This prospective multi-centre cohort study aims to evaluate the trueness and safety of implant placement using a Dynamic Navigation System (DNS) for implant bed preparation. A total of 109 dental implants were inserted using a DNS for implant bed preparation in 76 patients by five experienced surgeons in four study centres. Before implantation, a preoperative CBCT scan was performed for each patient. This was subsequently aligned with an intraoral scan. After digital planning of the implant position, a holding tray for the intra-oral marker was designed and printed with a 3D printer. Procedure duration as well as adverse events were recorded. After implant bed preparation with DNS, the implants were placed in a freehand manner. Postoperative surface scans were superimposed onto the pre-operative planning data to evaluate the angular and spatial deviations. Descriptive statistics were followed by a one-sided, one-sample t-test to compare the data with performance goals extracted from literature-based benchmark data from freehand surgery. The overall mean angular deviation was 3.37°±2.01° with a minimum of 0.20° and a maximum of 11.10°. The mean mesiodistal and orovestibular deviation at implant tip was 1.18 ± 0.66 mm. 3D deviation at implant base showed a mean ± SD of 1.24 ± 0.65 mm. No Serious Adverse Device Effects (SADE) were reported. The angular and mesiodistal, and orovestibular deviations were significantly better than the performance goals from freehand surgery (P<.001). The mean VAS was of 87.5 ± 14.3. The study-related DNS demonstrates trueness, safety and surgeon satisfaction.

Abstract Purpose This review aimed to evaluate the existing evidence on the effects of dietary factors and nutrients on dental implant osseointegration. Methods This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Electronic searches were performed in PubMed, Web of Science, and the Cochrane Library, supplemented by manual searches of relevant journals. Human clinical studies published up to November 2025 were included. Results Out of 592 screened studies, a total of 27 clinical studies were included, comprising 13 cohort studies, 8 randomized controlled trials, 3 cross-sectional studies, 2 retrospective case–control studies, and 1 uncontrolled interventional study. Most studies focused on vitamin D, whereas evidence for other micronutrients was limited. Fifteen studies reported a positive association between vitamin D and implant osseointegration. Five studies reported no significant association, while two studies investigating vitamin B and vitamin C showed that vitamin B did not influence postoperative pain or paresthesia and vitamin C improved soft tissue healing. Sufficient vitamin D status was associated with significantly higher implant stability quotient (ISQ) values, reduced early dental implant failure (EDIF), and lower marginal bone loss (MBL). Conclusion Current evidence indicates that sufficient vitamin D status may support early osseointegration and implant stability, while deficiency is linked to less favorable early outcomes. Well-designed randomized controlled trials with standardized outcome measures, longer follow-up, and evaluation of additional micronutrients are needed.

AIM:To compare one-year prosthetic, technical, and esthetic outcomes of screw-retained, implant-supported all-ceramic single crowns placed on two-piece zirconia (ZrO2) versus titanium implants. MATERIALS AND METHODS:In this randomized, prospective, multicenter clinical trial, patients received screw-retained, implant-supported all-ceramic single crowns placed either on a two-piece zirconia implant with a titanium base connection or on a titanium implant with a conventional titanium base (implant diameters: 4.1 mm). Restoration survival and technical complications were systematically recorded. Peri-implant soft-tissue parameters, including plaque index (PI), papilla bleeding index (PBI), and papilla index (PaI), were assessed at baseline and at the one-year follow-up. Baseline was set at three weeks after crown insertion. Statistical analyses were performed using descriptive statistics. Chi-square tests were used to compare outcomes between the zirconia and titanium implant groups, with the level of significance set at p < 0.05. RESULTS:A total of 117 implants were restored, and 112 restorations were available for analysis after one year of function. Restoration survival was 100% in both the zirconia and titanium implant groups. No statistically significant differences were observed between groups with regard to overall technical complication rates. Veneered zirconia crowns exhibited significantly higher complication rates compared with monolithic restorations, irrespective of the supporting implant material. Peri-implant soft-tissue parameters, including PI, PBI, and PaI, did not differ significantly between groups. CONCLUSION:Within the limitations of this prospective randomized clinical trial, restorations supported by zirconia implants with a screw-retained titanium base connection demonstrated short-term clinical performance comparable to that of restorations placed on titanium implants. Both groups showed a 100% restoration survival rate, with no significant differences in technical complications or peri-implant soft-tissue parameters. These findings should be interpreted considering the one-year follow-up, the study design primarily powered to detect differences in marginal bone loss, and the exclusive use of regular-diameter implants. Overall, the results support the favorable short-term clinical performance at 1 year. TRIAL REGISTRATION:The study is registered at the German Clinical Trial Register (https://drks.de/search/de/trial/DRKS00013209) as well as at the Federal Office of Public Health's (FOPH) portal for human research in Switzerland (kofam.ch).

