Search Results (3,455)

Background/Objectives It is known that failure to gain sufficient bone during skeletal growth and maturation phases predisposes to the development of senile osteoporosis as age-related bone loss ensues. There is limited knowledge about factors that are necessary for the pubertal growth spurt and achievement of peak bone mass. Diminution or disappearance of Juvenile Protective Factors (JPFs) after a given maturational stage could contribute to the onset of age-related declines in a variety of physiological functions, including bone physiology. Methods With available pediatric platelet-poor plasma (PPP) and mesenchymal/skeletal stem cells (MSCs), we tested whether proteomics and RNA-seq methodology have potential for the discovery of novel regulators of pubertal skeletal growth. Results Our data demonstrate that pediatric PPP rejuvenates age-related compromised MSC functions; that Mass Spectrometry (MS)-based proteomics identified known and novel circulating tissue growth/trophic factors in human PPP of pubertal, as compared with pre-pubertal, and post-pubertal subjects; and that the unbiased RNA-Seq approach revealed new genes and networks of genes that are dramatically elevated or diminished in pubertal MSCs. Conclusions The findings support the hypothesis that the characterization of pro-osteogenic JPFs could lead to the identification of novel therapeutic approaches to promote bone health in the elderly and of potential treatment regimens for senile osteoporosis. Full article

Peri-implant marginal bone stability remains a major determinant of long-term implant success, yet clinical studies report early marginal bone changes ranging from near-stable conditions in some protocols to approximately 1–2 mm during the first year in more traditional series, underscoring considerable biological variability. In the present review, a remodeling-dominant state refers to turnover-led peri-implant adaptation with limited net cortical gain, whereas modeling-driven apposition refers to uncoupled surface bone addition and cortical reinforcement. We conducted a structured narrative review of PubMed/MEDLINE, Scopus, and Web of Science for literature published between 2000 and February 2026 and qualitatively synthesized direct peri-implant evidence, craniofacial/oral non-implant evidence, and extrapolative mechanobiology from long-bone and systemic models. The available literature supports osteocyte-centered SOST/Wnt regulation as biologically plausible for peri-implant cortical adaptation; however, direct human peri-implant molecular validation remains limited. Based on this synthesis, we propose a hypothesis-generating framework in which mechanical signal profile, microenvironmental stability, and host-related factors influence the probability of transition from a remodeling-dominant to a modeling-dominant peri-implant state. This framework should therefore be interpreted as a testable conceptual model rather than a validated peri-implant mechanism. Its main value lies in organizing current evidence and defining priorities for translational studies that integrate molecular, imaging, and biomechanical endpoints. Full article

Background: Excessive gingival display is frequently associated with upper lip hypermobility and represents a common aesthetic concern. Several therapeutic approaches have been proposed, including botulinum toxin type A injections, lip repositioning surgery (LRS), and combined techniques; however, no clear consensus exists regarding the most effective and stable treatment option. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) guidelines. A comprehensive search of multiple electronic databases was performed, leading to the inclusion of 17 human studies that met predefined PICOS criteria. The review protocol was registered in PROSPERO (CRD420261281920). Results: Most included studies reported favorable outcomes in terms of reduction in gingival display, improvement in smile aesthetics, and patient satisfaction. No major adverse effects were reported, suggesting acceptable safety profiles for all therapeutic modalities. Outcomes varied depending on the type of intervention, surgical technique, botulinum toxin dosage and injection protocol, and the initial severity of upper lip hypermobility. Conclusions: Both botulinum toxin injections and LRS demonstrated effectiveness in reducing excessive gingival display. Botulinum toxin provided a rapid but temporary improvement, whereas modified LRS showed greater stability over time. Combined approaches appeared to offer the most consistent long-term results by limiting postoperative relapse. Further standardized protocols and long-term clinical studies are needed to confirm these findings and support evidence-based clinical decision-making. Full article

