Search Results (1,004)

Background: Computer-assisted implant surgery (CAIS) aims to improve placement accuracy versus freehand drilling. We compared the three-dimensional accuracy of robot-guided CAIS (r-CAIS), dynamic navigation (d-CAIS), static-template guidance (s-CAIS), and freehand (FH) in clinical and in vitro settings. Methods: We searched PubMed/MEDLINE, Scopus, and Web of Science (1 January 2019–2025). Eligible populations were adults receiving conventional or zygomatic implants in vivo, plus validated in vitro human-jaw models using plan-versus-placement workflows; studies had to report study-level means with dispersion for ≥1 primary outcome with ≥5 implants per arm. Interventions were r-CAIS, d-CAIS, or s-CAIS; with a baseline as the freehand technique. Risk of bias used RoB 2 (RCTs), ROBINS-I (non-randomized clinical), and QUIN (in vitro). Because of heterogeneity in definitions and workflows, we performed a descriptive synthesis by modality (no meta-analysis). Registration: OSF. Results: Forty-three studies (7 RCTs, 10 non-randomized clinical, 26 in vitro) reported more than 4000 implants. Across studies, typical study-level means for global linear deviation clustered around < 1 mm (r-CAIS), ~1 mm (d-CAIS), ~1.3 mm (s-CAIS), and ~1.8 mm (FH). In clinical contexts, d-CAIS often showed slightly lower angular deviation than s-CAIS. Conclusions: CAIS improves accuracy versus freehand. d-CAIS and s-CAIS show similar linear accuracy, with d-CAIS frequently yielding slightly lower angular deviation; r-CAIS exhibits tight error clusters in our dataset, but limited comparative clinical evidence precludes superiority claims. Limitations: non-uniform registration/measurement, variable operator experience, and absence of meta-analysis. Full article

Ceramic dental implants, particularly one-piece zirconia, offer a biocompatible and aesthetic alternative to titanium, with high strength and improved oral hygiene. By eliminating the implant–abutment micro-gap, they reduce bacterial accumulation because of their low plaque affinity and enhance stability. However, challenges remain, including alignment precision, limited retrievability, and sensitivity to mechanical stress. Misalignment can affect occlusal and functional outcomes, and zirconia’s rigidity complicates crown removal and modification. This case report explores the use of PEEK (polyether ether ketone) primary telescopic crowns to overcome these limitations, improving force distribution, enabling minor adjustments, and enhancing prosthetic retrievability in full-mouth zirconia restorations. A 62-year-old male patient seeking a fixed solution to replace removable dentures received 16 one-piece zirconia implants (eight per jaw). PEEK telescopic crowns were used over implant abutment copings, finalized with aesthetic zirconia bridges. The report details surgical and prosthetic procedures, along with a brief literature review on zirconia implants and PEEK applications. PEEK integration in telescopic prosthetic designs marks a notable advancement in prosthodontics. Its shock-absorbing, biocompatible, and stress-modulating properties make it valuable for implant-supported and hybrid restorations. As digital workflows advance, PEEK-based telescopic restorations may increasingly replace traditional metal-based solutions, improving long-term clinical outcomes. Further clinical research on a larger sample is needed. Full article

Background: Artificial intelligence technologies are increasingly integrated into dental practice, offering potential improvements in diagnostic accuracy, treatment planning, and patient outcomes. However, the extent and quality of evidence supporting these applications remain unclear. Methodology: We conducted a systematic literature search using PubMed, Cochrane Library, Embase, and IEEE Xplore databases from January 2015 to December 2024. Search terms included combinations of “artificial intelligence,” “machine learning,” “deep learning,” “dentistry,” “diagnosis,” and “treatment planning.” Studies evaluating AI systems in clinical or laboratory settings with measurable outcomes were included. Data extraction followed PRISMA guidelines, and methodological quality was assessed using the QUADAS-2 tool. Results: Twenty-three studies met the inclusion criteria. Most focused on diagnostic accuracy (n = 21), with few addressing treatment planning (n = 1) or outcome prediction (n = 1). Reported accuracies ranged from 82–94% for caries detection, 85–92% for periodontal disease assessment, and 88–96% for oral lesion identification. Orthodontic applications achieved 95–98% accuracy in cephalometric landmark identification, while implant planning studies demonstrated up to 96% agreement with expert strategies. Despite promising technical performance, 79% of studies were retrospective and conducted in controlled research settings, with limited external or prospective clinical validation. Risk of bias was highest in patient selection due to frequent use of case–control designs and archived imaging datasets. Conclusions: AI shows significant promise for enhancing dental diagnostics and treatment planning. However, most applications require further clinical validation before routine implementation. The disconnect between laboratory performance and real-world clinical validation represents a critical gap that must be addressed. Current AI systems should be viewed as diagnostic aids rather than replacements for clinical judgment. Practitioners considering AI adoption should understand current limitations and evidence quality, particularly the lack of prospective clinical validation in diverse populations. Full article

