every tooth was encoded for the absence (0) or presence (1) of radiographic findings: caries, restorations, fixed prosthesis, and implants. Cohen’s kappa (κ) with 95% bootstrap confidence intervals was used for assessment of inter-rater reliability. The AI system’s diagnostic accuracy was evaluated for sensitivity and specificity using human consensus reference standards. Results The annotated dataset consisted of 2,829 tooth-level observations. The two radiologists showed substantial to near-perfect agreement for prosthesis (κ = 0.925) and restorations (κ = 0.872) detection, moderate for caries detection (κ = 0.804), and lowest for implants detection (κ = 0.726). The AI system showed substantial agreement with the human observers for restorations (κ = 0.812–0.871) and prosthesis detection (κ = 0.882–0.940), moderate for caries (κ = 0.454–0.508), and the highest agreement for implant detection (κ = 0.763–0.974). Post-filtration for human consensus, the AI system showed high sensitivity for implant (1.000), prosthesis (0.984), restorations (0.974), and caries (0.972). The AI system showed high specificity for implant (1.000) and prosthesis (0.984), and restorations (0.936) detection, but slightly lower specificity for caries detection (0.842). Conclusions The AI system demonstrated diagnostic performance comparable to that of oral and maxillofacial radiologists for detecting multiple dental findings on bitewing radiographs, including restorations, prosthesis, and implants, and slightly lower for caries detection. These findings support the potential role of the AI system as a clinical adjunct to improve efficiency and consistency in routine dental imaging interpretation.

Titanium implants are widely used in medicine because of their favorable mechanical properties and biocompatibility; however, the rapidly forming titanium oxide coatings do not provide an ideal bioactive surface to stimulate osseointegration. This study aims to enhance titanium implant osseointegration through anodization processes designed to incorporate elements and compounds present within human bone into the surface oxides. Commercially pure titanium grade 4 (CPTi) discs were anodized in either oxalic, malic, or ascorbic acid-based electrolytes. Each resulting oxide exhibited complex surface topographies. EDS analyses revealed that Ca, P, and Mg bone chemistry dopant elements were incorporated into each of the oxide coatings. X-ray diffraction analyses revealed combinations of anatase and calcium titanate compounds present in each oxide. Additionally, two of the anodized oxides showed calcium oxide formation, and one oxide also revealed tricalcium phosphate (α-TCP) and hydroxyapatite (HA) formation. Subsequent FTIR spectroscopy analyses revealed carbonate substitution peaks to be present in two of the oxides. This finding indicated that the TCP and HA compounds shown in the XRD analyses of one oxide represented the formation of bone-like carbonated calcium phosphate compounds. A 21-day cell culture study showed favorable cell culture responses for each of the organic-acid-based anodized oxides. Moreover, two of the oxides showed good cytocompatibility and early osteogenic differentiation compared to non-anodized titanium controls. Thus, the organic acid anodization processes developed in this study show promise to enhance future titanium implant clinical outcomes.

OBJECTIVES:This study screened the design parameters of a reduced-diameter implant to determine which parameters have the most significant effect on the implant fatigue limit. METHODS:A dental implant assembly, which included an implant body (Biomet 3i), an abutment (GingiHue®), and an abutment screw (Gold-Tite Square screw) was scanned using micro-computed tomography (SkyScan 1172) and was measured using Mimics (Materialise) and an optical microscope (VHX-1000, Keyence). Sixteen design parameters were measured, and the values of the commercial design were taken as reference level for each design parameter. Values up to 20 % lower and 20 % higher than the reference were explored using a Taguchi orthogonal array (DOE++, Reliasoft), which varies more than one design parameter at a time to efficiently explore all main effects and lower order interactions across few implant designs. Solid models of these 27 implant designs and the reference design were constructed using SOLIDWORKS (Dassault Systèmes). Each solid model was loaded according to ISO 14801. fe-safe (Dassault Systèmes) was used to estimate the fatigue limits. ANOVA statistical test in DOE++ was used to screen the design parameters. RESULTS:Interaction between the coronal and apical tapers of the implant body had a significant effect on the fatigue limit (p ≤ 0.05), where fatigue limit was low for designs with a constant taper. Conversely, the combination of high degree of apical taper and low degree of coronal taper lead to the highest fatigue limit. SIGNIFICANCE:Using a Taguchi orthogonal array proved to be an efficient strategy for screening implant design parameters for effect on fatigue limit. The modified implant designed by manipulating the most influential parameters is predicted to have much greater fatigue limit compared to the commercially available design.

