Search Results (45)

Background: In modern dentistry, alveolar socket preservation after tooth extraction plays a critical role in maintaining the alveolar ridge for future dental implants. This retrospective clinical study evaluated bone-level changes 15 years after immediate implant placement, coupled with alveolar ridge preservation. Methods: Fifty non-smoking patients aged 25 to 75 (30 males and 20 females) who underwent single-implant rehabilitation in both anterior and posterior regions of the upper and lower jaws were included. The study examined bone levels and implant survival over time, using standardized intraoral radiographs at 1, 5, and 15 years post-loading. Implants were placed immediately after atraumatic extraction, and the residual gap was grafted with bovine hydroxyapatite and covered with a collagen membrane. The primary outcome was bone-level stability, while secondary outcomes included implant failure. No temporary crowns or removable dentures were provided during healing. Radiographs were digitized for detailed analysis. Results: The results for 50 patients with immediate implant placement showed that bone-resorption levels were significantly higher in the upper jaw than in the lower jaw. Conclusions: Posterior implants exhibited greater bone loss than anterior implants, particularly at 1 year and 15 years, while no implant failures occurred. Full article

Background/Objectives: Dental implants represent a viable solution for replacing missing teeth; however, multiple disconnections and reconnections of intermediate abutments contribute to the apical displacement of the peri-implant connective tissue barrier, resulting in additional marginal bone loss. To the best of our knowledge, no definitive customized abutments currently exist that are specifically designed according to the morphology of the tooth to be replaced and its position within the dental arch, allowing for digital planning within the prosthetic implant design and insertion during the surgical procedure without subsequent disconnection. Methods: The First Biological Respect (FR) technique, described in this case report, enables the digital planning not only of the implant but also of the patented FR customized-shaped, definitive abutment and associated FR prosthetic components. The FR technique was applied to a case involving an immediate post-extraction implant in position 12. Results: With the limitations of a case report, the application of the FR protocol demonstrated stable crestal bone levels at the 1-year follow-up. Additionally, soft tissue volume was maintained at 6 months, reflecting the accuracy of the customized prosthetic components in supporting, guiding, and protecting peri-implant soft tissues. At the 1-year follow-up, an increase in soft tissue volume was observed, likely attributable to tissue maturation and the further customization of the definitive prosthetic elements. Conclusions: The FR technique represents a viable therapeutic alternative that, through its patented, fully customized components, allows for the digital planning of the implant, as well as the customized definitive abutment, coping, provisional, and final prosthetic framework. This facilitates a single-stage surgical and prosthetic approach. By eliminating the need for repeated abutment disconnections, this method supports the long-term stability of both hard and soft peri-implant tissues while also reducing overall treatment time for both clinician and patient. Further studies involving larger patient cohorts are necessary to validate this protocol. Full article

Background: Tooth loss significantly impacts the quality of life for adults. Inferior alveolar nerve (IAN) repositioning has garnered interest as a treatment for facilitating dental implant placement in the severely atrophic posterior mandible. However, there remains a need for standardization and classification of these techniques to improve outcomes. This study aims to propose a new clinical classification system for IAN repositioning procedures based on anatomical and procedural parameters. Methods: This study retrospectively analyzed preoperative radiographic records and surgical procedure documents over a 15-year period (2008–2023) for patients who underwent implant placement combined with IAN repositioning in the posterior atrophic mandible. Cases were classified into four categories according to bone availability, nerve location, and type of surgical intervention. Results: The study analyzed 142 edentulous posterior mandibles in 105 patients (77 women, 28 men; age range: 20–75). The cases were divided into four categories: Category 1 (58 patients, 78 sites), treated with one surgery; Category 2 (15 patients, 15 sites), treated in two stages; Category 3 (20 patients, 25 sites); and Category 4 (12 patients, 24 sites), with Categories 3 and 4 treated in a single surgery. Across all 132 sites, 411 dental implants were placed and restored with implant-supported fixed prostheses. Conclusions: This proposed classification provides a structured systematic framework for assessing and planning IAN repositioning procedures. It facilitates better diagnosis, treatment planning, and prediction of surgical stages in patients needing IAN repositioning for dental implant placement. Full article

