Search Results (95)

Background: Osteoinduction and bone regeneration are fundamental biological mechanisms enabling osseointegration and long-term durability of endosseous dental implants. In clinical practice, poor bone conditions, aesthetic demands, and peri-implant soft tissue problems commonly need the utilization of regenerative techniques targeted at optimizing both hard and soft tissue results. The purpose of this narrative review was to examine osteo-inductive and regenerative strategies currently employed in implant dentistry, with particular emphasis on the mechanobiological integration of hard–soft tissue regeneration and its implications for peri-implant tissue stability, osseointegration, and clinical predictability. Methods: A narrative literature review was done using PubMed and Scopus databases. Based on predetermined inclusion and exclusion criteria, studies published in English during the previous five years were reviewed. The core narrative analysis comprised a selection of physiologically relevant research that addressed osteo-inductive techniques, bone regeneration, osseointegration, and peri-implant soft tissue outcomes, as well as clinical studies, randomized controlled trials, systematic reviews, and narrative reviews. A narrative synthesis was carried out because of methodological variability. Special emphasis was placed on evidence addressing the biological and clinical interaction between hard- and soft-tissue regenerative strategies, reflecting the specific conceptual focus of the review. Results: The evidence presented suggests that implant surface biofunctionalization, biologically active grafting materials, guided bone regeneration, and supplementary biological treatments may have a favorable impact on implant stability and peri-implant bone healing. Several investigations also underlined the biological dependency between peri-implant bone regeneration and soft tissue architecture, stressing the significance of soft tissue thickness, keratinized mucosa, and emergence profile stability. Even in inflammatory environments, bioactive titanium surface changes showed osteogenic potential, indicating a supporting function in early osseointegration. Conclusions: By promoting osseointegration and improving peri-implant tissue outcomes, osteo-inductive and regenerative techniques are essential to modern implant dentistry; however, their greatest potential may lie in integrated hard–soft tissue regenerative approaches aimed at improving long-term clinical predictability. To further understand the clinical efficacy of combination hard–soft tissue regeneration methods, future well-designed clinical trials with standardized outcome measures are needed. Future research should further clarify the mechanobiological principles underlying these integrated regenerative approaches. Full article

Objectives: Digital impression-taking techniques are widely used due to their many advantages. However, the accuracy of intraoral scanning in full-arch cases remains a matter of debate. The reliability of different digital implant impression techniques remains questionable in completely edentulous, full-arch cases. This review investigated the accuracy of digital implant impression techniques for full-arch use. Methods: Our study protocol was registered in the PROSPERO database (CRD42023393091). Data reporting was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, by the Cochrane Handbook. Comparative in vitro studies matching the PICO framework were included. A systematic search was conducted in four databases: PubMed (MEDLINE), EMBASE, Web of Science and the Cochrane Library (Cochrane Central Register of Controlled Trials [CENTRAL]). Results: Thirty-four papers were included in analyzing trueness and precision of root mean square (RMS) deviations. No significant differences were observed between test groups. The overall RMS trueness deviation was 53.36 μm [18.44; 88.28] in the extraoral stereophotogrammetry group, 73.88 μm [36.68; 111.09] in the conventional impression group, 99.54 μm [56.22; 142.86] in the IOS plain group, 104.88 μm [36.86; 172.90] in the IOS scanaid group, and 65.58 μm [5.24; 125.92] in the IOS splinted group. Substantial heterogeneity was observed across studies (I² ≈ 100%) Conclusions: In case of completely edentulous jaws restored with four to eight implants, digital techniques showed comparable accuracy to the conventional method with no statistically significant differences detected. Full article

