Search Results (171)

Background: Vertical implant positioning may influence peri-implant health outcomes and long-term stability; however, the impact of baseline vertical implant positioning relative to adjacent teeth remains unclear. The aim of this systematic review and meta-analysis was to assess the association between baseline vertical implant positioning and peri-implant clinical and radiographic outcomes. Methods: The Cochrane Central Register, PubMed, SCOPUS, and Web of Science were searched. Vertical implant positioning relative to adjacent teeth was assessed using two radiographic reference distances: implant platform to cemento-enamel junction (IP–CEJ) and implant platform to adjacent interproximal alveolar bone level (IP–ABL). The primary outcome was peri-implant marginal bone loss (MBL). Secondary outcomes included implant survival and success rates, peri-implant mucositis and peri-implantitis prevalence. Risk of bias was assessed using the Moga checklist, and certainty of evidence was evaluated according to GRADE. Results: Four studies including 267 implants fulfilled the inclusion criteria. The pooled mean baseline IP–CEJ and IP–ABL distances were 4.69 mm (95% CI 2.05 to 7.32) and 2.13 mm (95% CI 1.29 to 2.98), respectively. The pooled mean marginal bone loss after at least 12 months, based on three studies, was 0.21 mm (95% CI −0.28 to 0.70). Conclusions: The available evidence is insufficient to determine whether baseline IP–CEJ or IP–ABL distances are associated with peri-implant outcomes or to identify an optimal range of vertical implant positioning. The findings should be interpreted cautiously because the certainty of evidence is very low, highlighting the need for prospective studies with long-term follow-up. Full article

Advanced dental implant systems are clinically successful when their material properties, surface topography, abutment geometry and implant–abutment connection design support both mechanical stability and biological integration. In Morse-tapered implant–abutment systems and conometric prosthetic retention systems, the precision of conical interfaces has traditionally been discussed mainly in biomechanical terms; however, their clinical performance also depends on the formation and maintenance of a stable peri-implant soft tissue seal. This review examines micro-computed tomography (µCT), with emphasis on synchrotron radiation-based phase-contrast micro-computed tomography (SR-PhC-µCT), as an advanced characterization strategy for evaluating how implant and abutment design influence the three-dimensional architecture of peri-implant connective tissues. The review summarizes the biological organization of the peri-implant mucosa, the technical basis of absorption- and phase-contrast microtomography, sample preparation protocols, segmentation workflows, artificial intelligence-assisted image analysis and quantitative morphometric descriptors of collagen organization. Particular attention is given to human retrieval and biopsy studies of Morse-tapered/conometric systems, where three-dimensional imaging has revealed interwoven circumferential and longitudinal collagen bundles around the transmucosal implant component. These microarchitectural features have been directly visualized by SR-PhC-µCT and histology and may represent a biomechanically plausible basis for mucosal sealing and force distribution. However, their direct relationship with marginal bone preservation and long-term clinical outcomes remains to be demonstrated in longitudinal studies. Within the scope of advanced dental materials, the novelty of this review lies in framing SR-PhC-µCT, correlative histology and AI-assisted segmentation as enabling tools within a materials-design framework for implant–abutment optimization. In this framework, peri-implant collagen architecture is interpreted as an exploratory structural readout of the interaction among connection design, abutment geometry, surface topography and biological response. This approach does not yet establish validated clinical biomarkers, but it may generate testable hypotheses for future studies aimed at improving peri-implant soft tissue stability and implant–abutment system design. Full article

