Search Results (1,312)

A trend toward comorbid conditions is seen in around 50% of gynecological patients, with a significant contribution made by endometriosis as a common and incurable gynecological condition. Over the last decades, the global burdens of different forms of endometriosis have shown a progressive increase, while their diagnosis and management present persistent and significant challenges. Currently, endometriosis is divided into two primary types: genital (adenomyosis and external genital endometriosis, including ovarian endometriosis) and extragenital endometriosis. Regardless of the location of endometriosis, lesions or ectopic endometrium follow a consistent pathological process characterized by active proliferation, local inflammation, neoangiogenesis, and extracellular matrix remodeling. These pathogenetic patterns are associated not only with process progression, but also with the impact on the eutopic endometrium. External genital or extragenital endometriosis and adenomyosis (an internal genital endometriosis) are currently considered as a major cause of infertility and implantation failures due to the negative impact on the eutopic endometrium. However, it has been proven that the pathogenetic pathways for the development of eutopic endometrium dysfunction in these endometriosis phenotypes (despite the common pathophysiology of the ectopic endometrium) differ significantly. This narrative review is focused on highlighting the relevance and pathogenetic patterns of the two most frequently diagnosed forms of endometriosis—adenomyosis and ovarian endometrioid cysts—as key areas of research interest relating to their relevance, specific pathophysiology and impacts on the eutopic endometrium. Full article

Background/Objectives: Computer-aided surgical planning (CASP) technologies, including virtual surgical planning (VSP), 3D printed cutting guides, and patient-specific implants, have been increasingly applied to deep circumflex iliac artery (DCIA) free flap reconstruction of maxillofacial defects. Despite growing adoption, no systematic review has specifically evaluated their accuracy and clinical outcomes. This study aimed to comprehensively assess the impact of CASP on reconstruction accuracy, operative efficiency, flap survival, and implant rehabilitation in DCIA flap surgery. Methods: A systematic search of PubMed, Web of Science, and Google Scholar was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Studies reporting CASP-assisted DCIA free flap reconstruction with three or more patients were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist and the Cochrane Risk of Bias 2.0 tool for the randomized controlled trial (RCT). Results: Thirty studies (1 RCT, 13 comparative, and 16 non-comparative) involving 844 patients were included. VSP with 3D-printed cutting guides was the most frequently used technology (n = 22). Mean linear deviations between planned and actual outcomes ranged from 0.40 to 4.4 mm, with most studies reporting 0.7–2.7 mm. The sole RCT demonstrated significantly better accuracy (1.3 vs. 5.5 mm, p < 0.001) and shorter reconstruction time (16 vs. 39 min, p < 0.001) with CASP. Flap survival ranged from 90% to 100%. Conclusions: CASP technologies, particularly VSP with 3D-printed cutting guides, appear to improve the accuracy and predictability of DCIA flap reconstruction. However, the evidence base is predominantly retrospective and heterogeneous; prospective multicenter studies with standardized outcome measures are needed before definitive clinical guidelines can be established. Full article

This paper presents an open-source, fully parametric three-component total knee arthroplasty (TKA) implant system and an automated surgical planning pipeline, addressing the absence of publicly available, modifiable TKA design frameworks in the literature. A cruciate-retaining femoral component, tibial baseplate, and polyethylene insert were designed in Autodesk Fusion with 160 parameters governing all anatomically significant geometry. The femoral articulation surface uses a tangency-constrained triple-radius J-curve. An automated Blender (v. 5.1) Python pipeline performs bone model alignment, size selection from a twelve-size chart, Boolean resection via parametric cutting blocks, and final component placement. Prototypes were 3D printed and validated on 1:1 anatomical bone models. The implant system achieved flush seating on all resection surfaces and impingement-free articulation through the full range of motion on all bone sets. The pipeline correctly aligned bone models, performed resections, and selected appropriately sized implants in all 11 cases, processing each in 1–1.5 min. The system is the first open-source TKA framework to simultaneously provide full parametric definition, documented design rationale, three-component coverage, an automated planning pipeline, and an additive manufacturing fabrication path. By releasing the complete parametric model and pipeline as open source, this work enables independent validation, population-specific adaptation, and iterative improvement by the global research community. Full article

