Search Results (704)

Background/Objectives: Implant-supported rehabilitations using the All-on-4 concept represent a viable treatment option for completely edentulous patients. The guided surgery software allows for the performance of a flapless computer-guided surgery with similar results to those achieved through a flap surgery. This study aimed to evaluate the long-term outcomes of complete edentulous implant-supported rehabilitations using an All-on-4 arrangement, following a computer-guided protocol. Methods: A total of 111 patients (68 females, 43 males) with an average age of 60.9 years ± 9.67 years were treated. The primary outcome measures were implant and prosthetic survival. Secondary outcome measures were marginal bone loss (MBL) and the incidence of mechanical and biological complications. Results: Thirty-nine patients were lost to follow-up. Thirty-seven implants and five prostheses failed, rendering a 92.5% implant cumulative survival rate and a 96.2% prosthetic survival rate at 12 years. The average MBL per implant was 1.19 ± 1.16 mm, with 1.26 ± 1.33 mm for axial implants and 1.12 ± 0.95 mm for tilted implants at 10 years. The incidence rate of mechanical complications at the patient level was 90.1% for provisional prostheses and 55.9% for definitive prostheses. The rate of biological complications was 14.3% at the implant level. Conclusions: Full-arch rehabilitations following an All-on-4 implant arrangement and assisted by a computer-guided protocol may be a viable alternative for patients with edentulism/hopeless teeth in the long term. Full article

Background: Auricular defects resulting from congenital anomalies, trauma, or oncologic resection pose significant functional and psychosocial challenges. When autologous reconstruction is not feasible or not desired, implant-retained auricular prostheses represent a reliable alternative with high patient satisfaction. This study aimed to systematically evaluate the clinical performance of craniofacial implants used for auricular prosthetic rehabilitation, focusing on implant survival, prosthetic outcomes, workflow typologies, and complications. A secondary objective was to illustrate the long-term validity of a minimally invasive navigation technique through a clinical case with 6-year follow-up. Methods: A systematic review was conducted according to PRISMA guidelines. Clinical studies published between 2005 and 2025 reporting outcomes of implant-retained auricular prostheses were searched in PubMed and Scopus databases. Data were extracted on implant type, survival rates, prosthetic performance, workflow, and complications. Risk of bias was assessed using appropriate tools based on each study design. Results: A total of thirty-two studies were included, comprising fifteen case reports, fifteen case series, one cohort study, and one prospective observational study. Implant survival was consistently high across all workflow categories, with failures predominantly associated with irradiated or anatomically compromised bone. Prosthetic outcomes were favorable, showing excellent esthetics, stable retention, and high patient satisfaction irrespective of manufacturing method, although digital and navigation-assisted workflows improved reproducibility, symmetry, and planning precision. Complication rates were low and generally limited to mild peri-abutment inflammation manageable with conservative care. The clinical case confirmed these findings, showing stable osseointegration, healthy soft tissues, and uncompromised prosthetic function at 6-year follow-up. Conclusions: Implant-retained auricular prostheses show predictable long-term success, independent of whether traditional, hybrid, or fully digital workflows are employed. Digital technologies enhance surgical accuracy, minimize morbidity, and streamline prosthetic fabrication, although high-quality comparative studies remain limited. Full article

