Search Results (253)

Objectives: To quantitatively evaluate soft tissue dimensional changes after immediate implant placement and provisionalization (IIPP) in the esthetic zone with or without connective tissue grafting (CTG). Methods: In this prospective clinical trial, 44 patients requiring a single maxillary anterior immediate implant were randomly allocated to a test group (IIPP + CTG) or a control group (IIPP alone). At baseline and 6 months postoperatively, buccal soft tissue height (STH) and soft tissue thickness (STT) at various levels were recorded. Measurements were obtained through three-dimensional superimposition of cone-beam computed tomography (CBCT) and intraoral scanning data. Results: Forty-three patients completed the 6-month follow-up. From baseline to 6 months, buccal soft tissue height increased 2.14 ± 0.74 mm and 1.71 ± 0.81 mm in the test and control groups, respectively, without statistically significant differences between groups (p = 0.078). Buccal soft tissue thickness increased at most measured levels in both groups (p < 0.05), except at 1 mm apical to the crest in the control group (p = 0.11). However, thickness augmentation was consistently greater in the test group at all levels (p < 0.001). Conclusions: Within the 6-month follow-up period, both soft tissue height and thickness increased after IIPP. CTG performed simultaneously with IIPP was associated with significantly thicker buccal soft tissue compared with IIPP alone. Full article

Objective: The purpose of these two clinical cases reports was to present the variations in the surgical and prosthetic procedures related to an implant-supported fixed dental prosthesis (FDP) in the edentulous maxilla, following a fully guided implantation protocol and immediate loading. Case presentation: Two patients, one with terminal dentition and one with a completely edentulous maxilla, expressed the desire for immediate rehabilitation with an FDP and avoidance of multiple and complex surgical procedures. The clinical protocol for both cases included meticulous presurgical planning combining radiographic examination, diagnostic wax-up (conventional or digital), prosthetically driven digital planning of implant placement, fabrication of a surgical guide for fully guided implant installation, and delivery of a screw-retained fixed restoration. There was no report of any implant failure; the FDPs could be delivered as planned, and both patients expressed their satisfaction with the functional and esthetic outcomes. The clinical situation was stable at the recall. Full article

Background/Objectives: The aim of this study was to compare the augmentation stability and clinical outcomes of L-shaped collagenated soft block bone substitutes (BBS) used in combination with either a self-assembly technology (SAT)-based physically crosslinked resorbable collagen membrane (RCM) or a conventional non-crosslinked RCM for peri-implant dehiscence defects. Methods: This retrospective cohort study included 30 patients who underwent guided bone regeneration (GBR) with simultaneous implant placement. The patients were treated with either a physically crosslinked membrane (PCM group, n = 15) or a non-crosslinked membrane (NCM group, n = 15). Clinical, radiographic, and profilometric parameters were evaluated at baseline, immediately post-GBR, and at re-entry surgery. Early wound healing complications and patient-reported outcomes were also assessed. Results: Both groups achieved significant defect resolution without severe adverse events. The mean reductions in defect width and height were 4.47 ± 1.82 mm (92.9%) and 4.07 ± 2.19 mm (89.4%) in the PCM group and 3.80 ± 1.59 mm (89.5%) and 4.13 ± 1.64 mm (86.9%) in the NCM group, respectively. Both groups showed comparable dimensional changes in hard and soft tissues, with no statistically significant differences in radiographic or profilometric outcomes. The incidence of wound healing complications, as well as patient-reported postoperative pain and swelling, were similar between the groups. Conclusions: Within the limitations of this retrospective pilot cohort study, SAT-based physically crosslinked RCMs used in combination with L-shaped soft BBS demonstrated clinical, radiographic, profilometric, and patient-reported outcomes similar to those observed with conventional non-crosslinked RCMs, without major short-term postoperative complications. These preliminary findings suggest that SAT-based RCMs may represent a feasible membrane option for GBR; however, these findings should be interpreted as preliminary and hypothesis-generating and should be confirmed in larger, adequately powered prospective clinical studies. Full article