Enhancing osseointegration is a common goal for many titanium implant coatings, since the naturally forming oxides are often bioinert and exhibit less than ideal bone-to-implant contact. Oxide coating surface topographies, chemistries, and crystallinities are known to play key roles in enhancing bone–implant interactions. In the present study, two novel anodization processes were developed in electrolytes based on juiced navel oranges to create bioactive oxide coatings on commercially pure titanium (CPTi) surfaces. Both oxide groups revealed multi-scaled micro and nano surface topographies, significant Ca and P-dopant incorporation exhibiting Ca/P ratios similar to human bone (1.7 and 1.8), and physiologically relevant Mg uptake levels of <0.1% and 1.4 at%. XRD and FTIR analyses of each oxide revealed a combination of tricalcium phosphate and hydroxyapatite phases that showed carbonate substitutions indicative of bone-like apatite formation. Finally, VDI indentation testing revealed good adhesion strengths, minimal cracking, and no visible delamination for both oxides. In summary, the anodization processes in the present study were shown to produce carbonated tricalcium phosphate and apatite containing oxides with contrasting levels of Mg uptake that show much promise to improve future implant clinical outcomes.

The increasing demand for titanium implants necessitates improved longevity. Plasma-sprayed hydroxyapatite coatings enhance implant osseointegration but are susceptible to delamination. Alternatively, anodized hydroxyapatite coatings have shown greater adhesion strengths. The present study aimed to develop anodized hydroxyapatite coatings on titanium using commercial calcium-fortified fruit juice as a calcium source. Varying the electrolyte compositions enabled the formation of four oxide groups with different predominate calcium compounds. Each oxide’s morphology, crystallinity, chemistry, molecular structure, and adhesion quality were compared and contrasted. Nanoscale SEM images revealed a progression from porous surface oxide to white surface deposits to petal-like hydroxyapatite structures with the changing anodization electrolytes. Oxide thickness evaluations showed progression from a single-layered oxide with low Ca-, P-, and Mg-dopant incorporations to bi-layered oxide structures with increased Ca-, P-, and Mg-dopant incorporation with changing electrolytes. The bi-layered oxide structures exhibited a titanium-dioxide-rich inner layer and calcium-compound-rich outer layers. Furthermore, indentation analyses confirmed good adhesion quality for three oxides. For the predominate hydroxyapatite oxides, FTIR analyses showed carbonate substitutions indicating the presence of bone-like apatite formation, and ICP-OES analyses revealed prolonged Ca and Mg release over 30 days. These Mg-enhanced carbonated apatite coatings show much promise to improve osseointegration and future implant lifetimes.

Porosity and roughened surfaces of implant materials have been shown to lead to improved cellular attachment and enhanced osseointegration. These topography changes in the surface also aid in the mechanical interlocking of the material to the bone. Polyetheretherketone (PEEK) has emerged as a popular alternative to titanium-based implants due to its lack of stress-shielding effect, radiolucency, and high chemical resistance. However, PEEK is bioinert, thus requiring surface modifications to elicit appropriate cellular responses that lead to successful osteointegration of the material in vivo. Sulfonation is a process used to modify the surface of PEEK, which can be controlled by varying parameters such as soak time and soak temperature, thereby fabricating a porous surface on the material. This work aimed to ensure the repeatability of a previously optimized sulfonated and hydrothermally treated PEEK surface and subsequently observe the mechanical properties, bacterial attachment, and cellular response of pre-osteoblast MC3T3-E1 cells on the surface. This study found that while all PEEK surfaces had similar cell and Staphylococcus aureus attachment, the sulfonated and hydrothermally treated PEEK (peak mean load of 605 N, p ≤ 0.0001) and the sulfonated only PEEK (peak mean load of 495 N, p = 0.0240) had a higher level of performance in expulsion testing than smooth PEEK due to its mechanical interlocking ability. Imaging and contact angle analysis confirm that a surface with repeatable porosity can be achieved.