Background: To investigate whether coating xenogeneic bone grafts with hyaluronic acid influences early osteogenic and fibrotic marker expression in vitro. Methods: Three xenograft materials were evaluated, including one hyaluronic acid-coated product and two uncoated deproteinized bovine bone mineral products, all commercially available. Human osteoblast-like cells (U2OS) and bone marrow stromal cells (HS5) were cultured with material extracts. Proliferation was assessed using XTT assay at 24 and 48 h. Cell adhesion was evaluated through fluorescence microscopy. Osteogenic markers (RUNX2, COL1A1) and fibrotic markers (COL3A1, TGF-β3) were quantified using quantitative real-time PCR. Statistical analysis employed one-way ANOVA with Benjamini–Krieger–Yekutieli (BKY) two-stage FDR correction for datasets that met the normality assumption, and the Kruskal–Wallis test with Dunn’s post hoc test for non-normally distributed data (HS5 XTT assay). Pairwise comparisons were restricted to each xenograft group versus the untreated control; an adjusted p-value < 0.05 was considered statistically significant. Results: At 48 h, the HA-coated xenograft (Xeno1) showed the highest mean metabolic activity in U2OS cells (0.538 ± 0.056) compared with the uncoated Xeno2 (0.450 ± 0.120) and Xeno3 (0.439 ± 0.073); however, after FDR correction no statistically significant differences were observed between groups. The coated material was associated with upregulation of early osteogenic markers, 2.61-fold RUNX2 upregulation (p = 0.01) compared to untreated cells. Both coated and uncoated xenografts demonstrated equivalent suppression of fibrotic markers in HS5 cells, reducing COL3A1 by 92.7% (p = 0.001) and TGF-β3 by 92.1% (p = 0.001). Conclusions: These exploratory in vitro findings suggest that HA coating may enhance early osteogenic marker expression. The observed effects on stromal markers warrant further investigation using primary cells, additional fibrotic endpoints (e.g., TGF-β1, ACTA2), and in vivo models before translational conclusions can be drawn. Full article

Objective: Implant rehabilitation in grafted alveolar clefts requires a complex staged reconstructive approach, and a clinically important yet underexplored question is which patients require additional pre-implant block regrafting after primary grafting has already been completed. This single-centre retrospective cohort study aimed to evaluate whether a history of maxillary advancement is associated with a reduced likelihood of requiring pre-implant block regrafting (defined here as Re-graft 1), and to describe medium-term implant survival outcomes in a cleft implant cohort. Methods: Forty-two patients with Veau class III or IV cleft palate who underwent implant rehabilitation in grafted alveolar cleft sites between 2011 and 2023 were included. A total of 80 dental implants were evaluated at the implant level; analyses of primary grafting outcomes and the need for Re-graft 1 were performed at the patient level. Mean age at implant placement was 21.07 years (range, 17–38 years); mean follow-up was 83 months. Patients were categorised by maxillary advancement history: distraction osteogenesis (n = 11), orthognathic Le Fort I advancement (n = 9), or no advancement (n = 22). Bergland grades were assigned independently by two attending surgeons from postoperative radiographs. Implant outcomes were classified using the ICOI/Misch four-level scale (success, satisfactory survival, compromised survival, failure). Group comparisons used chi-square and Fisher’s exact tests. Results: Patients with any maxillary advancement history were significantly less likely to require Re-graft 1: 65.0% of patients with advancement did not require Re-graft 1, compared with 27.3% in the no-advancement group (Fisher’s exact p = 0.029; OR = 4.95). Overall implant survival was 93.75%; 58.75% of implants were classified as complete success, and 30.00% as satisfactory survival. Conclusions: In this observational, hypothesis-generating cohort, maxillary advancement history was associated with a lower likelihood of requiring pre-implant block regrafting. Implant rehabilitation showed favorable medium-term survival. These findings are limited by the retrospective single-center design, modest sample size, and absence of multivariable adjustment, and require confirmation in larger prospective studies with standardized regrafting criteria. Full article

Background/Objectives: Titanium implants remain the gold standard in implant dentistry. However, growing interest in metal-free alternatives has led to increased use of zirconia implants. Despite encouraging short-term outcomes, evidence regarding the medium- to long-term survival of one-piece zirconia implants (O-PZIs) and associated risk factors remains limited. The aim of this retrospective cohort study was to evaluate the survival of O-PZIs over follow-up periods of up to 8 years and to explore variables potentially associated with implant failure. Methods: This retrospective observational cohort study was conducted at a private dental clinic (Madrid, Spain). A total of 307 O-PZIs placed in 196 patients between 2017 and 2021 were analyzed. Implant survival was assessed using Kaplan–Meier analysis, while associations between clinical variables and implant failure were explored using chi-square tests and multivariate Cox regression models (p < 0.05). The mean follow-up period was 61.37 ± 2.25 months. Results: After a mean follow-up of 61.37 ± 2.25 months (range: 39–96 months), 42 failures were recorded, resulting in a cumulative survival rate of 86.32% (CI 95%: 79.28–92.96%). Most failures (64.29%) occurred before prosthetic loading. Kaplan–Meier analysis revealed significantly lower survival for tapered implants (p < 0.001) and among smokers (p < 0.001). Multivariate analysis indicated that only simultaneous guided bone regeneration (GBR) was independently associated with implant failure (Exp(B) = 3.191; 95% CI: 1.299–7.840; p = 0.011). However, this association should be interpreted with caution due to the retrospective design, potential confounding, limited number of events, and lack of adjustment for clustering at the patient level. The discrepancies observed between statistical methods highlight the importance of time-to-event analyses in implant research. Conclusions: Within the limitations of this study, O-PZIs demonstrated acceptable medium- to long-term survival. Simultaneous GBR may be associated with increased risk of failure. However, these findings should be considered exploratory. Further prospective studies are required to confirm these results and to better define risk factors in ceramic implant therapy. Full article