Background: Bone resorption following tooth loss poses significant challenges for dental implant success. Guided bone regeneration (GBR) techniques, particularly in vertically deficient ridges, often require complex procedures and soft tissue management. This case report introduces a modified occlusive barrier with a window, combined with tricalcium phosphate, to address these challenges. Methods: A 26-year-old female with significant bone loss in the mandibular anterior region underwent GBR using a digitally designed titanium occlusive barrier. The barrier was fabricated using CAD/CAM technology and secured with screws. A blood clot mixed with tricalcium phosphate was used to promote bone regeneration. Postoperative care included regular irrigation, de-epithelialization, and follow-up over six months. Implant placement and histological analysis were performed to evaluate outcomes. Case Presentation: The patient achieved 8.8 mm of vertical and 7.6 mm of horizontal bone regeneration. Histological analysis confirmed the presence of mature, mineralized bone, and keratinized gingiva. The implant was successfully placed, and a fixed prosthesis was restored after four months, with stable results at a three-year follow-up. Conclusion: This technique demonstrates effective bone and soft tissue regeneration in a single procedure, eliminating the need for autologous bone grafts and secondary surgeries. The use of a digitally designed occlusive barrier offers precision, reduces morbidity, and simplifies the surgical process, suggesting a promising advancement in GBR. Further studies are needed to validate these findings. Full article

Objectives: The primary objective of this systematic review was to compare IIP in intact versus non-intact sockets in terms of buccal bone thickness. Methods: Two independent reviewers carried out an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2024. Randomized controlled trials (RCTs), cohort studies, and case series on intact and/or non-intact sockets were included for analysis. The primary outcome was buccal bone thickness (BBT). Secondary outcomes were vertical midfacial soft tissue level change, pink esthetic score (PES), implant survival and complications. This systematic review was conducted in accordance with the PRISMA guidelines. Results: After screening 1001 unique titles and conducting manual searches, 20 articles reporting on 525 implants (intact: 265; non-intact: 260) in the anterior maxilla with a follow-up of up to 120 months were selected. The overall study quality was low, especially for non-intact sockets since only two RCTs could be found, and none demonstrated a low risk of bias. Meta-analyses were not feasible due to a lack of direct comparisons, and heterogeneity in terms of surgical approach, soft tissue handling, and restorative approach. BBT ranged between 1.10 and 3.18 mm (intact) and 1.18 and 3 mm (non-intact). Vertical midfacial soft tissue level change ranged between −0.13 and −0.58 mm (intact) and −0.03 and −0.59 mm (non-intact). Pink esthetic scores ranged between 10.48 and 12.80 (intact) and 9.25 and 12.43 (non-intact). Implant survival exceeded 90% in all studies and was 100% in the vast majority of the studies. Conclusions: This systematic review suggests a similar outcome of IIP in intact and non-intact sockets. However, the overall low study quality, a lack of direct comparisons, and heterogeneity rendered the comparison highly biased. Future studies should be conducted to establish an evidence-based treatment approach for IIP in non-intact sockets. Full article