Objective: The Ti6Al4V titanium alloy is widely used for dental implants because of its excellent mechanical properties, corrosion resistance, and biocompatibility. However, its bioinert surface limits both osseointegration and resistance to bacterial colonization. Methods: To address these challenges, this study develops a composite coating based on calcium phosphate (CaP) and silver (Ag), reinforced with zirconium oxide (ZrO₂). The coating was deposited on Ti6Al4V using an immersion technique to improve the surface properties of the alloy. Electrochemical analyses (OCP, EIS, and potentiodynamic polarization) were performed in simulated physiological conditions to evaluate the corrosion behavior, while SEM/EDS was used to characterize the surface morphology and composition. Results: The Ag- and Zr-containing CaP coatings significantly improved the corrosion resistance of Ti6Al4V compared with uncoated and CaP-coated samples. Conclusions: This approach provides a promising strategy to enhance the electrochemical stability and long-term durability of titanium dental implants, thereby contributing to their reliable performance in the oral environment. Full article

Microbial colonization is a major factor contributing to peri-implantitis, and creating durable glassy surfaces with antimicrobial agents such as silver and copper may reduce microbial accumulation on dental abutments. This study aimed to develop antimicrobial thin-film glassy surfaces on Ti6Al4V alloy and to evaluate their surface and mechanical properties, antimicrobial effectiveness, and biocompatibility before and after thermal aging. A sol–gel-derived glassy matrix (G) was synthesized, and two antimicrobial coatings were prepared by incorporating ionic Ag (GAg) or a combination of Ag/Cu (GAgCu). Ti6Al4V specimens; these were either left uncoated or dip-coated with G, GAg, or GAgCu and cured at 450 °C. Half of the specimens underwent thermal aging between 5 °C and 55 °C for 3000 cycles. Surface roughness, contact angle, hardness, adhesion strength, scratch resistance, cytotoxicity (Agar diffusion and MTT assay on L929 fibroblasts), and microbial adhesion were evaluated using Streptococcus sanguinis, Porphyromonas gingivalis, and Candida albicans as representative oral microorganisms. Both coatings exhibited low surface roughness, hydrophilic surfaces, improved hardness, and significantly reduced microbial adhesion for all tested species. GAg showed superior mechanical properties, whereas GAgCu demonstrated a relatively stronger antimicrobial effect. Cytotoxicity tests indicated that all coatings were biocompatible at levels suitable for oral use. Overall, these coatings demonstrated strong adhesion, durability, and antimicrobial activity, suggesting their suitability for dental abutments made of Ti6Al4V. Full article

In guided bone regeneration (GBR) procedures, d-PTFE membranes are often used as a barrier to promote alveolar ridge regeneration. The aim of this randomized clinical trial was to examine the microbial diversity and structure of biofilms on two types of d-PTFE membranes, Permamem^® and Cytoplast™, over four-week oral cavity exposure periods. Bacterial biofilm analysis was performed using 16S rRNA next-generation sequencing (NGS) on 36 samples (20 Permamem^® and 16 Cytoplast™). The results showed significant differences in the microbial profiles: Cytoplast™ membranes showed reduced microbial diversity and an enhanced proportion of pathobionts like Selenomonas, Segatella, Fusobacterium and Parvimonas, which are associated with periodontal and peri-implant diseases and alveolar bone loss. Permamem^® membranes promoted colonization by bacteria associated with healthy oral conditions, such as the genera Streptococcus, Kingella and Corynebacterium. Overall, our results showed that Cytoplast™ membranes generate a specific type of biofilm, leading to reduction in health-related bacterial species and facilitating growth conditions for dysbiosis shift. Further research and patient follow-ups are essential to thoroughly evaluate the clinical implications of different d-PTFE membranes used in guided bone regeneration. Full article

