Abstract Purpose Providing an overview on tenting screws/tent-pole technique for space-maintenance in vertical and horizontal alveolar ridge augmentation. Methods The protocol was registered at PROSPERO (CRD420251178321). PRISMA-2020 guidelines were applied. Medline via PubMed, Web of Science, Scopus, Embase, and Cochrane Library were all searched/screened. Randomized and non-randomized human studies with at least 10 patients were eligible. Random-effects model analysis was used in all cases. The risk of publication bias was assessed using a funnel plot and the Egger’s test. All statistical analyses were executed using STATA 17.0. Results Four randomized, 7 non-randomized and 13 cohort studies were included; 23 were selected for meta-analysis. Overall vertical and horizontal bone gains using tenting screws/tent-pole as the sole space-maintenance technique were at 5.43 mm (95% CI: 3.79–7.07) and 3.62 mm (95% CI: 3.21–4.02), respectively. One-staged augmentations/dental implantation showed significantly higher vertical gain compared to two-staged procedures ( P = 0.03). Regarding complementary grafted bone materials/particles, autografts (with/without xenografts) had significantly higher vertical gains than allografts (with/without xenografts) ( P = 0.00). Five cohorts compared the outcomes of tenting technique against conventional GBR (with no bone-blocks) in horizontal reconstruction; tenting technique significantly outperformed with 0.49 mm (95% CI: 0.00–0.97) superiority ( P = 0.05); GRADE certainty assessment reported as moderate. There were no signs of publication bias in any of the analyses ( P = 0.75, P = 0.75, and P = 0.23, respectively). Conclusions Tent-pole technique is desirable for space-maintenance without the complexity and surgical/healing complications of onlay-bone-blocks and titanium meshes. More RCTs are required to reach reliable conclusions.

ABSTRACT Objectives To investigate the effects of dental pulp stem cell‐derived conditioned medium (DPSC‐CM) on the proliferation, migration, and osteogenic differentiation of periodontal ligament stem cells (PDLSCs). Primary goals were to (i) identify the optimal DPSC‐CM' concentration and (ii) evaluate its effect both independently (under Growth Medium, [GM]) and synergistically (under Osteogenic Medium [OM]). Materials and Methods DPSC‐CM was collected, and an initial screen was conducted to determine their maximum non‐toxic concentration (MNTS). For functional assays, three non‐cytotoxic concentrations (V/V) (10% [CM‐10], 30% [CM‐30], 50% [CM‐50]) were selected. While cytokine release profile, cell proliferation, and migration were assessed under GM conditions, differentiation was evaluated over 14d under both GM and OM conditions (p < 0.05). Results The MNTS was established as CM‐50. DPSC‐CM promoted all cellular activities in a non‐linear, concentration‐specific manner. CM‐10 demonstrated the most beneficial effects; it yielded the highest levels of TGF‐β1 and VEGF secretion (p < 0.05), and significantly increased proliferation, alkaline phosphatase activity, and expression of osteogenic/angiogenic markers than CM‐50 and CM‐30 over time. However, peak cell migration was observed on Day 2 for both CM‐30 and CM‐10. While DPSC‐CM alone enhanced osteogenesis, the highest induction was achieved under OM conditions. Conclusions DPSC‐CM is a potent osteoinductive agent, enhancing proliferation, migration, and differentiation in a non‐linear concentration‐specific manner. The lowest concentration proved optimal for their proliferative and osteogenic properties, suggesting a Hormesis‐like effect where higher doses may become sub‐optimal due to inhibitory factors.