Introduction: Pancreatic cancer is one of the most lethal malignancies worldwide, and its incidence continues to rise. Periodontitis, a highly prevalent chronic inflammatory disease, has been linked to several systemic conditions, including a potential increase in pancreatic cancer risk. However, the available epidemiological evidence remains heterogeneous and fragmented. Objective: To evaluate whether periodontitis is associated with an increased risk of pancreatic cancer through a systematic review and meta-analysis of observational studies. Materials and Methods: A comprehensive search was conducted in PubMed, EMBASE, Web of Science, Scopus, the Cochrane Library, ClinicalTrials.gov, and the WHO regional databases, following PRISMA guidelines. Cohort, case–control, and cross-sectional studies assessing periodontitis through clinical parameters, radiographic measures, or tooth loss—and reporting pancreatic cancer risk (HR, RR, or OR)—were included. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analyses, meta-regressions, leave-one-out sensitivity analyses, influence diagnostics, publication bias assessment, and Trial Sequential Analysis (TSA) were performed. Results: Eight observational studies (primarily cohort designs) (n = 476,245 participants) met the inclusion criteria. Periodontitis was associated with an increased risk of pancreatic cancer (pooled HR = 1.56; 95% CI: 1.28–1.89), with moderate heterogeneity (I² = 55.5%). Sensitivity and influence analyses confirmed the robustness of the estimate. TSA showed a consistent trend, although the cumulative evidence remains insufficient for a definitive conclusion. Conclusions: Observational evidence suggests a modest statistical association between periodontitis and pancreatic cancer risk. However, the absolute risk increase is very small, and Trial Sequential Analysis indicates that cumulative evidence remains insufficient to establish causality or to support preventive or clinical recommendations. Further large-scale prospective studies with standardized periodontal assessments are required. Full article

Zirconia is known as a strong and bioinert load-bearing material for dental implants. It typically exhibits no antibacterial activity. Inflammation is a crucial problem for dental implant surgery: about 3–5% of all dental implants experience inflammation. This study demonstrates that either fullerene C₆₀ films or a tribomechanical loading of zirconia without the fullerene C₆₀ coating can cause an improvement in antibacterial activity against Gram-positive Staphylococcus aureus. This moderate antibacterial activity is especially important, because a strong antibacterial effect could disturb the sensitive and beneficial oral bacterial biota. In the present study, different fullerene C₆₀ films were examined. In addition to fullerene C₆₀ film in an “as deposited” condition, treatment with nitrogen plasma as well as tribomechanical produced surface patterns with and without plasma post-treatment were tested. An 85.8% (log reduction 0.85) reduction in Gram-positive Staphylococcus aureus bacterial formation was observed on the zirconia with fullerene C₆₀ film. Plasma treatment of the C₆₀ film increases the antibacterial impact to 72.2% (log reduction 0.56) in comparison to zirconia without fullerene C₆₀ film. Also, tribomechanical loaded fullerene C₆₀ films suppress the growth of Gram-positive Staphylococcus aureus. The tribomechanical loading seems to compensate for the effect of the plasma treatment. ZrO₂ samples with fullerene C₆₀ film and tribomechanical loading achieve an increase in antibacterial impact of 83.36% (log reduction 0.78). Furthermore, surprisingly yttria-stabilized zirconia bioceramic without fullerene C₆₀ film also shows an improved antibacterial efficacy after a tribomechanical patterning procedure. The addition of surface patterning on the ZrO₂ by scratching microgroove arrangements with a diamond tip, increased the antibacterial effect against Gram-positive Staphylococcus aureus by 70.46% (log reduction 0.53). Full article

Background and Objectives: Neoadjuvant chemoradiotherapy is a key component of the treatment strategy for locally advanced rectal cancer (LARC), both through its direct impact on oncological prognosis and by increasing the likelihood of sphincter-preserving surgery. Oncological prognosis improves dramatically following a complete pathological response to neoadjuvant therapy. Identifying predictors of response to neoadjuvant therapy has been a challenge over the past two decades, and these factors have not been fully identified. This study aimed to analyze the clinical, biological, and therapeutic factors associated with tumor response following neoadjuvant therapy in patients with locally advanced rectal cancer, with the aim of identifying independent predictors of the absence of a complete pathological response and optimizing personalized treatment strategies. Materials and Methods: This retrospective study included a cohort of 122 patients (81 men and 41 women), with a mean age of 63.5 years, diagnosed with locally advanced rectal cancer at two centers with expertise in colorectal surgery between January 2018 and December 2023. Patients received neoadjuvant treatment in two regimens: long-course chemoradiotherapy with oral radiosensitizing chemotherapy (82 patients) and total neoadjuvant therapy consisting of chemoradiotherapy followed by consolidation chemotherapy (40 patients). A series of clinical, biological, and therapeutic variables was analyzed for their association with pathological responses. Results: According to the Ryan score, the overall complete response rate following neoadjuvant therapy was 17.2%. pCR was observed more frequently in patients treated with total neoadjuvant therapy than in those treated with standard chemoradiotherapy. Elevated pre-treatment CEA levels were independently associated with a higher risk of unfavorable tumor response. The radiation dose and interval between completion of radiotherapy and surgery were significantly associated with tumor regression. Conclusions: These results underscore the importance of personalizing neoadjuvant therapy to improve cancer prognosis. Furthermore, optimizing tumor regression could lead to the potential expansion of sphincter-preserving resection techniques, which would have a direct and significant impact on the quality of life of these patients. Full article