OBJECTIVES:To evaluate the clinical performance of two-piece zirconia implants with screw-retained abutments compared to titanium implants after 1 year of loading. MATERIALS AND METHODS:In this multicenter, prospective, randomized clinical trial, 61 two-piece zirconia and 61 titanium implants were placed and restored with single crowns. Evaluations were performed at implant placement, crown delivery, and 1-year post-loading. Peri-implant Marginal Bone Loss (MBL), survival rate, early wound healing index, and soft tissue parameters were assessed. Intergroup comparisons of continuous outcomes were performed using Linear Mixed-Effects Models accounting for center and potential confounders. Categorical variables were analyzed using the chi-square or Fisher's exact test. Survival was analyzed using Kaplan-Meier estimates. Significance was set at p < 0.05. RESULTS:No significant differences were found between the two implant types. Mean MBL from implantation to crown insertion was 1.10 ± 0.78 mm for titanium and 0.94 ± 0.67 mm for zirconia implants. No significant additional bone loss occurred over the subsequent year, with changes of 0.07 ± 0.55 mm and 0.08 ± 0.51 mm for titanium and zirconia, respectively. After 1 year, zirconia implants showed a 100% survival rate, while titanium implants showed 96.5% with two failures. At 1 year, differences in probing depths, plaque accumulation, and Papilla Bleeding Index were not statistically significant. CONCLUSION:After 1 year of loading, no statistically significant differences in MBL, implant survival, or peri-implant health were found between zirconia and titanium implants, indicating no clinical superiority. Zirconia implants may therefore be considered a viable alternative in single-tooth implant restorations. TRIAL REGISTRATION:The study is registered at the German Clinical Trial Register (No. DRKS 00013209) as well as at the Federal Office of Public Health's (FOPH) portal for human research in Switzerland (kofam.ch).

Dynamic navigation systems offer significant potential to enhance dental implant surgery, particularly for novice surgeons. To compare the accuracy and time consumption of freehand implant surgery (group A), static computer-assisted implant surgery (sCAIS; group B), and dynamic computer-assisted implant surgery (dCAIS; group C) performed by novice and experienced surgeons in vitro. A total of 192 implants (n = 192) were placed in polyurethane mandibular models under simulated clinical conditions by 16 participants, divided into 2 groups. Implants were placed after CBCT-based virtual planning. Postoperative surface scans were superimposed on the preoperative planning data to evaluate the angular and spatial deviations. A linear mixed model analysis, followed by descriptive statistics, was used to determine the influence of experience level, method, and operative site on various accuracy parameters. The applied implant placement methodology showed a statistically significant influence on the angular deviation, the 3D deviation at the base and tip, the bucco-oral and mesial-distal deviation at the implant base (P < .05). The lowest mean angular deviation was recorded in group B with 3.12° (±1.49°). The regions where the implants were placed had a significant influence on the angular deviation parameter (P < .001). The level of experience showed a statistically significant difference in the angular deviation of the placed implants (P < .001) and in the bucco-oral deviation at the implant tip (P = .04). Novice surgeons consistently required significantly more time compared with experienced surgeons. Both CAIS approaches hold potential to improve implant placement outcomes, showing significant improvements over freehand techniques.