Background/Objectives: Peri-implant diseases, encompassing peri-implant mucositis and peri-implantitis, affect 43% and 18.8–23% of implant-bearing patients, respectively, representing significant clinical challenges in implant dentistry. While mechanical debridement remains foundational, biologically active materials offer promising adjunctive regenerative strategies. This narrative review synthesises current evidence regarding five biologically active materials: enamel matrix derivative (EMD), platelet-rich fibrin (PRF), fibroblast growth factor-2 (FGF-2), recombinant human platelet-derived growth factor-BB (rhPDGF-BB/GEM 21S^®), and polynucleotide–hyaluronic acid combinations (Regenfast^®). Methods: The relevant literature was identified using electronic databases, including MEDLINE, PubMed, Scopus, and Google Scholar. This review focused on clinical studies and randomised controlled trials with a minimum follow-up of six months investigating biologically active materials in peri-implant disease management. Material mechanisms, clinical efficacy, therapeutic limitations, and evidence quality were systematically evaluated. Attention was directed toward identifying genuine biological distinctions between peri-implant and periodontal disease contexts. Results: EMD demonstrates efficacy exclusively within multimodal surgical protocols, with isolated application yielding limited benefits. rhPDGF-BB shows superior periodontal regenerative capacity; however, dedicated peri-implantitis trials remain absent. FGF-2 exhibits paradoxical osteogenic suppression despite bone fill achievement, limiting peri-implant applicability. PRF and Regenfast^® demonstrate a mechanistically sound rationale yet lack substantive peri-implant disease validation. The critical findings revealed that peri-implant regeneration fundamentally differs from periodontal regeneration: implants lack periodontal ligament anatomy, rendering ligamentogenic differentiation-promoting agents biologically inappropriate. Conclusions: Contemporary biologically active materials demonstrate compelling periodontal efficacy yet remain inadequately validated for peri-implantitis management. This disparity reflects authentic biological distinctions rather than insufficient investigation. Until multicentre randomised controlled trials stratify efficacy across distinct peri-implant disease presentations, practitioners must prioritise evidence-based surgical fundamentals—meticulous decontamination, strategic grafting, and optimised wound healing—integrating biologically active materials judiciously within comprehensive, anatomy-respecting treatment protocols. Full article

Hydrogel scaffolds have emerged as instructive microenvironments for craniofacial tissue regeneration, moving beyond passive cell carriers toward platforms that regulate cell fate, vascularization, immune remodeling, and tissue-specific architecture. This review synthesizes hydrogel-associated strategies across dental pulp, periodontal ligament, gingival, bone marrow, jawbone, endothelial, oral mucosal, induced pluripotent stem cell (iPSC), extracellular vesicle (EV), exosome, secretome, and acellular systems. The evidence indicates that craniofacial hydrogel performance is governed by reciprocal interactions among biological source, scaffold composition, matrix mechanics, spatial architecture, mineral or ionic signaling, growth factor delivery, vesicle-mediated communication, and inflammatory niche modulation. Mineralized and ion-releasing hydrogels most consistently supported osteogenesis and bone repair, whereas extracellular matrix (ECM)-mimetic, peptide, collagen, fibrin, gelatin methacryloyl (GelMA), alginate, hyaluronic acid (HA), and chitosan-based systems enabled pulp–dentin, periodontal, peri-implant, oral mucosal, and soft-tissue reconstruction. Responsive, antimicrobial, antioxidant, conductive, and immunomodulatory hydrogels further expanded the field by targeting diseased microenvironments rather than regeneration alone. Despite strong preclinical evidence, translation remains limited by heterogeneity in scaffold formulations, biological sources, analytical endpoints, defect models, and long-term functional validation. Future progress will require standardized characterization, tissue-specific design criteria, clinically relevant large-animal models, scalable cell-free technologies, and integrated assessment of regeneration, immunity, vascularization, innervation, mechanics, and safety. Full article

