Search Results (104)

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Implant primary stability is a prerequisite for obtaining osseointegration and clinical success. Insertion torque (IT) is measured during implant placement and is expressed in Ncm. It represents the quantification of the frictional force experienced by the implant as it progresses apically through a rotational motion along its axis. Usually, to achieve osseointegration, a value within the range of 20–40 Ncm is desirable. Below a threshold of 20 Ncm, implants have a decrease in survival rate, while implant stability is guaranteed above 20 Ncm. The main goal of this study was to evaluate whether high values of IT affect osseointegration, implant health, and healing, by highlighting the positive and negative effects of IT > 50 Ncm on peri-implant bone, soft tissues, and long-term stability. This scoping review considered randomized clinical trials, observational studies, and cohort studies. Studies failing to meet the predefined inclusion criteria were excluded from the analysis. The review process adhered to the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines. Ultimately, a total of 11 studies were included in the final synthesis. Based on the studies included, the literature suggests that high values of IT guarantee adequate primary stability and better osseointegration. However, high IT is significantly associated with greater marginal bone loss, depending on bone density. Accordingly, IT values > 50 Ncm may provoke greater compressive forces with a negative impact on the jawbone. An elevated strain on the bone can induce necrosis and ischemia, due to an alteration of circulation, which in turn is responsible for marginal bone loss and reduced osseointegration. Lack of osseointegration ultimately leads to an early implant failure. As concerns soft tissue recession, a higher decrease is measured in implants placed with high-insertion torque. Nonetheless, additional clinical trials are warranted to assess long-term outcomes, quantify the incidence of these complications, and explore the impact of emerging clinical variables. Full article

Effective bone tissue regeneration remains pivotal in implant dentistry, particularly for edentulous patients with compromised alveolar bone due to atrophy and sinus pneumatization. Biomaterials are essential for promoting regenerative processes by supporting cellular recruitment, vascularization, and osteogenesis. This study presents the development and characterization of a novel lithography-printed ceramic β-TCP scaffold, with a macro/micro-porous lattice, engineered to optimize osteoconduction and mechanical stability. Morphological, structural, and biomechanical assessments confirmed a reproducible microarchitecture with suitable porosity and load-bearing capacity. The scaffold was also employed for maxillary sinus augmentation, with postoperative evaluation using micro computed tomography, synchrotron imaging, histology, and Fourier Transform Infrared Imaging analysis, demonstrating active bone regeneration, scaffold resorption, and formation of mineralized tissue. Advanced imaging supported by deep learning tools revealed a well-organized osteocyte network and high-quality bone, underscoring the scaffold’s biocompatibility and osteoconductive efficacy. These findings support the application of these 3D-printed β-TCP scaffolds in regenerative dental medicine, facilitating tissue regeneration in complex jawbone deficiencies. Full article

Objectives: Traditional 2D cell cultures on flat surfaces fail to replicate 3D environments, affecting cellular morphology and function. Various 3D techniques (e.g., spheroids, organoids, organs-on-chips, 3D bioprinting) have been used for disease modelling and drug testing, but their application in hard tissues remains challenging. This study aimed to develop a biocompatible 3D culture method for bone tissue organoids using human bone marrow-derived stem cells (hBMSCs) and hydrogels. Methods: hBMSCs were isolated from human jawbone marrow. The control group was cultured under 2D conditions, whereas the experimental group was cultured in a 3D hydrogel environment. In vitro analyses, including flow cytometry and RNA sequencing, were performed. Quantitative data were statistically analysed at a 0.05 level of significance. Results: hBMSCs cultured in 3D hydrogel conditions indicated enhanced reproducibility, increased cell viability, and significant osteogenic differentiation. Genes such as MMP-13, LPL, and SP7 showed substantially higher expression in 3D cultures, with protein-level confirmation by Western blot. These findings suggest that 3D culture more effectively supports the natural growth and differentiation of hBMSCs. Conclusions: Culturing hBMSCs in a 3D environment more closely mimics in vivo conditions, thus promoting the expression and activity of critical proteins involved in hBMSC differentiation. Full article