PURPOSE:This in vitro pilot study aimed to determine the impact of two different CBCT fields of view, intraoral scan areas and surgical template sizes on the accuracy of static computer-aided implant surgery. MATERIALS AND METHODS:A total of 20 implant sites in the anterior maxilla of 20 polyurethane models of partially edentulous arches were divided into four groups based on CBCT field of view and intraoral scan area. The groups used either a small (40 × 40 mm) or medium field of view (50 × 100 mm), a full-maxilla or partial intraoral scan area and a full or partial surgical guide. CBCT and intraoral scan data were registered for implant planning, and surgical templates (either supported by all the remaining teeth or only by teeth 11 and 23) were designed accordingly. The implants were randomly placed through the template in a fully guided manner. Postoperative surface scans were superimposed on the preoperative planning data to evaluate the angular and spatial deviation between the planned and inserted implants. Descriptive statistics were followed by a non-parametric Kruskal-Wallis test to compare the differences between the groups. RESULTS:No significant differences were found when comparing the effect of the size of field of view, intraoral scan area and surgical template on the accuracy of static computer-aided implant surgery (P > 0.05). CONCLUSIONS:Preliminary findings indicate that field of view size, intraoral scan area and surgical template dimensions do not significantly affect the accuracy of static computer-aided implant surgery in the partially edentulous anterior maxilla, supporting the application of As Low As Diagnostically Acceptable being Indication-oriented and Patient-specific principles. CONFLICT-OF-INTEREST STATEMENT:The authors declare there are no conflicts of interest relating to this study.

PURPOSE:The aim of this pilot preclinical study was to investigate the performance of a novel double-lead thread, conical bone-level ceramic implant manufactured by injection moulding (test group) in comparison to a well-established cylindrical, soft tissue-level ceramic implant with a single-lead thread manufactured by milling (control group), both sandblasted and acid-etched. MATERIALS AND METHODS:A total of 16 implants (n = 8 per group) with a diameter of 3.75 mm (test) and 4.1 mm (control) and a length of 8 mm were placed in the mandibles of four female Göttingen minipigs 12 weeks after tooth extraction. The surface microscopy was evaluated by scanning electron microscopy. Insertion torque values were measured during implant placement. Twelve weeks after implantation, histomorphometric analysis was performed to assess bone-implant contact and first bone-implant contact. An independent samples t test was used to compare the two groups. RESULTS:The surface of both ceramic implants showed similar roughness and hydrophilicity. No statistically significant difference was reported regarding the insertion torque, bone-implant contact and first bone-implant contact. The mean insertion torque was 64.38 ± 23.21 Ncm for the test group and 64.38 ± 25.42 Ncm for the control group (P = 1.000). The histomorphometric analysis showed mean bone-implant contact of 61.63% ± 13.26% and 70.68% ± 8.63% (P = 0.128) for the test and control group, respectively. The test group showed mean first bone-implant contact of -1.66 ± 0.56 mm for the test group and -1.27 ± 0.89 mm for the control group (P = 0.316). CONCLUSION:The novel double-lead thread, conical ceramic bone-level implant manufactured by injection moulding showed comparable primary stability and osseointegration to the established single-lead thread, cylindrical ceramic implant.