Background: Rehabilitation of edentulous mandibles in a post-oncologic setting remains a major clinical challenge. In such situations, placement of conventional endosseous implants may be compromised by severe bone deficiency, a history of peri-implant infection, and constraints related to reconstructive soft tissues. Customized titanium subperiosteal implants, made possible by three-dimensional imaging, computer-aided design, and additive manufacturing, represent a potential alternative when conventional options are unfavorable. This case report describes a full-arch fixed rehabilitation of an edentulous mandible in a patient previously treated for squamous cell carcinoma of the floor of the mouth. Methods: A patient-specific titanium additively manufactured subperiosteal jaw implant (AMSJI) made of biocompatible titanium was designed using a digital planning workflow. Implant placement was performed in a single surgical session under general anesthesia, with fixation using osteosynthesis screws. A screw-retained full-arch provisional prosthesis was delivered intraoperatively, allowing immediate loading with adjustments aimed at avoiding compression of the healing soft tissues. Results: The patient achieved satisfactory functional and esthetic rehabilitation. Postoperative follow-up showed overall favorable mucosal tolerance; an early, limited peri-abutment mucosal dehiscence was observed and managed with suturing under local anesthesia, without compromising implant stability. Conclusions: This case highlights the clinical interest of patient-specific titanium subperiosteal implants as a fixed rehabilitation option in post-oncologic patients with major osseous and mucosal constraints and a history of reconstructive procedures. The combination of accurate digital planning and custom-made manufacturing may avoid the need for extensive bone grafting. However, these findings should be interpreted with caution due to the short-term follow-up and the inherent limitations of a single-case report, which limit the level of evidence and generalizability. 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: In everyday practice, we observed an increased number of complications with a xeno-hybrid bovine graft in challenging cases, prompting a systematic review of timing strategies and the impact of the operator. Objective: To compare early safety and rehabilitation timelines for immediate versus delayed implant placement after alveolar ridge procedures with a xeno-hybrid bovine graft, and to examine operator-level effects. Materials and Methods: Single center retrospective cohort (Danube Private University, Krems, Austria; January 2021–October 2023). Consecutive patients undergoing alveolar ridge preservation (ARP) or reconstruction (ARR; conservative protocol without meshes or rigid frameworks) with a xeno-hybrid bovine graft and subsequent implant were included. Strata: ARP, ARR, ARP with immediate implant placement (ARP+II), ARR with immediate implant placement (ARR+II). Primary endpoint: early implant loss < 12 months after the index surgery. Secondary endpoints: days to implant exposure and days to definitive prosthesis. Results: We analyzed 158 coded interventions (ARP 33; ARR 16; ARP+II 32; ARR+II 77). Early implant loss was uncommon (7/158; 4.4%) and occurred only with immediate implant placement (ARP+II 6.3%; ARR+II 6.5%); no early failures occurred in delayed strata. Immediate implant placement accelerated rehabilitation (exposure: 358/364 vs. 144/162 days; prosthesis: 406/419 vs. 196/204 days; both p < 0.0001). After adjustment for treatment base, timing, and age, no independent operator level effect on early loss was detected. Conclusions: In this university cohort using a xeno-hybrid bovine graft, early implant loss was rare and confined to immediate implant placement, which nonetheless shortened the pathway to exposure and restoration by ~5–7 months. Differences across providers were explained by case selection and protocol choice after adjustment. Clinical Significance: With appropriate case selection and surgical execution, immediate implant placement after ARP/ARR can reduce treatment time by ~5–7 months without a clear increase in early failure within the limits of this cohort; treatment protocol and case triage are the main levers of early outcome. Full article

