Case–Control Study with a 6-Month Follow-Up to Compare the Effect of Nano-Hydrophilic and Moderately Rough Implant Surfaces in Association with Transcrestal Sinus Lift

Abstract

Background: Wettability of dental implant surfaces is a key factor in the osteointegration process. This study aimed to evaluate the effect of a new hydrophilic surface on implant stability in posterior maxilla rehabilitations. Materials and Methods: A 6-month, single-center, parallel-group clinical trial following STROBE guidelines was reported. Implant Stability Quotient (ISQ) changes were compared between implants with a moderately rough surface (MultiNeO CS, Alpha-Bio Tec, Israel, Control Group–CG) and those with the same surface and, in addition, nano-scale roughness and hydrophilic properties (MultiNeO NH CS, Alpha-Bio Tec, Israel, Test Group–TG) placed using a crestal sinus lift technique. ISQ values at bucco-lingual (ISQBL) and mesio-distal (ISQMD) sides were measured at insertion (t0), 4 months (t4), and 6 months (t6). Repeated measures ANOVA (RMA) was performed for statistical evaluation. Results: The study included 35 participants (18 TG, 17 CG). Mean ISQBL0 was 69.45 (SD = 12.62), increasing to 71.72 (SD = 6.74) at t4 and 75.21 (SD = 4) at t6. ISQMD0 mean was 67.54 (SD = 12.54), rising to 72.32 (SD = 6.90) at t4 and 75.67 (SD = 4.60) at t6. No statistically significant differences were found between groups, though TG showed a significant increase in ISQBL at t6 vs. t4 and ISQMD at t6 vs. t0. One-way ANOVA revealed no significant variations between mean ISQ differences over time. Conclusion: Both groups exhibited an increasing ISQ trend, but no significant differences were observed between t4–t0 and t6–t4 periods. Further research is required to assess the impact of hydrophilia on early loading, osteointegration, and long-term outcomes.

1. Introduction

Nowadays, dental implant treatment has achieved long-term successful outcomes to rehabilitate edentulous patients [1] and osseointegration represents a critical step to achieve stable and functional dental implants. Many variables can affect osseointegration and implant success, such as implant site preparation, systemic and local conditions, and dental implant characteristics [2,3,4,5,6,7].

Since the first approval for human use, implants underwent several improvements in terms of shape, materials, and surface biocompatibility [8,9,10,11,12,13]. The main goal of implant surface modification consists in creating a better substrate for the interaction between the surface and the bone environment [14,15,16,17,18,19].

For example, among the different macro- and microscopical characteristics, microrough surfaced implants have demonstrated superiority over smooth-surface implants due to their ability to influence and enhance protein adsorption, cell–surface interaction, and cell behavior [20]. These mechanisms can influence the physiological processes of bone regeneration and remodeling (secondary stability [21]).

The wettability of dental implant surface is an additional key variable [22,23].

Generally, wettability is quantified by the contact angle (CA), which is the angle between the tangent line to a liquid drop surface at the three-phase boundary, and the horizontal solid surface. In principle, the contact angle can range from 0 to 180° and values lower than 90° are indicative of improved hydrophilic properties. Surfaces with water CAs above 90° are considered hydrophobic. Highly hydrophilic surfaces allow for very effective interaction with biological fluids. This results in a greater protein adsorption phenomenon and subsequent improved interaction with cellular receptors, improving early wound healing [24]. Consequently, the surface chemical composition of dental implants influences the hydrophilicity of the surface, enhancing interaction with the biological environment [25]. Thus, topographical and chemical characteristics of implant surfaces can play a crucial role in interacting with bone cells and promoting cellular adhesion and proliferation [26,27,28].

These are fundamental aspects for the success of osseointegration [25,29]. Surface nano-patterning, nano-coating, and functionalization can significantly improve cellular and tissue responses, with benefits in osseointegration and dental implant procedures [25,30,31].