BACKGROUND:The aim of this study is to evaluate the impact of different implant materials and arrangements within the field of view (FOV) and exomass on the diagnostic accuracy and image quality of cone-beam computed tomography (CBCT) for the detection of peri-implant buccal bone defects of various sizes. METHODS:A total of 120 CBCT scans with three different implant materials with identical diameter (titanium [Ti], titanium-zirconium [TiZr], and zirconium dioxide [ZrO2]) and three surgically created peri-implant defect sizes (no defect, small defect: 3 mm, large defect: 6 mm) using two CBCT scanners (X800 and Planmeca) were generated. Three independent examiners assessed the scans for the presence of peri-implant bone defects, rated the impact of metal artefacts on diagnostic confidence (visual analog scale [VAS] 0-10), and measured the maximum height and width of the defect, when present. Diagnostic performance (sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve) was calculated by a generalized linear mixed model. Artefact perception (VAS) and measurement error (height and width) were analyzed using analysis of variance, with p < 0.05 considered significant. RESULTS:CBCT imaging demonstrated high overall diagnostic accuracy for detecting surgically created peri-implant bone defects when implants were positioned within FOV and the exomass. Nevertheless, defect size (p < 0.001) and implant material (p = 0.019) did affect the diagnostic accuracy significantly. Smaller bone defects (79.4%) were associated with a reduced diagnostic accuracy compared with larger defects (99.1%) and non-defect sites (95.3%). ZrO2 dental implants (85.4%) were associated with a reduced diagnostic accuracy compared with Ti (97.5%) and TiZr implants (92.6%). CONCLUSIONS:CBCT reliably detects peri-implant bone defects, irrespective of the implant material or the presence in the exomass. While ZrO2 implants and smaller defects can reduce diagnostic accuracy, its overall performance remains robust, warranting further clinical validation. PLAIN LANGUAGE SUMMARY:This study explored how well cone-beam computed tomography (CBCT), a 3D dental imaging technique, can detect bone loss around dental implants. The authors tested three commonly used implant materials-titanium (Ti), titanium-zirconium (TiZr), and zirconium dioxide (ZrO2)-and created small and large buccal bone defects around them in a controlled laboratory setting. They also tested the effect of implants outside the CBCT scanning area to mimic real-world clinical situations. Three trained examiners reviewed 120 CBCT scans to judge whether a bone defect was present, how much the implant material affected image assessment, and how closely their measurements matched the true size of the defects. Overall, CBCT was highly reliable in identifying bone defects, especially when defects were large. However, very small buccal defects were harder to detect, and zirconia implants produced more image distortion, making diagnosis slightly less accurate compared with Ti implants. Importantly, even when implants were positioned at the edge of the scan, CBCT still performed well. These findings support the use of CBCT as a dependable tool for evaluating bone loss around implants, while highlighting situations-such as small defects or zirconia implants-where interpretation should be made with extra care.

This study aimed to compare the in vitro performance of anterior and posterior crowns with screw-retained polyetherketoneketone (PEKK) or zirconia abutments on two-piece zirconia implants. Monolithic incisor and molar zirconia crowns (n = 8 per group) were cemented on either PEKK or zirconia screw-retained abutments on zirconia implants. Molar and incisor crowns were also cemented on screw-retained titanium abutments on titanium implants as control. All specimens were subjected to combined mechanical loading (1.2 × 106 cycles of 50 N, f = 1 Hz) and thermal cycling (2 × 3000 × 5°C/55°C cycles of 2 minutes). Complications, such as loosening of the crowns and fractures, were observed. The surviving specimens were subjected to a fracture test. Descriptive statistics were applied to complications, survival times, and fracture forces. The occurrence of complications depended significantly on location (anterior or posterior) and material (P < .0001). While the incisor test groups presented higher failure rates for both PEKK and zirconia abutments, the survival rates of the molar-shaped crowns of both test groups were comparable with those of the titanium control group. This highly significant interaction is caused by a substantial difference in location for PEKK and zirconia (P < .05). The titanium control group showed uniform performance independent of the simulated site. PEKK abutments showed high survival rates for in vitro simulated molar sites. Screw-retained zirconia abutments have shown higher complication rates, especially in simulated anterior sites. Neither zirconia nor PEKK abutments are recommended in clinical application for anterior indication.

Digital technologies are reshaping dental implantology, with dynamic navigation and robotic systems offering high implant placement accuracy within clinically acceptable error ranges, the latter often achieving slightly higher accuracy. These systems enhance surgical accuracy and minimise trauma; however, high costs, extended preparation time, steep learning curves and uncertain patient acceptance limit their widespread adoption. This review summarises current principles, applications, benefits and limitations of dynamic navigation and robotic computer-assisted implant surgery (d-CAIS and r-CAIS), highlighting the need for clinicians to refine system proficiency and adapt their roles for future implant treatment procedures.

The aim of this study was to assess the antibacterial efficacy of nanostructured dental implant surfaces against Porphyromonas gingivalis, a crucial bacterium in the progression of peri-implantitis. Additionally, to evaluate the possible effect of the modified implant surface on the viability of human gingival fibroblasts (HGnFs). As detailed in prior research, helium ions sputtering was used to produce nanospiked titanium surfaces with a height of 1000 nm (Ti1000). Smooth machined (Ti machined) and SLA titanium disks (TiSLA) served as controls. The antibacterial characteristics of the samples against P. gingivalis were evaluated by conventional culturing and SEM. The vitality of HGnFs was assessed using the MTT assay. Generally, nanostructured Ti1000 surfaces exhibited less bacterial counts than the two controls (Ti1000 vs TiSLA -36% and Ti1000 vs Ti machined -37%.) without being statistically significant. Moreover, the nanosurface did not affect the vitality of HGnFs. The nanospikes of the modified titanium implant surface did not hinder gingival fibroblasts' vitality or proliferation characteristics. Optimizing the spacing and height parameters of the nanospikes could further improve the antibacterial effects of this unique re-modification approach.

