Risk Factors in Implantology

A special issue of Dentistry Journal (ISSN 2304-6767). This special issue belongs to the section "Dental Implantology".

Deadline for manuscript submissions: 15 September 2025 | Viewed by 12164

Special Issue Editor


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Guest Editor
1. Oral and Maxillofacial Surgery of the Mediplus Clinic, Haifa-Allee 20, 55128 Mainz, Germany
2. Department of Oral and Maxillofacial Surgery, University Medical Centre, Johannes Gutenberg University Mainz, Augustusplatz 2, 55131 Mainz, Germany
Interests: dental implants; oral and maxillofacial surgery
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Special Issue Information

Dear Colleagues,

Missing teeth can be substituted through many methods, including dental implants. There are several points that define implant success over time. Past studies have described an implant survival rate of approximately 95% after 15 years. However, there are risk factors that are associated with a higher implant loss rate. Risk factors can occur due to general diseases, such as diabetes, or due to their treatment with potentially problematic drugs that interfere with the healing process, such as bisphosphonates, chemotherapies, or immune system depressing drugs. Further risk factors could include local factors such as periodontal disease, mucosal membrane diseases, a potential radiation to the bone, and the quality and quantity of the bone. Other factors that may play a role could be the implants themselves, along with the materials, design, design of the abutment, and artificial dentation. Further factors include the surgeons, their expertise, and their treatment protocols (immediate implant or delayed). This list makes no claim for completeness, so further topics are welcome.

Papers addressing the general topic of risk factors in dental implantology are welcome for this Special Issue. This includes pre-clinical studies, epidemiologic studies, clinical trials, narrative reviews, and systematic reviews, as well as meta-analyses.

Prof. Dr. Christian Walter
Guest Editor

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Keywords

  • dental implantology
  • risk factor
  • implant success
  • implant survival

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Published Papers (8 papers)