Cold Atmospheric Plasma (CAP) is known for its ability to interact with living tissues without causing thermal damage. In dentistry, CAP has been explored for its potential for direct therapeutic applications, such as tissue regeneration, wound healing, and sterilization. CAP is currently transitioning from strong preclinical evidence to limited but growing clinical use, mainly within specialized research settings. This study aimed to systematically review the current literature on the effects of CAP on oral and dental tissue cell behavior, focusing on outcomes like proliferation, differentiation, apoptosis, wound healing, and anti-inflammatory responses. A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases up to February 2025, addressing the following PICO question: “What is the effect of CAP (I) on the behavior of oral and dental tissue cells (P) compared to standard treatments or no treatment (C) in the context of dental therapies concerning outcomes such as proliferation, differentiation, apoptosis, wound healing, or anti-inflammatory effects (O)?”. Studies that investigated the direct application of CAP on relevant cell types in dental contexts were included. Risk of bias was assessed using the risk of bias tool for animal intervention studies (SYRCLE’s RoB tool) and JBI Critical Appraisal Tool for Assessment of Risk of Bias for Randomized Controlled Trials. The search yielded 964 studies. A total of 29 studies were included in the review: 22 in vitro, 8 in vivo, and 1 clinical study. CAP promoted oral tissue healing by enhancing cell proliferation, migration, and wound closure, with low cytotoxicity. It also reduced inflammation and modulated immune responses, supporting regenerative processes in oral tissues. CAP facilitates tissue repair by promoting cell activity, reducing inflammation, and inducing osteogenic differentiation. However, extended exposure may cause harmful effects such as apoptosis and inflammation, emphasizing the need for precise control of exposure for effective therapeutic outcomes.

This study aimed to systematically review the data on interventions involving adjunctive photochemical therapy in treating peri-implant mucositis (PIM) and peri-implantitis (PI). The electronic search was conducted through six databases in October 2023, seeking studies relying on any kind of adjunctive photochemical therapy in treating inflammatory peri-implant diseases (PIDs). To showcase the effect size, mean differences along with 95% confidence intervals were utilized. Forty-seven studies were deemed eligible for qualitative synthesis, 14 of which were included in the meta-analysis. Low-level light therapy and photodynamic therapy led to enhanced improvements in clinical and radiographic indices, such as bone level (BL), bleeding on probing (BoP), clinical attachment level (CAL), and probing depth (PD), during the 3-month follow-up. However, the differences in efficacy between treatments incorporating adjunctive photochemical therapy and those relying solely on mechanical debridement, considered the gold standard, lessened over extended follow-up periods of 6, 9, and 12 months. Significant differences were observed when comparing the treatment outcomes following adjunctive photochemical therapy between obese and smoker patients with healthy subjects. Incorporating adjunctive photochemical therapy for PID treatment might improve clinical and radiographic parameters in a short-term follow-up of 3 months, but longer-term benefits appear comparable to routine treatments.

Oroantral fistula is a pathologic condition caused by various procedures including extraction, trauma and implant insertion. To date, various techniques have been suggested for oroantral fistula management. The aim of this review was to evaluate the outcomes of oroantral communication/fistula closure techniques followed by simultaneous or delayed implant placement. Based on the search strategy, an electronic search for English-language clinical studies was performed in PubMed, Web of Science, Scopus and Google Scholar from January 2000 until December 2024. All studies with the focus on the outcomes of oroantral communication/fistula closure followed by simultaneous or delayed implant placement were included. Initial research led to 56 studies. Following removal of duplicates and irrelevant studies, full texts of 20 articles studies. Finally, 15 studies were included in the review. In 3 and 11 studies, implant placement was performed simultaneously or delayed, respectively and one reported both protocols. The largest and smallest diameter of fistula were 20 mm and 4 mm, in order. Different treatment protocols including bone grafting, buccal fat pad and collagen strip technique were performed in included studies. None of the studies mentioned undesirable effects during follow-ups. All treatment modalities offered acceptable outcomes. However, because of heterogeneity of studies, no standard treatment protocol can yet be suggested. However, influential factors including defect characteristics, patient’s medical history and sinus health, location and accessibility must be considered prior to choose the best treatment approach.