Background: Rehabilitation of edentulous mandibles in a post-oncologic setting remains a major clinical challenge. In such situations, placement of conventional endosseous implants may be compromised by severe bone deficiency, a history of peri-implant infection, and constraints related to reconstructive soft tissues. Customized titanium subperiosteal implants, made possible by three-dimensional imaging, computer-aided design, and additive manufacturing, represent a potential alternative when conventional options are unfavorable. This case report describes a full-arch fixed rehabilitation of an edentulous mandible in a patient previously treated for squamous cell carcinoma of the floor of the mouth. Methods: A patient-specific titanium additively manufactured subperiosteal jaw implant (AMSJI) made of biocompatible titanium was designed using a digital planning workflow. Implant placement was performed in a single surgical session under general anesthesia, with fixation using osteosynthesis screws. A screw-retained full-arch provisional prosthesis was delivered intraoperatively, allowing immediate loading with adjustments aimed at avoiding compression of the healing soft tissues. Results: The patient achieved satisfactory functional and esthetic rehabilitation. Postoperative follow-up showed overall favorable mucosal tolerance; an early, limited peri-abutment mucosal dehiscence was observed and managed with suturing under local anesthesia, without compromising implant stability. Conclusions: This case highlights the clinical interest of patient-specific titanium subperiosteal implants as a fixed rehabilitation option in post-oncologic patients with major osseous and mucosal constraints and a history of reconstructive procedures. The combination of accurate digital planning and custom-made manufacturing may avoid the need for extensive bone grafting. However, these findings should be interpreted with caution due to the short-term follow-up and the inherent limitations of a single-case report, which limit the level of evidence and generalizability. Full article

Background: The biomechanical behaviour of mandibular Ti-Zr mini-implant (MDI) retained overdentures is influenced by implant number, loading conditions, and mucosal thickness. This study assessed the effect of mucosal thickness and other factors on peri-implant and distal edentulous ridge microstrain values under functional loading. Methods: Eight stereolithographic mandibular models simulating D2 bone were fabricated with one, two, three, or four Ti–Zr MDIs and covered with artificial mucosa of 1.9 mm (thin) or 3.8 mm (thick). Standardized overdentures were loaded anteriorly, unilaterally, and bilaterally with forces ranging from 50 to 300 N. Strain gauges measured micro-deformation at vestibular and oral peri-implant sites and the distal edentulous ridge. Data were analyzed using MANOVA and between-subject tests, with effect sizes (η²) calculated. Results: Peri-implant microstrain decreased with increasing implant number, with single-implant overdentures reaching more than 2500 µε under anterior loading, as well as two-implant overdentures under unilateral loading; four-implant configurations remained <2000 µε. Mucosal thickness had no influence on peri-implant strains in two- and four-implant setups; however, thicker mucosa showed a very small attenuation effect in one-implant arrangements and medium effect in three-implant arrangements. Loading force and position were the dominant determinants of peri-implant strain. Distal ridge microstrain was significantly attenuated by thicker mucosa (η² ≈ 0.449). Conclusions: Implant number, loading force and position predominantly govern peri-implant strain distribution, while thicker mucosa effectively reduces distal ridge strain beneath the overdenture. Single- or two-implant mandibular overdentures are more vulnerable to high unilateral or anterior loads, emphasizing the importance of careful implant planning and occlusal management in clinical practice. Full article

Background/Objectives: Photobiomodulation therapy (PBMT) is a non-invasive therapeutic modality that enhances tissue healing, modulates inflammation, and reduces pain. Despite increasing clinical use, evidence regarding PBMT in geriatric oral conditions has not been comprehensively synthesized. This systematic review aimed to evaluate the clinical efficacy and safety of PBMT in managing orofacial conditions in older adults. Methods: A systematic search of PubMed, Embase, Scopus, and Google Scholar was conducted to identify randomized controlled trials (RCTs) published between January 2000 and March 2025. Eligible studies included patients aged ≥60 years receiving PBMT for orofacial conditions. Study selection followed predefined criteria. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and findings were narratively synthesized. Results: Twenty-three RCTs were included. Evidence for PBMT was most frequently reported in cancer therapy-induced oral mucositis (n = 8), with consistent reductions in lesion severity and pain. Studies on burning mouth syndrome (n = 7) and hyposalivation (n = 2) generally reported improvements in symptoms, although placebo effects were noted. Fewer studies evaluated postoperative pain (n = 2), oral lichen planus (n = 1), peri-implant conditions (n = 1), and implant osseointegration (n = 2). No clinically significant adverse events were reported. However, heterogeneity in PBMT parameters and outcome measures limited comparability. Conclusions: PBMT is a safe and clinically effective adjunctive therapy for managing orofacial conditions in older adults, particularly oral mucositis. These findings support its integration into geriatric oral care. Standardized protocols and well-designed RCTs are needed to determine optimal treatment parameters and long-term effectiveness. Full article