Fractional laser photothermolysis, long established in dermatology, enables controlled microthermal injury that stimulates repair without scarring, but its potential in oral tissue regeneration has not been systematically explored. In this study, we conducted the first controlled experimental evaluation of a 1550 nm erbium fiber laser for oral mucosa regeneration. Thirty-two rabbits underwent fractional photothermolysis at energy levels of 70, 100 and 130 kJ, with gingival biopsies collected at 1, 14, 28 and 42 days for histological and immunohistochemical assessment of epithelial repair, stromal remodeling, inflammation and angiogenesis. All energy modes produced microcoagulation columns followed by progressive epithelial thickening, fibroblast proliferation and neoangiogenesis. The 70 kJ mode occasionally led to residual fibrosis, whereas higher energies (100–130 kJ) promoted effective connective tissue remodeling and de novo tissue formation without scarring. Complete epithelial recovery occurred within two weeks, indicating a safe and optimal interval for repeated exposure. Overall, the results demonstrate that 1550 nm fractional photothermolysis is a safe and effective method to induce regenerative responses in oral tissues, establishing a foundation for its translational application in periodontal and peri-implant regeneration. Full article

Candida species are common commensals within the human microbiome but can transition opportunistically to pathogenic states when host–microbe homeostasis is disrupted. Their ability to adhere to mucosa and implanted medical devices, form thick biofilms, and invade epithelial tissues makes candidiasis particularly harmful in immunocompromised and elderly populations. This review examines the reported antifungal activity of common probiotic genera such as Lactobacillus, Bacillus, Bifidobacterium, and Saccharomyces across the oral cavity, gastrointestinal tract, and vaginal tract. The probiotic mechanisms of action, such as competitive exclusion, secretion of antifungal metabolites, and immunomodulation, are explored in detail, and research methodologies are scrutinised to assess the robustness of current evidence. This review compiles evidence from a variety of studies and clinical trials showing certain probiotic strains and formulations have the ability to significantly decrease Candida colonisation and reduce candidiasis symptom prevalence. Although outcomes vary greatly between probiotic strains tested, species of Candida targeted, and specific site of infection, it is clear that selected probiotic species and their secreted substances can have prominent anti-Candida effects and promote tangible clinical improvements. Future directions for the field of probiotic study are suggested, including the roles of prebiotics, postbiotics, and synbiotic formulations to enhance probiotic efficacy against candidiasis. Full article

Computer-assisted surgery (CAS) and virtual surgical planning (VSP) have transformed jaw reconstruction, allowing immediate insertion of dental implants during surgery for better rehabilitation of occlusal function. However, traditional planning for optimal location and angulation of dental implants and fibula relies on experience and can be time-consuming. This study aimed to propose a function-driven workflow and develop an automatic computer program for optimal positioning of simultaneous dental implants and fibula segments. A customized computer program was developed using MATLAB. Computed tomography (CT) of the lower limbs of ninety-one Southern Chinese individuals was retrieved and cross-sections of three-dimensional (3D) fibula models were comprehensively investigated for implant installation. Our research proves that the accuracy of the program in identifying the anatomical orientation of the fibula was 92%. The ideal location, angulation and length of implant could be automatically generated based on any selected implant diameter, with a surgical feasibility of 94%. To the best of our knowledge, this is the first study to develop and validate a customized automatic computer program for osseointegrated implant design in fibula flap surgery. This program can be incorporated into the current workflow of CAS to further the development of reliable and efficient surgical planning for function-driven jaw reconstruction. Full article

Background/Objectives: For most adults receiving a cochlear implant (CI), the primary goal is to enhance their oral communication with others. The aim of this study was to investigate the total CI usage time per day among retired CI users and to characterize in which auditory environments they were using their CI. One additional aim was to analyze whether usage time, auditory environment, or social factors influenced CI speech perception. Methods: Participants completed a questionnaire addressing retirement status, whether they lived with another adult, educational level, and participation in social activities. Speech perception scores were obtained from medical records, and CI datalogging was extracted from the CI programming software. Results: Seventy-three CI users aged >65 years were included. The average usage was 12.9 h/day. No statistically significant correlations were found between total usage time or time spent listening to speech and CI speech perception. CI users who regularly met with family or friends had statistically significantly higher CI speech perception than those who did not (p = 0.003). Conclusions: Social interaction may play a crucial role in supporting speech perception among elderly CI users. Opportunities for communication and participation in social life appear to be important for maximizing benefit. Full article