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Research

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13 pages, 2643 KiB  
Article
Balancing the Load: How Optimal Forces Shape the Longevity and Stability of Orthodontic Mini-Implants
by Tinela Panaite, Carmen Savin, Nicolae Daniel Olteanu, Cristian Liviu Romanec, Raluca-Maria Vieriu, Carina Balcos, Alice Chehab and Irina Nicoleta Zetu
Dent. J. 2025, 13(2), 71; https://doi.org/10.3390/dj13020071 - 5 Feb 2025
Viewed by 514
Abstract
Objective: This study aims to investigate the mechanical behavior of titanium (Ti6Al4V) mini-implants (MIs) under varying orthodontic forces using finite element analysis (FEA) and to evaluate their performance and durability under realistic clinical conditions. Optimal orthodontic forces significantly influence the structural integrity [...] Read more.
Objective: This study aims to investigate the mechanical behavior of titanium (Ti6Al4V) mini-implants (MIs) under varying orthodontic forces using finite element analysis (FEA) and to evaluate their performance and durability under realistic clinical conditions. Optimal orthodontic forces significantly influence the structural integrity and functional longevity of MIs while minimizing adverse effects on surrounding bone tissues. Materials and Methods: A commercially available MI (diameter: 2.0 mm, length: 12 mm) was modeled using FEA. The mandible geometry was obtained using computed tomography (CT) scanning, reconstructed in 3D using SpaceClaim software 2023.1, and discretized into 10-node tetrahedral elements in ANSYS Workbench. Material properties were assigned based on the existing literature, and the implant–bone interaction was simulated using a nonlinear frictional contact model. Orthodontic forces of 2 N and 10 N, inclined at 30°, were applied to simulate clinical loading conditions. Total displacement, von Mises stresses, equivalent strains, fatigue life, and safety factors were analyzed to assess the implant’s mechanical performance. Results: At 2 N, the MI demonstrated minimal displacement (0.0328 mm) and sustained approximately 445,000 cycles under safe fatigue loading conditions, with a safety factor of 4.8369. At 10 N, the implant’s lifespan was drastically reduced to 1546 cycles, with significantly elevated stress (6.468 × 105 MPa) and strain concentrations, indicating heightened risks of mechanical failure and bone damage. The findings revealed the critical threshold beyond which orthodontic forces compromise implant stability and peri-implant bone health. Conclusions: This study confirms that maintaining orthodontic forces within an optimal range, approximately 2 N, is essential to prolong MI lifespan and preserve bone integrity. Excessive forces, such as 10 N, lead to a rapid decline in durability and increased risks of failure, emphasizing the need for calibrated force application in clinical practice. These insights provide valuable guidance for enhancing MI performance and optimizing orthodontic treatment outcomes. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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12 pages, 1537 KiB  
Article
Clinical Performance of Extra-Short (≤5.5 mm) Compared to Longer Implants Splinted under the Same Prosthesis: A Randomized Clinical Trial
by Eduardo Anitua, Adriana Montalvillo, Asier Eguia and Mohammad Hamdan Alkhraisat
Dent. J. 2024, 12(9), 292; https://doi.org/10.3390/dj12090292 - 13 Sep 2024
Viewed by 1134
Abstract
Objective: This randomized controlled split-mouth trial compared the performance of 5.5 mm length implants (test group; TG) splinted within the same fixed prosthesis as longer implants (≥6.5 mm; control group; CG) in posterior regions. Methods: The primary hypothesis was that implant length does [...] Read more.
Objective: This randomized controlled split-mouth trial compared the performance of 5.5 mm length implants (test group; TG) splinted within the same fixed prosthesis as longer implants (≥6.5 mm; control group; CG) in posterior regions. Methods: The primary hypothesis was that implant length does not affect marginal bone loss (MBL) one year post-implantation, while the secondary hypotheses included implant survival, peri-implant clinical variables, and prosthetic complications. Fifteen patients (eight males, seven females) with a mean age of 67 ± 9 years were included. Results: No significant difference in the implant position between groups (p = 0.808) was observed. Implant diameters ranged from 3.00 to 4.25 mm, and the most common bone type was type I (67%). Bone density (p = 0.574) and implant insertion torque (p = 0.888) were similar between groups. Mesial MBL (mean: −0.1; range: −1.19 to 0.24 for TG, and −0.03; −1.75 to 0.45 for CG; p = 0.955) and distal MBL (mean: −0.05; range: −1.41 to 0.27 for TG, and 0.08; −1.45 to 0.72 for CG; p = 0.118) did not show statistical differences. There were no implant failures or technical complications. Conclusions: These findings suggest that 5.5 mm length implants could be a viable option for use in posterior regions, providing similar clinical outcomes to longer implants one year post-implantation. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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11 pages, 514 KiB  
Article
Cone Beam Computed Tomography Panoramic Mandibular Indices in the Screening of Postmenopausal Women with Low Bone Mass: Correlations with Bone Quantity and Quality
by Ioana Ruxandra Poiană, Iulia Florentina Burcea, Silviu-Mirel Pițuru and Alexandru Bucur
Dent. J. 2024, 12(8), 256; https://doi.org/10.3390/dj12080256 - 14 Aug 2024
Viewed by 1117
Abstract
Objective. This study examined the potential use of computed tomography panoramic mandibular indices on cone beam CT (CBCT) for assessing bone density in postmenopausal women with low bone mass. Study design. The study enrolled 104 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) [...] Read more.