Recently, there has been significant attention given to the development of implants with salts on their surfaces [32,33]. The presence of dry salts on implant surfaces allows for an increase in their hydrophilic characteristics while also enabling them to be stored in a dry environment. A 2021 in vitro study compared the surface characteristics of traditional dual acid-etched and sandblasted implants with the addition of air-dried salts. While greater osteoblastic differentiation was observed on more hydrophilic surfaces, higher cell adhesion and proliferation was reported on conventional implants [33]. Both in vivo study on dogs and minipigs showed a trend correlating implant hydrophilia to an increased bone deposition in the early stages of healing and high implant stability quotients (ISQ) [34]. These controversial results may be partially explained by the competitive absorption conditions existing in the bone–implant interface, in which hydrophilicity promotes the selection of specific proteins [35,36]. Despite the growing clinical application of these treated surfaces, there is still limited evidence, supported by controversial results. A meta-analysis of randomized clinical trials in humans failed to prove superiority of hydrophilic surface in ISQ at different timepoints, from baseline to 8 weeks of follow-up [37]. The authors stressed the limited number of published articles on this topic, as only five studies were included in the meta-analysis.

The rationale for the present case–control study was to evaluate the effect of a new hydrophilic surface in the dental implant rehabilitation of posterior maxilla and exemplify a deficient bone environment, both quantitatively (in terms of bone volume) and qualitatively (in terms of bone quality). The primary aim of this study was to investigate changes in the ISQ over 6 months of implant placement in posterior edentulous maxillary regions following a crestal sinus lift procedure using sugar cross-linked collagen sponge as a graft. Two different types of implants with identical macrostructure and produced by the same manufacturer were considered: moderately rough surface implants (MultiNeO CS, Alpha-Bio Tec, Modi’in-Maccabim-Re’ut, Israel) and implants with a nano-scale roughness and hydrophilic surface (MultiNeO NH CS, Alpha-Bio Tec, Modi’in-Maccabim-Re’ut, Israel).

2. Materials and Methods

2.1. The Study Design

This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement (STROBE) guidelines. A 6-month, single-center, parallel group clinical trial was conducted to compare (superiority) the changes in ISQ of moderately rough-surfaced implants and hydrophilic surface implants inserted through a crestal sinus lift technique. Two groups were outlined: a test group, MultiNeO NH CS group—receiving nano-scale roughness and hydrophilic surface implants (MultiNeO NH CS, Alpha-Bio Tec, Modi’in-Maccabim-Re’ut, Israel)—and a control group or MultiNeO CS group—receiving traditional moderately rough surface implants (MultiNeO CS, Alpha-Bio Tec, Modi’in-Maccabim-Re’ut, Israel). Both implant surfaces were produced by the same manufacturer (Alpha-Bio Tec). The two implants had identical macrostructure; they differed only for their surface characteristics. Implants were inserted performing a fully guided osteotomy. During the phase of implant planning, residual bone height (expressed in mm) and bone density (expressed in Hounsfield Units) were registered for each implant using a specific software (RealGUIDE 5.0, 3Diemme, Cantù, Italy). ISQ at bucco-lingual (BL) site and mesio-distal (MD) site were registered.

The specific smartpeg was attached to the implant. Once the smartpeg was screwed effortlessly into the implant’s internal threads (approximately 6–8 Ncm of torque), the devise (Osstell^® Mentor device, W&H, Burmoos, Salzburg, Austria) was put near the smartpeg and then measurements were taken two times for each direction. These two measurements for each direction were also summarized as mean ISQ value.

Measurements were taken at the time of implant positioning (t0) and subsequently followed up at 4 (t4) and 6 months (t6).

The same surgical procedures were performed in both groups by a single expert clinician (L.C.) in a private dental clinical setting, in Rome, Italy from April 2022 to October 2023. Patients were followed for up to 6 months in the aims of this study. Data were anonymized, and treatment groups were labeled as generic A and B and the file for the statistical analysis was sent to V.C.A.C., who was blind to the characteristics of the treatments.

The study protocol was approved by Lazio 1 Ethics Committee (Prot.887/CE Lazio) and was registered within a clinical trials database (www.clinicaltrials.gov (accessed on 1 April 2025)) with the registration number NCT05500911. Signed informed consent was obtained from all the participants included in the study before the surgery. The study was carried out according to the principles outlined in the Declaration of Helsinki of 1975, as revised in 2013.

