Search Results (66)

Alveolar ridge preservation (ARP) aims to reduce post-extraction bone resorption and facilitate implant placement. Among alloplastic grafts, β-tricalcium phosphate (β-TCP) is widely used due to its osteoconductive properties and complete resorbability. This systematic review evaluated the clinical effectiveness of β-TCP for ARP, focusing on ridge dimensional changes assessed by cone–beam computed tomography (CBCT). Electronic searches were performed in major scientific databases up to April 2026. Randomized controlled trials (RCTs) reporting CBCT-based dimensional outcomes after at least 4 months were included. Five RCTs met the inclusion criteria. Considerable heterogeneity was observed in biomaterial formulations, socket management, and outcome assessment. When used alone, β-TCP showed variable results, ranging from greater ridge resorption compared with xenograft to outcomes comparable with those of freeze-dried bone allograft. More consistent findings were reported when β-TCP was used in combination with other biomaterials, with outcomes generally comparable to those of deproteinized bovine bone mineral (DBBM). Overall, β-TCP may have a potential role in alveolar ridge preservation; however, evidence remains limited and heterogeneous. Differences between β-TCP alone and composite formulations should be carefully considered, and no definitive conclusions can be drawn regarding its comparative predictability versus xenografts. Further RCTs are needed to clarify its clinical effectiveness and identify optimal applications. Full article

The manuscript details the influence of high-temperature and high-shear processing, as well as radiation sterilization, on properties of bioresorbable and osteoconductive, patient-tailored alloplastic scaffolds for guided bone regeneration. Functionalized poly(l-lactide-co-d,l-lactide) copolymer filled with hydroxyapatite was used to produce two personalized implants for upper and lower jaw reconstruction via 3D printing. Morphology analysis (SEM, µCT), gel permeation chromatography, and thermal analysis quantified the effects of melt processing and sterilization on chain structure. Physical properties of sterilized parts, such as hardness and density, proved suitable for bone implants. Removal of the upper jaw implant after 4 months and of the lower jaw substitute after 18 months enabled monitoring of bioresorption and tissue regrowth over time. Gradual overgrowth of the implants with human tissue, initiated by the osteoconductive filler, was observed, along with time-dependent polylactide degradation, showing up to 92% molar mass reduction. The medical procedures confirmed safety, nontoxicity, non-allergenicity, and, most importantly, the tissue-forming properties of the polylactide-based formulation. Full article

Adequate alveolar bone volume is a prerequisite for predictable and long-term success in dental implant therapy. Physiological post-extraction remodeling frequently results in horizontal and vertical ridge deficiencies, which may compromise optimal implant placement. Guided bone regeneration (GBR) has become a cornerstone procedure in implant dentistry, with clinical outcomes largely influenced by the biological and mechanical characteristics of grafting materials. Different bone grafts and their combinations are currently clinically applicable, each exhibiting distinct osteogenic, osteoinductive, and osteoconductive properties, as well as varying resorption profiles and volumetric stability. This narrative review aims to analyze the biological principles of alveolar ridge augmentation, compare the properties of commonly used graft materials, evaluate clinical outcomes, and discuss emerging regenerative strategies. Literature published between 2000 and 2025 was assessed to synthesize current evidence regarding graft integration, bone formation, desorption dynamics, and clinical indications. Autogenous bone remains the gold standard due to its combined osteogenic, osteoinductive, and osteoconductive potential; however, its limitations have driven the development of alternative materials, including allografts, xenografts, alloplastic substitutes, demineralized tooth matrices, platelet concentrates, and customized scaffolds. While no single material is universally ideal, appropriate selection based on defect characteristics and clinical objectives is essential for predictable outcomes. Future research should prioritize long-term comparative trials, biomaterial standardization, and biologically enhanced regenerative approaches. Full article

