Abstract

This multicenter study investigated patient-reported outcome measures (PROMs) following immediate placement of zirconia dental implants. Fifty-four patients from Austria, Spain, and Germany received 272 implants and completed the PROM questionnaires before implantation (T0) and at the time of definitive prosthetic restoration (T1). Patient experiences were assessed using a visual analog scale (VAS) across the following five domains: functional limitations, psychological discomfort, physical pain, physical and social disability, and handicap. The follow-up duration was 8.1 ± 1.5 years, with a 100% implant survival rate. Overall patient satisfaction rate improved from 77.88% at T0 to 94.99% at T1 (P < .0001). Significant correlations were observed between higher VAS scores at T0 and clinical variables, such as implant diameter, number of implants placed, use of augmentation procedures, and loading timing. Qualitative differences between the participating countries were also noted, with Spanish patients reporting the most significant reduction in VAS scores from T0 to T1. This study highlights the importance of integrating PROMs in implant dentistry to address the efficacy-effectiveness gap and support a value-based care model. The results demonstrated high long-term patient satisfaction and acceptance of immediately placed zirconia implants in diverse clinical settings.

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Implant placement is often combined with contour augmentation surgery, involving flap elevation and material placement extending to the ridges of adjacent teeth. This study evaluated horizontal ridge dimensional changes and the stability of the implant site and adjacent teeth in the esthetic zone following early implant placement with contour augmentation. Twenty-one patients received maxillary incisor single implant placement with contour augmentation. Alginate impressions were taken before tooth extraction (T0) and at 1-year follow-up (T1), and stone casts were scanned using a desktop 3D scanner to generate stereolithography (STL) files. Horizontal ridge dimensions were measured at 0, 1, 3, and 5 mm below the mucosal margin at the groups of implant site (I), mesial tooth (MI), distal tooth (DI), and contralateral canine (C). Results indicated significant differences in ridge dimensions between T0 and T1 at the 3-mm and 5-mm levels in Group MI (P < 0.05). No significant differences were observed among the four groups at any level.

Early implant placement with contour augmentation appeared to maintain the facial-palatal ridge dimension close to pre-extraction width, suggesting acceptable hard and soft tissue stability in the esthetic zone after 1 year, with no consistent adverse effects on ridges of adjacent teeth.

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During the osteotomy and placement of dental implants, anatomical positions of adjacent natural teeth to a dental implant site may be very close or in actual contact. This can be due to anatomy, the size of the implant site, a misguided osteotomy, drifting, or migration of the adjacent tooth. The implant surgeon needs to be aware of the position of adjacent teeth to avoid root damage from the implant drill or the implant itself. The dimension of 1.5mm space has been discussed, but it is an arbitrary speculative dimension. There is no agreed-upon “safe” proximity to adjacent tooth roots.

Theoretically, a large displacement size of an implant may inhibit bone remodeling and cause bone loss if placed close to an adjacent tooth. A small diameter or mini-implant may not significantly affect bone remodeling when placed in close proximity or even in contact with an adjacent tooth root.

Many factors dictate “safe” proximity, including the implant diameter, tooth root displacement, periodontal ligament, bone quality, and patient physiologic factors, including diseases and medications.

The degree of root contact by an implant or implant drill may be graded by the contact depth. Grade 1 is contact with periodontal ligament, Grade 2 is contact with periodontal ligament and cementum, Grade 3 is contact with periodontal ligament, cementum, and dentin penetration, and Grade 4 is contact with periodontal ligament, cementum, root dentin, and pulpal penetration. This discussion highlights the need for further research on dental implant proximity and contact with adjacent teeth.