2.2. Sample Size Calculation

Sample size calculation was undertaken before starting the study. The online tool GLIMMPSE [38] was employed for this purpose, as suggested by Guo et al. for sample size calculations of studies with repeated measures [39]. GLIMMPSE lets the user estimate the sample size based on a specific study design, outcome, and planned statistics. As stated above, the study design included the observation of the ISQ values at t0, t4, and t6 and repeated measures ANOVA (RMA) was chosen for the statistical analysis. The target power was set to 0.8 with a type I error of 0.05; uncorrected and Geisser–Greenhouse corrected were picked as planned statistical tests. ISQ values from a previously published paper were input into the GLIMMPSE interface [40]. Since it was not possible to include the matched standard deviations (SD) from the chosen means, an expected value of 5 was set with a 1:1:1 SD ratio among t0, t4, and t6. Also based on the results from the above-mentioned study, the ISQ time-dependent correlation matrix remained close to 1, and 0.99 was input when defining the months correlation matrix. A sample size of 14 per group would have conferred a power of 0.807 and 0.817 for the Geisser–Greenhouse corrected and uncorrected test, respectively. In this study, 18 patients were recruited for each group, respectively, the MultiNeO NH CS and MultiNeO CS implant treatment.

2.3. Presurgical Procedures

Intraoral scanning and CBCT, using specific software (RealGUIDE 5.0, 3Diemme, Cantù, Italy) were used to plan the correct implant insertion and to produce a surgical template for each patient recruited in the study. Residual bone height and bone density for each implant were recorded during this stage. To be enrolled, participants had to fulfil the following inclusion criteria:

• Patients requiring single implant insertion in the posterior maxilla in need of sinus elevation not needing horizontal bone regeneration;
• Subject of 30–80 years old;
• Patients in ASA 1 or 2;
• Patients with healthy periodontal conditions (treated periodontitis, plaque index < 25%, bleeding on probing < 25%);
• Patients who were willing to sign an informed consent and participate in the clinical study.

Patients with not-controlled chronic diseases, such autoimmune disease or diabetes, ASA 3 or 4, patients with cancer or who received radiotherapy in the head and neck region, patients with history of implant failure or reporting allergy to specific drugs employed in the clinical study, as well as pregnant patients, were excluded.

Once selected for the study, patients were consequently assigned to the test group (MultiNeO CS NH—nano-scale roughness superhydrophilic surfaced implants) or control group (MultiNeO CS group—moderately rough surfaced implants). Based on the chronological recruitment order, the first patient was randomly assigned to one group using a toss of a coin and the following patients were alternatively assigned to control or intervention group.

2.4. Surgical Procedure

Following local anesthesia (articaine 4% with adrenaline 1:100,000), the patients were instructed to rinse with 0.2% chlorhexidine solution for 5 min. Therefore, a full-thickness gingival flap was raised in the alveolar ridge area until the mucogingival junction. Once the alveolar ridge was exposed, a fully guided crestal osteotomy was conducted [41]. The protocol of implant insertion was described by Canullo et al. [41]. Guided surgery was chosen for site preparation as the precise drill calibration and optimum drill length can reduce the risk of membrane damage [41]. The initial drilling was performed above the sinus floor using a pilot drill (2–3 mm, depending on preoperative CBCT guidance), following a customized surgical drill guide. Access to the sinus mucosa was created using a specifically designed kit consisting in a series of burs with different cutting/non-cutting apices (Umberto Merighi, Rimini, Italy) aimed to create an access to sinus mucosa. Thereafter, micro-elevators were used to gradually lift the schneiderian membrane. In addition, 5 × 5 × 10 mm increments of OSSIX™ Bone Graft (DentsplySirona, Charlotte, NC, USA) were placed in the created space, moistened with the patient’s blood, and condensed by the osteotomes to elevate the schneiderian membrane. The integrity of the membrane was maintained and confirmed using a dental microscope to allow the pressure to elevate the membrane and prevent displacement of the grafting material into the sinus.

Following the site preparation according to the manufacturer’s instructions, Multineo CS or Multineo NH CS implants were inserted using a specific micromotor (SA-310 W&H Elcomed implant units, W&H, Burmoos, Salzburg, Austria). ISQ values were assessed at MD and BL sites (Osstell^® Mentor device, W&H, Burmoos, Salzburg, Austria). A two-stage surgical approach was followed with submerged healing and, to adapt flaps for primary intention, sutures 6.0 (Polynil, Sweden & Martina SpA, Due Carrare, Padua, Italy) were used.

2.5. Post-Surgical Procedures

At 4 months, a full-thickness flap was raised and, before inserting healing abutment, ISQ values were recorded. ISQ measurement was repeated 6 months after implant insertion. Figure 1 explains the procedure with a before and after CBCT scan.