Objectives: To retrospectively evaluate the survival rate and complications of immediately loaded implant-supported restorations in atrophic mandibles of patients subjected to inferior alveolar nerve relocation for the placement of dental implants. Methods: Consecutively treated patients having a follow-up of four years after loading of implants immediately placed after inferior alveolar nerve repositioning were included. Outcome measures were implant and prothesis survival rates and any type of complications related to the surgery, in particular related to post-operative neurosensory disturbance. Results: Data from 14 consecutive patients rehabilitated with 51 implants were analyzed. All provisional prosthetic restorations could be immediately placed after implant placement, none failed, and no patient dropped out over the four years after definitive loading. Only one implant failed. One day postoperatively, all patients experienced dysesthesia or paresthesia. At two weeks, nine patients had a total neurological recovery and one had partial recovery, while the remaining four patients did not recover. One mandible fractured three weeks after implant placement. At one-year post-loading, one patient was still affected by neurosensory dysfunction and three partially recovered (one of these had it preoperatively). After three years, two patients still presented partial recovery. After four years, no further changes were recorded, and no patients reported total neurosensory dysfunction. The patient with the fractured mandible recovered completely with no neurosensory disturbances. Conclusions: Implant placement in atrophic mandibles following inferior alveolar nerve transposition or lateralization may represent a viable alternative to vertical ridge augmentation, with the added advantage of allowing immediate fixed provisional prothesis. Although severe complications and neurosensory disturbances are not uncommon, all patients experience gradual recovery within one to three years. Full article

Echocardiographic assessment is essential for evaluating patients with cardiogenic shock (CS) and determining their potential need for mechanical circulatory support (MCS) implantation. The use of Impella devices has increased significantly in recent years, paralleling the growing recognition of their hemodynamic benefits in selected patient populations. As the clinical experience with these devices has expanded, the need for a more standardized imaging approach has emerged. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) play complementary roles in guiding the pre-implantation evaluation, placement procedure, and post-implantation management of Impella devices. Currently, no comprehensive guidelines exist concerning the echocardiographic evaluation of Impella devices throughout their entire clinical course, from initial patient selection and device implantation to ongoing monitoring and eventual weaning. This gap in standardized guidance has led to significant variability in clinical practice across different institutions and healthcare systems. This comprehensive review examines the role of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in managing patients on Impella support across five distinct phases: candidate identification and pre-implantation assessment, intraoperative procedural guidance and device positioning, postoperative monitoring and haemodynamic optimisation, complication detection and troubleshooting, and weaning strategies with post-explantation surveillance. Both left-sided devices (Impella CP, CP Smart Assist, and Impella 5.5) and right-sided support (Impella RP) are covered, including combined configurations with VA-ECMO (ECPella). For each phase, we detail the recommended echocardiographic views, essential measurements and their evidence-based thresholds, signs of device malposition, and practical corrective strategies. A level-of-evidence approach is adopted throughout, specifying whether proposed thresholds derive from randomised trials, observational studies, expert consensus, or manufacturer recommendations. Summary tables and a bedside workflow are provided to facilitate immediate clinical application. Full article

Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) instrumentation is increasingly preferred in spinal oncology for its physical properties, minimizing imaging artifacts and facilitating precise postoperative radiotherapy planning and tumor surveillance. However, a significant technical limitation exists: the current unavailability of dedicated CFR-PEEK pedicle screws for the cervical spine. The smallest available implants are designed for thoracic use (minimum diameter 4.5 mm, minimum length 25 mm), posing substantial risks of neurovascular injury when applied to smaller cervical pedicles. We present a technical note/feasibility report illustrated by a single case of robot-assisted placement of thoracic CFR-PEEK screws in the cervical spine for the treatment of a C7 Giant Cell Tumor. Following neoadjuvant therapy with Denosumab, a single-stage, two-step circumferential resection and reconstruction was performed. The anterior step was complicated by an iatrogenic injury to the highly adherent left vertebral artery (VA), which was successfully repaired. Consequently, the posterior step required maximal precision to preserve the sole remaining intact VA on the right side. Given the anatomical mismatch between the 4.5 mm thoracic screws and the narrow cervical pedicles (measuring as narrow as 3.2 mm on the critical right side), robotic navigation (ExcelsiusGPS^®) was utilized to plan and execute safe trajectories. Specifically, on the side of the intact VA, a small, controlled medial cortical violation was planned to avoid lateral vascular compromise. The procedure resulted in rigid, artifact-free stabilization with no immediate neurological sequelae. This single-case experience suggests that robotic guidance may facilitate adaptation of thoracic CFR-PEEK instrumentation to the cervical spine in selected oncologic scenarios; reproducibility, costs, and long-term outcomes remain uncertain. Full article