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A 64-year-old female patient was referred for the treatment of peri-implantitis around an implant at site 46. Bleeding on probing, excessive probing depth and extensive bone loss (more than 50% of the implant length) were evident around the implant. Moreover, the implant site suffered from a lack of keratinized mucosa at the buccal side. The patient received a sequence of cleaning with a titanium brush, decontamination with tetracycline paste, H₂O₂ and saline, titanium mesh placement, use of xenogenic bone substitute, and eventually, covering the area with a xenogenic collagen matrix. Four years’ results showed favorable probing depth, bone gain (more than 80% of the implant length), lack of bleeding on probing, and formation of a keratinized mucosal rim at the buccal side. In the presented case, the mesh technique with xenogenic bone substitute and collagen matrix effectively manages a severe peri-implantitis case.

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The rehabilitation of the atrophic maxilla poses a significant challenge, especially in cases with limited bone height. Nasal floor augmentation has been proposed to improve bone height in the anterior maxilla. However, its effects on nasal function and passage volume have not been thoroughly investigated. The objective of this study was to evaluate the correlation between nasal passage volume changes and patient-reported nasal obstruction after nasal floor augmentation using the Nasal Obstruction Symptom Evaluation (NOSE) scale. This retrospective study included patients undergoing iliac bone grafting and nasal floor augmentation for the rehabilitation of severely atrophic maxilla. Nasal passage volume alterations were measured using cone beam computed tomography, and nasal function was assessed using the NOSE scale. The correlation between NOSE scores and volume changes was analyzed. A total of 12 patients met the inclusion criteria. The mean bone height increase was 5.70 ± 3.75 mm, and the mean nasal passage volume decrease ratio was 17.73 ± 18.23 %. The findings demonstrated a significant correlation between NOSE scores and nasal passage volume alteration (Spearman’s rank correlation, ρ = .889, 95% CI [.732, .960], P < 0.001); however, no significant correlation was found between NOSE scores and bone height alterations (Spearman’s rank correlation, ρ = - .129, 95% CI [.-736, .457], P = .689). The results suggest that changes in nasal passage volume may influence patient-reported breathing function more than bone height increase. While a correlation was observed, causality cannot be inferred due to the study’s retrospective nature and the limited sample size. Nevertheless, these findings provide preliminary evidence pointing to the potential importance of careful surgical planning to minimize volume reduction during nasal floor augmentation. Further prospective studies with larger and more diverse sample sizes must validate these results and strengthen the conclusions.

Abstract

The bone shell approach to lateral ridge augmentation has overcome many limitations of the classic block graft and guided bone regeneration approaches. Surgical complexity and expensive dedicated armamentarium may partially explain why it has not yet become ubiquitously adopted. We propose a screwless simplification of the bone shell approach concerning the posterior mandible lateral defect. Two cases are described to highlight the unique aspects of each case.

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The canine fossa is an important facial concavity on the labial surface of the maxilla, which needs to be considered when placing implants in the maxillary canine and premolar region. The present study assessed the canine fossa and analyzed the depth and distance of its deepest point from the root apex as a guide for immediate implant placement. 100 cone beam computed tomography (CBCT) scans taken between January 2017 and December 2021 were analyzed in the sagittal section, evaluating the depth of the canine fossa and its proximity to the root apex. The average depth of the canine fossa was 1.62 ± 0.54 mm, and the distance between the deepest point of the fossa and the root apex was 4.52 ± 1.70 mm. No significant correlation was found between these parameters and gender or age (p > 0.05). It can be concluded that the canine fossa is near the roots of the canine and first premolar, increasing the risk of fenestration of buccal bone during immediate implant placement.