To assess the differences between adjunctive therapy with Concentrated Growth Factor (CGF), Platelet-rich Fibrin (PRF) membranes, and available control groups in the clinical outcomes of root coverage. Randomized controlled clinical trials (RCTs) were identified in Pubmed/Medline, Scopus, and ISI Web of Science databases to assess the treatments after 6 months using a Bayesian random-effect network meta-analysis (NMA) framework regarding reduction in pocket depth (PD), clinical attachment loss (CAL), recession depth (RD), and width (RW), as well as, keratinized tissue width (KTW) and thickness (KTT) gain, and complete (CRC) and mean (MRC) root coverage percentages. Thirty-two RCTs were included, from which 27, 18, 12, eight, one, and one studies investigated PRF, connective tissue graft (CTG), flap alone, CGF, enamel matrix derivative (EMD), and dehydrated amniotic membrane, respectively. Thirty studies comprising CTG and flap-alone arms other than CGF and PRF were added to NMA. No significant difference has been found between CGF and PRF; however, CGF have a higher probability of being a better treatment than PRF in PD, CAL, and RW reduction and KTW gain, and PRF has a higher probability for being better in MRC, CRC, KTT gain, and RD reduction. PRF was significantly superior to flap-alone in terms of KTT gain and RD reduction. CGF had the highest probability of being the best treatment in PD and RW reduction, but in other outcomes, CTG was superior. PRF was significantly superior to flap-alone in terms of KTT gain and RD reduction. Both adjunctive CGF and PRF demonstrated improvements regarding root coverage outcomes. Although there is no significant difference between PRF and CGF, these two membranes might have different impacts on different outcomes. Further studies are required for a more comprehensive conclusion, especially on CGF. CTG is recommended for achieving ideal results in root coverage procedure. Since PRF and CGF both have a higher probability for being superior to flap alone, both could be suggested in cases which less than ideal outcomes are acceptable and minimization of patient discomfort is necessary.

Background:This study assessed the effect of the number of short implants on stress and strain distribution in bone in the posterior mandible using finite element analysis (FEA). Materials and Methods:The study design utilized FEA, a computational technique. In FEA models, short implants (4 mm diameter and 6 mm length) were placed at the site of the mandibular first premolar to the second molar in four models: (I) two implants at the sites of teeth #4 and #7 with two pontics at the sites of teeth #5 and #6, (II) three implants at #4, #5, and #7 with one pontic at #6, (III) three implants at #4, #6, and #7 with one pontic at #5, and (IV) four implants at #4, #5, #6, and #7 with no pontic. A 100 N load was applied vertically and at a 30° angle to the occlusal surface of the crowns. Stress and strain distribution patterns in bone were evaluated using ANSYS Workbench. Results:The highest maximum von Mises and shear stress and strain values under vertical and off-axial loadings were observed in the model with two short implants at the sites of teeth #4 and #7 with two pontics at the sites of teeth #5 and #6. In general, the highest stress and strain values were recorded following the application of off-axial loads compared to vertical loads. In all models, the highest stress was noted in the cervical part of the implants, while the maximum strain occurred in the apical part of the implants. Conclusion:Increasing the number of short implants significantly reduces stress and strain values in peri-implant bone.

The aim of this review is to compare the clinical outcomes of different soft tissue grafting materials (connective tissue graft (CTG), platelet-rich fibrin (L-PRF), allogenic and xenogenic substitutes) applied in immediate implant placement with each other. Through an electronic search regarding the study’s main question (“In patients with non-restorable teeth, who receive immediate dental implants (P), what is the best adjunctive soft tissue grafting approach among different autogenous, allogenous, and xenogenous grafts (I), to achieve the desired hard and soft tissue structure (O), compared to sites without grafting (C)?”) in PubMed, Scopus, and ISI Web of Science, randomized controlled clinical trials (RCTs) using different soft tissue grafts were identified and analyzed using a Bayesian random-effect network meta-analysis framework. The pink esthetic score (PES), marginal interproximal bone level changes (MIBL), buccal bone thickness changes (BBT), keratinized tissue width changes (KTW), soft tissue thickness changes (STT), papilla height changes (PH), midfacial gingival margin level changes (MGML) were defined as desired outcomes of the study; except for the MIBL with 12 – 24 months of follow-up, 6 – 12 months is considered for other outcomes. After duplication removal, 903 studies were identified through the electronic search; from which 21 RCTs were included in the review. Among all comparisons in different outcomes, only CTG demonstrated a significantly higher gain in STT compared to not placing soft tissue graft. However, CTG in MIBL, KTW, STT, PH, and MGML, and uni-layer xenogenic collagen matrix in PES were the superior treatments, according to the treatment ranking based on surface under cumulative ranking (SUCRA). At the time of immediate implantation, there is no significant difference between different soft tissue grafts regarding the clinical outcomes of implants. However, the utilization of CTG can be suggested in cases with thin soft tissue. The acceptable efficacy of allogenic and xenogenic materials and the non-significant difference between them and CTG indicate supporting evidence for the application of these materials to specific clinical situations simultaneously with immediate implantation. CRD42024568586.