Reconstruction of the ear and temporal region presents unique challenges due to the complex anatomy of the lateral skull base and the need to restore both structural integrity and auditory function. Historically managed as separate entities, auricular reconstruction and hearing rehabilitation are increasingly approached in an integrated manner, supported by advances in microsurgical techniques and implantable hearing technologies. This narrative review synthesizes contemporary evidence on microsurgical reconstruction of the ear and temporal region in conjunction with hearing rehabilitation, analyzing a wide range of existing surgical techniques in an integrative manner. Reconstructive techniques discussed include local and regional flaps, free tissue transfer, auricular framework reconstruction using autologous cartilage or alloplastic materials, external auditory canal reconstruction, and subtotal petrosectomy. Hearing rehabilitation options reviewed encompass bone-anchored hearing systems, active and passive transcutaneous devices, middle ear implants, and cochlear implantation. Simultaneous reconstruction and implantation may reduce surgical burden and enable earlier hearing restoration in carefully selected patients, while staged approaches remain advantageous in complex or high-risk scenarios, particularly in the presence of chronic infection or extensive temporal bone surgery. Multidisciplinary collaboration, meticulous preoperative planning, and long-term follow-up are essential to optimize outcomes. Full article

Paediatric orbital fractures require careful reconstruction to prevent long-term functional and aesthetic sequelae. Material selection is critical due to the anatomical and developmental considerations unique to children. Comparative data to guide decision making remain sparse and inconclusive. A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase (through February 2025), following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Studies reporting outcomes and/or complications associated with implant materials used in the reconstruction of paediatric orbital fractures were included. Outcomes included postoperative diplopia, enophthalmos, restriction of eye movements, removal of material, and return to theatre (RTT). In total, 54 studies encompassing a total of 562 patients and 563 implants were included. Polymers (n = 169), alloplasts (n = 167) and autologous (n = 166) implants were the most commonly used reconstructive material. Late postoperative diplopia occurred in 7% of polymers (12/169), 6% of alloplasts (10/167), 29% of allografts (6/21), 24% of xenografts (6/25) and 33% of metals (2/6). Reported enophthalmos was highest in the autologous group (8%) but was only reported in 34 of the 54 studies. Infection, removal of implant material and RTT were low across all groups (1–4%). No donor site morbidity was reported. Robust studies with standardised outcomes and adequate follow-up are needed to inform evidence-based material selection in paediatric orbital reconstruction. Full article

Introduction: Implant-based breast reconstruction is associated with an increased risk of ischemic complications, which may result in implant loss, suboptimal aesthetic outcomes, and delays in adjuvant oncological treatment. Additionally, axillary surgery carries a risk of upper-limb lymphedema. Indocyanine green (ICG) angiography enables more accurate real-time assessment of tissue perfusion than clinical evaluation alone, while axillary reverse mapping (ARM) facilitates the preservation of upper-limb lymphatics. The integration of these techniques reduces complications and improves both functional and aesthetic outcomes. Materials and methods: A total of 208 breast cancer patients who underwent mastectomy followed by immediate implant-based breast reconstruction were enrolled in this case–control study. The prospective intervention group received intraoperative ICG angiography at three time points and underwent ARM with ICG. Conventional surgical techniques were applied in the retrospective control group. Results: ICG angiography showed excellent diagnostic accuracy for predicting postoperative ischemic complications (AUC = 0.93, 95% CI 0.82–0.99, p < 0.001). Compared with the control group, patients in the ICG group had significantly lower rates of mastectomy skin flap necrosis (11.5% vs. 30.8%, p = 0.001), seroma (4.8% vs. 14.4%, p = 0.032), hematoma (1.9% vs. 9.6%, p = 0.033), and lymphedema (2.9% vs. 17.3%, p < 0.001). They also experienced shorter hospitalization (6.2 ± 1.9 vs. 8.0 ± 2.8 days, p < 0.001), fewer delays in adjuvant treatment initiation (16.3% vs. 32.7%, p = 0.010), and higher aesthetic satisfaction scores (81.41 ± 10.12 vs. 76.03 ± 9.74, p <0.001). Conclusions: Intraoperative indocyanine green angiography is a valuable tool for predicting ischemic complications in alloplastic breast reconstruction and is associated with reduced morbidity, fewer delays in adjuvant treatment, and improved aesthetic outcomes. Preliminary evidence suggests that axillary reverse mapping is associated with lower rates of upper-limb lymphedema. Full article