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A technique paper on double-crown systems and a case presentation are presented to describe the short-term outcomes of tooth-implant connections using double-crown systems. A 42-year-old man wearing an upper clasp-retained removable partial denture visited the Department of Prosthodontics at Greifswald University Polyclinic to enhance his chewing efficiency and appearance. The patient underwent a thorough evaluation encompassing medical, social, and systemic health assessments and comprehensive extraoral and intraoral examinations, esthetic analyses, and functional screening. Three prosthodontic treatment options were provided. The patient selected the tooth-implant-supported upper gold-foil double-crown-retained removable partial denture (DCRPD) and lower fixed prostheses with a double-crown tooth-implantsupported bridge. The oral health-related quality of life (OHRQoL) and patient satisfaction were measured before treatment and after inserting the DCRPD and cementing the lower fixed prostheses. The patient reported improved retention, support, stability, chewing efficiency, esthetics, and OHRQoL. Measurements recorded after 1 year indicated that these improvements had been maintained. The outcomes in this case report are consistent with those of several long-term clinical studies and systematic reviews.

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Recombinant human bone morphogenetic protein-2 (rhBMP-2) has emerged as an alternative to autogenous bone grafts in maxillofacial surgery, reducing donor-site morbidity while promoting osteoinduction. This case report evaluates the 10-year outcomes of rhBMP-2 use for mandibular bone regeneration in a 55-year-old male with extensive periapical osteolytic lesions on teeth #s 23, 24, 25, and 26 linked to childhood trauma. Following extraction, curettage, and rhBMP-2 grafting with a collagen membrane and titanium mesh, three implants (2.9 x 12 mm) were placed after six months, followed by osseointegration and a connective tissue graft for prosthetic rehabilitation. Over 10 years, clinical and radiographic assessments indicated stable bone levels (<1 mm crestal loss) and implant success, with no complications reported despite acknowledged risks of edema or carcinogenesis. This case aligns with the literature supporting rhBMP-2’s efficacy (81.4‥ bone regeneration success) and underscores the importance of delivery systems in optimizing outcomes. Continued research investigating dosing and carriers is warranted to enhance its application in implant dentistry.

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During and after implant surgery, pain is one of the most frequent complaints, and its intensity is thought to be influenced by a variety of factors. This study aimed to examine the association between insertion torque values and patients' pain levels measured with the visual analog scale and investigate the relationship between insertion torque, implant stability quotient, and periotest values. This study was designed as a randomized, controlled, split-mouth clinical trial. Fifteen patients with bilateral single tooth loss in the posterior mandible were included. A total of 30 implants were randomly placed with high insertion torque (≥ 50 Ncm) on one side and regular insertion torque (<50 Ncm) on the other side in the same operation. The insertion torque, implant stability quotient, periotest values, and preoperative anxiety and postoperative pain levels were recorded. Mean insertion torque values for high and regular insertion torque groups were 77.27±5.77 Ncm and 30.47±8.33 Ncm, respectively. Pain levels were higher in the high insertion torque group than the regular insertion torque group on the operation day (p=0.016) and the following day (p=0.007). Furthermore, correlations were observed between insertion torque, implant stability quotient, and periotest values (p < 0.05). The study found that implants placed with high insertion torque had higher reported pain levels on the day of the operation and the following day.

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The Socket Shield Technique (SST) is a method that aims to preserve the alveolar bone and reduce post-extraction bone resorption by retaining part of the tooth root; despite significant advancements in immediate implant placement and bone regeneration techniques in implant dentistry, alveolar bone resorption after tooth extraction remains a major clinical challenge, with current methods failing to prevent bone remodeling completely. This review aims to summarize the application progress of SST in implant restoration, discuss its advantages and limitations, and analyze key issues in its clinical application. By reviewing the existing literature, we conclude that SST, as a considerable potential treatment approach, the effectiveness of SST is still influenced by factors such as the three-dimensional position of the tooth slice, bone graft materials, and surgical procedures. However, it offers significant benefits, including the effective preservation of bone resorption, reduction in the need for bone augmentation procedures, high implant survival rates, and favorable clinical outcomes. SST provides a potential therapeutic paradigm for immediate implant placement, offering significant clinical value and research significance.