Background/Objectives: Large osteochondral lesions of the talus (OLT) pose a major challenge because their size and depth often exceed the indications for bone marrow stimulation, and durable biological repair remains difficult to achieve. However, evidence for autologous osteochondral transplantation (AOT) in extensive talar defects is still limited. Methods: In this retrospective cohort, 40 consecutive patients ≥ 14 years with ICRS grade III–IV lesions of the talar dome were treated with AOT at a tertiary referral center. One to three overlapping cylindrical osteochondral grafts (mean diameter 0.9 cm) were harvested from non-weight-bearing regions of the ipsilateral patellofemoral groove using a water-cooled diamond trephine system and implanted press-fit into the talar dome. Donor sites were refilled with autologous iliac crest bone cylinders and hydroxyapatite substitute. Pain (Numeric Rating Scale, NRS) and function (AOFAS Ankle–Hindfoot Score) were recorded preoperatively and at 3, 6, 9, and 12 months, and changes over time were analyzed using generalized estimating equations. Results: Mean defect size was 137.4 ± 31.9 mm², and 82.5% of lesions were ICRS grade III. NRS pain improved from 5.69 ± 2.52 preoperatively to 0.53 ± 0.98 at 12 months (p < 0.001). AOFAS score increased from 63.79 ± 2.55 to 97.36 ± 2.49 (p < 0.001). Age and graft location significantly influenced postoperative pain, whereas graft size and sex did not. No infections, graft failures, conversions to arthrodesis or arthroplasty, or clinically relevant donor-site symptoms occurred. Conclusions: Multi-plug AOT using a diamond trephine system provides substantial and durable pain relief and functional improvement in patients with large OLT, with low complication and donor-site morbidity rates. These findings support AOT as a joint-preserving option for extensive talar defects and justify further prospective, comparative studies with long-term follow-up. Full article

Background: The objective of this study was to evaluate the short-term clinical and radiological outcomes of a conservative cementless stem (Minima) in total hip arthroplasty (THA) for patients presenting with a narrow femoral canal. Methods: We retrospectively analyzed 18 patients (18 THAs) who received a size 1 Minima stem between 2018 and 2022. Clinical assessment was performed using the Harris Hip Score (HHS). Radiological evaluation focused on stem migration, trabecular bone development, cortical hypertrophy, and the presence of radiolucent or reactive lines. Implant survival was determined using Kaplan–Meier analysis. Results: The mean patient age was 51.6 years, with an average follow-up of 57 months. The mean HHS improved significantly from 38.3 preoperatively to 96.4 at the final evaluation (p < 0.001). Initial stem migration occurred in two hips (11.1%) within the first 6 postoperative months, with no further progression or loosening observed thereafter. Bony trabecular development was identified in Gruen zones 3 (27.8%), 4 (5.5%), and 5 (16.7%). Reactive lines were present around four stems (zones 3–5). One intraoperative complication (5.5%) occurred (acetabular component migration during trial reduction), which required screw fixation. No revisions were performed. Both clinical and radiological implant survival at the final follow-up was 100.0%. Conclusions: At a mean follow-up of 57 months, the use of the size 1 Minima stem in patients with a narrow femoral canal demonstrated excellent clinical and radiological outcomes. These findings suggest that this conservative stem is a reliable option for this specific patient population. Full article

Maxillofacial skeletal reconstruction presents significant challenges due to anatomical complexity, functional requirements, and aesthetic demands. Traditional materials such as titanium and autogenous bone grafts have limitations, prompting interest in Polyetheretherketone (PEEK), a versatile thermoplastic polymer with advantages like biocompatibility, radiolucency, and elasticity similar to human bone. This multi-year case series evaluates the clinical outcomes of PEEK implants used in 56 cases on 53 patients for maxillofacial reconstruction, primarily for trauma (44 patients) and deformity (9 patients). PEEK implants were applied to various facial regions including the orbit, zygoma, mandible, and maxilla. The majority of surgeries utilised virtual surgical planning. Patient-specific implants were fabricated using 3D imaging technologies, allowing customisation for optimal fit and functionality. The mean patient age was 37 years with a split of 37 to 16 females. Some complications were noted such as infection and paraesthesia. However, the majority of patients experienced positive outcomes. The findings support PEEK implants as a safe, effective, and adaptable material for maxillofacial surgery, with potential for further advancements in material properties and surgical technologies to improve long-term outcomes. Full article