Hyaluronic acid (HA) is a biologically active glycosaminoglycan with recognized roles in wound healing and inflammation modulation, and its adjunctive use in dental and periodontal therapy has gained interest, particularly in medically compromised patients. This narrative review critically evaluated preclinical and clinical evidence on locally applied HA in periodontal, oral surgical, peri-implant, and oral medicine treatments in patients with systemic conditions. A literature search of PubMed/MEDLINE, Scopus, and Web of Science (January 2015–December 2025) identified in vivo translational studies, randomized and controlled clinical trials, and selected systematic reviews involving medically compromised populations. Qualitative synthesis focused on biological plausibility, clinical outcomes, and safety. Nine core studies were included, comprising two preclinical in vivo investigations and seven clinical trials. In diabetic models, cross-linked high-molecular-weight HA reduced macrophage infiltration and delayed collagen membrane degradation without impairing angiogenesis. Clinically, adjunctive HA use in patients with type 2 diabetes mellitus was associated with modest but statistically significant short-term improvements in clinical attachment level (CAL) and enhanced early soft tissue healing following tooth extraction. In peri-implantitis therapy and oncology-related oral complications, HA application was linked to reduced inflammatory markers, decreased lesion severity, and improved patient-reported symptoms. No systemic adverse effects were reported. Overall, HA appears to be a locally safe adjunct that may support early healing and inflammation control in medically compromised patients, although its effects are primarily short-term and do not indicate disease-modifying potential. Full article

Background/Objectives: This systematic review and meta-analysis evaluated the clinical effectiveness of regenerative surgical treatments compared with open flap debridement (OFD) in the management of peri-implantitis and, secondarily, assessed whether more advanced regenerative approaches, including guided bone regeneration (GBR), platelet-rich fibrin (PRF), and hyaluronic acid (HA), provide additional clinical benefit compared with bone grafting alone. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted in accordance with PRISMA guidelines and the PICO model, covering the period from 1993 to 2024. From 2119 identified articles, 63 full-text papers were reviewed, and 12 studies met all inclusion criteria. These studies compared regenerative treatments with OFD and bone grafting using clinical outcomes of probing pocket depth (PPD), radiographic bone level (RBL), bleeding on probing (BOP), suppuration (SUP), mucosal recession (REC), and clinical attachment level (CAL). Meta-analysis was performed using a random-effects model. Results: Regenerative treatments demonstrated superior outcomes in radiographic bone level gain compared with OFD (p < 0.001), while no statistically significant differences were observed for PPD (p = 0.77), BOP (p = 0.13), SUP (p = 0.42), REC (p = 0.14), or CAL (p = 0.96). Comparisons between bone grafting and other regenerative materials also showed no statistically significant differences. Conclusions: Regenerative procedures improved radiographic bone outcomes but did not consistently outperform OFD in soft tissue parameters, and no advanced regenerative modality demonstrated clear clinical superiority over bone grafting alone. Further high-quality randomized controlled trials with standardized methodologies are needed to establish clinical guidelines for peri-implantitis surgery. Full article