Background: Maxillary sinus lift is among the most common preprosthetic procedures in the posterior maxilla due to alveolar ridge resorption and the maxillary sinus pneumatization. It often extends treatment duration, significantly increases costs, and is not without complications. Objective: To explore the prevalence and morphology of the palatal bone reservoir as a viable site for dental implant insertion, offering a conservative alternative to avoid maxillary sinus lift. Methods: DICOM data sets from helical CT of maxillofacial trauma patients aged 50 years and older were used to perform virtual dental implant positioning in the edentulous second premolar, first molar, or second molar areas using ImplaStation software (version 5.3.2; ProDigiDent, Inc., Scottsdale, AZ, USA). A 3D Slicer software (version 5.3.2; ProDigiDent, Inc., Scottsdale, AZ, USA) was used to calculate the volume of the palatal bone reservoir and identify its mean density. The density of the residual alveolar process was also identified and compared with that of the previous one. Results: A total of 1822 maxillofacial trauma cases with helical CT between 2015 and 2025 were retrieved. After exclusion, 305 cases were analyzed. A total of 65 implants were virtually positioned in 50 patients. The mean volume of the palatal bone reservoir was 229 ± 139.2 mm³ with a mean radiodensity of 546.7 ± 159.6 HU. The mean radiodensity of the residual alveolar process was 286.3 ± 118.0 HU. The palatal bone reservoir was significantly denser than the residual alveolar process (95% CI [184.2, 336.6]; p < 0.01). Conclusions: The presence of a palatal bone reservoir is not uncommon and can offer a more conservative alternative for implant placement, potentially increasing primary stability and facilitating immediate loading. Full article

Background/Objectives: Peri-implant inflammatory complications remain a major cause of late implant failure and are closely associated with the condition of peri-implant soft tissues. Insufficient keratinized attached mucosa has been identified as a potential risk factor for peri-implant inflammation; however, morphological and immunohistochemical validation of soft tissue remodeling following corrective interventions remains limited. The aim of this study was to perform a morphological and immunohistochemical evaluation of a reproducible surgical approach for increasing keratinized attached mucosa around dental implants. Methods: A comparative clinical–morphological study included 25 patients undergoing implant-supported prosthetic treatment. Patients were divided into a control group (standard prosthetic protocol without soft tissue augmentation, n = 10) and a study group (soft tissue correction using a previously developed technique, n = 15). Punch biopsies of peri-implant mucosa were obtained at baseline and prior to definitive prosthetic restoration. Histological examination and immunohistochemical analysis were performed using the semi-quantitative Astaldi–Verga method. Expression of inflammatory markers (MPO, CD3, CD20, CD68), vascular marker CD31, and remodeling markers MMP-9 and TIMP-2 was evaluated. Data were analyzed using the Mann–Whitney U test (p < 0.05). Results: The study group demonstrated significantly lower expression of inflammatory markers, including MPO, CD68, CD3, and CD20 (p < 0.001), and reduced MMP-9 expression (p = 0.001) compared with controls. The MMP-9/TIMP-2 balance was more favorable in the study group, suggesting more regulated extracellular matrix remodeling. Histologically, the control group exhibited epithelial disruption and microcirculatory alterations, whereas the study group showed preserved epithelial architecture and reduced inflammatory infiltration. Conclusions: Morphological and immunohistochemical assessment suggests that soft tissue correction of keratinized mucosa deficiency may be associated with more favorable early peri-implant soft tissue characteristics, including reduced inflammatory activity and modulation of matrix remodeling. Immunohistochemical markers such as MMP-9 and TIMP-2 may provide additional insight into early soft tissue integration around dental implants. However, these findings should be interpreted with caution due to the exploratory design and short follow-up period. Full article