With humans living longer and the median age of the population increasing, there is an ever-increasing demand for better biomedical implants. Titanium implants have a long history of successful use, but their naturally forming amorphous oxide surfaces are not ideal to promote bone growth. Therefore, titanium surfaces are often modified to improve bioactivity through electrochemical processes such as anodization which can crystallize the oxide into more bioactive titanium oxide phases, form hierarchical micro- and nano-scale roughness profiles, and incorporate beneficial bone chemistry into the oxide layer to improve interactions with bone cells. We have recently developed three innovative anodization electrolytes based on combinations of citrus fruit juices and commercially available calcium compounds. Anodization in these electrolytes produced citrus-based oxides exhibiting surface Ca/P ratios within the range of human bone, unique cauliflower-like hierarchical micro- and nano-scale surface roughness profiles, and the formation of titanate compounds which have been shown to be precursors for subsequent apatite formation. Thus, our titanate-containing citrus-based oxides show much promise for improving future osseointegration.

OBJECTIVES:This study utilizes contemporary placement approaches and implant design to investigate zygomatic implants' biomechanical behavior and fatigue lifetime in clinical contexts. METHODS:A commercially available zygomatic implant assembly and an ex vivo skull were subjected to computed tomography. Three-dimensional models representing intra-sinus, extra-sinus, and extramaxillary configurations were constructed. The finite element analysis (FEA) was executed with vertical, lateral, and masseteric loads applied simultaneously. Von Mises stress served as the failure criterion, with data collection on implant fixtures, abutments, connector screws, and simulated bone structures. The analysis included peak stress locations, contour plots illustrating stress distribution, and fatigue limit assessments for implant components. RESULTS:Results revealed lower stress concentrations in mesial implant components compared to distal ones. The extra-sinus approach showed lower stresses in most prosthetic components. Peak stress concentrations in the maxillary bone layers (ranging from 25 to 27 MPa) were primarily localized at the alveolar ridge's crest at the zygomatic implant entrance point. On the zygomatic bone, the peak stresses were in the interface with the distal implant and ranged from 12 to 26 MPa. The in silico fatigue testing demonstrated an equally high fatigue lifetime of the implant components in all the approaches analyzed. SIGNIFICANCE:Because of additional clinical advantages, the extra-sinus approach was considered the optimal reconstruction method when patients' anatomy permits its application. Given the limited long-term clinical data on the latest implant designs and placement techniques, these findings provide valuable insights into the biomechanical performance of zygomatic implants and offer guidance for clinical practice.

Zygomatic implants (ZIs) were developed as a graftless alternative to rehabilitate severely reabsorbed maxillae. This study aims to employ three-dimensional finite element analysis (FEA) to simulate the impact of external hexagonal implant connection (EHC) and internal hexagonal implant connection (IHC) on the stress distribution and fatigue lifetime within the ZI systems using parameters defined in ISO 14801:2016. Two ZI assemblies (Nobel Biocare and Noris Medical) were scanned in a micro-CT scanner and reconstructed using Nrecon software. Three-dimensional models were generated by Simpleware ScanIP Medical software. All models were exported to FEA software (ABAQUS) and subsequently to a fatigue analysis software (Fe-safe). A compressive 150 N load was applied at a 40° angle on the cap surface. A 15 Hz frequency was applied in the in silico cyclic test. The implant components had material properties of commercially pure grade 4 titanium (CPTi) and Titanium-6Aluminum-4Vanadium alloy (Ti64). Von Mises stress data, contour plots, and fatigue limits were collected and analyzed. EHC models exhibited higher peak stresses in implant components for both materials compared to IHC models. However, simulated bone support results showed the opposite trend, with higher stresses on IHC than EHC models. The fatigue analysis revealed that assemblies with both designs exceeded ISO 14801:2016 number of cycles limits using Ti64, while CPTi groups exhibited comparatively lower worst life-repeats. In conclusion, ZIs with IHC were found to have a more homogeneous and advantageous stress distribution within both materials tested. Ti64 demonstrates a prolonged service life for both design connections.