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This study aimed to determine the frequency of anatomical variants of the jaws considered critical and their limitations in implant surgical procedures by analyzing conebeam computed tomography (CBCT) scans. A random sample of 46 CBCT images was retrieved. Computed tomography (CT) scans with correct visualization of the anatomical area to be studied with different fields of view (FOV) were included: 5X5, 8X5, and 8X8. Ex3D-plus software was used to obtain the various measurements of each patient. The statistical program STATA V.15 was used, and p=≤0.05 was considered significant. In total, six anatomical structures corresponding to 46 CBCT images were analyzed. Seventy-eight percent of mentonian foramen (n=39) were oval, while 16% (n=8) were circular. In 81% of the CT scans (n=21), no accessory mentonian foramen were seen. In 100% of patients (n=25), anterior loops were present. In addition, 96% (n=24) presented lingual foramen. According to gender, it was found that the average distance between the maxillary sinus floor and the disto-vestibular and palatal apices of the upper second molar was significantly greater in men than in women (p≤0.05). In conclusión, dentists should have a comprehensive knowledge of the anatomy of the maxilofacial. Based on the results reported in our study, it should be considered that structures that have been classically determined to be inconstant, such as the lingual foramen and the anterior loop, should now be considered part of normal anatomy.

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Replacing congenitally missing teeth can be challenging due to anatomical limitations. This retrospective radiographic study aimed to evaluate i) the dimensions of the alveolar ridge in congenitally missing maxillary lateral incisor sites and ii) whether straightforward implant placement and placement in a prosthetically ideal position was possible. CBCT images of the maxillary alveolar ridge were measured at 3, 8, and 13 mm from the planned crown margin in a labio-palatal and mesio-distal dimension. Virtual implant planning was completed in 3D planning software to evaluate whether the straightforward placement of a 3 mm wide and 10 mm long implant (with 1.5mm safety distance to neighboring teeth; 1mm bone wall on the buccal and palatal aspect of the implant) was possible in a prosthetically driven position. Twenty-three patients with 39 missing maxillary lateral incisors were analyzed. The mean (SD) of the alveolar ridge labio-palatal width was varying, 4.6 mm (1.3) at 3 mm, 5.6 mm (1.2) at 8 mm, and 7.8 mm (1.9) at 13 mm. Radiologically straightforward implant placement was possible in 56.4% (n=22) of the sites. In five sites (22.7%) where straightforward implant placement was possible, the implants could be planned in a prosthetically driven position. According to patient records, straightforward implant placement was performed in 33.3% (n=13) of the cases, five of them in prosthetically driven position. In congenitally missing maxillary lateral incisor sites, the alveolar ridge width is limited in the labio-palatal direction and might affect the possibility of straightforward and prosthetically driven implant placement.

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Introduction This study aimed to assess the effect of slice thickness of 3D printer in fabrication of surgical guide (SG) on the accuracy of dental implant placement. Materials and Methods After preparation of two dry human mandibles, Cone-beam computed tomography (CBCT) scans were obtained, and the location and direction of implants in the edentulous ridge of the mandible were identified using Romexis software. Data in STL format were transferred to a 3D printer and two SGs with 50 µm and 100 µm thicknesses were fabricated for each mandible. Drilling was performed using two SGs. The pre- and post-intervention CBCT scans were superimposed to measure the magnitude of differences. The two groups were compared using the Mann-Whitney U test. Results No significant difference was noted in SGs with 50 and 100 µm thicknesses in the coronal and apical regions of the implants or the depth of drilling. However, the difference in angular deviation was statistically significant. Conclusion Considering the higher accuracy of SGs with 50 µm thickness (despite the presence of a significant difference in AD between the SGs with different thicknesses), it is recommended to use a SG with 50 µm thickness in cases where anatomical limitations exist.