Background/Objectives: Immune cells are integral to bone homeostasis, including the repair and remodeling of bone tissue. Chronic dysregulation within this osteoimmune network can lead to bone marrow defects of the jaw (BMDJ), particularly fatty degenerative osteonecrosis of the jaw (FDOJ). These localized pathologies are implicated in systemic immune dysfunctions. Methods: This study is designed to determine whether BMDJ/FDOJ samples are indicative of medullary bone pathology by evaluating FDOJ gene expression patterns using quantitative real-time PCR. Results: Comparative analyses between pathological and healthy samples evaluated the dysregulation of key molecular pathways. BMDJ/FDOJ samples showed significant upregulation of inflammatory mediators, including CCL5/RANTES, VEGF, IGF and KOR, and downregulation of structural proteins, such as collagen types I, II and IV, and osteogenesis-associated factors, such as SP7. Conclusions: The study provides new insights into the molecular mechanisms of BMDJ/FDOJ by identifying potential molecular changes suggesting a pro-inflammatory state in the affected jawbone which may contribute to systemic immune dysregulation. The findings are consistent with morphologic observations of BMDJ/FDOJ in degenerated jawbone and underscore the need for integrative approaches in dentistry and medicine while highlighting BMDJ/FDOJ as a potential target for therapeutic and preventive strategies against systemic diseases and emphasizing its clinical significance. Full article

Mastication exerts a significant influence on both the structural and immunological environment of the jawbone. The mechanical stress generated during chewing initiates bone remodeling through the coordinated activities of osteoclasts and osteoblasts, with these processes being modulated by immune cell responses. This review summarizes the interaction between masticatory forces and jawbone immunity, focusing on key mechanisms such as mechanotransduction in osteocytes, macrophage polarization, and the activation of T cells. The review also delves into the role of the receptor activator of nuclear factor κ-B ligand (RANKL), receptor activator of nuclear factor κ-B (RANK), and osteoprotegerin (OPG) signaling pathway, highlighting its critical function in bone resorption and immune regulation. Additionally, the review summarizes how masticatory forces modulate the immune response through changes in immune cells, particularly focusing on cytokines, and the involvement of hormonal and molecular pathways. These findings provide valuable insights into the complex interplay between mechanical forces and immune cells, with implications for bone health. Full article

Background: Oral squamous cell carcinoma (OSCC) frequently invades the jawbone, leading to diagnostic and therapeutic challenges. While tumor–bone interactions have been studied, the specific roles of dental follicle cells (DFCs) and periodontal ligament cells (PDLCs) in OSCC-associated bone resorption remain unclear. This study aimed to compare the effects of DFCs and PDLCs on OSCC-induced bone invasion and elucidate the underlying mechanisms. Methods: Primary human DFCs and PDLCs were isolated from extracted third molars and characterized by Giemsa and immunofluorescence staining. An in vitro co-culture system and an in vivo xenograft mouse model were established using the HSC-2 OSCC cell line. Tumor invasion and osteoclast activation were assessed by hematoxylin and eosin (HE) and tartrate-resistant acid phosphatase (TRAP) staining. Immunohistochemical analysis was performed to evaluate the expression of receptor activator of NF-κB ligand (RANKL) and parathyroid hormone-related peptide (PTHrP). Results: DFCs significantly enhanced OSCC-induced bone resorption by promoting osteoclastogenesis and upregulating RANKL and PTHrP expression. In contrast, PDLCs suppressed RANKL expression and partially modulated PTHrP levels, thereby reducing osteoclast activity. Conclusions: DFCs and PDLCs exert opposite regulatory effects on OSCC-associated bone destruction. These findings underscore the importance of stromal heterogeneity and highlight the therapeutic potential of targeting specific stromal–tumor interactions to mitigate bone-invasive OSCC. Full article