Background. The study aimed to compare the results of cytotoxicity and in vivo irritation and sensitization tests of a new antler-derived bone substitute with those of a bovine-derived xenograft. Methods. This study included an in vitro cytotoxicity test based on ISO 10993‐5 standard. Additionally, in vivo irritation and sensitization tests were carried out according to ISO 10993-10 standard protocol. Results. The cytotoxicity test showed a viability of 99.46±1.09% for the antler-derived bone substitute and 98.42±1.84% for the bovine xenograft (P=0.445). Furthermore, after 24 hours, no differences in morphological grade were found in both samples. The irritation test indicated a primary irritation index (PII) score of 0 for both the antler and bovine xenografts. Likewise, the sensitization test demonstrated a sensitization score of 0 for both the antler and bovine xenografts. All animals appeared clinically normal throughout the study in both in vivo tests, and all sites of the test extract and the reagent control seemed normal. Conclusion. Both the antler-derived and bovine xenografts were found to be non-toxic, non-irritating, and non-sensitizing. Further studies should be conducted on other essential laboratory tests and animal and clinical studies.

OBJECTIVE:Plasma cell gingivitis is a rare non-dental plaque-induced gingival disease often associated with hypersensitivity reactions. Due to its rarity many questions present around its presentation, etiology, and treatment. Moreover, its histopathology has many similarities with other periodontal condition such as periodontitis. The present systematic review aimed to assess the cases of plasma cell gingivitis focusing on its clinical features, possible etiologic factors, and treatment modalities. METHODS:The search was done in The MEDLINE database, Scopus, and Web of Science from January 1999 until August 2024 for English publications using the following terms: (plasma cell gingivitis OR atypical gingivostomatitis OR allergic gingivostomatitis) AND (etiology OR clinical feature OR clinical manifestation OR treatment OR management). Any presented cases with clinical manifestation of plasma cell gingivitis confirmed with histopathologic assessment were included. Studies with unclear data, periodontitis or gingivitis cases which was not first treated for periodontal disease or not allowed for proper check-ups were excluded. RESULTS:Sixteen articles comprise 19 cases included in this review from them 13 were female (68.420 %) and 6 were male (31.57 %) with wide age range from 9 to 64 years. Anterior of the maxilla were affected in all cases. Erythematous gingiva are presented in all cases which were mostly diffuse involvement. Bleeding on slight provocation and lip swelling were another clinical signs. Treatment modalities were different from discontinuing possible etiologic factors, topical drugs, to removing the lesion, and photobiomodulation. CONCLUSION:In cases of gingival inflammation, it is important to first rule out other diseases such as gingivitis, periodontitis, and inflammatory gingival enlargement. The diagnosis of plasma cell gingivitis should be based on a detailed past medical history, accurate clinical evaluation, laboratory, microscopic, and immunohistochemical assessment.

Background:The current study aimed to systematically review the existing evidence on potential links between gene polymorphisms and the occurrence of peri-implant mucositis (PIM) or peri-implantitis (PI). Methods:The electronic search was executed through six databases in November 2022: PubMed, Embase, Google Scholar, Scopus, Cochrane CENTRAL, and Web of Science. The search sought studies delving into the possible association of gene polymorphisms with PIM or PI. To showcase the effect size, odds ratios along with 95% confidence intervals were used. The meta-analysis was performed on polymorphisms/alleles reported in at least two studies. Results:The initial search yielded 2162 results, which were reduced to 1327 following deduplication. After evaluating titles, abstracts, and full texts, 30 studies were deemed suitable for inclusion. Forty-nine gene polymorphisms were examined among 50 PIM patients, 1603 PI patients, and 2407 healthy controls spanning seven ethnicities. The meta-analysis showed that IL-1α -889 (95% CI: 1.070‒2.850, OR=1.746, P=0.026), IL-1β+3954 (95% CI: 1.265‒2.851, OR=1.899, P=0.002), and OPG -3618 (95% CI: 1.158‒2.983, OR=1.859, P=0.010) gene polymorphisms significantly differed between healthy controls and PI patients. However, IL-1β -511, IL-6 -174, OPG -3617, and TNF-α -308 gene polymorphisms did not significantly alter PI risk. Due to insufficient data, performing a meta-analysis on PIM was not feasible. Conclusion:The findings suggest that IL-1α -889, IL-1β+3954, and OPG -3618 gene polymorphisms are associated with the predisposition to PI. However, further research among diverse populations is warranted to draw more definitive conclusions.