2.6. Statistical Analysis

Statistical analysis was performed according to the guidelines for repeated measures statistical analysis and RMA was employed. Sphericity was evaluated as an assumption to undertake an RMA. Mauchly’s test of Sphericity was employed to test for the sphericity. In case of Mauchly’s test p-value < 0.05, Huynh–Feldt and Geisser–Greenhouse corrections were applied to account for the violation of sphericity assumption. In case of different statistical significance conclusions, we used Geisser–Greenhouse correction ε for values below 0.60, and the Huynh–Feldt one for values equal to or above 0.60, as suggested by Blanca et al. [42]. Shapiro–Wilk was employed to test for normality. Primary variables fell into a normal distribution, while RMA was employed to investigate the differences of ISQ values among different time points. Multiple-comparison p-values were evaluated by a Bonferroni post-hoc test. RMA was employed also in the case of non-normal distribution, as it is demonstrated that relative type I error is not altered by the violation of normality [43]. To further address the role of age, bone height, bone density, and implant surface, these variables were input as covariate in the RMA model and relative between-subjects effects were estimate. Implant surface was calculated estimating the surface of a cylinder with one base, in theory representing the surface in contact with the bone. The base of this cylinder was calculated by the formula of πr^2, while the lateral surface was estimated by 2πrh, where r is the radius of the implant and h represents the bone height.

In the last instance, mean differences t4–t0 and t6–t4 were calculated and one-way ANOVA was employed to test diverse mean differences between implant treatment groups. Chi-square test was used to explore differences among participants’ clinical variables and implant treatment groups. Because of the non-normal distribution of most clinical variables (Shapiro–Wilk p-value < 0.05), a Mann–Whitney test was used to account for linear variables and implant treatment groups.

3. Results

At the end of the recruitment period, 40 patients were eligible and accepted to be part of the study. During the study period, 4 patients (2 controls and 2 tests) dropped out, and 1 patient (control group) lost the implant at the 4-month appointment.

No other technical nor biological complications occurred during the study period.

This study was completed by 35 participants (18 and 17 patients, respectively, in the test group (MultiNeO NH CS) and control group (MultiNeO CS)). Regarding implant characteristics, such as length, diameter, total implant surface, and positioning torque, there was no statistically significant difference between the two implant treatment groups (Mann–Whitney p-value, respectively, 0.424, 0.782, 0.273, and 0.636). Regarding patients’ variables, bone height and density were also similar (Mann–Whitney p-value, respectively, 0.163 and 0.303). Older patients were allocated in the MultiNeo CS NH group (Mann–Whitney p-value = 0.017, mean 61.33 years (SD = 12.79)) compared to the MultiNeo CS group (mean 56.64 (SD = 7.37)). Sex and ASA patient status were not different among treatment groups (Chi-Square p-value > 0.05) (

Table 1. Clinical characteristics of the included patients. Mean and SD for linear variables. p-values derived from Mann–Whitney and Chi-square test.

Clinical Variables	MultiNeO CS	MultiNeO CS NH	p-Value
Age (years)	56.64 (7.37)	61.33 (12.79)	0.017
Bone height (mm)	4.88 (2.11)	5.49 (1.30)	0.163
Bone density (HU)	393.48 (220.74)	447.20 (193.15)	0.303
Implant Surface (mm)	148.91 (26.84)	148.54 (19.35)	0.757
Implant diameter	4.65 (0.55)	4.58 (0.60)	0.782
Implant length	9.00 (1.41)	9.22 (1.00)	0.424
Implant torque	37.41 (27.49)	36.05 (19.88)	0.636
Sex	8/9	11/7	0.404
Male/Female
ASA	9/8	14/4	0.122
ASA1/ASA2

).

ISQBL0 mean registered value was 69.45 (SD = 12.62) and showed a positive increase over time with mean values of 71.72 (SD = 6.74) and 75.21 (SD = 4.00) at t4 and t6, respectively. As Mauchly’s p-value was <0.001, sphericity was not assumed. RMA with a Geisser–Greenhouse correction mean value was statistically significant among assessment stages (t0, t4, and t6, p-value = 0.029), although without statistically significant differences between implant treatment groups (p-value = 0.577) (Figure 2). Of interest, only the MultiNeO CS NH group reported a statistically significant ISQBL increase in the comparison of t6 vs. t4 (

Table 2. Bonferroni post-hoc test showing p values and mean differences for each comparison in ISQBL. * statistically significant differences for p values < 0.05.