Objective: The purpose of this study was to assess the outcome of sinus grafting with a beta-tricalcium phosphate/hydroxyapatite (ß-TCP/HA) alloplast particulate biofunctionalized with cross-linked hyaluronic acid (xHya), comparing two surgical access techniques. Clinical, histological, histochemical, immunohistochemical and histomorphometrical parameters were used to characterize the tissue samples, which were retrieved at the second surgery for implant placement five months after sinus floor elevation (SFE). Materials and Methods: Twenty patients with a residual bone height ≤ 4 mm, estimated by a Cone Beam Computed Tomography (CBCT), were randomly allocated either to an innovative transcrestal sinus floor elevation (tSFE = tests) approach or a conventional lateral window approach (lSFE = controls) using piezoelectric preparation. The tSFE was carried out using the hydraulic Jeder^®-System. Grafting in both groups was performed using a ß-TCP–HA combination, which was biofunctionalized with a cross-linked hyaluronic acid. For both access techniques, a cross-linked collagen membrane covered either the bone window or transcrestal osteotomy. For second-stage surgery, a second CBCT was used to assess the bone volume and possible implant positioning to compare it with the baseline CBCT. Bone cores were harvested at implant placement and evaluated histomorphometrically. Patients were followed for 1-year post-op for survival rate estimation. Non-superiority was hypothesized for both surgical methods; thus, the primary outcome measure assessed different discomfort levels using patient-reported outcome measures (PROMs) for each therapeutic approach. Secondary outcomes were the volume change in subantral bone after sinus floor elevation, the chance of placing a 10 mm long implant with no need for additional augmentation, histological evaluation of the newly gained tissue, and implant integration and one-year survival. Results: Eighteen patients (n = 18/20) qualified for implant placement at five months, and ten donated tissue biopsies for microscopic analysis. Primary outcome reporting using PROMs was discarded due to truncated patient enrollment. The secondary parameter, placement of a ≥10 mm long implant without additional augmentation, was achieved for nine sites/patients from the lSFE control group. All patients from the tSFE test group received an implant that was positioned alongside additional augmentation. In both groups, all implants integrated and were functionally loaded. A total of 10 core samples (3 from the tSFE group and 7 from the lSFE group) were obtained and analyzed. Microscopically, new bone formation appeared consistent in all obtained samples. Specimens revealed advanced and ongoing osteogenesis, with most histological markers reacting positively in the immunohistochemical (IHC) staining. The histomorphometric calculation revealed that a mean of 61.17 ± 16.55% of the total area was occupied by newly formed bone, 30.43 ± 10.09% by connective tissue and 8.92 ± 15.29% by residual graft substitute. One-year follow-up of the loaded implants showed a 100% implant survival rate. Conclusions: Biofunctionalizing ß-TCP + HA particulate with cross-linked hyaluronic acid in sinus floor elevation procedures appears to be a safe and beneficial approach, resulting in satisfactory clinical, radiographic and histological parameters. In our study population, which presented with very atrophic residual subantral bone conditions, the hydrodynamic transcrestal sinus floor elevation method required a back-up treatment by the conventional lateral approach. Full article

Orthognathic surgery restores functional balance and facial esthetics in patients with dentofacial deformities. The use of adjunctive facial implants—made from materials such as porous polyethylene, titanium, or polyetheretherketone (PEEK)—has increased to enhance contour and projection, although standardized guidelines for their selection and integration remain scarce. Following PRISMA-ScR guidelines, a systematic search of PubMed, Scopus, Embase, and LILACS identified studies reporting facial implants placed concomitantly with orthognathic surgery. Eligible studies included case reports, case series, observational studies, clinical trials, and reviews involving human patients, without language or date restrictions. Seventeen studies published between 1998 and 2025 met the inclusion criteria, comprising retrospective and prospective designs, case series, and one technical note. Implants were used in the malar, infraorbital, paranasal, chin, mandibular body, and angle regions. Materials included PEEK, porous polyethylene, silicone, hydroxyapatite, polymethylmethacrylate, and titanium. PEEK was mainly used for patient-specific implants, while porous polyethylene was commonly used as stock implants. Follow-up time, outcome reporting, and study design varied widely, reflecting substantial methodological heterogeneity and predominantly observational evidence. As a result, outcomes were primarily reported qualitatively, limiting comparative assessment and long-term inference. Overall, the available literature suggests that alloplastic facial implants may serve as useful adjuncts to orthognathic surgery for contour enhancement, with outcomes influenced by implant design, surgical expertise, fixation, and soft tissue conditions. However, the current evidence base remains limited, underscoring the need for standardized outcome measures, comparative studies, and longer follow-up to better inform clinical decision-making and future research. Full article