Background/Objectives: It remains unclear which drilling strategy is most effective for maximizing mechanical stability in low-density bone and whether high insertion torque is determinative. The aim of this in vitro study was to compare the primary stability of implants placed using different drilling protocols—conventional (CV), undersized (US), and osseodensification (OD). Three osseodensification systems—Versah burs (V), Bone Reamer Drills (WF), and Master Conical Densifiers (DSP)—were also compared. Methods: A set of 11 blocks was used for the drilling protocol comparison (CV, US, OD) and a separate set of 11 blocks was used for the osseodensification system comparison (V, WF, DSP). External-hexagon implants were inserted epicrestally. Insertion torque was measured using a torque meter, and implant stability quotients (ISQs) were assessed through resonance frequency analysis. Results: ISQ for OD was significantly higher than that for CV but statistically similar to that for US, whereas insertion torque for OD was significantly higher than that for both US and CV. A weak correlation was found between variables for CV and US, and a moderate one was observed for OD. Both WF and DSP showed significantly higher ISQ values than V. Insertion torque for DSP was significantly higher than that for both WF and V. A moderate correlation was found between variables for DSP and V, and a weak one for WF. Conclusions: In this invitro study, the OD protocol performed better than CV in terms of ISQ and better than both CV and US in terms of insertion torque. WF and DSP outperformed V in ISQ, whereas DSP yielded the highest insertion torque. Weak-to-moderate correlations between variables in both analyses indicated that higher insertion torque did not necessarily translate into greater stability. Full article

Background/Objectives: This systematic review and meta-analysis evaluated the clinical effectiveness of regenerative surgical treatments compared with open flap debridement (OFD) in the management of peri-implantitis and, secondarily, assessed whether more advanced regenerative approaches, including guided bone regeneration (GBR), platelet-rich fibrin (PRF), and hyaluronic acid (HA), provide additional clinical benefit compared with bone grafting alone. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted in accordance with PRISMA guidelines and the PICO model, covering the period from 1993 to 2024. From 2119 identified articles, 63 full-text papers were reviewed, and 12 studies met all inclusion criteria. These studies compared regenerative treatments with OFD and bone grafting using clinical outcomes of probing pocket depth (PPD), radiographic bone level (RBL), bleeding on probing (BOP), suppuration (SUP), mucosal recession (REC), and clinical attachment level (CAL). Meta-analysis was performed using a random-effects model. Results: Regenerative treatments demonstrated superior outcomes in radiographic bone level gain compared with OFD (p < 0.001), while no statistically significant differences were observed for PPD (p = 0.77), BOP (p = 0.13), SUP (p = 0.42), REC (p = 0.14), or CAL (p = 0.96). Comparisons between bone grafting and other regenerative materials also showed no statistically significant differences. Conclusions: Regenerative procedures improved radiographic bone outcomes but did not consistently outperform OFD in soft tissue parameters, and no advanced regenerative modality demonstrated clear clinical superiority over bone grafting alone. Further high-quality randomized controlled trials with standardized methodologies are needed to establish clinical guidelines for peri-implantitis surgery. Full article

Background/Objectives: Adequate peri-implant soft tissue thickness is essential for long-term peri-implant health and esthetics. Horizontal platelet-rich fibrin (H-PRF) has been proposed to support soft tissue regeneration; however, experimental and translational evidence for its application in peri-implant soft tissue augmentation remains limited. This study aimed to evaluate a H-PRF membrane block approach primarily through an experimental animal model, with clinical cases presented to illustrate translational feasibility. Methods: A customized compression device was used to fabricate the H-PRF membrane block. The biological performance of the H-PRF membrane block was first evaluated in a rabbit model, with histologic assessment of peri-implant soft tissue thickness and integration at 8 weeks. Representative clinical cases requiring peri-implant mucosal thickening were subsequently treated with H-PRF membrane block on the buccal aspect of the alveolar bone beneath a supra-periosteal flap to demonstrate clinical applicability. Results: In the animal model, the H-PRF membrane block resulted in a significant increase in peri-implant soft tissue thickness by increasing the lamina propria compared with control sites demonstrated by histologic analysis. The clinical illustrations showed stable buccal soft tissue volume and contour with minimal patient morbidity. Conclusions: Within the limitations of this experimental study, the horizontal H-PRF membrane block technique demonstrated promising biological performance for peri-implant soft tissue augmentation in an animal model. The accompanying clinical illustrations support the translational feasibility of this approach. Clinical relevance: This experimental study provides biological and translational insight into a minimally invasive strategy for peri-implant soft tissue thickening and may inform future controlled clinical investigations. Full article