The coexistence of cancer and severe aortic stenosis (AS) is increasing as a result of population aging and substantial improvements in cancer survival. Transcatheter aortic valve implantation (TAVI) has transformed the management of AS; however, patients with active malignancy or a history of cancer remain markedly under-represented in pivotal randomized trials. This under-representation has resulted in persistent uncertainty regarding patient selection, risk stratification, and the expected benefit of TAVI in this growing and clinically heterogeneous population. This review provides a comprehensive and contemporary synthesis of the evidence on TAVI in patients with cancer, integrating cardiovascular (CV), oncologic, and geriatric perspectives. Available data on epidemiological overlap, cancer-specific procedural challenges, and short- and long-term outcomes following TAVI are critically examined, with particular emphasis on distinctions between active cancer and cancer survivorship. Key modifiers of risk and benefit—including prior thoracic radiotherapy, competing thrombotic and bleeding risk, immunosuppression, frailty, sarcopenia, and nutritional status—are discussed in detail. Limitations of conventional surgical risk scores in oncology populations are highlighted, underscoring the need for individualized assessment beyond traditional CV metrics. Across registries and meta-analyses, TAVI is associated with high procedural success and comparable short-term outcomes in patients with and without cancer. Excess mortality observed during mid- and long-term follow-up is driven predominantly by non-CV causes related to malignancy rather than valve-related complications. Importantly, patients with cancer in remission demonstrate outcomes similar to those of non-cancer populations, whereas prognosis in active cancer is strongly influenced by disease stage, biology, and competing risks. Overall, cancer diagnosis alone should not preclude consideration of TAVI. Optimal management requires multidisciplinary, goal-oriented decision-making that integrates oncologic prognosis, functional status, and patients’ priorities. As cancer survivorship continues to expand, prospective studies, integrated risk stratification tools, and closer alignment between cardio-oncology and structural heart programs are essential to guide evidence-based and equitable care. Full article

Objective: Osteosynthesis in the case of a sternal wound infection is challenging. It requires osteosynthesis systems that go beyond the usual wire techniques. In principle, there are three different systems, namely plates with locking screws, clips, and distance systems, which are the original methods used in chest wall reconstruction. The aim of this study is to assign these systems to the corresponding sternal pathologies. Patients and methods: This is a retrospective single-center analysis. Bone pathology is divided into three grades: grade I (good substance/no fractures), grade II (good substance/few transverse fractures), grade III (poor substance/substance defects/multiple transverse fractures). The individual osteosynthesis systems are assigned to the different grades accordingly. The suitability of the individual systems is analyzed in the short term and long term. Results: A total of 130 patients were included. Stable osteosynthesis was achieved in all patients. For grade I defects, 75 plates and 24 clips were used. For grade II defects, mainly plates (255) but also clips (16) were used. A distance system was used 24 times for grade III defects. One plate fractured. No other implant-related complications occurred. Discussion: If the different osteosynthesis systems are used according to the bone pathology, a stable chest wall can be restored in all patients. The individual systems have their own specific characteristics, which must be taken into account with regard to the suitability and invasiveness of the procedure. No single system is suitable for treating all sternal pathologies. Full article

Breast cancer accounts for nearly one in four cancer diagnoses amongst women, with 36–50% of patients electing to undergo post-mastectomy breast reconstruction. Though immediate reconstruction has risen in popularity due to higher patient satisfaction scores, factors such as individual patient anatomy, patient preference, and adjuvant oncologic treatments may preclude this option for some patients. In such circumstances, a delayed approach to reconstruction offers a promising alternative, often offering comparable aesthetic results with lower rates of major complications. Autologous, implant-based, and hybrid reconstructive techniques may all be applied in a delayed setting at a time point clinically distinct from oncologic resection, with each technique carrying unique advantages and risks that must be evaluated in the context of patient-specific factors. By providing an overview of common complications associated with various delayed breast reconstruction modalities, this review seeks to synthesize the current approaches to prevention, management, and treatment of reconstructive obstacles and outcomes to foster shared decision-making, individualized surgical planning, and optimal reconstructive results. Full article