Methods: Currently available randomized controlled clinical trials (RCTs) reporting on the adjunctive clinical effects of biomaterials, grafting materials, and grafting techniques on immediate implant placement (IIP) were systematically assessed. Data were qualitatively analyzed and, when appropriate, meta-analysis was performed. Risk of bias and quality of evidence were evaluated using the Cochrane RoB 2 tool and the GRADE framework, respectively. Results: A total of 12 RCTs (484 implants, 6–36 months of follow-up) were included and consistently reported high implant survival rates (96–100%). Data on the use of xenografts, alloplastic and mixed grafts, connective tissue grafts and socket shield technique seem, to different extents, to demonstrate favorable results in terms of peri-implant hard and soft tissue dynamics and esthetic outcomes. Quantitative synthesis conducted on four RCTs demonstrated significantly higher short-term patient-reported postoperative pain, assessed on a 0–100 Visual Analog Scale (VAS) (weighted mean difference 19.45 mm; 95% CI 0.55–38.36; p = 0.04). Most RCTs were rated at moderate to high risk of bias, and certainty of evidence was low to moderate. Conclusions: Regardless of the use of adjunctive materials/approaches, IIP guarantees high implant survival rates. Although different adjunctive strategies to IIP may favor hard and soft tissue stability, they appear to increase short-term patient-reported morbidity. Currently available evidence lacks standardized and patient-centered outcome reporting. Full article

Regeneration of jawbone defects poses major challenges. The combination of dental pulp stem cells (DPSCs) or DPSC-derived extracellular vesicles (EVs) with bone substitute materials shows promising potential for bone tissue engineering in vitro. This study evaluated the in vivo bone regeneration potential of DPSCs and EVs with bone graft substitutes in a novel intrabony defect model. DPSCs were isolated from 35 male Sprague–Dawley rat incisors, and EVs were collected from the cell culture medium. DPSCs were seeded onto alloplastic and xenogeneic bone graft materials and implanted into bone defects. Control groups received bone substitutes without DPSCs or EVs. Micro-computed tomography (µCT) was performed at 12 and 24 weeks post-implantation to assess bone volume (BV), bone density (BD), trabecular thickness (Tr.Th), bone growth rate (BGR), and bone-to-mineral ratio (BMR). Both graft types increased BV and BD, with no significant differences between them. Tr.Th increased across all treatments after 24 weeks, indicating ongoing bone remodeling. Notably, xenogeneic grafts combined with DPSCs and EVs significantly improved BGR (p = 0.034) and BMR (p = 0.021) compared to alloplastic grafts with DPSCs. Xenogeneic bone grafts combined with DPSCs and EVs appear to be a promising approach for bone regeneration of alveolar bone defects. Full article

Background: Tooth extraction is often accompanied by bone tissue loss. This systematic review aims to compare osteoplastic materials for socket preservation. Methods: This systematic review was carried out with the PRISMA statement. To identify relevant studies, a thorough literature search was executed in several databases, such as Medline, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. The inclusion criteria were restricted to randomized controlled trials, and their methodological quality was evaluated with the Cochrane Risk of Bias tool (ROB 2). Results: Based on the predefined inclusion and exclusion criteria, nine randomized clinical trials published before 2024 were selected for analysis, all of them investigating the application of osteoplastic materials. Six studies performed xenogenic bone augmentation; one of them compared alloplastic and xenogenic materials; two studies described synthetic osteoplastic materials; and one described autogenic bone material. Conclusion: Socket augmentation with osteoplastic materials demonstrates effectiveness in preserving alveolar ridge dimensions and creating favorable conditions for further implant placement, though differences in clinical performance highlight the need for careful material selection. Full article

Background: In atrophic posterior maxillary regions, sub-antral surgery is often used for rehabilitation with implants. In order to stimulate bone regeneration, autogenous, xenogenic, alloplastic and platelet-rich fibrin (PRF) grafts are commonly used. Aim: To assess the effectiveness of PRF alone or combination with synthetic bone substitutes on bone formation, implant stability, and survival in sub-antral surgery. Materials and Methods: A literature review was carried out from September 2024 to April 2025, according to PRISMA guidelines using the PubMed, Cochrane Library, Wiley, ScienceDirect, and Web of Science databases. From a total of 601 articles identified, 11 met the inclusion criteria and were selected for analysis. Results: PRF in combination with synthetic materials has shown potential benefits, especially in increasing biomechanical stability and bone formation. Although, most studies have not reported statistically significant differences when comparing the use of synthetic material alone against its combination with PRF. Discussion: The use of synthetic grafts in combination with PRF has become increasingly common in sub-antral implant procedures. PRF promotes angiogenesis, osteoprogenitor cell differentiation and bone regeneration, favouring the healing and remodelling process of the tissues, as well as greater stability and longevity of the implant. Conclusions: The combination of PRF with synthetic bone grafting shows promising results; however, further studies are needed to confirm the efficacy of PRF in maxillary sinus grafts in conjunction with the use of biomaterials. Full article