Background: Digital technologies, particularly CAD/CAM workflows, have transformed implant prosthodontics by improving the accuracy and efficiency of impression procedures, facilitating clinician–laboratory communication, and supporting the preservation of peri-implant tissues. Objective: To compare the three-dimensional accuracy (trueness) and passive fit of five conventional and digital impression techniques for fixed prostheses supported by two implants. Methods: An in vitro experimental study was conducted using a partially edentulous maxillary model with two implants supporting a three-unit zirconia bridge. Five impression workflows were evaluated: conventional techniques (open-tray and closed-tray, splinted and non-splinted) and digital impressions using plastic and titanium scan bodies. Three-dimensional accuracy was assessed by digital superimposition analysis, and passive fit was evaluated by marginal gap measurements using digital microscopy and ImageJ (version 1.54r) software. Statistical analyses were performed using exploratory ANOVA with Welch’s correction and Games–Howell post hoc tests (p < 0.05), complemented by effect size analysis. Results: Three-dimensional superimposition analysis revealed that digital impression workflows and the splinted conventional open-tray technique exhibited the highest trueness, with minimal spatial deviations relative to the reference model, together with the lowest marginal gap values (<1 µm). The non-splinted open-tray technique presented higher discrepancies (7.37 ± 0.94 µm), although all techniques remained within clinically acceptable tolerance ranges (60–150 µm). Conclusions: Under controlled in vitro conditions, both digital impression techniques and conventional splinted protocols achieve high three-dimensional accuracy and clinically acceptable passive fit for multi-implant-supported fixed prostheses. Digital workflows represent a predictable and efficient alternative, while conventional splinted impressions remain a reliable option depending on clinical and technological considerations. Full article

Background: Peri-implantitis, a condition characterized by inflammation and progressive bone loss around dental implants, presents a significant challenge in contemporary dentistry. Conventional non-surgical treatments often fail to fully eliminate bacterial biofilms, particularly on complex implant surfaces. Laser therapies have emerged as potential adjuncts due to their antimicrobial and bio-modulatory properties. However, their microbiological effectiveness and suitability for individualized patient treatment planning remain unclear. Objective: Τhis study aims to systematically assess and synthesize the microbiological effects of various laser-assisted non-surgical treatments for peri-implantitis compared to conventional mechanical debridement. Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251035354). Randomized controlled trials (RCTs) evaluating microbiological changes following laser-assisted non-surgical treatment of peri-implantitis, with a minimum follow-up of one month, were identified through searches in multiple databases and registries up to February 2025. The ncluded studies used lasers such as diode, Er: YAG, and photodynamic therapy (PDT) either alone or as adjuncts to mechanical debridement. Outcomes of interest included bacterial counts. Risk of bias was assessed using the RoB2 tool, and certainty of evidence was evaluated via GRADE. Quantitative synthesis used random-effects meta-analysis, with standardized mean differences (SMDs) calculated. Results: Eight RCTs involving 266 patients and 335 implants were included in the systematic review. Quantitative synthesis of three pathogens (counts of Fusobacterium nucleatum, P. gingivalis, T. denticola) across three studies displayed no statistically significant differences between laser and control groups at 3 and 6 months (p > 0.05 for all comparisons). When examining individual study findings, PDT, particularly in patients with diabetes or acute abscess, showed short-term reductions in red complex bacteria (e.g., Porphyromonas gingivalis and Treponema denticola). In contrast, diode and Er: YAG lasers demonstrated inconsistent or transient effects. The quality of evidence was rated as very low according to GRADE. Conclusions: Laser-assisted therapies, especially PDT, may provide targeted microbiological benefit in selected patient groups, supporting their adjunctive use within personalized treatment planning rather than as replacements for mechanical debridement, which remains the gold standard. Further high-quality RCTs incorporating well-defined patient risk profiles, such as systemic conditions and behavioral factors, and precision treatment algorithms are needed. Full article