Pairwise Comparisons
Implant Type			Mean Difference (I-J)	Std. Error	Sig.	95% Confidence Interval for Difference
						Lower Bound	Upper Bound
MULTI_NEO_CS	t0	t4	−3.824	3.273	0.753	−12.079	4.432
		t6	−7.294	3.190	0.086	−15.341	0.753
	t4	t0	3.824	3.273	0.753	−4.432	12.079
		t6	−3.471	1.378	0.050	−6.946	0.005
	t6	t0	7.294	3.190	0.086	−0.753	15.341
		t4	3.471	1.378	0.050	−0.005	6.946
MULTI_NEO_CS_NH	t0	t4	−0.806	3.181	1.000	−8.828	7.217
		t6	−4.306	3.100	0.523	−12.126	3.515
	t4	t0	0.806	3.181	1.000	−7.217	8.828
		t6	−3.500 *	1.339	0.040	−6.878	−0.122
	t6	t0	4.306	3.100	0.523	−3.515	12.126
		t4	3.500 *	1.339	0.040	0.122	6.878

).

ISQMD0 registered mean was 67.54 (SD = 12.54) and showed a positive increase overtime with mean values of 72.32 (SD = 6.90) and 75.67 (SD = 4.60) at t4 and t6. As Mauchly’s p-value was <0.001, sphericity was not assumed. RMA with a Geisser–Greenhouse correction mean value was statistically significant between assessment stages (t0, t4, and t6, p-value = 0.002), however without statistically significant differences between implant treatment group (p-value = 0.306) (Figure 3). Of interest, only the MultiNeO CS group reported a statistically significant mean increase in a single comparison t6 vs. t0 (

Table 3. Bonferroni post-hoc test showing p-values and mean differences for each comparison in ISQMD. * Statistically significant differences for p-values < 0.05.

Pairwise Comparisons
Implant Type			Mean Difference (I-J)	Std. Error	Sig.	95% Confidence Interval for Difference
						Lower Bound	Upper Bound
MULTI_NEO_CS	t0	t4	−7.294	3.250	0.095	−15.491	0.903
		t6	−10.706 *	3.094	0.005	−18.509	−2.902
	t4	t0	7.294	3.250	0.095	–0.903	15.491
		t6	−3.412	1.358	0.051	−6.836	0.013
	t6	t0	10.706 *	3.094	0.005	2.902	18.509
		t4	3.412	1.358	0.051	−0.013	6.836
MULTI_NEO_CS_NH	t0	t4	−2.417	3.158	1.000	−10.383	5.550
		t6	−5.694	3.007	0.201	−13.278	1.889
	t4	t0	2.417	3.158	1.000	−5.550	10.383
		t6	−3.278	1.320	0.055	−6.606	0.050
	t6	t0	5.694	3.007	0.201	−1.889	13.278
		t4	3.278	1.320	0.055	−0.050	6.606

).

Accounting for covariates in the RMA model, age, bone height, bone density, and implant surface did not account for between-subject effects (respectively, p-values = 0.060, 0.255, 0.103, and 0.414).

One-way ANOVA failed to find statistically significant variation between the mean differences of ISQBL and ISQMD values at t4–t0 and t6–t4 (

Table 4. Mean differences variation between ISQBL and ISQMD values calculated as delta of t4–t0 and t6–t4.

Descriptives
		N	Mean Differences	Std. Deviation	Std. Error	95% Confidence Interval for Mean		p-Value
						Lower Bound	Upper Bound
DeltaISQBLT4T0	MULTI_NEO_CS	17	3.82	16.82	4.08	−4.82	12.47	0.513
	MULTI_NEO_CS_NH	18	0.81	9.34	2.20	−3.84	5.45
	Total	35	2.27	13.38	2.26	−2.33	6.87
DeltaISQBLT6T4	MULTI_NEO_CS	17	3.47	6.67	1.62	0.04	6.90	0.988
	MULTI_NEO_CS_NH	18	3.50	4.56	1.07	1.23	5.77
	Total	35	3.49	5.60	0.95	1.56	5.41
DeltaISQMDT4T0	MULTI_NEO_CS	17	7.29	16.87	4.09	−1.38	15.97	0.290
	MULTI_NEO_CS_NH	18	2.42	8.99	2.12	−2.05	6.89
	Total	35	4.79	13.43	2.27	0.17	9.40
DeltaISQMDT6T4	MULTI_NEO_CS	17	3.41	6.78	1.65	−0.08	6.90	0.944
	MULTI_NEO_CS_NH	18	3.28	4.19	0.99	1.20	5.36
	Total	35	3.34	5.52	0.93	1.45	5.24

).