Background/Objectives: Limited residual bone height in the atrophic posterior maxilla complicates implant placement. Transcrestal sinus elevation can be used to correct bone shrinkage after sinus pneumatization or crestal bone loss. This study evaluated a minimally invasive, one-stage transcrestal sinus lift using a double-layer crosslinked collagen scaffold (MCCS) with autogenous bone from the implant osteotomy site in patients with RBH ≤ 6 mm. Methods: In this prospective series, 11 patients (48–64 years, mean RBH 4.75 mm, SD 0.95 mm) underwent one-stage transcrestal sinus floor elevation with simultaneous implants. After osteotomy, autogenous bone chips collected during drilling were compacted into the site, and two layers of MCCS were placed under the elevated Schneiderian membrane. Buccal and palatal bone heights were measured on CBCT before and after surgery to assess vertical bone gain (ΔRBH). Results: All implants achieved stable osseointegration. Mean ΔRBH was approximately 3.1 ± 0.9 mm (combined buccal–palatal). No postoperative complications occurred. Two small Schneiderian membrane perforations were sealed intraoperatively by MCCS placement, with uneventful healing. Follow-up imaging showed maintenance of the augmented bone around the implants. Conclusions: This double-layer MCCS plus autogenous bone approach is a safe, effective, and minimally invasive transcrestal sinus lift for atrophic maxillae. It yielded crestal bone gains even with minimal initial RBH, leveraging the palatal sinus wall’s osteogenic potential and the implant’s tent-pole effect. The MCCS scaffold maintained space for bone formation and enabled immediate sealing of any membrane perforations. This one-stage protocol is viable for implant placement in low-RBH sites. Full article

Background: Three-dimensional virtual surgical planning (Three-dimensional VSP) has become standard practice in the treatment of mandibular oral squamous cell carcinoma (OSCC) in the last decade. Dutch guidelines recommend a care pathway interval (CPI) of a maximum of 30 days, and a free bone margin of at least 5 mm. Fused MRI and CT data are used for accurate tumor delineation. Based on this data, a virtual surgical plan is created and transferred to the operating room using resection guides and patient-specific implants (PSIs). Long-term evaluation is needed to further optimize its clinical use. Objectives: This study evaluates adherence to bone margin and CPI guidelines in mandibular OSCC. Additionally, it assesses the accuracy of tumor resection and reconstruction using 3D-VSP and compares the complications of 3D-planned mandibular reconstruction using different kinds of osteosynthesis plates. Methods: All patients who underwent a segmental mandibulectomy between 2014 and 2024 at the University Medical Center Groningen were included. CPI, clinical outcomes, and complications were analyzed. The preoperative virtual plan was compared with the postoperative outcome to assess accuracy. Results: The median CPI was 34 days, and 93.7% of bone margins were tumor-free. Mean absolute resection deviation was 1.63 mm (±1.42). PSI reconstructions were significantly more accurate in intergonial distance and coronal angle compared to conventional plates. Plate-related complications were more common in non-bony reconstructions; PSI reconstructions showed significantly more plate exposure. Conclusions: 3D-VSP leads to high accuracy in resection and reconstruction and favorable bone margins. Shortening the CPI and reducing biological complications are essential to further improve oncological outcomes. Full article

Objectives: This study aims to evaluate the efficacy of hydroxyapatite-tricalcium phosphate (HAP-TCP) as a bone substitute in subantral augmentation for dental implants. Specifically, it investigates the effects of HAP-TCP on bone quality, density, and integration with implants over time. Methods: A prospective controlled longitudinal study was conducted on 22 patients (39–75 years of age) undergoing subantral augmentation and dental implantation. A total of 52 sites of augmented bone and 67 sites of native bone were analyzed using computed tomography (CT) to assess bone density in Hounsfield Units (HU), insertion torque measurements, and the Misch classification for bone quality. Augmented and native bone measurements were compared within each patient. Results: The augmented bone exhibited an average density of 1132.6 ± 334.9 HU, which is significantly higher (45.9%) than the average density of native bone at 519.3 ± 395.0 HU. Insertion torque values in the HAP-TCP augmented sites averaged 35 N·cm, showing a 71.4% increase compared to adjacent native bone sites (25 N·cm). The study found notable improvements in bone homogeneity and vascularization within the augmented zones. Conclusion: HAP-TCP demonstrates significant potential as a reliable and effective synthetic bone substitute for subantral augmentation in dental implants. It yields higher radiodensity and insertion torque than adjacent native bone, while mitigating complications associated with autogenous grafts. These observational findings support the potential clinical use of HAP-TCP for sinus augmentation. Full article