PURPOSE:This study aimed to compare different surgical timings for keratinized mucosa (KM) augmentation and assess the impact on peri-implant parameters stability. METHODS:Electronic searches were conducted through MEDLINE (via PubMed), Scopus, Embase, and Web of Science up to June 13, 2024, which was completed with a manual search. The inclusion criteria focused on randomized and non-randomized human clinical studies that assessed outcomes of KM augmentation, with at least 3-months follow-up. The analysis included changes in KM width over time and several secondary outcomes. RESULTS:Twenty-five studies satisfied the inclusion criteria. The studies included 855 patients and 1588 implants. The KM width significantly increased after surgery, regardless of the time or method of intervention (MD: 5.17, 95% CI: 4.59, 5.75, p<0.001). The second-stage surgery, particularly with the use of autogenous graft, indicated the lowest reduction in KM width up to 3 months after surgery, while a significant shrinkage was found when the augmentation was performed post-restoratively. CONCLUSION:The evidence suggests that second-stage surgery is acceptable for KM augmentation, whereas the post-restorative phase is generally not the primary option. In cases where suboptimal soft tissue conditions are detected, it is advisable to either undertake KM augmentation or refer the patient for additional assessment before proceeding with the delivery of the restoration. Due to limited data, it is not possible to come to a definitive conclusion about the other surgical phases.

Background: Vertical ridge augmentations (VRAs), including guided bone regeneration (GBR) techniques, have been utilized in the reconstruction of deficient alveolar ridges for quite some time. GBR-based VRA procedures are technique-sensitive, operator-dependent, and often lead to complications detected during or after the treatment. The main objective of this systematic review was to include randomized and non-randomized human studies that investigated the regenerative outcome differences, as well as the incidence rates of healing and surgical complications of titanium meshes and/or titanium-reinforced membranes with and without collagen membranes utilized in GBR-based VRA. Methods: This systematic review has been prepared and organized according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines and is registered at PROSPERO (Registration ID: CRD420251002615). Medline via PubMed, Scopus, Web of Science, Embase, and the Cochrane Library were searched for eligible studies up to 5 June 2025. Randomized and non-randomized human clinical studies, except for case reports, focused on applying titanium meshes or titanium-reinforced membranes with or without collagen membranes in GBR-based VRA, were eligible. Results: A total of 119 patients from three human randomized clinical trials (RCTs) and one case series reported across nine articles were included. The addition of collagen membranes causes no significant differences in vertical bone gain or surgical/healing complication rates. Conclusions: The addition of collagen membranes on top of titanium meshes and titanium-reinforced membranes might not be necessary in GBR-based VRA. Further human RCTs are required to reach a reliable conclusion.

Many patients require edentulous ridge augmentation for dental implant placement. The main objective of this study was to evaluate the results of maxillary edentulous ridge augmentation exclusively with xenograft materials with and without simultaneous sinus floor elevation. This study reports the data retrieved from the records of 16 patients. The treatment outcome was assessed at least 6 months, postoperatively. Paired samples t-test or Wilcoxon Signed Rank test was used to compare the pre-and postoperative ridge dimensions. Dental implants were placed simultaneously in 7 patients, while 9 patients underwent delayed implant placement. In total, 68 implants were placed, and 12 patients also underwent maxillary sinus floor augmentation. A significant bone gain was achieved in both horizontal and vertical dimensions of edentulous maxillary ridges (P < 0.001). Ridge width increased by an average of 4.35 ± 1.90 mm (95% CI: 3.84 to 4.85 mm) while ridge height in areas of sinus floor augmentation increased by 8.19 ± 2.91 mm (95% CI: 7.33 to 9.05 mm). Within the study limitations, it appears that maxillary ridge augmentation according to the guided bone regeneration (GBR) protocols with exclusive use of xenograft particulate materials can provide optimal bone quantity for dental implant placement.