Medication-related osteonecrosis of the jaw (MRONJ) is a multifactorial condition defined as an adverse drug reaction that results in progressive jawbone destruction and necrosis in individuals treated with certain medications, occurring without a history of prior radiotherapy. These drugs are mainly bisphosphonates, denosumab, and other bone-modifying agents, anti-angiogenic agents such as anti-endothelial growth factor, tyrosine kinase inhibitors, and proteins classified as mammalian targets of rapamycin. The diagnosis of MRONJ is based on clinical (exposed jawbone, fistula with pus, hyperplasia of the mucosa overlying the necrotic bone tissue) and radiological evaluation. We report four cases of clinical and radiological evidence of osteonecrosis of the jaw that are unrelated to the use of antiresorptive or anti-angiogenic agents. In two instances, histological and microbiological evidence was also found (high concentration of Actinomyces, the microbe most commonly found in oral sites affected by MRONJ). These atypical cases are reported to highlight the possibility that other, previously undocumented, drugs may also contribute to the development of ONJ Full article

(1) Background: A decrease in bone mineral density has been noted not only in at-risk patients (e.g., postmenopausal women) but also in young and middle-aged individuals due to changes in lifestyle. The aim of the study was to find a possible correlation for dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) with cone beam computed tomography (CBCT) of the jaws. (2) Methods: A total of 24 patients (14 women and 10 men aged 25 to 50 years) with partial secondary tooth loss and vitamin D insufficiency underwent cone beam computed tomography of the jaws and skeletal mineral density assessment using DXA (n = 12) and QCT (n = 12). (3) Results: When conducting CBCT of the jaws, a predominance of bone tissue type D3 (350–850 Hu) on the upper jaw (p > 0.05 (F = 0.68) and D2 (850–1350 Hu) on the lower jaw (p > 0.05 (F = 1) was revealed. According to the results of QCT densitometry of the skeleton, signs of osteopenia were found in four patients (with vitamin D3 deficiency) (33%) according to DXA; signs of osteopenia were found in six patients (with severe deficiency and deficiency of vitamin D3) (50%). The difference between QCT and DXA was not significant (p > 0.05) for each group. The significant strong correlation between CBCT and DXA or QCT was not found (p > 0.05). (4) Conclusions: Primary changes in bone density can be detected earlier in the dental system using cone beam computed tomography of the jaws. At the same time, the question of using a specific densitometry method—DXA or QCT—remains open, as their results correlating with CBCT optical density was not approved. Full article

The aim of the study was to evaluate the effect of titanium implants (Ti6Al4V) on the surrounding tissues by analyzing the concentration of titanium particles, TNF-α, and caspase-3 in patients treated for jaw fractures and dentofacial deformities. The research material consisted of peri-implant tissues: fragments of periosteum adhering to a titanium miniplate and blood serum collected from 42 patients treated for mandibular fractures (Group I), and dentofacial deformities (Group II) who underwent bimaxillary osteotomy. The control group consisted of 24 generally healthy patients before bimaxillary osteotomy. The concentrations of selected cytokines, caspase-3, TNF-α in blood serum, and homogenized tissues, were determined using the immunoenzymatic method (ELISA). The concentration of titanium particles was assessed using a scanning electron microscope equipped with an X-ray microanalyzer. A significant increase in the concentration of titanium, caspase-3, and TNF-α was observed in serum and periosteum in all patients who underwent bone fixation. Increased TNF-α levels indicate an intense immune response, which may lead to the degradation of peri-implant tissues and bone resorption around the miniplates and screws, while an increase in caspase-3 levels suggests that cells surrounding the implants are destroyed in response to inflammatory stress or damage induced by the presence of titanium particles. Full article