Background: The global increase in orthopedic implant use—both for trauma fixation and arthroplasty—has profoundly transformed musculoskeletal surgery. As a consequence, fractures occurring in the presence of implants have become more frequent and clinically relevant. Yet, these injuries are currently described using highly heterogeneous terminology, including periprosthetic (fracture occurring in the presence of a prosthetic joint replacement) peri-implant (fracture occurring around an osteosynthesis or fixation device), implant-related, and hardware-related fractures (umbrella terms encompassing both prosthetic and fixation devices, used descriptively rather than classificatorily). This coexistence of multiple, context-specific terminologies hinders clinical communication, complicates registry documentation, and limits research comparability across orthopedic subspecialties. Because fractures occurring in the presence of orthopedic implants significantly alter load transfer, muscle force distribution, and musculoskeletal biomechanics, a clear and unified terminology is also relevant for muscle-focused research addressing implant–tissue interaction and functional recovery. Objective: This systematic review aimed to critically analyze the terminology used to describe fractures influenced by orthopedic implants, quantify the heterogeneity of current usage across anatomical regions and publication periods, and explore the rationale for adopting a unified umbrella term—“artificial fracture.” Methods: A systematic search was performed in PubMed, Scopus, and Web of Science from January 2000 to December 2024, following PRISMA guidelines. Eligible studies included clinical investigations, reviews, registry analyses, and consensus statements explicitly employing or discussing terminology related to implant-associated fractures. Data were extracted on publication characteristics, anatomical site, terminology employed, and classification systems used. Quantitative bibliometric and qualitative thematic analyses were conducted to assess frequency patterns and conceptual trends. Results: Of 1142 records identified, 184 studies met the inclusion criteria. The most frequent descriptor in the literature was periprosthetic fracture (68%), reflecting its predominance in arthroplasty-focused studies, whereas broader and more practical terms such as implant-related and peri-implant fracture were more commonly used in musculoskeletal and fixation-related research. Terminological preferences varied according to anatomical site and implant type, and no universally accepted, cross-anatomical terminology was identified despite multiple consensus efforts. Discussion and Conclusions: The findings highlight persistent heterogeneity in terminology describing fractures influenced by orthopedic implants. A transversal, descriptive framework may facilitate communication across subspecialties and support registry-level harmonization. Beyond orthopedic traumatology, this approach may also benefit muscle and musculoskeletal research by enabling more consistent interpretation of data related to muscle–bone–implant interactions, rehabilitation strategies, and biomechanical adaptation. Full article

Background/Objectives: Dental implant placement protocols including immediate (IIP) and delayed implant placement (DIP) are likely to affect bone tissue repair and regeneration after the surgery. Despite many benefits of IIP, it has remained unclear whether IIP demonstrates comparable healing processes and outcomes to those observed in DIP. This review aims to summarize and compare biological and clinical outcomes of IIP and DIP, focusing on success and survival rates, periodontal status, esthetics and radiographic outcomes, and biochemical markers. Methods: A literature search of electronic databases was conducted using PubMed/MEDLINE, Embase, and the Scopus databases (January 1983–February 2025). 109 articles published in English, consisting of in vitro, in vivo, and clinical studies met the inclusion criteria. Results: This review shows that both IIP and DIP show similar implant survival rates, but IIP may lead to a higher risk of mid-facial recession in esthetic areas. DIP, on the other hand, can result in better soft tissue and bone healing. Histological and radiographic evidence shows comparable bone to implant contact (BIC) between the two methods, although peri-implant bone loss tends to be higher with IIP. Lastly, although specific molecular markers are well-established in all phases of osseointegration following DIP, there is no available literature comparing differences in biomarkers during healing periods between IIP and DIP. Conclusions: This review highlights the similarities and differences in the outcomes of IIP and DIP, as well as the knowledge gaps that require further investigation, providing valuable insights for predicting treatment outcomes and managing complications associated with dental implant placement. Full article