Background: This case report outlines the clinical workflows for immediate implant placement for both maxillary central incisors and ceramic laminate veneers for the remaining teeth in the smile zone. Methods: The patient’s chief complaint was to improve her smile and address periapical infections with purulent exudate at the apex of her central incisors. Clinical and CBCT evaluations determined that the maxillary central incisors were non-restorable, while the lateral incisors and canines showed signs of incisal wear. Atraumatic extractions were performed for the central incisors, and immediate implants were placed with a 3D-printed surgical guide in conjunction with an autogenous soft tissue grafting procedure. Once the soft tissue between the central incisors was contoured with provisional implant restorations, minimally invasive veneer preparations were performed for porcelain laminate veneers. Final restorations were bonded under dental dam isolation. Results: Single immediate implants for maxillary central incisors can be successfully paired with ceramic laminate veneers on adjacent teeth in the smile zone to replace non-restorable teeth in the esthetic zone. Conclusions: Atraumatic tooth extraction, 3D implant planning with grafting procedures, and minimally invasive ceramic veneers can help in meeting patients’ esthetic and functional expectations. Total isolation using a dental dam maximizes the bonding performance of ceramic restorations. Full article

Background and Objectives: The manufacturing of single crowns using hybrid abutments is an alternative that may be interesting in clinical practice, combining the advantages of the different materials used in a personalized design for each case. The purpose of this in vitro study was to evaluate the torque loss, survival, reliability, failure mode, and strain distribution of implant-supported prostheses with zirconia (Zir) and cobalt–chromium (Co-Cr) hybrid abutments. Materials and Methods: Abutments were milled by CAD/CAM and divided into two groups according to the materials used, Zir and Co-Cr, and cemented on titanium bases screwed to dental implants. Monolithic zirconia crowns were cemented on the abutments. The implant/abutment/crown sets were subjected to thermomechanical cycling (n = 10) (2 Hz, 140 N, 1 × 10⁶ cycles, immersed in water at 5–55 °C) to evaluate the torque loss. The single load to fracture test (SLF) was performed to design the loading profiles (light, moderate, and aggressive) of the step-stress accelerated life testing (SSALT) (n = 21) to evaluate the survival and reliability. The representative fractured specimens were analyzed under optical and scanning electron microscopy. The digital image correlation (DIC) (n = 1) was performed using specimens embedded in polyurethane resin models that received static point loading, and the strain distribution was analyzed. Results: There was no difference in torque loss, survival, or reliability between zirconia and Co-Cr abutments. An analysis of the fractured surfaces showed that the abutments presented the same failure mode, where the fracture probably started in the titanium base/screw. The zirconia abutment model presented only compressive strains around the implant, while the Co-Cr abutment model showed tensile and compressive strains in the middle of the implant; however, all strains were within the clinically acceptable limits. There was a strain concentration in the titanium base close to the implant platform for both groups. Conclusions: Zirconia and Co-Cr hybrid abutments presented similar torque loss, survival, reliability, and failure modes, but the abutment material influenced the strain distribution around the implant. The titanium base screw was the weakest link in the system. Full article

Background/Objectives: In the last decades, dental implant surfaces have been evolving to increase success and implant survival rates. More studies evaluating outcomes with implants with ultra-hydrophilic multi-zone anodized surfaces are necessary. The aim of this study is to evaluate the short-term outcome of implants of conical connection with anodized ultra-hydrophilic surfaces for support of single teeth and partial rehabilitations. Methods: In this retrospective study, patients received parallel-walled implants with a gradually anodized surface. The primary outcome measure was implant survival. Secondary outcome measures were marginal bone loss and mechanical and biological complications. This study included 253 conical connection implants with anodized ultra-hydrophilic surfaces, placed in 145 patients (71 males and 74 females; average age: 55.8 years). Sixty patients presented comorbidities, and 19 patients presented smoking habits. Results: Ten patients (15 implants) were lost to follow-up. Two implants failed in two patients, resulting in a cumulative survival rate of 99.2%, with 98.5% and 100% for males and females, respectively, and 99.1% and 100% for single teeth and partial rehabilitations, respectively. The average marginal bone loss was 0.52 mm at 1 year, with 0.60 mm and 0.42 mm for males and females, respectively, and 0.52 mm and 0.50 mm for single teeth and partial rehabilitations, respectively. The rate of mechanical complications was 4.8% and 3.2% at patient and implant levels, respectively. Biological complications occurred in one patient (0.7%) at one implant (0.4%). Conclusions: These results indicate that the use of implants with ultra-hydrophilic multi-zone anodized surfaces for single teeth and partial rehabilitations is viable in the short term. Full article