Prosthetics, a rapidly advancing field in dentistry, aims to improve patient comfort and aesthetics by addressing the challenge of replacing missing teeth. A critical obstacle in dental implantation is the condition of the jawbone, which often necessitates reconstruction prior to implant placement. Guided bone regeneration (GBR) and guided tissue regeneration (GTR) techniques utilize membranes that act as scaffolds for bone and tissue growth while serving as barriers against rapidly proliferating cells and pathogens. Commonly used membranes, such as poly(tetrafluoroethylene) (PTFE) and collagen, have significant limitations—PTFE is non-bioresorbable and requires secondary removal, while collagen lacks adequate mechanical strength and exhibits unpredictable degradation rates. To overcome these challenges, nanofiber membranes produced via electrospinning using polylactic acid (PLA) were developed. The novel composites were functionalized with bioactive additives, including periclase (MgO) nanoparticles and polydopamine (PDA), to enhance osteoblast adhesion, antibacterial properties, and tissue regeneration. This study comprehensively evaluated the biological, mechanical, and physicochemical properties of the prepared nanofibrous scaffolds. Experimental results revealed controlled degradation rates and improved hydrophilicity due to surface modifications with PDA and MgO. Moreover, the nanofibers exhibited enhanced swelling behavior, which promoted nutrient exchange while maintaining structural integrity over prolonged periods. The incorporation of bioactive additives contributed to superior osteoblast proliferation, antibacterial activity, and growth factor immobilization, supporting bone tissue regeneration. These findings suggest that the developed nanofibrous composites are a promising candidate for GBR and GTR applications, offering a balanced combination of biological activity, mechanical performance, and degradation behavior tailored for clinical use. Full article

Fatty degenerative osteonecrosis of the jaw (FDOJ) is a chronic, aseptic inflammatory condition that is characterized by molecular disruptions in bone metabolism and necrotic bone marrow within the jawbone cavities. In contrast to the overt clinical signs typically observed in osteopathies, FDOJ frequently presents with a “silent inflammation” phenotype. The electronic databases PubMed, Scopus, and Embase were searched using appropriate search terms, and the methodology was performed according to PRISMA-ScR guidelines. The elevated expression of inflammatory mediators, particularly C-C motif Chemokine Ligand-5/Regulated on Activation, Normal T Cell Expressed and Secreted (CCL5/RANTES), fibroblast growth factor-2, and interleukin-1 receptor antagonist, distinguishes FDOJ at the molecular level and links it to systemic inflammatory and autoimmune diseases. These immunohistochemical markers play a pivotal role in the pathogenesis of chronic inflammation, immune response regulation, and abnormal bone remodeling. Advanced diagnostic tools, such as conebeam computed tomography and trans-alveolar ultrasonography, facilitate the detection of pathological changes that are not easily discernible with conventional radiography. Surgical intervention remains the primary treatment modality, often complemented by therapies that target these molecular pathways to modulate chronic inflammation. This article underscores the importance of integrating molecular diagnostics, advanced imaging, and clinical data for effective FDOJ detection and management. Full article

Background/Objectives: Large cystic lesions in the maxillofacial region present a challenge for clinicians due to their impact on the health and functionality of the involved teeth. This longitudinal, ambidirectional cohort study aimed to evaluate the prognosis of vital teeth affected by large cystic lesions following surgical intervention. Methods: Data were gathered from patients at King Abdulaziz University Dental Hospital and King Fahad General Hospital in Jeddah, Saudi Arabia, between July 2021 and August 2022. Seventeen individuals with large jawbone cysts were included in the study. Clinical and radiographic assessments were performed including sensibility testing and the function of teeth. The results indicated a linear relationship between the size of postoperative bony defects and the sensibility testing of teeth. Results: Of the 63 examined teeth, 54% did not receive endodontic treatment, 33% had pre-surgical treatment, and 12.7% had post-surgical treatment. The study revealed a high prevalence of inflammatory cysts, particularly in the maxilla. Surgical enucleation was the primary treatment modality, with few postoperative complications. Conclusions: This study highlights the necessity for standardized follow-up protocols and more extensive research to develop universal guidelines for managing large cystic lesions affecting vital teeth. Understanding the prognosis of cystic lesions is crucial for effective treatment planning and ensuring optimal patient outcomes. Full article