OBJECTIVES:The aim of this study was to assess the antibacterial efficacy of nanostructured dental implant surfaces against Porphyromonas gingivalis, a crucial bacterium in the progression of peri-implantitis. An additional aim was to evaluate the possible effect of the modified implant surface on the viability of human gingival fibroblasts (HGnFs). METHOD AND MATERIALS:As detailed in prior research, sputtering by helium ions was used to produce nanospiked titanium surfaces with a height of 1,000 nm (Ti1000). Smooth machined (Ti machined) and sand-blasted, large-grit, acid-etched titanium disks (TiSLA) served as controls. The antibacterial characteristics of the samples against P gingivalis were evaluated by conventional culturing and SEM. The vitality of HGnFs was assessed using the MTT assay. RESULTS:Generally, nanostructured Ti1000 surfaces exhibited lower bacterial counts than the two controls (Ti1000 vs TiSLA -36% and Ti1000 vs Ti machined -37%) without being statistically significant. Moreover, the nanosurface did not affect the vitality of HGnFs. CONCLUSION:The nanospikes of the modified titanium implant surface did not hinder gingival fibroblasts' vitality or proliferation characteristics. Optimizing the spacing and height parameters of the nanospikes could further improve the antibacterial effects of this unique remodification approach.

Dental implant therapy is a widely used clinical procedure for restoring missing teeth in patients. Zirconia implants were introduced as an alternative to titanium implants due to their excellent biocompatibility and esthetic properties. The nuclear factor kappa B (NF-κB) signalling pathway is responsible for multiple aspects of innate and adaptive immune functions and serves as a significant and crucial mediator of inflammatory processes. The dysregulation of NF-κB activation induces pathological processes in multiple diseases. The purpose of this study was to investigate the activation of the NF-κB pathway upon stimulation with tumour necrosis factor (TNF)-α in osteoblast-like cells (MG-63) cultured on zirconia surfaces in comparison to titanium surfaces. Several methods such as immunoblot, immunofluorescence, MTT assay, and flow cytometry were used in this study. We observed that human recombinant TNF-α caused a strong activation of the NF-κB pathway on both zirconia and titanium discs and in wells without any discs. This activation was marked by the upregulation of MHC class I proteins in MG-63 cells grown on both titanium and zirconia discs; however, there was no effect on MHC class II protein expression. In summary, the present study has shown that TNF-α stimulation equally activates the NF-κB pathway in MG-63 cells cultured on both titanium and zirconia surfaces.

While peri-implant mucositis relies solely on clinical parameters, radiological assessment becomes indispensable for diagnosing peri-implantitis. Intraoral radiography, with its simplicity of application, low radiation exposure, and adequate representation of peri-implant structures, stands out as the standard of care for both immediate and follow-up assessments. Standardization by custom-made radiologic splints allows for excellent comparability with previous images and allows for the determination of even small changes in contour and density of the peri-implant bone. Furthermore, other radiographic modalities like panoramic radiography and cone beam computed tomography (CBCT) may provide useful features for specific patients and clinical cases while also showing innate limitations. Beyond the assessment of the marginal peri-implant bone level as the crucial parameter of clinical relevance, radiologic assessment may reveal various other findings related to the prosthetic restoration itself, the precision of its fit to the implant, and the peri-implant soft and hard tissues. Since such findings can be crucial for the assessment of peri-implant health and the implants' prognosis, a systematic diagnostic evaluation pathway for a thorough assessment is recommended to extract all relevant information from radiologic imaging. This article also provides an overview of the clinical and chronological indications for different imaging modalities in peri-implant issues.