This study aimed to evaluate the influence of the guidance level on the accuracy of immediately placed implants. Methods: Eighteen identical maxillary models (randomly split into three groups (n = 6): fully guided (FG), pilot-guided (PG), and freehand (FH)) were used to place 72 implants (n = 24). After placement, the mean global, angular, mesial–distal, buccal–palatal, and vertical deviation at the platform and apex of the placed implants, relative to the preoperatively planned positions, was calculated. Results: Significant differences in global and mesial–distal deviation were found between implants in the FG group and implants in the PG and FH groups. Significant differences were also found between the implants in the FG and FH groups as well as the implants in the PG and FH groups in terms of angular and mesial–distal apex deviation. Finally, significant differences were found between the implants in the FG and PG groups in terms of buccal–palatal platform deviation. Conclusions: The results of this in vitro study show that immediate implants placed using fully guided surgical guides have significantly less deviation, and are therefore more accurate, than implants placed freehand or using pilot guides, but this should be further validated in a clinical trial. Full article

This study develops a structural stability monitoring method for an implant structure (i.e., a single-tooth dental implant) through deep learning of local vibrational modes. Firstly, the local vibrations of the implant structure are identified from the conductance spectrum, achieved by driving the structure using a piezoelectric transducer within a pre-defined high-frequency band. Secondly, deep learning models based on a convolutional neural network (CNN) are designed to process the obtained conductance data of local vibrational modes. Thirdly, the CNN models are trained to autonomously extract optimal vibration features for structural stability assessment of the implant structure. We employ a validated predictive 3D numerical modeling approach to demonstrate the feasibility of the proposed approach. The proposed method achieved promising results for predicting material loss surrounding the implant, with the best CNN model demonstrating training and testing errors of 3.7% and 4.0%, respectively. The implementation of deep learning allows optimal feature extraction in a lower frequency band, facilitating the use of low-cost active sensing devices. This research introduces a novel approach for assessing the implant’s stability, offering promise for developing future radiation-free stability assessment tools. Full article

There are a series of protocols regarding the placement of dental implants after tooth extraction. The advantages and disadvantages that determine the procedure and timing of each dental implant placement process are key to achieving success. The main objective of this study was to elucidate/establish/determine whether there are differences in the survival and marginal bone loss between implants placed immediately after placement and those placed following a delayed protocol. A search was conducted in Pubmed, BVS, and Cochrane. Eleven randomized clinical trials that fulfilled the inclusion criteria were selected, and a meta-analysis was carried out to compare the implant failures and marginal bone loss between study groups. The analysis showed that delayed implant placement had fewer failures (odds ratio, fixed effects: 3.47 [CI: 95% (1.17, 10.48)]). As regards marginal bone loss, there was a tendency towards less tissue loss in the delayed placement group (mean difference, random effects: 0.11 [CI: 95% (−0.10, 0.33)]); however, further research is needed to evaluate this variable. Full article

Background: The increase in soft tissue (ST) around implants can benefit peri-implant health and aesthetic results. The objective was to compare the gingival and esthetic health benefits of immediate implant placement (IIP) with simultaneous or delayed connective tissue graft (CTG) compared to IIP without CTG. Methods: A systematic review was carried out by two reviewers in Medline-Pubmed, Scopus, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were considered. Randomized Clinical Trials (RCTs) that were published between April 2017 and February 2024 were used. Studies that analyzed the performance of a simultaneous or deferred CTG after the placement of an implant in the aesthetic zone, with or without immediate provisionalization, without previous regeneration, with a follow-up of 6 months, and that were performed in humans were included. Results: Quantitative analysis was performed using data provided by the RCTs. The five RCTs that were selected analyzed a total “n” of 245 subjects who met the inclusion criteria and focused on the subject of the study. In the quantitative analysis, four RCTs were included. The studies evaluated buccal gingiva levels when placing the IIP with and without CTG, obtaining a mean buccal gingiva level difference of 0.09 mm (95% CI: −0.54 to 0.72, p = 0.05), statistically not significant, but with a favorable trend. Conclusions: The use of CTG associated with the II can maintain the gum level but not increase the volume. CTG is favorable for achieving successful esthetic results when immediate placement of an implant with a provisional prosthesis is planned. Full article