Patient-specific implants (PSIs) in orthognathic surgery offer optimal intraoperative accuracy. However, evidence regarding their postoperative skeletal stability, specifically comparing distinct fixation designs and segmentation patterns, remains limited. We present a retrospective cohort study that evaluated 64 adult patients undergoing customized maxillary orthognathic surgery between January 2020 and June 2025. The primary predictor variables were fixation design (conventional customized plates vs. minimally invasive plates) and maxillary segmentation (monoblock vs. multisegmental). The outcome variable was 3D skeletal stability, measured as linear displacement between preoperative planning and 6-month postoperative imaging. Non-parametric tests compared displacements and clinical instability rates (defined as ≥2.0 mm). Mann–Whitney tests compared landmark displacements, Fisher’s exact tests compared proportions with ≥2.0 mm displacement, and ORs with 95% CIs were computed (α = 0.05). Analysis of 64 patients revealed that median displacement across landmarks ranged from 0.7 to 4.28 mm and 28.1% exhibited displacement ≥ 2.0 mm, primarily in molar and canine regions. While overall instability rates did not differ significantly between single-segment and multisegmental osteotomies (p = 0.28), multisegmental cases showed significantly higher displacement at the left canine (p = 0.027). Plate design was not associated with skeletal instability (p = 0.88), suggesting that minimally invasive plates provide comparable stability to conventional designs. Customized maxillary plates provide reliable postoperative stability with median displacements within clinically acceptable limits (<2 mm). Minimally invasive PSI designs offer stability comparable to conventional extended designs. However, localized instability in multisegmental cases suggests a need for careful biomechanical management regardless of the fixation method used. Full article