Acute kidney injury (AKI) continues to pose a significant clinical challenge due to its high morbidity rates and limited therapeutic options. Recent evidence suggests that natural compounds may provide renoprotective benefits by modulating oxidative stress and inflammation. This study examines the protective effects of a novel polysaccharide peptide extracted from Ganoderma lucidum (GL-PPQ1) against renal ischemia–reperfusion (I/R) injury, with particular emphasis on the integrin β3/Fibronectin 1 (Fn1) signaling axis. A murine model of renal I/R injury was established, and GL-PPQ1 was administered orally for seven days before surgery. The assessment included renal function, histopathology, oxidative stress markers, and inflammatory cytokines. Additionally, transcriptomic profiling and protein expression analyses were conducted to elucidate the underlying mechanisms. The results revealed that GL-PPQ1 pretreatment significantly reduced renal tubular damage, lowered serum creatinine and blood urea nitrogen levels, and diminished oxidative stress and inflammatory responses. RNA sequencing revealed that GL-PPQ1 affected gene sets associated with extracellular matrix remodeling and cell adhesion. Western blot and immunohistochemistry further confirmed that GL-PPQ1 decreased the expression of integrin β3 and Fn1, suggesting a regulatory effect on their interaction during I/R injury. These findings demonstrate that GL-PPQ1 offers substantial kidney protection by mitigating oxidative stress, inflammation, and dysregulation of the integrin β3/Fn1 signaling pathway. Thus, this study supports that polysaccharide peptides derived from Ganoderma lucidum could have the potential to serve as both a dietary supplement and a therapeutic agent in the treatment of AKI. Full article

Background: Quality-of-life (QoL) assessment has become an essential component of outcome evaluation in oral and maxillofacial surgery (OMFS), particularly in interventions with functional implications for breathing, sleep, and oro-facial performance. Existing instruments often lack specificity for the postoperative OMFS population. This study aimed to develop and psychometrically validate the OMFS-QoL-18 questionnaire, a condition-oriented patient-reported outcome measure designed for postoperative assessment. Methods: A cross-sectional validation study was conducted on 226 adult patients evaluated 6–12 months after orthognathic or function-oriented OMFS procedures. Internal consistency was assessed using Cronbach’s alpha, and reproducibility using the intraclass correlation coefficient (ICC) based on a two-way random-effects model with absolute agreement. The internal structure of the instrument was explored through an exploratory dimensionality analysis using Principal Component Analysis (PCA), including Kaiser–Meyer–Olkin (KMO) testing and Bartlett’s test of sphericity. Descriptive statistics were calculated for item and domain scores. Results: The OMFS-QoL-18 demonstrated good internal consistency (Cronbach’s α = 0.789; standardized α = 0.783) and satisfactory reproducibility (ICC = 0.81; 95% CI: 0.74–0.87). The exploratory dimensionality analysis suggested a multidimensional structure, with five components explaining 67.1% of the total variance. Item clustering was broadly consistent with the predefined conceptual domains, including respiratory comfort, sleep quality, daytime function, oro-maxillofacial function, and global satisfaction. Given the use of PCA as a component-based method, these findings are interpreted as preliminary evidence of dimensional organization rather than confirmation of latent constructs. Conclusions: The OMFS-QoL-18 demonstrated good internal consistency and preliminary evidence of a coherent factor structure. These findings support its use as a promising condition-specific instrument, pending further validation studies. Further multicenter and longitudinal validation studies are warranted to confirm structural stability and responsiveness over time. Full article