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental implant placement and dental prosthesis fixation for mandibular reconstruction was developed at Ghent University Hospital. A follicular ameloblastoma of the left mandible was resected in a 28-year-old male. The defect was reconstructed with a two-segment fibular free flap with immediate placement of three dental implants and immediate implant loading with a screw-retained bridge. A split thickness skin graft and Elemental PerioPlast were used as wound dressing. Comparison of the preoperative planning with the postoperative CT-scan showed a deviation immediately after surgery, which was no longer present at the 6-month follow-up. The patient achieved a stable occlusion and 44 mm mouth opening and reported high satisfaction. This case illustrates that fully digital, immediate mandibular reconstruction with simultaneous implant placement and prosthetic rehabilitation is feasible and accurate and enhances early functional recovery. Future improvements in intraoperative validation may further refine accuracy and reproducibility in complex oncologic reconstructions. Full article

Background: Rehabilitation of the severely atrophic maxilla remains a major challenge in implant dentistry, particularly when conventional endosseous implants and regenerative procedures are contraindicated due to extensive bone loss, sinus pathology, or patient-related factors. Advances in digital planning and additive manufacturing have enabled the reintroduction of juxta-osseous subperiosteal implants as a graftless, patient-specific treatment option. This case report aimed to describe the complete digital workflow, surgical placement, and immediate prosthetic rehabilitation of a customized juxta-osseous subperiosteal implant in a patient with severe posterior maxillary atrophy and a history of failed sinus augmentation procedures. Case Presentation: A 75-year-old male patient presenting with left severe posterior maxillary atrophy and previous unsuccessful sinus lift surgeries was rehabilitated using a digitally designed, additively manufactured titanium subperiosteal implant. Cone-beam computed tomography–based planning and CAD–CAM technology were used to design a patient-specific framework, which was rigidly fixed to stable maxillofacial support and immediately loaded with a screw-retained provisional prosthesis. Results: Clinical and radiographic follow-up demonstrated stable implant fixation, soft tissue healing, absence of biological or mechanical complications, and satisfactory functional and aesthetic outcomes. The patient reported high levels of comfort and satisfaction throughout the treatment period. Conclusions: Digitally manufactured juxta-osseous subperiosteal implants may represent a predictable and minimally invasive graftless alternative for selected patients with severe maxillary atrophy, particularly when conventional implant placement or extensive bone augmentation is not feasible. Accurate digital planning, rigid fixation, and appropriate patient selection appear to be key factors for clinical success. Full article

Background: Buccal bone dehiscence is a frequent finding during implant placement and often requires horizontal bone augmentation. When combined with immediate loading protocols, concerns remain regarding early implant stability and failure risk. This retrospective case series aimed to describe the early clinical outcomes of immediately loaded implants placed in sites with buccal dehiscence treated by horizontal bone augmentation and restored with full-arch screw-retained prostheses. Methods: Fifty-nine consecutive edentulous patients were rehabilitated with immediately loaded cross-arch implant-supported prostheses. A total of 253 implants were placed, including 148 implants presenting buccal dehiscence and treated with horizontal bone augmentation using particulate grafting materials with or without autogenous bone and a resorbable collagen membrane. Clinical outcomes were assessed over a 1-year follow-up period. Implant survival and biological complications were recorded. Descriptive statistics were applied. An exploratory event-based comparison between augmented and non-augmented implants was performed using Fisher’s exact test, and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: At 1 year, no patients were lost to follow-up. Two implant failures occurred, both in augmented sites (2/148; 1.35%), while no failures were observed among non-augmented implants (0/105). The exploratory comparison did not show a statistically significant difference in failure rates between groups (p = 0.51). The estimated RR for implant failure associated with horizontal augmentation was 3.56 (95% CI: 0.17–73.34). Two biological complications (one peri-implantitis and one peri-implant mucositis) were recorded, both involving augmented implants. Conclusions: Within the limitations of this retrospective case series, immediately loaded implants placed in sites with buccal dehiscence and treated with horizontal bone augmentation demonstrated high early survival rates and a low incidence of biological complications. These findings are descriptive and exploratory and should be interpreted as hypothesis-generating. Further prospective controlled studies with longer follow-up are needed to confirm these observations. Full article