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This case series presents three patients undergoing minimally invasive regenerative surgery for peri-implantitis using peri-implant excision and regenerative surgery (PERS). No report of a resolved inflammatory state with peri-implant bone loss following nonsurgical treatment was included in this case report. After the suprastructure of the implant was disconnected, a peri-implant circular incision was made to remove inflammatory tissue. The combination decontamination method was conducted using a chemical agent and a mechanical device. After copious irrigation with normal saline, collagenated demineralized bovine bone mineral was applied to fill the peri-implant defect. The suprastructure of the implant was connected following the PERS procedure. The three patients with peri-implantitis that underwent successfully PERS procedures suggest that surgical intervention is a feasible approach to obtaining proper peri-implant bone filling of 3.42 ± 1.08 mm. However, this novel technique should be investigated in a larger sample size to determine its reliability and validity.

Polycaprolactone has exhibited expediency as a biomaterial for bone regenerative procedures preclinically. The present report of the two clinical cases in the posterior maxilla is the first to describe clinical application of a customized 3D printed polycaprolactone mesh for alveolar ridge augmentation. Two patients needing extensive ridge augmentation procedures for dental implant therapy were selected. Polycaprolactone meshes were virtually designed, 3D printed and applied in combination with a xenogeneic bone substitute. Cone-beam computed tomography was taken pre-operatively, immediately after the surgery, and 1.5 to 2 years after the delivery of implant prostheses. The serial cone-beam computed tomography images were superimposed to measure the augmented height and width at 1 mm increments from the implant platform to 3 mm apically. After 2 years, the mean [maximum, minimum] bone gain was 6.05 [8.64, 2.85] mm vertically and 7.77 [10.03, 6.18] mm horizontally at 1 mm below the implant platform. From immediately postoperative to 2 years, there was 14 % reduction of augmented ridged height and 24 % reduction of augmented width at 1 mm below the platform. All implants placed in augmented sites were successfully maintained until 2 years. The customized Polycaprolactone mesh might be a viable material for ridge augmentation in the atrophic posterior maxilla. This needs to be confirmed through randomized controlled clinical trials in future studies.

Aim :  To evaluate the available literature reporting the survival and complication rate of zygomatic implants, assessing factors (such as surgical technique, surgical/restorative plan, population, study design and characteristics, etc.)  associated with these outcomes. Materials and Methods:  A comprehensive search was performed in three electronic databases, together with a manual search, to identify clinical studies reporting the survival and/or complication rates following zygomatic implant therapy, to quantify relative rates for both stated outcomes.  Results:  101 articles were included: 69 were retrospective in nature, 29 were prospective non-randomized studies and 3 were randomized trials (RCTs). The mean survival rate among retrospective studies was 97.61%, while among prospective non-RCTs and RCTs was 98.53% and 95.92%, respectively. The survival rate was not associated with the surgical technique, nor with the surgical/restorative plan. A trend towards higher survival rate, although not statistically significant (p>0.05), was observed in more recent vs less recent studies. Forty-eight articles reported data on complications related to zygomatic implants, with labial laceration, orbital cavity penetration, hematoma, epistaxis, maxillary sinusitis, infection and oro-antral communication being among the most common adverse event. A lower incidence of maxillary sinusitis was observed for zygomatic implants placed using the extrasinus approach compared to the other surgical approaches (p<0.01). The incidence of maxillary sinusitis and oro-antral communications was found to be less likely in “recent” vs “less recent” studies (p<0.05). Conclusions:  Zygomatic implant therapy is a reliable treatment option for rehabilitating the severely atrophic maxilla, with high implant survival rate and relatively low complication rate. Several factors were found to be associated with the incidence of post-operative complications. Nevertheless, the evidence from the literature is mainly based on non-RCTs and therefore these findings have to be interpreted with cautions.