Medication-related osteonecrosis of the jaw (MRONJ) represents a major clinical challenge for oral and maxillofacial surgery departments as well as dental practices. With increasing life expectancy and the more frequent use of medications associated with osteonecrosis, the incidence of MRONJ continues to rise. To date, there are no uniform treatment standards with scientifically proven effectiveness for this condition. To evaluate the impact of platelet-rich fibrin (PRF) on the outcomes of MRONJ treatment and to identify factors that may influence the effectiveness of PRF therapy, we conducted a comparative prospective study including 22 patients divided into two groups: patients treated with PRF and patients treated without PRF. PRF was prepared according to the PRF Duo Quattro Process protocol for PRF (Nice, France). The study was registered at ClinicalTrials.gov (NCT07464678). The following parameters were assessed: age, smoking status, gender, lesion location, body mass index (BMI), C-reactive protein (CRP) concentration, pain intensity, presence or absence of fistulas, soft tissue healing and radiological findings. Patients were evaluated preoperatively and postoperatively at 14 days, 6 weeks, and 6 months. The study demonstrated a reduction in pain after surgery among patients treated with PRF. In addition, the use of PRF resulted in improved healing outcomes in patients with elevated CRP. Higher BMI was associated with poorer therapeutic response to PRF. Improvements in soft tissue healing and disease stage were observed in the PRF group; however, these differences did not reach statistical significance. All findings should be interpreted with caution due to the limited sample size. There is still no standardized treatment for MRONJ. The use of platelet-rich fibrin as an inexpensive and safe adjunctive therapy may provide clinical benefits for patients, particularly through a significant reduction in pain. Further large-scale, multicenter studies are required to confirm these findings. Full article

Background/Objectives. Radiomics is an emerging imaging-based tool that enhances lesion characterization beyond conventional diagnostic approaches. Its potential in evaluating osteolytic lesions of the jaws lies in improving discrimination between benign and malignant entities. This study aimed at developing a predictive model to identify radiomic features capable of distinguishing benign from malignant lesions. Methods. Subjects with preoperative CT or CBCT and histopathological confirmation were included. A pilot cohort was used for feature selection via LASSO regression, which ranked features by frequency and absolute coefficient. Malignancy was coded as class 1, benign lesions as class 0. Positive coefficients indicated association with malignancy, while negative coefficients with benign characteristics. The most stable features were initially trained on the pilot cohort and then validated on an independent test set through machine learning classifiers as LASSO, support vector machine, artificial neural network, random forest e XGboost. Results. The sample comprised 69 subjects (pilot cohort = 57, test cohort = 12). The predictors selected from LASSO regression were: DifferenceEntropy_GLCM (−0.768), CenterOfMassShift_MORPHOLOGICAL (−1.390), INTENSITY-HISTOGRAM_MaximumHistogramGradientGrayLevel (1.139), GLRLM_ShortRunLowGrayLevelEmphasis (−0.742), and Maximum3DDiameter_MORPHOLOGICAL (0.932). As for model performance on test, LASSO achieved the best performance (AUC 0.83), with perfect specificity and sensitivity of 0.71. SVM showed good AUC but poor sensitivity, while random forest and XGBoost performed poorly (AUC 0.57 and 0.37, respectively). Conclusions. The LASSO model proved to be a transparent and robust classifier, suitable for both feature selection and external validation. The selected features demonstrated strong discriminative ability, supporting the potential of radiomics in improving lesion assessment and guiding clinical decision-making. Full article