The cryopreservation of pre-implantation embryos has become routine in medically assisted reproduction (MAR), and the proportion of frozen embryo transfers has steadily increased in recent years. Because cryopreservation through either slow-cooling protocols or ultra-rapid vitrification requires potentially cytotoxic cryoprotective agents to prevent uncontrolled and detrimental ice crystal formation, the safety of these procedures must be carefully considered. Evidence from human epidemiological studies, including retrospective and prospective controlled studies, and data from national patient registries indicate that children born after frozen embryo transfer have a higher birth weight than those born after spontaneous conception and have an increased risk of rare genomic imprinting disorders, such as Beckwith–Wiedemann, Silver–Russell, or Prader–Willi syndrome. Encompassing not only reversible DNA methylation patterns established during gametogenesis, but also the timed abundance and availability of transcripts and proteins required to establish or maintain epigenetic marks throughout development and differentiation, as well as persistent or transient post-translational histone modifications and non-coding RNAs, the epigenome may be particularly sensitive to cryopreservation. Importantly, epigenetic regulation is highly complex. Alterations of the epigenome at any developmental stage are often not monocausal, do not necessarily result in immediate disturbances in the pre-implantation embryo, and are unlikely to operate through simple all-or-nothing mechanisms; however, they may have long-lasting effects at later developmental stages. To make matters even more complex, differences between species in terms of epigenetic regulation or lineage differentiation are well known and translation from animal model systems to humans must be considered with caution. More recently, epigenetic regulation by non-coding RNAs has also come into focus, as these molecules are crucial, either directly or indirectly, for gene expression, translation, and protein biosynthesis during development. Therefore, assessing potential adverse effects of cryopreservation on the entire epigenome remains a major challenge, particularly because little is known about indirect factors, such as post-translational histone modifications and non-coding RNAs. In this review, we focus on the potential influence of the cryopreservation of pre-implantation embryos on the epigenetic profile in humans and animals. Specifically, we consider DNA methylation of imprinted genes and global DNA methylation; post-translational histone modifications; the abundance and availability of transcripts and proteins required to establish, maintain, or protect epigenetic patterns; and the presence of non-coding RNAs involved in epigenetic control. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Background and Clinical Significance: SWI/SNF chromatin remodeling complex-deficient malignancies constitute an aggressive group of undifferentiated tumors defined by inactivation of core subunits including SMARCA4 (BRG1) or SMARCB1 (INI1). In the head and neck, these tumors predominate in the sinonasal tract; oral cavity presentations are exceedingly rare, with reported cases predominantly representing metastatic disease. Peri-implant gingival masses in clinical practice are overwhelmingly reactive, but their occasional malignant nature mandates timely biopsy and thorough pathologic workup. We report the first comprehensively molecularly characterized case of a peri-implant gingival SWI/SNF complex-deficient tumor with confirmed biallelic SMARCA4 inactivation. Case Presentation: A 75-year-old man presented with a one-week history of a rapidly enlarging exophytic erythematous peri-implant gingival mass in the right posterior mandible (region 44–47). Incisional biopsy demonstrated an undifferentiated high-grade tumor with epithelioid, plasmablastoid, and focally rhabdoid morphology with necrosis. Immunohistochemistry showed complete loss of BRG1 (SMARCA4) with retained INI1 (SMARCB1), EMA positivity, Ki-67 of approximately 100%, and negativity across all lineage-specific markers (hematolymphoid, epithelial, melanocytic, endothelial, squamous). Comprehensive next-generation sequencing (Oncomine Comprehensive Assay Plus) confirmed biallelic SMARCA4 inactivation via a truncating nonsense mutation (p.Trp1346Ter; VAF 73.85%) combined with copy number loss, establishing the molecular mechanism underlying BRG1 protein loss. Co-occurring alterations included homozygous CDKN2A/CDKN2B deletion, MTAP loss (9p21.3), clonal TP53 and KEAP1 mutations, and intermediate–high tumor mutational burden (13.3 mutations/Mb) with microsatellite stability. The patient initiated carboplatin–paclitaxel and achieved a partial response at one month with further shrinkage by four months. This case illustrates a rare oral cavity manifestation of SWI/SNF complex deficiency arising in a peri-implant location, with a diagnostic workup that required integration of immunohistochemistry and molecular profiling for definitive characterization. The MTAP deletion co-occurring with homozygous CDKN2A/B loss identifies a potentially actionable synthetic lethal vulnerability to MAT2A and PRMT5 inhibitors currently under clinical investigation. An occult primary site could not be fully excluded due to absence of a dedicated staging workup. Conclusions: Rapidly enlarging peri-implant gingival masses should prompt timely biopsy and SWI/SNF marker testing when histology is high-grade and lineage-ambiguous. NGS-based molecular profiling confirms diagnosis, elucidates mechanism, and reveals actionable targets in this rare tumor class. Full article

Background: Custom-made subperiosteal implants have re-emerged as a valuable option for the rehabilitation of patients with severe maxillofacial atrophy and post-oncological defects. Despite advances in digital workflows and implant design, their unique anatomical, biological, and prosthetic characteristics pose specific challenges for long-term maintenance, and no dedicated standardized guidelines are currently available. Methods: This narrative review critically appraises the available literature on implant maintenance and related fields. A comprehensive search was conducted across PubMed, Scopus, and Web of Science, including studies on peri-implant maintenance, supportive periodontal therapy, full-arch and zygomatic implant rehabilitations, and subperiosteal implants. Due to the lack of direct evidence, a qualitative narrative synthesis was adopted to develop preliminary clinical considerations for maintenance of custom-made subperiosteal implants. These considerations should be interpreted as an expert-informed perspective rather than validated clinical guidelines. Results: Conventional maintenance protocols developed for endosseous implants are not directly transferable to subperiosteal implants due to differences in the implant–tissue interface, biomechanics, diagnostic parameters, and hygiene accessibility. Key challenges include the absence of a conventional peri-implant sulcus, possible implant exposure, complex prosthetic geometries, and potential susceptibility to biofilm accumulation in areas with limited access. Evidence from related fields highlights the importance of structured maintenance, individualized risk-based follow-up, effective biofilm control, and patient-specific home-care strategies. Conclusions: Preliminary evidence-informed clinical considerations for the maintenance of subperiosteal implants are proposed, with emphasis on plaque control, individualized follow-up, descriptive clinical monitoring, and hygiene-oriented prosthetic and surgical planning. These considerations are not intended as validated guidelines, but as a practical starting point for clinical reasoning in an area where dedicated evidence remains limited. Full article