The goal of this paper was to determine the efficacy of the surgical treatment of two-wall peri-implant defects filled with L-PRF/xenograft block in the reduction of peri-implant marginal bone levels after 12 months. Ten patients with two-wall peri-implant defects were included. Patients received presurgical treatment followed by a surgical reconstructive intervention with bone blocks obtained by mixing bovine origin xenogeneic bone graft grains with L-PRF membranes. Patients were followed up at 3, 6, 9, and 12 months for oral hygiene and disease relapse evaluation and assessment of the primary outcome marginal bone levels (MBL) and clinical outcome variables such as probing depth (PD), bleeding on probing (BOP), and mucosal recession. Data was analyzed for changes between baseline and the 6- and 12-month follow-ups. Mean MBL was 5.1 ± 1.7 mm and 1.58 ± 0.92 mm at baseline and 6 months after the procedure, indicating a statistically significant decrease (p = 0.0005). At 12 months post-surgery, marginal bone levels remained stable at 1.8 ± 0.9 mm, with no statistically significant difference from the previous evaluation (p > 0.05). From baseline to 6 months there was also a statistically significant decrease in PD (from 8.07 ± 1.51 mm to 3.33 ± 0.59, p < 0.0001) and BOP (from 60.0% to 13.0% of affected surfaces, p < 0.001). No changes were observed from the intermediate to the 12-month follow-up (p > 0.05 for all variables). Full article

Background/Objectives: The formation of a soft tissue seal through mucosal integration around dental implants is critical for potentially achieving long-term peri-implant health and clinical success. Understanding how different implant and abutment surfaces interact with individual layers of the oral mucosa remains limited. This study aimed to compare the differential attachment of tissue-engineered oral epithelium, connective tissue, and full-thickness human oral mucosa to various implant and abutment materials and surface topographies. Methods: Sand-blasted, large-grit, acid-etched (TiZr-SLA), machined TiZr (TiZr-M), machined zirconia (ZrO₂-M), polished zirconia (ZrO₂-P), and machined PEEK rods, along with commercially available titanium and ZrO₂ healing abutments, were inserted into 3D oral mucosal models following a 4-mm punch biopsy. Inflammation was induced using Escherichia coli lipopolysaccharide. Analyses included histology, PrestoBlue viability assay, scanning electron microscopy, and ELISA quantification of cytokines IL-1β, IL-6, and IL-8. Results: Epithelial attachment was greater on TiZr-SLA, ZrO₂-P, and PEEK-M (p < 0.05 and p < 0.01) surfaces compared with TiZr-M and ZrO₂-M. TiZr-SLA exhibited the highest connective tissue attachment (p < 0.05). Commercial titanium and ZrO₂ healing abutments demonstrated the highest post-pull PrestoBlue viability and overall soft tissue attachment. SEM confirmed cell retention on all implant surfaces. Elevated IL-1β levels were detected in models exposed to ZrO₂-M and PEEK-M, whereas IL-6 and IL-8 levels were not influenced by any material or surface topography. Conclusions: In vitro epithelial and connective tissue responses are influenced by implant material, surface topography, and design. Rough TiZr-SLA surfaces promote superior connective tissue attachment, while smooth commercial abutments support optimal overall soft tissue integration. These findings highlight the importance of surface engineering in preclinical optimization of peri-implant soft tissue attachment. Full article

Background/Objectives: Adequate peri-implant soft tissue thickness is essential for long-term peri-implant health and esthetics. Horizontal platelet-rich fibrin (H-PRF) has been proposed to support soft tissue regeneration; however, experimental and translational evidence for its application in peri-implant soft tissue augmentation remains limited. This study aimed to evaluate a H-PRF membrane block approach primarily through an experimental animal model, with clinical cases presented to illustrate translational feasibility. Methods: A customized compression device was used to fabricate the H-PRF membrane block. The biological performance of the H-PRF membrane block was first evaluated in a rabbit model, with histologic assessment of peri-implant soft tissue thickness and integration at 8 weeks. Representative clinical cases requiring peri-implant mucosal thickening were subsequently treated with H-PRF membrane block on the buccal aspect of the alveolar bone beneath a supra-periosteal flap to demonstrate clinical applicability. Results: In the animal model, the H-PRF membrane block resulted in a significant increase in peri-implant soft tissue thickness by increasing the lamina propria compared with control sites demonstrated by histologic analysis. The clinical illustrations showed stable buccal soft tissue volume and contour with minimal patient morbidity. Conclusions: Within the limitations of this experimental study, the horizontal H-PRF membrane block technique demonstrated promising biological performance for peri-implant soft tissue augmentation in an animal model. The accompanying clinical illustrations support the translational feasibility of this approach. Clinical relevance: This experimental study provides biological and translational insight into a minimally invasive strategy for peri-implant soft tissue thickening and may inform future controlled clinical investigations. Full article