Backgrounds: Tooth loss in the posterior maxilla often necessitates dental implant placement, but the maxillary sinus anatomy poses challenges, especially during sinus floor elevation. Mesially angled implants are an alternative for total edentulism, but for single tooth deficiencies, palatally angled implants may offer a solution. This study evaluates the prevalence of avoiding sinus floor elevation by placing palatally angled implants in cases with a single missing tooth. Methods: A retrospective study at Ahmet Keleşoğlu Faculty of Dentistry involved 100 participants with a single missing tooth and prior CBCT scans. Virtual implants were placed using OnDemand3D (version 1.0.7462) software. On CBCT sections, implants were angled palatally to avoid sinus or nasal cavity perforation. Statistical analysis was conducted using R and MedCalc (version 4.3.2) software. Results: Of the participants (60% female, average age 50.45), 76 edentulous regions required sinus elevation. The implant placeability rates varied across zones (second molar: 39.3%, first molar: 63.1%, second premolar: 78.5%). Implant placement at a palatal angle was significantly higher in the second premolar and first molar regions. Statistically significant differences were observed in the implant placeability between regions. Conclusions: This study supports the feasibility of avoiding sinus floor elevation through palatally angled implants in specific cases, reducing the associated complications. Full article

A healthy 47-year-old woman consulted the Oral Surgery and Implantology Unit of the University Hospitals of Geneva with a request to treat her painful tooth 11 and replace the missing tooth 21. The dental history revealed that the patient had lost teeth 21 and 22 due to advanced caries. On clinical examination, tooth 11 showed an ill-fitting prosthetic crown with overhanging margins, an increased localized probing depth of 8 mm in the disto-vestibular area, and sensitivity to percussion. The edentulous site 21 showed horizontal bone atrophy. Radiological examination revealed a well-defined unilocular radiotransparent lesion surrounded by a thin radiolucent border, located at the apex of tooth 11 and measuring 10 × 8 mm. The treatment consisted of extraction of 11, enucleation of the apical lesion, and insertion of implants at sites 11 and 21 with simultaneous bone augmentation in a single surgical procedure, with aesthetic and functional results at 3-year follow-up without any complications. Our case highlights that immediate implant placement in cases of cystic periapical lesions represents a good valid alternative to standard treatment. Full article

This study aimed to evaluate the effect of two coating materials, a silicone sealing gel and a polytetrafluoroethylene (PTFE) tape, on the screw preload and removal torque value (RTV) to develop strategies to prevent prosthetic screw loosening. We examined 45 complexes comprising an implant, abutment, and prosthetic screw, of which 15 samples were uncoated, 15 were coated with GapSeal^® (Hager & Werken GmbH & Co., Duisburg, Germany), and 15 were coated with PTFE tape (MIARCO^®, Valencia, Spain). The screws were tightened to register the preload and then untightened to register the RTV. The preload values showed a statistically significant difference only in the PTFE group, suggesting that this lubricant negatively affects the preload. The RTVs showed statistically significant differences among all groups, with the GapSeal^® group and PTFE group showing the highest and lowest values, respectively. It can be concluded that the application of the PTFE tape on the screw significantly reduced the preload and RTV. The silicone sealing gel did not affect the preload but increased the RTV. Therefore, the use of GapSeal^® should be considered to prevent prosthetic screw loosening, while the use of PTFE tape should be avoided. Full article