The rising demand for dental and orthopedic implants and their frequent aseptic loosening failure mode necessitate the drive to continue modifying implant surfaces to improve osseointegration outcomes. Plasma-sprayed hydroxyapatite coatings are widely used but are prone to delamination. This study involves a single-step anodization process utilizing a novel electrolyte to produce Mg-doped carbonated hydroxyapatite and tricalcium phosphate-containing coatings on four titanium alloy surfaces. XRD confirmed hydroxyapatite and tricalcium phosphate formation, with FTIR examination revealing carbonate substitutions indicative of bone-like apatite formation in each oxide. SEM analyses revealed micro- and nano-scaled surface features on each oxide. SEM and EDS analyses of the oxide coating cross-sections showed each group to be bi-layered with an inner titanium dioxide-rich layer and an outer hydroxyapatite/tricalcium phosphate-rich layer. The oxide layer adhesion quality was shown to be good on CPTi, TAV, and TiMo α + β implant alloy surfaces. Unfortunately, the anodization process also resulted in an undesirable and embrittling omega phase at the substrate–oxide interface due to the migration of molybdenum into the inner oxide. Nonetheless, the anodized coatings on the CPTi and TAV alloy substrates, which are the most widely used titanium alloys for implant applications, show much potential for improving future patient outcomes.

Objective The purpose of the present study was to verify the diagnostic performance of an AI system for the automatic detection of teeth, caries, implants, restorations, and fixed prosthesis on panoramic radiography. Methods This is a cross-sectional study. A dataset comprising 1000 panoramic radiographs collected from 500 adult patients was analyzed by an AI system and compared with annotations provided by two oral and maxillofacial radiologists. Results A strong correlation (R > 0.5) was observed between AI perception and observers 1 and 2 in carious teeth (0.691–0.878), implants (0.770–0.952), restored teeth (0.773–0.834), teeth with fixed prostheses (0.972–0.980), and missing teeth (0.956–0.988). Discussion Panoramic radiographs are commonly used for diagnosis and treatment planning. However, they often suffer from artifacts, distortions, and superimpositions, leading to potential misinterpretations. Thus, an automated detection system is required to tackle these challenges. Artificial intelligence (AI) has revolutionized various fields, including dentistry, by enabling the development of intelligent systems that can assist in complex tasks such as diagnosis and treatment planning. Conclusion The automatic detection by the AI system was comparable to oral radiologists and may be useful for automatic identifications in panoramic radiographs. These findings signify the potential for AI systems to enhance diagnostic accuracy and efficiency in dental practices, potentially reducing the likelihood of diagnostic errors caused by unexperienced professionals.

Medication-related osteonecrosis of the jaw is an adverse reaction caused by the use of antiresorptive antiangiogenic medication. The most commonly affected areas are posterior regions of mandible and maxilla. However, a simultaneous occurrence in both jaws is rarely observed. We present an interesting case of MRONJ affecting both jaws. A 47-year old female presented with pain and swelling in the left posterior region of the mandible. The patient’s medical history was significant for breast cancer with ongoing bisphosphonate therapy. Cone-beam CT (CBCT) confirmed the presence of an extraction socket at the site of complaint. There was evidence of a diffuse sclerotic bone reaction in the maxillary posterior region bilaterally. The mandible showed presence of diffuse sclerotic bone only in the left para-symphysis and posterior region in addition to association with a periosteal bone reaction in the left para-symphysis region. Considering these findings and a history of exposure to bisphosphonate medication, the final diagnosis was conclusive of MRONJ. Management was aimed at suppressing the symptoms of pain and infection. The present case study reinforces the importance of correlating clinical and radiographic findings. Early diagnosis of MRONJ may lead to a more conservative treatment approach, greatly improving the patient’s prognosis. Keywords: MRONJ, Cone-beam CT, breast cancer, bisphosphonate