Atlantoaxial instability (AAI) in toy- and small-breed dogs remains a significant clinical challenge, as the restricted anatomical space and risk of complications complicate the selection of implants. This study aimed to compare three patient-specific Ti-6Al-4V stabilizers for the C1–C2 region: a clinically used ventral C1–C3 plate, a shortened ventral C1–C2 plate, and a dorsal C1–C2 implant. Computed tomography, segmentation, virtual reduction, CAD/CAM design, and finite element analysis were employed to evaluate the linear-static mechanical behavior of each construct under loading ranging from 5 to 25 N, with a focus on displacements, von Mises stresses, and peri-screw bone strains. Additionally, cadaver procedures were performed in nine small-breed dogs using custom drill guides and additively manufactured implants to evaluate procedural feasibility and implantation time. Finite element models demonstrated that all stabilizers operated within material and biological safety limits. The C1–C3 plate exhibited the highest implant stresses, while the C1–C2 plate demonstrated an intermediate response, and the dorsal implant minimized implant stresses, albeit by increasing bone stresses. Cadaver experiments revealed that dorsal fixation required less implantation time than ventral fixation. Collectively, the findings indicate that all evaluated constructs represent safe stabilization options, and the choice of implant should reflect the preferred load-transfer pathway as well as anatomical or surgical constraints that may limit ventral access. Full article

Background/Objectives: Edentulism represents a major public health challenge, causing disorders of social, psychological and biological origin. Full-arch implant-supported restorations represent a viable alternative to mitigate this problem. This study aimed to evaluate immediate implant-supported restorations for the rehabilitation of the edentulous maxilla using four implants and distal implant tilting between 15 and 20 years. Methods: A total of 740 patients were included (women: 440; men: 300; average age: 55.3 years) rehabilitated with 740 prostheses, supported by 2960 dental implants. The primary outcome measure was prosthetic/implant cumulative survival and success (CSurR;CSucR). Secondary outcome measures included marginal bone loss (MBL), and the incidence of complications was evaluated as a secondary outcome measure. The outcomes were evaluated at 15 and 20 years. Results: In total, 287 patients (38.8%) with 1148 implants (38.8%) were lost to follow-up. A total of 170 implants (5.7%) in 101 patients (13.6%) failed, resulting in an implant CSurR and CSucR of 90.7% and 84.6%, respectively, after up to 20 years of follow-up. The prosthetic success rate was 98.1%. The average MBL was 1.07 mm ± 1.38 mm and 1.46 mm ± 1.56 mm at 15- and 20-years, respectively. Mechanical complication incidence was 78.5%, occurring in 581 patients (provisional prostheses: n = 448, 60.5%; definitive prostheses: n = 374, 50.5%). Biological complications occurred in 449 implants (15.2%) in 260 patients (35.1%). Biological complications and smoking habits were major risk indicators. Conclusions: Considering the study limitations, it can be concluded that the current rehabilitation concept is a viable treatment option in the long term, with mechanical and biological maintenance being necessary throughout the patients’ lives. Full article