Accuracy of completely edentulous arch scanning with implant scan bodies has not been completely validated for intraoral scanners. For desktop laboratory scanners validations were found in the literature. The aim of this in vitro study was to compare the dimensional accuracy of scanning with splinted and unsplinted scan bodies on a completely edentulous maxillary arch with 6 implants. A maxillary edentulous master cast with 6 implants was used as control for all implant level impressions. 6 implants were digitally planned and placed at different angulation of 0, 0  17° and 30°. A contact coordinate measuring machine (CMM) was used to generate baseline linear measurements of the master cast. Four test groups included: 2 intraoral scanners Trios (3shape, Copenhagen, Denmark) and True Definition (3M ESPE, St Paul, MN), one industrial scanner Atos (Core optical 3D scanner) and one conventional impression group scanned with laboratory scanner Dental Wings 7 Series. Each scan recording was made with splinted and unsplinted scan bodies. Digital datasets of all measurements were compared with the CMM baseline values using PolyWorks® InnovMetric Software in order to assess the linear and angular deviations and determine the accuracy of complete arch digital impression. Factorial ANOVA showed significant effect with splinting, scanner type, inter-implant distance and implant angulation for linear deviations. Splinted scan bodies revealed elevated linear and angular deviation values for all scanners with significantly highest deviations for True Definition scanner. Significant correlation was found between inter-implant distance and linear deviation (r =0.45, P =<0.001) with increased linear deviations among all scanners, regardless of splinting. ( P <0.05). Significant effect on accuracy was seen for angular deviation with splinting, scanner type and implant angulation; significant difference was found between 0° and 30° implant angulation ( P =0.035) with more deviation with 30° implant angulation. The accuracy of the complete arch implant digital impression using splinted scan bodies was significantly reduced for measurements that crossed the arch midline. The digital impression technique using a broad splint design to connect scan bodies was not found to improve the scan accuracy for intraoral scanners.

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The main cause of peri-implantitis and crestal bone resorption is bacterial infection. The present study aimed to comparatively assess the microbiological parameters in sulci around teeth and crowns supported by dental implants and also compare microbiological parameters around deep and shallow implant sulci. In this cross-sectional study, 34 partially edentulous patients with a total of 72 implants (22 deep vs. 50 shallow sulci) were included. Excluded were the patients with compromised systemic and periodontal health or smoking habits. All Implants (ITI) were at least 6 month in place covered by definite prostheses. Samples of gingival sulci were taken around teeth and implants with paper points and transported in Stuart Transport Medium. Samples were cultured and examined by dark field microscope to determine the microorganisms. Data were evaluated statistically in SPSS (v11.5) using chi-square test. Cocci G+, Cocci G-, Prevotella, Porphyromonas gingivalis, Bacteroid fragilis and Fusobacterium were found. The relative frequency of P. gingivalis was significantly higher in deep implant sulci compared to shallow implant sulci (p = 0.044) and natural sulci (p = 0.009). B. fragilis was also significantly more isolated from the deep implant sulci compared to shallow implant sulci (p = 0.001) and natural sulci (p = 0.064). Within the limitations of the present study, it may be concluded that peri-implantitis is more likely in deep sulci compared with shallow sulci in partial edentulousness.

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Auricular defects can result from tumor resection, congenital malformations, and trauma. These defects lack hard or soft tissue undercuts, and prosthesis retention is obtained primarily by the use of skin adhesives. There are significant disadvantages to the use of skin adhesives.The margins of the facial prosthesis may be damaged by repeated application and removal of the adhesive, and occasionally a patient will have a toxic skin reaction. The retentive capacity of adhesives may be insufficient in mobile tissues or in moist environments. The presence of hair also complicates the use of skin adhesives. The use of craniofacial titanium implants for restoring auricular defects may provide many benefits. The quality of retention provided far exceeds that obtained with adhesives, and skin-penetrating osseointegrated implants have demonstrated an excellent level of predictability when placed in bone in the auricular area.The aim of this paper is to present concept and principles of maxillofacial implants, history, literature review , advantages and disadvantages, considerations in treatment planning, finally the treatment phases of an implant-supported auricular prosthesis in particular and prospective developments for ear prosthesis.