Bone tissue engineering requires biomaterials capable of simultaneously supporting regeneration and preventing infection. Platelet-rich fibrin (PRF) has been widely used due to its autologous origin and growth factor release, but its rapid resorption limits its clinical applications. Albumin-PRF (Alb-PRF) membranes were developed to improve stability, and their combination with carbonated nanostructured hydroxyapatite (nCHA) may further reinforce osteoconductive properties. In this proof-of-concept study, we fabricated Alb-PRF, Alb-nCHA-PRF, and Alb-nCHA-PRF + doxycycline (DOX) membranes and characterized their physicochemical, antimicrobial, and biological performance in vitro. Membrane stability was monitored for up to 14 days; DOX incorporation and release were evaluated by autofluorescence and spectrophotometry; antimicrobial activity was assessed against E. faecalis and S. aureus; and MG-63 osteoblast-like cells were used to test cytocompatibility, proliferation, mineralization, and alkaline phosphatase (ALP) activity. The release of 27 cytokines and growth factors was quantified by multiplex immunoassay. Alb-PRF exhibited morphological integrity and an enhanced trophic secretome, and supported proliferation and late mineralization. nCHA incorporation reduced cell proliferation and secretome output, while DOX conferred sustained antibacterial activity and enhanced early ALP expression even with attenuated cytokine release, positively impacting mineralization, when compared to nCHA alone. These preliminary results provide preliminary feasibility evidence that Alb-PRF can be engineered as a multifunctional scaffold combining antimicrobial and regenerative functions, though some trade-offs indicate the need for dose optimization and validation with in vivo models. Full article

Obesity in women of reproductive age is a major issue. It is associated with reduced fertility and an increased risk of obstetric and perinatal complications. Bariatric surgery is the most effective treatment for severe obesity, leading to substantial weight reduction, improvement of metabolic disorders, and enhanced fertility. Consequently, an increasing number of women are becoming pregnant after undergoing bariatric surgery. The aim of this paper is to review current recommendations and research data regarding the care of women after bariatric surgery in the periconceptional and perinatal periods, as well as throughout pregnancy, delivery, and the postpartum period. Research suggests that pregnancy after bariatric surgery is associated with a lower risk of gestational diabetes, hypertension, preeclampsia, and fetal macrosomia compared with pregnancies in women with similar baseline BMI (body mass index) who have not undergone surgical treatment. At the same time, an increased risk is observed for low birth weight, maternal micro- and macronutrient deficiencies, and complications characteristic of bariatric procedures, such as dumping syndrome or intra-abdominal hernias. Most scientific societies recommend postponing pregnancy planning for 12–18 months after surgery and using effective contraception, preferably methods that do not require gastrointestinal absorption. Regular monitoring of laboratory parameters, individually tailored supplementation, and interdisciplinary care are essential for the safe management of pregnancy after bariatric surgery. In particular, care should include achieving a stable body weight before conception, monitoring of nutritional status, verifying proper weight gain during pregnancy, and considering alternative methods for gestational diabetes screening (e.g., glycaemic monitoring instead of oral glucose tolerance testing) due to the risk of dumping syndrome. Appropriate preparation for pregnancy and proper management throughout its course allow for reducing the risk of perinatal complications. Bariatric surgery itself is not a contraindication to vaginal delivery. Full article

Background/Objectives: The uprighting of mesially tipped mandibular second molars following first molar loss is a complex surgical and orthodontic challenge. Conventional methods often result in reciprocal anchorage loss. Mini-implants (MIs) have emerged as essential temporary anchorage devices (TADs) that provide absolute anchorage and enable more predictable tooth movements. Methods: Numerical simulations were performed to evaluate the forces required for mandibular second molar uprighting under two conditions: first, only with the second molar present, and second, with both the second and the third molars present. Although the periodontal ligament exhibits nonlinear and viscoelastic behavior in vivo, a linear elastic approximation was adopted to allow for a reliable evaluation of comparative stress distribution and initial displacement patterns within the scope of this exploratory biomechanical study. Stress distribution in the roots, periodontal ligament, and alveolar bone was assessed for each scenario. Two three-dimensional (3D) models of the left mandibular segment were created from scans of a human mandible and its teeth. The first model included the canine, the first and second premolars, and the second molar. A second model additionally incorporated the third molar. A retromolar MI was placed in both models. Molar uprighting was simulated using a spring connecting the implant to a button bonded on the mesial surface of the second molar. A force of 200 g was applied because in clinical orthodontic practice, forces that exceed approximately 2 N may cause pain or undesirable tooth mobility. Displacements along the X, Y, and Z axes, as well as regions of peak stress, were analyzed. Results: Model 1 showed maximum displacements at the furcation/mid-root, distal root apex, and distal crown, with von Mises stresses of 0.470 to 0.371 MPa. In Model 2, peak displacements occurred at the mesial root and crown, with stresses of 0.185 and 0.149 MPa, respectively. The magnitude of displacements was in the order of 10⁻⁵ mm. Such values represent initial mechanical responses rather than clinically observable tooth movements. However, the differences between models (e.g., the stress reduction) are expected to be clinically meaningful. Conclusions: Since clinical measurements regarding the stress distribution on teeth and surrounding tissues during orthodontic molar uprighting movements are impossible to perform, the finite element method (FEM) can offer insight into these aspects. The presence of the third molar significantly modulates the biomechanics of second molar uprighting via retromolar MIs. When the third molar is present, the second molar exhibits a reduced tendency for deformation during distalization, although this leads to a slower displacement. This FEM provides biomechanical insights but does not support direct clinical decision-making. The present findings should be viewed as theoretical biomechanical tendencies that require confirmation through clinical, experimental, and longitudinal studies before translation into clinical practice. Full article