Background/Objectives: Surgical management of atypical femoral fractures (AFFs) stabilized with intramedullary (IM) nailing is frequently challenged by delayed union or nonunion due to the severely suppressed bone turnover characteristic of bisphosphonate-related bone pathology, often leading to a hypertrophic nonunion-like state at the fracture site. This consecutive case series aimed to evaluate the effectiveness of intraoperative percutaneous decortication at the hypertrophic cortex in promoting rapid bone healing in complete AFFs. Methods: This was a single-center consecutive case series of patients with complete atypical femoral fractures (AFFs) treated with intramedullary nailing and adjunctive percutaneous decortication since February 2021. The standardized surgical protocol—including percutaneous decortication performed through a small anterolateral incision using an osteotome to create bone chips and stimulate the sclerotic cortex—was applied prospectively to all consecutive patients from February 2021. Of the 20 patients who underwent surgery during this period, 14 with sufficient radiographic follow-up were included in the final retrospective analysis. Data collected included patient demographics, duration of bisphosphonate use, fracture location (diaphyseal vs. subtrochanteric), operative details (including iatrogenic fracture), and radiographic bone union time. Bone union was assessed on serial radiographs by two independent observers. Results: All 14 patients were female, with a median age of 75 years (IQR 67–79 years). Thirteen patients (92.9%) had prior bisphosphonate exposure for a median of 4.5 years (IQR 3–10 years). Six fractures were subtrochanteric fractures, and six were complicated by iatrogenic fracture during nail insertion. Postoperative teriparatide was administered to six patients. Radiographic bone union was achieved in all 14 patients at a median of 19 weeks (IQR 16–22 weeks; range 16–24 weeks). No major complications (infection, implant failure, nonunion, or neurovascular injury) occurred during follow-up. Conclusions: Percutaneous decortication is a simple, safe, and biologically plausible adjunct to intramedullary nailing. In this series of 14 elderly women with long-term bisphosphonate exposure (median 4.5 years), the technique was associated with 100% radiographic union at a median of 19 weeks without major complications, suggesting a promising strategy that warrants validation in larger, controlled trials. Full article

Background: Several minimally invasive techniques have been introduced to augment horizontal ridge volume for prosthetically driven implant placement, utilizing different biomaterials to enhance regenerative outcomes. This article presents two clinical cases illustrating a tunneling approach for horizontal alveolar ridge augmentation using a combination of xenogeneic bone graft, hyaluronic acid, and an acellular dermal matrix. Methods: A single vertical incision was made mesial to the bone defect and a dermal matrix was suitably shaped and positioned into the subperiosteal tunnel. Subsequently, the bone graft was inserted between the dermal matrix and the buccal bone plate. Primary wound closure was achieved. After six months, implants were placed. For each patient, an optical scan was performed at baseline (T₀), at six months post-operative ridge augmentation surgery (T₁) and at two months post-implant insertion (T₂). A digital measurement of the horizontal ridge thickness was performed at each inserted implant site. Clinical parameters and patient postoperative morbidity were recorded. Results: The procedure was well tolerated by the patients. No postoperative clinical complications were observed. The mean tissue thickness achieved at T1 was recorded to be 13.3 mm. The same value was recorded at T2. Conclusions: This technique allowed the placement of prosthetically guided implants, with minimal morbidity and no observed complications. Further studies analyzing the histology of newly formed bone and performing three-dimensional radiological examinations to confirm the effectiveness of the surgical technique are warranted to validate these preliminary findings. Clinical Trial Number (NIH): NCT06424223 Full article

Background/Objectives: Periprosthetic humeral fractures (PF) after reverse total shoulder arthroplasty (RSA) are expected to increase. This study investigated PF after RSA with short stems and reported outcomes. Methods: A total of 165 patients underwent short-stem RSAs between 2014 and 2023. Among them, patients who developed postoperative PFs were identified and classified by fracture location and stem loosening. Operative data, complications, and bone union time were analyzed. Clinical outcomes before injury and at final follow-up were evaluated. Results: PF occurred in 5/165 patients (3.0%). Based on our classification, four had type B1 fractures and one had a type B3 fracture. All underwent revision RSA (Re-RSA) with conversion to long-stem implants. Bone union was achieved in four patients, while one patient experienced infection without union. Among the four patients without complications, mean shoulder flexion declined from 138° pre-injury to 103°, abduction from 118° to 95°, external rotation from 37° to 31°, the American Shoulder and Elbow Surgeons (ASES) score from 82.0 to 68.7, Constant Score from 67 to 43, while the Visual Analog Scale (VAS) pain score increased from 1.7 to 2.6. Conclusions: All five cases of PF following short-stem RSA were stem-level (type B) fractures. All patients underwent Re-RSA using long-stem conversion. Four patients had bone union. Clinical outcomes at one year postoperatively had deteriorated mildly compared to pre-fracture. However, this change was not statistically significant. One patient had a postoperative infection, and bone union was not observed. This study indicates the need for caution regarding postoperative infections after RSA. Full article