Background: Primary malignant bone tumors of the pelvis account for 10–15% of all primary bone sarcomas, most commonly chondrosarcoma, osteosarcoma, and Ewing’s sarcoma. Although advances have shifted treatment toward internal hemipelvectomy, pelvic resections remain challenging due to the complex anatomy. The need for pelvic reconstruction is controversial, balancing potential stability against higher complication rates. This review evaluates the role of pelvic ring reconstruction, focusing on techniques, outcomes, and complications. Methods: A systematic literature review was performed in June 2025 using PubMed, MEDLINE and Cochrane Library as the primary databases, with the following search string: (hemipelvectomy) AND (orthopedic), acknowledging that this search strategy may be limited in scope. Studies published within the last five years were considered. After performing a full-text assessment of 80 studies, 14 studies were included in this review. Data regarding patients, methods, and outcomes were extracted and summarized. Results: Among the 14 included studies, seven investigated patient-specific three-dimensional (3D) printed pelvic reconstructions, four reported biological reconstruction techniques, two studies focused on non-reconstructive management and one study evaluated alternative stabilization using segmental spinal instrumentation. 3D printed and other reconstructive techniques were associated with improvements in the Musculoskeletal Tumor Society score, reduced pain, and demonstrated osseointegration with few mechanical failures. Although individual case series demonstrated good ambulation and stable fixation, complication rates, particularly wound and infection-related events, remained frequent. Type III reconstructions and personalized implants showed the highest functional gains but occasionally revealed asymptomatic fretting wear. In contrast, the only Level I evidence indicated significantly higher complication and infection rates in reconstructed patients and better functional outcomes in those managed without reconstruction when spinopelvic stability was preserved. Non-reconstructive strategies, including spinal instrumentation, supported early ambulation with low mechanical failure, while pediatric patients treated without reconstruction experienced a high complication rate but acceptable long-term oncologic outcomes. Conclusions: Current evidence suggests that routine pelvic ring reconstruction after internal hemipelvectomy may not be justified based on the currently available evidence. Patient-specific 3D-printed implants appear to provide consistent improvements in function, pain reduction, and mechanical stability, but are associated with a relevant risk of wound-related and infectious complications. In patients with preserved spinopelvic stability, non-reconstructive strategies may achieve comparable functional outcomes with lower morbidity. Therefore, pelvic reconstruction should be performed selectively, and further prospective multicenter studies are needed to better define appropriate patient selection and optimize reconstructive strategies. Full article

Background: Despite the widespread clinical use of dental implants, research in implant dentistry remains active, aiming to develop new materials, designs, and surface morphologies, as well as to better understand the biological mechanisms underlying the pathophysiology of certain diseases to improve patient outcomes. In this context, preclinical animal models provide an essential opportunity to explore and validate new technologies and protocols before their application in humans. Although large vertebrate species have historically been preferred due to their biological similarity to humans, small animal models such as rats offer significant advantages. Additionally, they allow researchers to work with larger sample sizes, improving the statistical power of experimental outcomes. This scoping review aimed to analyze the current literature on intraoral rat surgical models in the field of implant dentistry. Methods: We included the preclinical studies using rat models focused on implant placement in the oral cavity and published in English. We excluded all studies that involved animal models other than rats or used implant placements in anatomical sites different from the target region. An electronic search was conducted in the PubMed and Scopus databases. From an initial 1032 results, 680 articles remained after duplicate removal. A first screening retained 191 articles, and after full-text review, 98 studies were ultimately included. The selection process was conducted using the software Rayyan. Data were extracted and analyzed across nine domains: Publication metadata, Focused Research Questions, Animal specificities, Study Design, Surgical Protocol Features, Medications Administered to Establish the Experimental Model, Timing of Euthanasia, Characterization methods, and Drop-Out Information. Results: The evaluation of the selected literature revealed a lack of standardization in study design. There is no consensus regarding the rat species used, the age at the time of implant placement, the anatomical site, or the implant morphology. Even more concerning is the presence of methodological deficiencies in the reporting of study design and outcome measures. Conclusions: By summarizing the available data, this review proposes the most commonly used features across preclinical trials in rats. Moreover, it offers a comprehensive overview of the current scientific landscape in this field, enabling researchers to compare different study designs and more easily access relevant information. Full article