Background/Objectives: In staphylococcal implant infections, there is often discussion about the optimal postoperative timing of the introduction of rifampicin in the postoperative period with open wounds. Methods: We reviewed all adult patients with residual staphylococcal implant infections between January 2014 and May 2024. We analyzed the delay to rifampicin use in relation to therapeutic failures, infection recurrences, and development of ultimate rifampicin resistance. Results: Among 103 independent infection episodes, 47 (46%) contained the pathogen S. aureus, and the remainder were different coagulase-negative staphylococci. The median number of surgical interventions was one, and the median duration of postsurgical systemic antibiotic treatment was 84 days (interquartile range (IQR), 42–84 d). The median daily dose of oral rifampicin was 900 mg, and the median delay in its introduction was 5 days (IQR, 3–8 d). Overall, 18% of patients experienced an adverse event related to rifampicin (mostly gastrointestinal), requiring treatment to be stopped. The incidences of clinical failures and of microbiologically identical recurrences were 27% and 10%, respectively. The risk of rifampin resistance among any new staphylococcal infection or colonization during a median follow-up of 1.9 years was 1%. In the multivariate Cox regression analysis, the delay in rifampicin administration, its dose, or its duration failed to alter outcomes. Conclusions: In our retrospective cohort of staphylococcal orthopedic implant infections, the timing of rifampicin introduction failed to alter clinical and microbiological outcomes. Full article

This work investigates and compare the corrosion behavior in artificial saliva of oxide thin films grown on commercially pure titanium (cp-Ti), via electrochemical oxidation (EO) in sulphate bath at 1 V and thermal treatment (TT) at 450 °C, for durations between 20 min and 4 h. The goal is to determine which method and duration provide the optimal protection for titanium against degradation in dental environment particularly in varying fluoride concentration and acidity. Surface characterizations were performed through morphological and microstructural analysis using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD). Electrochemical behavior was conducted in Fusayama-Meyer solution (pH = 6.50 and T = 37 °C) using potentiodynamic polarization curve (PPC) and electrochemical impedance spectroscopy (EIS), under varying pH and fluoride ion concentrations. The results demonstrated that a 3-h duration treatment provided the optimal corrosion resistance for both EO and TT processes. The pH of the environment influenced corrosion performance markedly: both acidic (pH 2.5) and basic (pH 9.0) conditions increased I_corr and decreased R_p, indicating degradation of the passive oxide layer outside neutral conditions. Similarly, increasing fluoride concentrations (1000; 5000; and 12,300 ppm) significantly impaired corrosion resistance. At 12,300 ppm F⁻, untreated Ti showed severe degradation, with EIS revealing the formation of a porous outer layer and a weakened inner barrier layer (R_f = 33 W·cm² for the outer layer and R_ct = 21 kW·cm² for the barrier layer). In contrast, the TT-treated surface remained highly protective even under these aggressive conditions, with minimal surface damage and the highest resistances for both the outer and the inner layers (R_f = 1610 kW·cm²; R_ct = 1583 kW·cm²), significantly outperforming the EO film. These findings highlight the superior performance of thermal oxidation at 450 °C for 3 h as a promising surface treatment for enhancing the corrosion resistance of titanium in fluoride-rich oral environments. Understanding these strategies helps improve the longevity and security of titanium dental implants. Full article

Background/Objectives: Chlorhexidine (CHX)-based mouthwashes are the most commonly used chemical methods as adjuvants for the treatment of peri-implant diseases, but there is a lack of information on their effect on the peri-implant microbiota. The objective of this study was to evaluate the impact of short-time (15 days) self-administered 0.05% and 0.12% commercial chlorhexidine mouthwashes on the peri-implant pocket microbiota of patients with peri-implantitis. Methods: In this pilot study, we analyzed the microbial composition of peri-implant lesions in 22 patients before and after a 15-day regimen of thrice-daily use of two commercial chlorhexidine mouthwashes containing 0.05% (n = 11) and 0.12% chlorhexidine (n = 11). Microbial samples were collected using paper points, and the taxonomic composition was determined through sequencing of 16S rRNA gene amplicons using Illumina MiSeq. Results: Although individual responses to chlorhexidine mouthwash treatment varied significantly, neither concentration produced a statistically significant change in the microbial diversity associated with peri-implantitis, suggesting limited treatment penetration into peri-implant lesions. Similarly, changes in the abundance of specific odontopathogens were not statistically significant. Conclusions: We found no significant differences in the effect of mouthwashes with different chlorhexidine concentrations on the peri-implant microbiota in short-period applications. Even though more extensive studies are required, the observed patient-dependent outcomes of both chlorhexidine mouthwashes on the peri-implant microbiota and their limited effect in controlling the abundance of oral pathogens indicate that prescription of chlorhexidine mouthwashes for the treatment of peri-implantitis should be carried out with caution. Novel presentations of chlorhexidine with better penetration capacities should be developed, as they could offer enhanced benefits in managing peri-implant diseases. Full article