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a common adverse event following antiresorptive treatment, leading to chronic inflammation and exposed, necrotic bone surfaces in the jawbone. There is an increasing recognition of the role of compositional changes in the colonizing members of the oral microbiota implicated in triggering and/or maintaining MRONJ. The aim of our study was to characterize the culturable and non-culturable microbiota—with particular focus on Actinomyces spp. and Actinomyces-like organisms (ALOs)—from surgically removed bone samples of MRONJ patients and healthy control subjects. Methods: n = 35 patients (median age: 70 years) in various stages of MRONJ, with a history of receiving oral or intravenous antiresorptive treatment were included in the study. The controls (n = 35; median age: 35 years) consisted of otherwise healthy individuals undergoing tooth extraction. Traditional, quantitative, aerobic, and anaerobic culture, and Actinomyces-specific PCR was performed for all bone samples from patients and controls, while microbiome analyses—based on 16S rRNA sequencing—were carried out in 5-5 randomly selected samples. Mann–Whitney U test, Wilcoxon rank sum test (alpha diversity), and PERMANOVA analysis (beta diversity) were performed. Results: In MRONJ samples, 185 anaerobic isolates, corresponding to 65 different species were identified (vs. 72 isolates, corresponding to 27 different species in the control group). The detection of Actinomyces spp. and ALOs was more common in MRONJ bone samples, based on traditional culture (65.7% vs. 17.1%; p < 0.001) and PCR (82.9% vs. 37.1%; p < 0.001), respectively. The isolation of Fusobacterium spp. (22 vs. 7; p = 0.001), Prevotella spp. (22 vs. 6; p = 0.034), and Gram-positive anaerobic cocci (GPAC) (30 vs. 9; p = 0.016) was significantly more common in MRONJ patient samples. The microbiota of the controls’ bone samples were characterized by a considerable dominance of Streptococcus spp. and Veillonella spp, while the bacterial abundance rates were substantially more heterogeneous in MRONJ bone samples. Notable differences were not observed among the samples related to the abundance of Actinomyces in the bone microbiota. Conclusions: According to the “infection hypothesis”, alterations in the oral microbiome—with Actinomyces and ALOs being the most relevant—may play a key role in the development, aggravation, and progression of MRONJ. The timely detection of Actinomyces in necrotic bone is crucial, as it has important therapeutic implications. Full article

Background/Objectives: This study investigates stress distribution in cancellous bone during pilot drilling for dental implants using the Cowper–Symonds model. Understanding the biomechanical effects of drilling parameters on bone health is essential for optimizing implant stability and longevity. Methods: A finite element analysis (FEA) approach was employed to simulate the pilot drilling process in cancellous bone. A three-dimensional jawbone model was developed from CT scan data, processed using 3D Slicer, and refined with CAD tools. The drilling simulation incorporated a rigid pilot drill and flexible cancellous bone, utilizing explicit dynamic methods. Stress distribution was evaluated for drilling depths ranging from 6 mm to 16 mm, with mesh density and strain rate effects considered to ensure accuracy. Results: The results showed an increase in stress levels with drilling depth, with maximum stress recorded at 16 mm. Initial contact stress was 17.3 MPa, rising to 228.9 MPa at deeper penetration due to increased interaction between the drill and bone. Stress distribution patterns emphasized the critical role of drilling depth and design parameters in mitigating bone damage. Conclusions: This study highlights the importance of optimized drilling protocols and pilot drill design to reduce stress and preserve bone integrity. The findings provide valuable insights into improving implant procedures and demonstrate the utility of FEA as a robust tool for evaluating biomechanical impacts during implant placement. Future research should incorporate cortical bone and thermal effects for a comprehensive analysis. Full article