OBJECTIVES:To evaluate the influence of different dental implant materials within the exomass on the image quality in cone-beam computed tomography (CBCT). MATERIAL AND METHODS:Five pig jaws were scanned using four CBCT devices, first without any dental implants, followed by scans with three dental implants of the same material-pure titanium, titanium-zirconium alloy, and zirconium dioxide. Two fields of view (FOVs) were used for each device to position the implants in the exomass of a small FOV and within a large FOV. Voxel values were obtained from tubes containing a radiopaque solution to calculate mean voxel value (MVV), voxel value inhomogeneity (VVI), and image noise (IN), which were compared across implant materials and FOVs using repeated measures analysis of variance (α = 0.05). Three observers independently scored image quality using a 5-point scale. RESULTS:In general, MVV remained unaffected, except for a significant increase in the X800 device when titanium or titanium-zirconium alloy implants were in the exomass of a small FOV (p ≤ 0.05). A trend of increased VVI was observed when implants were in the exomass of a small FOV, with a greater effect for zirconium dioxide, followed by titanium-zirconium alloy and titanium. IN was higher when implants were in the exomass, especially for zirconium dioxide implants (p ≤ 0.05). Image quality perception was consistent overall, though zirconium dioxide implants in both FOVs resulted in diminished quality. CONCLUSIONS:The presence of implants in the exomass can negatively affect CBCT image quality, with zirconium dioxide having the greatest impact.

OBJECTIVES:The aim of the present study was to compare a novel tapered, double-threaded self-tapping tissue-Level design implant (TLC) to a well-established parallel walled tissue-level (TL) implant in terms of primary and secondary stability over time. MATERIALS AND METHODS:Test TLC (n = 10/per timepoint) and control TL (n = 10/per timepoint) implants were placed in the mandible of minipigs and left for submerged healing for 3, 6, and 12 weeks. Maximum insertion torque and implant stability quotient (ISQ) were measured for each implant at placement. Osseointegration and cortical bone maintenance were histologically evaluated by measuring total bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC). RESULTS:A significantly higher maximum insertion torque was measured for the test implant TLC compared to the control TL implant (57.83 ± 24.73 Ncm and 22.62 ± 23.16 Ncm, respectively; p < .001). The mean ISQ values were comparable between the two implant types (75.00 ± 6.70 for TL compared to 75.40 ± 3.20 for TLC, p = .988). BIC was comparable between both implant types at each of the evaluated time points. The fBIC was found to be significantly more coronal at 12 weeks for the TLC implant compared to the TL implant (0.31 ± 0.83 mm for TLC compared to -0.22 ± 0.85 for TL, p = .027). CONCLUSION:The novel tapered tissue level design implant showed improved primary stability and an overall improved crestal bone height maintenance compared to the parallel walled design at 12 weeks.

This study investigates nanostructured titanium surfaces (Ti2 spikes) that promote the viability of osteoblasts and fibroblasts and prevent bacterial colonisation. Helium ion irradiation was adopted to produce nanometric-sized cones on titanium. Human osteoblasts (hFOB) and human gingiva fibroblasts (hGF) were used for analysis. A viability and a cytotoxicity assay were conducted to evaluate the lactate dehydrogenase (LDH) activity and assess cell damage in Ti2 spikes compared to titanium discs with a sandblasted and acid-etched (Ti2 SLA) surface. The antibacterial activity was investigated against Escherichia coli, Streptococcus mutans, Fusobacterium nucleatum, and Porphyromonas gingivalis. In the course of the cultivation, both hGF and hFOB demonstrated significantly reduced viability on the Ti2 spikes surface. hGF cells exhibited a slight but significant increase in LDH release. In contrast, hFOB showed reduced cytotoxicity on this surface. On the Ti2 spikes surface, hGF cells exhibited a significant reduction in gene expression of VCL, Src-1, and ITGα5. However, the integrin subunits ITGα1 and ITGα3 showed upregulation on the Ti2 spikes surface. The Ti2 spikes surface significantly increased the expression of almost all osteogenic markers. The results of conventional culturing demonstrated a statistically significant decrease in the number of viable cells for S. mutans, F. nucleaum, and greater quantities of P. gingivalis on Ti2 spikes surface compared to control. However, no such reduction was detected for E. coli. The long-term success of implants relies on establishing and maintaining hard and soft peri-implant tissues. Ti2 spikes represent a novel and promising approach to enhance osseointegration and optimize biocompatibility.