Background and Objective . The success of implant treatment may be compromised by peri‐implant diseases. It would be advantageous to identify the factors that could make implants more susceptible to these conditions in order to prevent and manage peri‐implant diseases. This study aimed to determine the prevalence of peri‐implantitis, peri‐implant mucositis, and their potential risk indicators. Methods . Patients examined during postloading maintenance visits were included in this study. The presence of peri‐implant mucositis, peri‐implantitis and several patient‐ and implant‐related independent variables was recorded. Statistical analysis was performed using the logistic regression analysis. The odds ratios (OR) of the potential association between each variable and the occurrence of peri‐implant diseases were evaluated. Results . Among the 114 participants with 403 implants, peri‐implantitis was found in at least one implant of nine individuals (7.89%), and a total of 13 implants were affected by peri‐implantitis (3.22%). The univariate regression analysis revealed a statistically significant association between arch (OR = 4.81; 95% CI = 1.27–31.36) and soft tissue thickness (OR = 4.07; 95% CI = 1.33–13.73) with the occurrence of peri‐implantitis. The multivariate analysis confirmed the significant impact of soft tissue thickness (OR = 3.60; 95% CI = 1.16–12.24). Conclusion . The occurrence of peri‐implant diseases can be influenced by various factors. However, in order to accurately identify risk indicators, it is necessary to conduct long‐term prospective studies.

In addition to the proper selection of techniques, appropriate treatment sequencing and prioritization are prerequisites for successful periodontal and implant procedures. The aim of this study was to provide evidence-based time frames for various procedures pertaining to periodontal and implant treatment. A literature review was conducted to collect data on tissue healing; in areas in which data were lacking, the viewpoints of experienced clinicians were solicited to establish a consensus. This review reports recommended time frames for the healing processes associated with surgical crown-lengthening procedures (both functional and esthetic), fresh socket management, alveolar ridge management, soft tissue management, sinus floor augmentation, implant loading, and peri-implant defect management.

Background:The purpose of this study was to review the literature on the efficacy of different surgical regenerative methods for peri-implantitis treatment. Methods:A preliminary search was conducted in seven electronic databases. The studies included in the analysis implemented surgical regenerative treatment in at least one study group. Baseline and follow-up values for bleeding on probing (BoP), pocket depth (PD), plaque index (PI), bone level (BL), and bone gain (BG) were extracted. The standardized mean difference (SMD) was calculated using Cohen's d or Hedges' g, and a random-effects-restricted maximum likelihood (REML) method was applied for the meta-analysis. Results:Fifteen studies were included in the qualitative synthesis. The meta-analysis was performed on six studies comparing regenerative techniques that involved bone grafts with those that did not. The overall effect size for using bone grafts at the one-year follow-up was 0.04 (95% CI: -0.26‒0.35; P=0.78) for BoP, -0.08 (95% CI: -0.42‒0.27; P=0.66) for PD, 0.37 (95% CI: 0.08‒0.65; P=0.01) for PI, -0.44 (95% CI: -0.84 to -0.03; P=0.03) for BL, and 0.16 (95% CI: -0.68‒1.01; P=0.70) for BG. Conclusion:Various materials have been employed for peri-implant defect filling and coverage. A bone substitute did not significantly improve BoP, PD, and BG values, while PI and BL were significantly ameliorated at one-year follow-up. However, recommending a single unified protocol as the most effective for surgical regenerative treatment of peri-implantitis was not feasible.