Background/Objectives: To determine the optimal site preparation and placement protocols for immediate implant positioning in robot-assisted surgeries. Methods: In vitro models of immediate and healed extraction sockets were created using 3D printing. A robotic system was used for implant site preparation and implant placement. The implant surgeries were allocated into eight experimental groups using 12 printed models in total. Each model incorporated two implant sites, an immediate site (tooth 21) and a healed site (tooth 26), resulting in 24 implants overall. With 3 implants assigned to each group, the 24 implant placements were evenly distributed across the 8 groups. For each group, the lateral force experienced during surgery was recorded by the haptic sensor on the robotic arm, and implant positional deviations were assessed by superimposing post-surgical CBCT images with the virtual implant planning. Results: Healed sites showed significantly higher accuracy than immediate sites, with reduced platform and apical deviations (p < 0.001) and markedly lower lateral force experienced by drills. In fully guided procedures, thread tapping greatly improved accuracy in immediate sites but had limited benefit in healed sites. Compared with partially guided workflows, fully guided rCAIS markedly enhanced accuracy in immediate sites (≈0.8 mm reduction in platform/apical deviation, p < 0.001), while no meaningful differences were observed in healed sites. Fully guided protocols also reduced insertion force in healed sites. Conclusions: Immediate sites showed lower implant positional accuracy and experienced higher lateral forces during surgery than healed sites. In immediate sites, thread tapping and fully guided rCAIS improved placement accuracy. Full article

Background: Maxillary sinus floor augmentation is widely used to enable implant placement in the atrophic posterior maxilla, yet comparative data for porcine-derived xenografts remain limited. Objective: To evaluate long-term bone regeneration and implant outcomes following sinus augmentation using a collagenated porcine xenograft. Methods: This paper reports a retrospective case series of three partially edentulous patients (aged 46–56 years) who underwent lateral sinus augmentation with a small-particle collagenated porcine xenograft (THE Graft™, Purgo Biologics, Gyeonggi-do, Republic of Korea) and staged implant placement. In one case, a controlled perforation of the Schneiderian membrane was performed to access and remove a sinus mucocele, followed by repair using a resorbable collagen membrane. Core biopsies were harvested at implant placement for histology (hematoxylin-eosin, Masson–Goldner) and tartrate-resistant acid phosphatase (TRAP) staining. Clinical outcomes included surgical events, vertical bone gain, marginal bone levels, and implant survival at long-term follow-up. Results: Healing was uneventful in all cases. Mean vertical bone gain was 12.0 mm (baseline 1.33 mm to 13.33 mm final). At a mean 46.8-month follow-up (range 38.3–52.2 months), 100% of implants were functional without failure; marginal bone loss remained < 1 mm during the first year and was stable thereafter. Histology at 3.7, 4.7, and 7.5 months showed vascularized new trabecular bone intimately contacting residual xenograft particles (new bone 20–30%, residual biomaterial 30–40%, connective tissue 30–50%). TRAP-positive multinucleated giant cells at 7.5 months indicated ongoing biomaterial degradation without severe inflammatory reactions. Conclusions: Within the limits of a small case series, collagenated porcine xenograft supported predictable bone regeneration and stable long-term implant function after sinus floor elevation, with favorable histologic integration and gradual resorption. Full article

Background: Dental implants are popular among both healthy and medically complex patients. Patients prone to thromboembolic events receive anticoagulant treatment, like direct oral anticoagulants (DOACs). When those patients undergo dental implantation, the risk of bleeding is higher. Objectives: This study primarily aims to describe and analyze bleeding events following dental implantation. The secondary aim is to identify risk factors for bleeding events in patients receiving DOACs, and to suggest precautions. Methods: A case–control retrospective study was carried out on patients who underwent dental implant insertion in a single dental clinic. The experimental group comprised patients on DOACs, while the control group consisted of healthy patients without anticoagulant treatment. The study was submitted and approved by the Helsinki committee of the medical center (ASF-205-23). Results: Out of 100 patients initially screened for the study, 80 were included: 41 in the experimental group and 39 in the control group. A total of 11 patients presented with bleeding: 7 in the experimental group and 4 in the control group. A higher incidence of bleeding was observed in the experimental group (17%) compared with the control group (10%). The odds of bleeding in patients receiving DOACs were 1.8 times higher than for those not receiving anticoagulant therapy. Bleeding risk was also elevated among patients who underwent bone grafting procedures, with an odds ratio (OR) of 3.47, and among patients aged over 75 years, with an OR of 3.92. All bleeding events were successfully managed using local hemostasis. Conclusions: Despite the study’s limitations, it can be concluded that surgeons should consider complex surgical intervention, but should be careful and aware of several risk factors and precautions regarding bleeding. Patients on DOACs with additional bone grafting and medically compromised patients over 75 years old should be monitored in the first postoperative days, and the postoperative guidelines should be refined to address the risks effectively. Full article