The reconstruction of a severely resorbed alveolar bone is a significant challenge in dental implantology and maxillofacial surgery. Traditional bone grafting materials, including autogenous, allogeneic, xenogeneic, and alloplastic materials, have limitations such as donor site morbidity, limited availability, and prolonged maturation periods. To address these challenges, recombinant human bone morphogenetic protein-2 (rhBMP-2) has emerged as a potent osteoinductive factor that facilitates bone regeneration without the need for additional donor site surgery. This study introduces a box technique which combines rhBMP-2 (CowellBMP^®, Cowellmedi, Busan, Republic of Korea) with a 3D-preformed titanium mesh (3D-PFTM), utilizing a mixture of allografts and xenografts for horizontal and vertical alveolar ridge augmentation. The technique leverages the structural stability provided by the OssBuilder^® (Osstem, Seoul, Republic of Korea), a preformed titanium mesh, that allows for simultaneous implant placement and vertical ridge augmentation. This technique not only reduces the treatment time compared to traditional methods but also minimizes post-operative discomfort by eliminating the need for autogenous bone harvesting. Clinical outcomes from this technique demonstrate successful bone regeneration within a shorter period than previously reported techniques, with excellent bone quality and implant stability being observed just four months after vertical augmentation. In conclusion, the so called BOXAM (BMP-2, Oss-builder, Xenograft, Allograft, Maintenance) technique presents a promising therapeutic strategy for alveolar bone reconstruction, particularly in cases of severe bone resorption. Further studies are needed to evaluate the long-term outcomes and potential limitations of this approach, especially in scenarios where the inferior alveolar nerve proximity poses challenges for fixture placement. Full article

Facial reconstruction presents complex challenges due to the intricate nature of craniofacial anatomy and the necessity for individualized treatment. Conventional reconstructive methods—such as autologous bone grafts and prefabricated alloplastic implants—pose limitations, including donor site morbidity, implant rejection, and suboptimal aesthetic results. The emergence of 3D printing technology has introduced patient-specific implants (PSIs) that enhance anatomical fit, functional restoration, and biocompatibility. This review outlines the evolution of 3D-printed implants, key materials, computer-assisted design (CAD), and their applications across trauma, oncology, congenital conditions, and aesthetics. It also addresses current challenges and explores future directions, such as bioprinting, smart implants, and drug-eluting coatings. Full article

Objective: A peri-implant gap or a “jumping gap” between an implant surface and the buccal bone can often complicate the successful integration of dental implants, impairing osseointegration and long-term implant stability. Although various techniques and materials are available for managing this gap, there is no consensus on the most effective approach. The current literature lacks standardized, evidence-based guidelines for selecting the optimal technique or material for managing peri-implant gaps, especially following immediate implant placement. This systematic review aims to evaluate the efficacy of various techniques and materials to manage the peri-implant gap to improve the implant stability, bone preservation, and esthetic outcomes using the PROSPERO registration number CRD42024508852. Methods: A comprehensive search of the MEDLINE, Embase, and Cochrane databases was conducted, and various studies were selected, including 11 randomized clinical trials that investigated different grafting materials and techniques for managing the gap between the implant and the buccal plate. The selected studies were assessed for the risk of bias, and the data were extracted based on primary outcomes such as implant stability, bone density, and esthetic parameters. Results: The findings indicate that xenografts and alloplastic grafts were superior in preserving bone volume compared to platelet-rich fibrin. Techniques like the socket shield and immediate provisional prothesis methods showed promise in maintaining soft tissue and bone integrity. However, heterogeneity across the studies limits definitive conclusions. Conclusions: Further high-quality research is needed to establish standardized guidelines for peri-implant gap management. The selection of techniques and materials should be tailored to individual patient needs. Full article