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

Background: Soft tissue stability around dental implant abutments is critical for maintaining a functional peri-implant seal. Yellow anodization is used to improve the aesthetic and surface characteristics of titanium abutments, yet its epithelial effects under more physiologically relevant 3D conditions remain insufficiently explored. Objective: To develop a 3D bioprinted in vitro peri-implant mucosa model and to compare epithelial cell responses on yellow anodized versus turned titanium abutment surfaces. Methods: Commercial Grade 5 (Ti6Al4V) titanium abutments were anodized and compared with turned controls. A collagen-based 3D bioprinted “collar-like” construct incorporating YD-38 epithelial cells was fabricated using a custom holder system to simulate peri-implant mucosal contact. Samples were cultured for 14 and 21 days. Cell distribution and morphology were assessed by optical microscopy and HE staining, while cytoskeletal organization was evaluated by TRITC-phalloidin/Hoechst staining and confocal microscopy. Quantitative fluorescence analysis was performed at 21 days. Results: Both surfaces supported epithelial coverage in the 3D environment. Anodized specimens showed more pronounced actin cytoskeletal organization and the presence of actin-rich, filamentous cellular extensions compared with turned controls. Quantitative image analysis demonstrated significantly higher TRITC-phalloidin signal intensity at 21 days on anodized samples (p < 0.001). Conclusions: Within the limitations of a 3D epithelial in vitro model using YD-38 cells, yellow anodization was associated with enhanced epithelial cytoskeletal organization compared with turned titanium. The presented 3D bioprinted platform may serve as a practical in vitro tool for screening abutment surface modifications relevant to peri-implant soft tissue integration. Full article

Growing evidence suggests that persistent oral infectious diseases (OIDs) contribute to systemic disease, highlighting the importance of understanding their pathogenic mechanisms. Conventional dental treatments, primarily mechanical debridement, surgical intervention, or antimicrobial therapy, often struggle to fully control inflammation or prevent progressive tissue destruction. The nucleotide-binding oligomerization domain, leucine-rich repeat, and pyrin domain-containing 3 (NLRP3) inflammasome is a key regulator of innate immunity, mediating the maturation of proinflammatory cytokines (IL-1β and IL-18) and the pyroptosis-inducing protein gasdermin D. Dysregulated or excessive activation of NLRP3 contributes to the initiation and progression of major oral diseases, including periodontitis, peri-implantitis, pulpitis, and oral mucosal inflammation. Despite growing interest in NLRP3, comprehensive and up-to-date reviews integrating its pathogenic mechanisms and therapeutic potential remain limited. This review summarizes current and past evidence on the role of the NLRP3 inflammasome in oral disease development, highlights emerging pharmacological strategies, and outlines future research directions. Existing studies demonstrate that microbial components and danger signals from injured tissues activate NLRP3, thereby amplifying inflammation, tissue degradation, and bone resorption. Preclinical studies indicate that inflammasome inhibitors and several natural compounds reduce tissue damage; however, their clinical translation remains limited. These findings emphasize the need for deeper understanding of NLRP3-mediated pathways, with translational and clinical research offering promising therapeutic opportunities for oral diseases. Full article