Background/Objectives: Total hip arthroplasty (THA) is a common orthopedic procedure, and with projected growth in both primary and revision surgical volumes, robust implant performance data is necessary to inform surgical decision-making. To ensure successful outcomes in primary THA (pTHA) and revision THA (rTHA), surgeons need versatile implant systems that can address patient-specific surgical challenges. This study aimed to evaluate the outcomes of a next-generation acetabular system used for various indications in both pTHA and rTHA. Methods: We retrospectively reviewed 319 patients who underwent either pTHA or rTHA using a modern acetabular system at a single urban academic center between 2014 and 2023 with at least 18 months of follow-up. Baseline characteristics and the patient-reported Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) were collected. A total of 284 patients who underwent pTHA and 35 patients who underwent rTHA were included. Median follow-up was 2.6 years (range: 1.5–8.4 years). Results: The most common indication was osteoarthritis (90%) for pTHA and instability (46%) for rTHA. Most rTHAs utilized a dual-mobility construct (74%), compared to pTHAs (22%). There were ten all-cause acetabular revisions in the entire cohort (eight in pTHA, two in rTHA), four of which were aseptic (three in pTHA, one in rTHA). All-cause and aseptic acetabular survivorship of the pTHA cohort was 97.2% and 98.7%, respectively, and of the rTHA cohort was 94.3% and 97.1%, respectively. Improvement in the median HOOS, JR score was 21.5 points at one year and 25.5 points at two years among pTHAs. Conclusions: The findings with this system support adequate mid-term acetabular component survivorship in pTHA and rTHA, along with clinically meaningful functional improvement following pTHA. Given the retrospective, observational nature of this study, further prospective research with extended follow-up and larger sample sizes, particularly in the rTHA cohort, is needed to better assess long-term outcomes. Full article

Background-Objectives: Edentulism remains a major global health problem, and implant-supported overdentures (ISODs) are widely used to restore oral function and improve quality of life in edentulous patients. Among the available attachment systems, bar configurations play an important role in determining biomechanical behaviour, retention, stability, and maintenance requirements. This scoping review aimed to map and evaluate the influence of key bar attachment parameters—such as cross-sectional geometry, material, splinting configuration, and distal extension—on the clinical performance of overdenture therapy. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework. A comprehensive search was conducted in PubMed, Scopus, and the Cochrane Library. Eligible studies included clinical investigations, in vitro mechanical studies, and finite element analyses addressing bar-retained implant-supported overdentures. Extracted data included bar configuration characteristics, implant distribution, and reported outcomes such as retention forces, stress distribution, prosthetic complications, and patient-reported measures. Results: The available evidence indicated a recurring balance between increased retention and higher peri-implant stress, particularly in association with Hader bar designs. Material selection also appeared to influence performance. CAD/CAM-milled titanium bars demonstrated favourable mechanical durability, whereas alternative materials such as PEEK and zirconia were associated with improved stress distribution and potential biological advantages, although concerns regarding long-term durability remain. Differences related to arch type were also observed, with splinted bars supported by four implants generally favoured in the maxilla, while two-implant bar overdentures appear to provide satisfactory outcomes in the mandible. Conclusions: Bar selection should be individualised according to anatomical conditions, biomechanical demands, and patient-specific factors. Longer-term clinical studies and more standardised testing protocols are still required, particularly for newer materials and digitally fabricated bar systems, to support more consistent evidence-based decision-making. Full article