Background: Peri-implantitis is an inflammatory condition caused by bacterial plaque and several factors like diabetes, smoking, titanium bio-tribocorrosion, implant–abutment micromovements, occlusal overload, cement remnants, and poor oral hygiene, resulting in bone resorption. The aim of this review was to evaluate the relationship between titanium metal particles and the development of peri-implantitis, specifically the characterisation of the inflammatory response regarding cytokine profile, immune cell infiltration, and transcription factors up-regulated in the peri-implant sites. Methods: A systematic review was conducted following the PRISMA guidelines, from January 2004 to January 2025, in three databases: PubMed, Web of Science, and Wiley Library. The inclusion criteria included in vivo human studies and in vitro studies with a focus on bio-tribocorrosion of titanium particles in peri-implant tissues, and their immunological and cellular implications. Quality assessment of in vivo transversal and case–control studies used Joanna Briggs Institute Critical Appraisal Tools, and, for in vitro studies, the modified CONSORT checklist. Results: A total of 27 studies were included, 20 in vitro and 7 in vivo. Titanium particles induced the secretion of IL-1β, IL-6, and TNF-α by peri-implant cells, activation of the NLRP3 inflammasome, and RANKL/OPG bone resorption, further stimulating an exacerbated inflammatory response, LPS independent. There was a significant increase in IL-33, an alarmin, possibly associated with implant–pillar micromovements. IL-8 production by gingival stromal cells and fibroblasts, and downregulation of CCR7 can explain an altered leukocyte migration and the mixture of M1/M2 macrophage populations in peri-implantitis. Conclusions: Titanium particle bio-tribocorrosion stimulates a chronic inflammatory response impacting immune cell composition and cytokine secretion in peri-implant tissue, leading, ultimately, to osteolysis. Modulation of the immune response may contribute to the development of therapeutic strategies and the prevention of implant failure. Full article

Objective: Morphine is a widely used analgesic for severe pain, but tolerance is a major challenge in long-term pain management. This study examined the potential of Daflon^® to enhance morphine’s pain-relieving effects and to reduce tolerance in a rat model with neuropathic pain induced by partial sciatic nerve transection (PSNT). Methods: Male Wistar rats were divided into five groups: (1) Sham + Saline, (2) PSNT + Saline, (3) PSNT + morphine, (4) PSNT + Daflon, and (5) PSNT + morphine + Daflon. Morphine tolerance was induced through continuous intrathecal infusion (15 µg/µL/h, i.t.) for 7 days, starting on day 7 post-PSNT, while Daflon was administered orally (50 mg/kg/day, oral) for 7 days. Pain relief was assessed using tail-flick and paw withdrawal on days 1, 4, and 7 after osmotic pump implantation. Spinal cords were collected for immunohistochemistry to analyze glial expression, and serum biomarkers (TNF-α, IL-1β, IL-6, and IL-10) were measured to evaluate neuroinflammation. Results: The results showed that oral Daflon significantly enhanced morphine’s analgesic effects, evidenced by improved pain thresholds in all behavioral tests. Moreover, Daflon reduced morphine tolerance. Mechanistically, Daflon upregulated the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and activated heme oxygenase-1 (HO-1), reducing oxidative stress and modulating neuroinflammation through glial regulation. Combining morphine and Daflon reduces pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) and enhances anti-inflammatory IL-10 serum level, showing a synergistic effect in managing neuropathic pain with greater efficacy and lower drug dependence. Histology and immunohistochemistry evaluations further confirmed that morphine and Daflon co-treatment substantially reduced mononuclear cell infiltration, astrocyte activation (as indicated by GFAP expression), and microglial activation (as indicated by Iba-1 expression) compared to single treatment. Conclusions: Our findings suggest that dual therapy synergistically targets both oxidative stress and inflammatory pathways, leading to stronger neuroprotection and pain relief. Importantly, the combination approach may allow for lower opioid dosages, minimizing the risks of opioid-related side effects. Overall, morphine and Daflon co-administration offers a promising and safer strategy for managing neuropathic pain and preserving spinal cord integrity. Full article