This study evaluated the effectiveness and safety of mechanical debridement (MD) in treating experimental peri-implantitis (EPI) in rats with osseointegrated implants, specifically those treated with high-dose zoledronate. Senescent Wistar rats underwent the extraction of their upper incisor, followed by immediate implant placement. After 8 weeks, the implants were exposed, and a transmucosal component was placed. The animals were divided into four groups: Control (C), ZOL, ZOL-EPI, and ZOL-EPI-MD. In the 9th week, drug treatment commenced, consisting of the administration of 0.45 mL of a vehicle (for group C) or zoledronate (for groups ZOL, ZOL-EPI, and ZOL-EPI-MD) every 4 days over 10 weeks. After 5 weeks of drug treatment, a cotton bandage was placed around the implants to induce EPI in the ZOL-EPI and ZOL-EPI-MD groups. In the ZOL-EPI-MD group, the ligature was removed at week 16, and local treatment was performed using MD. Euthanasia was conducted at week 19. Histological sections were obtained and stained with hematoxylin–eosin for histopathological and histometric analyses, such as the percentage of total bone tissue (B.Ar/T.Ar) and the percentage of non-vital bone tissue (NVB.Ar/B.Ar). Immunohistochemical reactions were performed to detect TNFα, IL-1β, VEGF, OCN, and TRAP. In the peri-implant connective tissue, mild, intense, and moderate inflammatory infiltrates were observed in the ZOL, ZOL-EPI, and ZOL-EPI-MD groups, respectively. Immunolabeling for TNFα and IL-1β correlated with these histopathological findings. The ZOL and ZOL-EPI-MD groups showed lower immunolabeling for VEGF compared to the control group. There was a reduction in TRAP-positive cells and lower immunolabeling for OCN in the groups treated with zoledronate, with the ZOL-EPI-MD group displaying even lower levels of OCN compared to the ZOL group. While there was no significant difference in B.Ar/T.Ar across the groups, both the ZOL, ZOL-EPI, and ZOL-EPI-MD groups exhibited higher levels of NVB.Ar/B.Ar, with the ZOL-EPI-MD group showing the highest NVB.Ar/B.Ar compared to ZOL and the other groups. In conclusion, MD, as a standalone treatment, showed neither effectiveness nor safety in the management of EPI in rats that received high doses of zoledronate. 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

Objective: To evaluate the clinical success outcomes and risk factors associated with dental implants placed with simultaneous bone augmentation in a large-scale, real-world cohort. Methods: A retrospective analysis was conducted on 158,824 implants, including 45,715 Dental Bone Grafts, placed between 2014 and 2022 within a national healthcare network. Multivariate Generalized Estimating Equations were utilized to assess the impact of demographic, anatomical, and procedural variables on implant failure. Results: The augmented cohort demonstrated a high clinical success rate of 97.83% (2.17% failure), statistically comparable to the general implant population. Failures were predominantly early (<1 year), accounting for 70% of losses. Significant independent risk factors included immediate implant placement (3.08% failure vs. 2.07% for delayed), male gender, and maxillary location. Notably, low socioeconomic status (SES) emerged as a significant predictor, with a failure rate of 3.07% compared to 2.06% in high-SES groups. Conclusions: Simultaneous bone augmentation is a predictable modality that does not inherently increase implant failure risk, supporting the stabilization hypothesis. However, failure is modulated by specific variables. The identification of lower SES, male gender, and immediate placement as significant risk indicators highlights the necessity for personalized risk assessment and targeted protocols to optimize outcomes in augmented sites. Full article