Titanium alloys are commonly used for implants, but the naturally forming oxides are bioinert and not ideal for bacterial resistance or osseointegration. Anodization processes are a modification technique that can crystallize the oxides, alter oxide surface topography, and introduce beneficial chemistries. Crystalline titanium oxides are known to exhibit photocatalytic activity (PCA) under UVA light. Anodization was used to create mixed-phase oxides on six titanium alloys including commercially pure titanium (CPTi), Ti-6Al-4V (TAV), Ti-6Al-7Nb (TAN), two forms of Ti-15Mo (TiMo-β and TiMo-αβ), and Ti-35Nb-7Zr-5Ta (TNZT). Combined EDS and XPS analyses showed uptake of the electrolyte and substrate alloying elements into the oxides. The relative oxide PCA was measured using methylene blue degradation assays. CPTi and TAN oxides exhibited increased PCA compared to other alloys. Combined XRD and EBSD oxide phase analyses revealed an unfavorable arrangement of anatase and rutile phases near the outermost surfaces, which may have reduced PCA for other oxides. The relative Staphylococcus aureus attachment to each oxide was also assessed. The CPTi and TiMo-αβ oxides showed significantly reduced S. aureus attachment after 1 h of UVA compared to un-anodized CPTi. Cell culture results verified that the UVA irradiation did not negatively influence the MC3T3-E1 attachment or proliferation on the mixed-phase oxides.

Periapical radiographs are routinely used in dental practice for diagnosis and treatment planning purposes. However, they often suffer from artifacts, distortions, and superimpositions, which can lead to potential misinterpretations. Thus, an automated detection system is required to overcome these challenges. Artificial intelligence (AI) has been revolutionizing various fields, including medicine and dentistry, by facilitating the development of intelligent systems that can aid in performing complex tasks such as diagnosis and treatment planning. The purpose of the present study was to verify the diagnostic performance of an AI system for the automatic detection of teeth, caries, implants, restorations, and fixed prosthesis on periapical radiographs. A dataset comprising 1000 periapical radiographs collected from 500 adult patients was analyzed by an AI system and compared with annotations provided by two oral and maxillofacial radiologists. A strong correlation (R > 0.5) was observed between AI perception and observers 1 and 2 in carious teeth (0.7–0.73), implants (0.97–0.98), restored teeth (0.85–0.89), teeth with fixed prosthesis (0.92–0.94), and missing teeth (0.82–0.85). The automatic detection by the AI system was comparable to the oral radiologists and may be useful for automatic identification in periapical radiographs.

Titanium has a long history of clinical use, but the naturally forming oxide is not ideal for bacterial resistance. Anodization processes can modify the crystallinity, surface topography, and surface chemistry of titanium oxides. Anatase, rutile, and mixed phase oxides are known to exhibit photocatalytic activity (PCA)-driven bacterial resistance under UVA irradiation. Silver additions are reported to enhance PCA and reduce bacterial attachment. This study investigated the effects of silver-doping additions to three established anodization processes. Silver doping showed no significant influence on oxide crystallinity, surface topography, or surface wettability. Oxides from a sulfuric acid anodization process exhibited significantly enhanced PCA after silver doping, but silver-doped oxides produced from phosphoric-acid-containing electrolytes did not. Staphylococcus aureus attachment was also assessed under dark and UVA-irradiated conditions on each oxide. Each oxide exhibited a photocatalytic antimicrobial effect as indicated by significantly decreased bacterial attachment under UVA irradiation compared to dark conditions. However, only the phosphorus-doped mixed anatase and rutile phase oxide exhibited an additional significant reduction in bacteria attachment under UVA irradiation as a result of silver doping. The antimicrobial success of this oxide was attributed to the combination of the mixed phase oxide and higher silver-doping uptake levels.