4. Discussion

This study did not reveal significant differences in terms of ISQ between the t4–t0 and t6–t4 periods in surfaces treated with sandblasting and double acid-etching compared to those subjected to surface salt treatment to enhance wettability. Additionally, both the implant types proved to be effective when associated with transcrestal sinus lift using collagen bone, with only one early failure case within the control group.

Clinical studies conducted by Buser have highlighted a faster integration rate of implants with hydrophilic surfaces compared to those with SLA surfaces [44]. Similarly, a study by Att [45] et al. confirmed this observation.

However, it is crucial to consider the role of titanium aging on the osteoconductivity of dental implants, as demonstrated by Lee et al. [46]. The reaction of titanium dioxide with atmospheric CO2 can lead to the formation of hydrophobic hydrocarbons, compromising the initial stages of adsorption of proteins and interstitial fluids essential for the proliferation and differentiation of osteoblasts. To address this issue, surface treatments such as SLActive have been developed to preserve the hydrophilic properties of titanium, on which higher initial cell attachment and osteoblastic cells were observed. Preclinical studies have shown that hydrophilic treated implants may favor osteointegration by improving angiogenesis during the early stages, and while this might contribute to increased availability of nutrients and growing factors, on the other hand, osteogenic cells have been observed to develop from pericytes of small blood vessels.

Martins et al. [47] have demonstrated the importance of surface osteoconductivity influencing the healing pattern after bone regeneration. However, a study conducted by Gursoytrak et al. [48] highlighted a significant difference in ISQ favoring alkali-modified surfaces over sandblasted surfaces in the posterior mandible. A prospective study compared standard implants to sand-blasted, acid-etched surface implants. This modification of the surface aims to improve hydrophilia. Of interest, statistically significant differences were not found when comparing the treatment groups; however, whether the treatment was performed in the mandible or maxilla impacted the statistically significant difference. Another study, comparing a new hydrophilic surface to sandblasted and acid-etched implants, found opposite results, with improved outcomes in maxilla. The authors suggested that increased hydrophilia may be beneficial in area of poor bone quality or compromised patients. These controversial results may be partially explained by different implant surface modifications of these studies; while it is reported that these modifications increase the hydrophilic properties of the implant surface, on the other hand, biochemical and cellular events might be triggered differently.

Despite the trend of increasing ISQ over time observed in both groups in our study, it is important to note that this was not accompanied by a significant increase in insertion torque, suggesting a stable interface between implant and bone.

Our results may be added to a recently published systematic review and meta-analysis on this topic. The meta-analysis evaluated 246 dental implants and reported that there was no significant difference in ISQ between nano-scale roughness, superhydrophilic surface, and conventional implants [37].

This, along with the minimally invasive nature of the transcrestal sinus lift technique, may lead to less post-operative trauma and faster healing for the patient [49].

Preclinical research findings demonstrated a greater degree of stability disparity between hydrophilic and hydrophobic implant surfaces than did clinical investigations. This variation may result from the biological differences between humans and animals as well as the different ossification procedures and functions of the tibia, femur, and mandibles [34].

The limitations of our study include the inability to conduct histological analyses on human patients for ethical reasons, thus limiting the understanding of healing patterns and bone–implant contact. The topic investigated remains open since the study could not demonstrate a clear advantage of nano-superhydrophilic surfaces. Future studies are needed to assess whether the bioactivity of implant surfaces can influence the stability and volume of regenerated bone over time. These should focus on a better understanding of the combination of nano-scale roughness and hydrophilia, and how different implant surface chemical treatments can lead to the same hydrophilic characteristics but to different biomolecular and biological effects.

5. Conclusions

In summary, the results of our clinical study indicate that both tested implant surfaces demonstrated reliability when dental implants are inserted in tandem with a crestal sinus lift technique, with a steady increase in ISQ over time and a tendency towards uncomplicated healing. However, a deeper understanding of the underlying mechanisms and the effect of implant bioactivity on regenerated bone over time will require future studies, elucidating how hydrophilia could impact early loading, osteointegration, and long-term outcomes.