Background. Xenograft bone substitutes can be obtained from different animals and processed using various methods. The present in vivo study evaluated bone regeneration after using three types of xenografts with different sources in critical-sized bone defects in rabbit calvaria. Methods. Four 8-mm defects were created in calvaria of 14 New Zealand and white male rabbits. Three out of four defects were filled with xenografts of bovine, camel, and ostrich sources. The fourth defect was left unfilled as the control group. Seven rabbits were sacrificed after eight weeks and seven others after 12 weeks. Micro-CT imaging and histologic evaluation were further performed on dissected calvarias. Results. After 8 and 12 weeks, the highest and lowest percentages of new bone formation were observed in the camel (27.71% and 41.92%) and control (11.33% and 15.96%) groups, respectively. In the case of residual material, the ostrich group had the most value after eight weeks (53%), while after 12 weeks, it was highest in the camel group (37%). Micro-CT findings were consistent with histologic results. Conclusion. Although all three xenografts can be good choices for treating bone defects, camel-sourced xenograft seemed to be better than the other two groups. The origin and processing procedures of xenografts affected their final characteristics, which should be considered for clinical use.

BACKGROUND:Different methods have been proposed to investigate the fixation stability of dental implants, each of which has its limitations. Among these methods, resonance frequency analysis (RFA) has been widely utilized to measure dental implant stability. This study aimed to assess dental implants with two non-destructive RFA and acoustic modal analysis (AMA) validated with a finite element simulation of the fundamental natural frequency (NF) of the bone analog-implant structure. MATERIAL AND METHODS:A total number of 18 implants were inserted into two Polyurethane (PU) bone blocks with different densities (0.16 g/cc and 0.32 g/cc). AMA was used to measure NF; First, the sound originating from the axial tapping of the implant was recorded with a simple microphone. Secondly, a fast Fourier transformation algorithm was conducted to determine the NF of the implant-bone analog structure. In parallel, the ISQ (Implant Stability Quotient) value was measured using the Osstell® device. Finally, using finite element analysis (FEA), the implant-bone analog structure was modeled for validation. RESULTS:Doubling the bone analog density resulted in an average increase of 82% and 47% in the NF and ISQ using AMA and Osstell®, respectively (P-value<0.05). Furthermore, a strong linear relationship (R2= 0.93) was observed between the measured NF and ISQ values in the linear regression analysis. The NF of the dental implant predicted by FEA was overestimated by about 15.2% and 15.0% than those in the low- and high-density PUs, respectively. Moreover, the FEA predicted an increase of 83% in NF by increasing the bone analog density from 0.16 to 0.32 g/cc. CONCLUSIONS:Having required the minimum process combined with easily available equipment makes it an ideal method for fixation strength studies. The good correspondence between the ISQ values and NFs, in addition to the good accuracy and reliability of the later method, confirms its application for fixation stability assessment.

This systematic review and meta-analysis assess the clinical outcomes of implants inserted during or following the transcrestal sinus lifting. The study protocol has been prospectively registered into PROSPERO (CRD42024504513). Pubmed, Web of Science, Embase, and Scopus databases were searched up to February 21, 2024. Randomised clinical trials utilising transcrestal sinus lifts were included in the study. Qualitative and quantitative synthesis have been conducted. A random effect model was used to pool the survival rate of placed implants with trasncrestal sinus lift using hand osteotomes without grafting, along with meta-regression and subgroup analyses. Funnel plots and Egger’s linear regression were used to explore possible publication bias. A P < 0.05 was considered significant.One thousand eight hundred seven records were identified after the initial search, from which 17 studies were included, and 10 of them were considered for meta-analysis. Studies used hand osteotomes, the combination of piezoelectric and hand osteotomes, drills, and smart lifts for sinus elevation. Only studies that used hand osteotomes reported the following vertigo and dizziness in patients. The meta-analysis showed a 100% (95% CI: 99% - 100%) survival rate for both grafted and non-grafted transcrestal sinus lift using hand osteotomes. Meta-regression showed follow-up time did not affect the implants’ survival rate significantly. Subgroup analyses showed no significant difference between the bone- and tissue-level implants and one-stage or two-stage implants. Upon considering the limitations of this study, it can be concluded that the closed maxillary sinus elevation could be considered a relatively safe technique, which is associated with a high survival rate. However, caution should be made when using hand osteotomes because of their higher rate of sinus lining perforations and reported patient vertigo.