Objective. This study examined the potential use of computed tomography panoramic mandibular indices on cone beam CT (CBCT) for assessing bone density in postmenopausal women with low bone mass. Study design. The study enrolled 104 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen region CBCT alongside the NewTom VGi EVO Cone Beam 3D system. We assessed the relationship between the following DXA parameters: lumbar, femoral neck, and total hip T score, bone mineral density (BMD), and lumbar trabecular bone score (TBS). The following panoramic mandibular indices were also considered: the computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)), and computed tomography mental index (CTMI). Results. The study revealed moderate correlations between CBCT indices and BMD/TBS scores: CTMI showed the highest correlation with the femoral neck T-score (r = 0.551, p < 0.0001). TBS scores were also moderately correlated with CBCT indices: CTMI showed a moderate positive correlation with TBS (r = 0.431, p < 0.0001); CTI(S) had a similar moderate positive correlation with TBS (r = 0.421, p < 0.0001). AUC values ranged from 0.697 to 0.733 for osteoporosis versus the osteopenia/normal group and from 0.734 to 0.744 for low versus normal bone quality groups, p < 0.0001. The comparison of the values of the studied indices between low versus normal bone quality (quantified with TBS) groups showed high sensitivity but low specificity. Conclusions. CBCT-measured indices CTI(S), CTI(I), and CTMI are useful in assessing patients with low bone mass to improve, by specific treatment, the prognosis of dental implants. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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12 pages, 1103 KiB  
Systematic Review
Dental Implant Failure Risk in Patients with Bruxism—A Systematic Review and Meta-Analysis of the Literature
by Josephine A. Ionfrida, Hanna L. Stiller, Peer W. Kämmerer and Christian Walter
Dent. J. 2025, 13(1), 11; https://doi.org/10.3390/dj13010011 - 26 Dec 2024
Viewed by 669
Abstract
Background/Objectives: Recent research has indicated that placing dental implants in patients diagnosed with bruxism has led to higher rates of implant failure. This study aimed to provide more accurate knowledge about the relationship between bruxism and implant loss in patients (number, age, gender) [...] Read more.
Background/Objectives: Recent research has indicated that placing dental implants in patients diagnosed with bruxism has led to higher rates of implant failure. This study aimed to provide more accurate knowledge about the relationship between bruxism and implant loss in patients (number, age, gender) with different numbers of implants and prosthetic restorations, considering the follow-up time, compared to non-bruxers. Methods: A systematic search was conducted in PubMed and Cochrane Library using the keyword combination “dental implant”, “bruxism”, and “implant failure”. This search had no language or time restrictions. Results: The review included 15 papers, which were divided into four groups. The first group focused on studies regarding implant loss regardless of the superstructure. In the second group, research on implant-supported removable prostheses was examined. The third group consisted of a single study specifically addressing implant-supported single crowns. Lastly, the fourth group comprised two studies investigating implant-supported single crowns and fixed partial dentures. Only three out of the fifteen studies failed to find a correlation between bruxism and implant failure. The meta-analysis shows a significant pooled effect across the included studies, with an odds ratio of 4.68. Conclusions: Bruxism is a probable risk factor for mechanical issues in implant-supported prostheses and implant-supported crowns. Additionally, elevated failure rates have been documented in patients with bruxism. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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11 pages, 6131 KiB  
Case Report
Dental Implants and Orthodontic Mini-Screws in a Patient with Undiagnosed Von Willebrand’s Disease: A Case Report
by Alessandro Bruni, Francesca Giulia Serra, Andrea Abate, Alessandro Ugolini, Cinzia Maspero, Francesca Silvestrini Biavati and Valentina Lanteri
Dent. J. 2024, 12(12), 381; https://doi.org/10.3390/dj12120381 - 25 Nov 2024
Viewed by 835
Abstract
Background: Dental implants are commonly employed to address edentulism, while orthodontic treatments often incorporate mini-screws to enhance tooth movement and provide stable anchorage. Both procedures are integral to modern dental practice and frequently interact in comprehensive care scenarios. While oral health professionals routinely [...] Read more.
Background: Dental implants are commonly employed to address edentulism, while orthodontic treatments often incorporate mini-screws to enhance tooth movement and provide stable anchorage. Both procedures are integral to modern dental practice and frequently interact in comprehensive care scenarios. While oral health professionals routinely assess patients’ medical histories before procedures, undiagnosed coagulopathies, such as Von Willebrand Disease (VWD), can present significant challenges when invasive procedures are carried out, such as the insertion of implants or mini-implants. Case description: This case report discusses the surgical placement of dental implants and orthodontic mini-screws in a patient with previously undiagnosed VWD, underscoring the potential complications and the importance of recognizing bleeding disorders in clinical practice, and provides some advice on the management of patients with previously undiagnosed VWD after/during surgical procedures. Conclusions: To prevent the risk of excessive bleeding, before surgery, all patients should be screened through precise questions on bleeding history. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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15 pages, 974 KiB  
Systematic Review
The Effects of Smoking on Dental Implant Failure: A Current Literature Update
by Hanna L. Stiller, Josephine Ionfrida, Peer W. Kämmerer and Christian Walter
Dent. J. 2024, 12(10), 311; https://doi.org/10.3390/dj12100311 - 29 Sep 2024
Viewed by 3065
Abstract
Background: This systematic review assesses the current literature (2020–2024) evaluating the impact of smoking on dental implant failure rates. Methods: A non-funded Pubmed database review was conducted according to PRISMA guidelines, and the results were tabulated to extract the study design, patient characteristics, [...] Read more.