The accuracy of static computer-aided implant surgery (s-CAIS) is fundamental for predictable clinical outcomes. The objective of this study was to evaluate the influence of different guide-support modalities on the linear and angular accuracy of implant placement. In this retrospective clinical investigation conducted at a single specialty hospital, a total of 180 implants were analyzed, divided into three equal groups (n = 60) based on the guide support type: tooth-supported, bone-supported, and mucosa-supported. Accuracy was assessed by superimposing preoperative virtual plans with postoperative cone-beam computed tomography (CBCT) scans, measuring linear deviations at the neck and apex of the implant, as well as angular discrepancies. The type of guide support was found to be a significant factor associated with surgical accuracy (p < 0.001). Tooth-supported guides demonstrated the highest level of accuracy, with a mean angular deviation of 1.81° ± 0.45° and linear deviations at the neck and apex of 0.59 ± 0.18 mm and 0.73 ± 0.19 mm, respectively. These were followed by bone-supported guides (2.14° ± 0.48°; 1.04 ± 0.26 mm; 1.61 ± 0.31 mm), while mucosa-supported guides exhibited the greatest deviations (2.95° ± 0.60°; 1.47 ± 0.29 mm; 1.87 ± 0.37 mm). Significant intergroup differences and large effect sizes were observed, particularly regarding angular and horizontal discrepancies. These findings demonstrate a distinct gradient of accuracy based on guide support, establishing tooth-supported guides as the most accurate, followed by bone-supported and, lastly, mucosa-supported guides. While all modalities are clinically applicable, the use of mucosa-supported guides necessitates increased safety margins to account for the increased risk of linear and angular discrepancies inherent to mucosal tissue displacement. Full article

Background and Objectives: Severe alveolar atrophy may pose significant challenges for dental rehabilitation. Recent advances in digital planning and CAD/CAM technology have renewed the interest in patient-specific subperiosteal implants as a treatment option for anatomically challenging cases. This cohort study evaluated changes in oral health-related quality of life and patient satisfaction following rehabilitation with customized subperiosteal implants in severe alveolar atrophy. Materials and Methods: This cohort study included all consecutive adult patients with severe alveolar atrophy who underwent reconstruction with patient-specific subperiosteal implants at the Department of Oral and Maxillofacial Surgery of “Evangelismos” General Hospital, Athens, Greece, in 2025. Oral health-related quality of life was assessed using the validated OHIP-14 questionnaire preoperatively and 12 months postoperatively. Patient satisfaction was evaluated using a numerical rating scale (NRS). Secondary outcomes included postoperative complications, implant exposure, implant stability, and need for reoperation. Comparisons between baseline and 12-month scores were performed using the Wilcoxon signed-rank test. Results: Nine patients who had completed 12-month follow-up were included. Five were male, and all implants were placed in the maxilla. Significant improvement was observed in oral health-related quality of life, with the median OHIP-14 total score decreasing from 41 preoperatively to 1 at the 12-month follow-up. Patient satisfaction also improved significantly, with the median NRS total score increasing from 17 to 58. Improvements were consistent across all OHIP-14 domains and all NRS items. No major complications were recorded. One patient developed early wound dehiscence, and one patient presented with implant exposure at the anterior palate. At the final follow-up twelve months postoperatively, all implants remained clinically and radiographically stable. Conclusions: These preliminary short-term findings suggest that customized subperiosteal implants may be a promising option for selected patients with severe alveolar atrophy in whom placement of conventional endosseous implants is not feasible; however, the results should be interpreted cautiously given the very small sample size and observational design. Full article