Background: This systematic review assesses the current literature (2020–2024) evaluating the impact of smoking on dental implant failure rates. Methods: A non-funded Pubmed database review was conducted according to PRISMA guidelines, and the results were tabulated to extract the study design, patient characteristics, follow-up time, comparison, outcome, and strengths and weaknesses, including risk of bias. This review included 33 studies with 29,519 implants placed in over 18,301 patients. We included prospective and retrospective clinical studies, randomized and non-randomized controlled trials, cohort studies, and observational studies that examined smoking’s effects on implant failure rates. Studies had to classify individuals into two groups, smokers and non-smokers, with at least ten implants. Exclusions included reviews, case reports, experimental studies, guidelines, non-English publications, studies lacking comparative data on failure rates, those excluding smokers, and studies focusing on head and neck cancer patients or specialized implants. Results: Our findings indicate a significant correlation in 25 out of 33 studies between smoking and increased implant failure rates, affecting both early and late stages of implant integration and survival as well as revealing a dose–response relationship, with higher daily cigarette consumption significantly increasing the risk of implant failure. Conclusions: This review highlights the importance of smoking cessation efforts, patient education, and tailored patient care in dental implantology. Future research should explore the effects of smoking frequency and alternative tobacco products, such as e-cigarettes, aiming to improve success rates among smokers. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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18 pages, 19065 KiB  
Systematic Review
Correlation between Implant Surface Roughness and Implant Stability: A Systematic Review
by Marta Romero-Serrano, Manuel-María Romero-Ruiz, Mariano Herrero-Climent, Blanca Rios-Carrasco and Javier Gil-Mur
Dent. J. 2024, 12(9), 276; https://doi.org/10.3390/dj12090276 - 23 Aug 2024
Cited by 3 | Viewed by 1612
Abstract
The aim of this study was to find in the literature data on the relationship between implant surface roughness and implant stability achieved, from the time of placement to three months afterward, to help us to know what type of surface roughness is [...] Read more.
The aim of this study was to find in the literature data on the relationship between implant surface roughness and implant stability achieved, from the time of placement to three months afterward, to help us to know what type of surface roughness is more favorable to guarantee implant stability and osseointegration. A systematic review was conducted in accordance with the PRISMA 2020 (Preferred Reporting Items for Systematic Review and Meta-analysis) statement, and the protocol was registered on the Open Science Framework. The specific inclusion and exclusion criteria were selected using the PICOS framework. The databases Medline (PubMed), Scopus, the Web of Science and The Cochrane Library were searched up to October 2023. The selection of studies and data extraction were conducted by two independent reviewers. The review included a total of 11 studies. A total of 1331 dental implant placements were identified. Two of the eleven selected studies were on humans in vivo, eight were on animals in vivo, and one was on animals in vitro. A statistically significant correlation between surface roughness and implant stability as measured by resonance frequency analysis (RFA) was not identified in ten of the eleven selected studies. It appears that there is no correlation between primary stability and the degree of implant roughness. However, there appears to be a correlation between the roughness of the implant and the degree of osseointegration, as indicated by bone-implant contact values. This correlation is more closely related to secondary stability. The great methodological variability makes it difficult to compare data and draw conclusions, so it would be desirable to agree on a common methodology to help draw appropriate conclusions from published studies. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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18 pages, 707 KiB  
Systematic Review
Clinical Factors on Dental Implant Fractures: A Systematic Review
by Mattia Manfredini, Pier Paolo Poli, Luca Giboli, Mario Beretta, Carlo Maiorana and Matteo Pellegrini
Dent. J. 2024, 12(7), 200; https://doi.org/10.3390/dj12070200 - 28 Jun 2024
Cited by 4 | Viewed by 2544
Abstract
Dental implant fractures pose a significant challenge to long-term treatment success. This systematic review aims to comprehensively examine the clinical factors influencing dental implant fractures (IFs). Furthermore, strategies to choose the right type of implant and prevent this complication are addressed. A systematic [...] Read more.
Dental implant fractures pose a significant challenge to long-term treatment success. This systematic review aims to comprehensively examine the clinical factors influencing dental implant fractures (IFs). Furthermore, strategies to choose the right type of implant and prevent this complication are addressed. A systematic search was conducted across PubMed, Scopus, and Web of Science databases. Eligible studies included retrospective case–control, prospective cohort studies, and clinical trials. The initial search yielded 361 articles, of which 312 were excluded being these reviews, case reports, irrelevant, or written in languages other than English. This left 49 articles, with only 6 meeting the eligibility criteria for an in-depth review. These studies, all retrospective case–control, examine implant characteristics, patient demographics, surgical and prosthetic variables, biomechanical and functional factors, clinical and procedural variables, complications and maintenance issues. The risk of bias was assessed as low using the ROBINS-I tool. Key findings suggest a correlation between implant diameter and structural resistance, with wider implants demonstrating reduced fracture risk. Additionally, posterior regions, especially molars and premolars, exhibit higher susceptibility to IFs due to increased masticatory forces. Implant design and material may considerably influence fracture risk, with conical implants and screw-retained prostheses showing higher vulnerability. Biomechanical overload, particularly in patients with bruxism, emerges as a primary contributing factor to IFs. Prosthesis type significantly influences fracture incidence, with cantilever prostheses posing a higher risk due to increased stress. Peri-implant bone loss is strongly associated with IFs, emphasizing the need for meticulous preoperative assessments and individualized management strategies. Future research should prioritize larger and heterogeneous populations with long-term follow-up and standardized methodologies to enhance the generalizability and comparability of findings. Randomized controlled trials and biomechanical studies under controlled conditions are also essential to elucidate the complex interactions contributing to IFs and developing effective prevention strategies. Additionally, integrating patient-reported outcomes may offer a comprehensive understanding of the impact of IFs on quality of life. Full article
(This article belongs to the Special Issue Risk Factors in Implantology)
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