Search Results (1,225)

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence. Full article

A novel macrodesign for a dental implant characterized by a non-monotonic variation in core diameter and thread shape has been described to produce lower stress levels during insertion as compared to conventional tapered implants. Two finite element models resembling the lower left molar region with preformed osteotomies were created based on a cone beam computed tomography (CBCT) scan. Insertion of both the novel and the conventional, tapered implant type were simulated using Standard for the Exchange of Product model data (STEP) files of both implant types. Von Mises equivalent stress, strain development, and amount of redistributed bone were recorded. The conventional implant demonstrated a continuous increase in strain values and reaction moment throughout the insertion process, with a brief decrease observed during the final stages. Stress levels in the cortical bone gradually increased, followed by a reduction when the implant was finally positioned subcrestally. The novel implant achieved the maximum magnitude of reaction moment and cortical bone strain values when the implant’s maximum core diameter passed the cortical bone layer at around 60% of the insertion process. Following a notable decrease, both the reaction moment and stress started to rise again as the implant penetrated further. The novel implant removed more bones in the trabecular region while the conventional implant predominantly interacted with cortical bone. Overall, the novel design seems to be less traumatic to alveolar bone during the insertion process and hence may lead to reduced levels of initial peri-implant bone loss. Full article

Background and Objectives: We wished to evaluate the effect of antiresorptive agents (ARAs) on peri-implant tissues and to examine the risk factors for peri-implant medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: The study cohort consisted of patients who underwent implant surgery or maintenance treatment between March 2012 and December 2024. The patients were divided into two groups: those in whom bisphosphonates (BPs) or denosumab (Dmab) was used to treat osteoporosis after implant treatment (the ARA group) and a control group. Peri-implant clinical parameters (implant probing depth (iPPD), implant bleeding on probing (iBoP), marginal bone loss (MBL), and mandibular cortical index (MCI)) measured at the baseline and at the final visit were statistically evaluated and compared in both groups. Risk factors were examined using a multivariate analysis of adjusted odds ratios (aORs). Results: A total of 192 implants in 61 patients (52 female, 9 male) were included in this study. The ARA group consisted of 89 implants (22 patients). A comparison of the clinical parameters showed that the ARA group had significantly higher variations in their maximum iPPD and iBoP values over time than those in the control group. Risk factors for peri-implantitis as objective variables were the use of ARAs (aOR: 3.91; 95% confidence interval [CI]: 1.29–11.9) and the change in the maximum iPPD over time (aOR: 1.86; 95% CI: 0.754–4.58). Conclusions: During long-term implant maintenance treatment, patients’ health and medication status change. Monitoring peri-implantitis, the presumed cause of peri-implant MRONJ, is essential, especially in patients who started ARA treatment after implant placement, and special attention should be paid to changes in implant pocket depth. Full article

Objectives: The aim of this study was to determine the differential temperature produced on ceramic implants using laser irradiation on a pulsed setting of intrabony defects in vitro. Methods: A ceramic (Zr) dental implant (Zeramex, 4.8 × 12 mm) was placed into a bovine bone block. A three-wall intrabony defect (6 × 4 × 3 mm) was created to mimic an osseous peri-implant defect. Thermocouples were placed on the apical and coronal areas to measure temperature changes (∆T) during 60 s of laser irradiation. The bovine block was heated to 37 °C, and the defect walls were irradiated with the CO₂ and Er,Cr:YSGG laser. The settings used were pulsed mode for both lasers, with 30 Hz and 1.5 W for the Er,Cr:YSGG laser and 70 Hz and 2 W for the CO₂ laser. The same laser settings were repeated at room temperature (RT, 23 °C). Twenty trials were performed for each experimental group at room and body temperature for assessment of ∆T. Paired t-test were used to compare the measurements between 37 °C and 23 °C for the Er,Cr:YSGG, and CO₂ laser, respectively. Results: The CO₂ laser resulted in the highest ∆T (°C) at the coronal (15.22 ± 0.28/8.82 ± 0.21) and apical (5.84 ± 0.14/2.30 ± 0.28) level when this laser was used in both room temperature and body temperature, respectively. The highest ∆T (°C) for the Er,Cr:YSGG laser at body temperature at the coronal thermocouple was 7.64 ± 0.55, while for the CO₂ laser, at body temperature was 8.82 ± 0.21. Conclusion: Within the limitations of our study, the use of CO₂ laser and Er,Cr:YSGG laser on peri-implant defects generally appears to be safe in treating peri-implant defects around zirconia implants in vitro. Full article

Background and Clinical Significance: The retreatment of failed dental implants remains a challenging clinical scenario, particularly when complicated by peri-implantitis and as sociated bone loss. Successful management requires a comprehensive and predictable approach that addresses both hard and soft tissue deficiencies. Case Presentation: This case report illustrates a fully digital, prosthetically driven workflow for the rehabilitation of a posterior mandibular site following implant failure. A 44-year-old female patient underwent removal of a failing implant and adjacent tooth due to advanced peri-implantitis and periodontitis. After healing, a digital workflow—including intraoral scanning, cone-beam computed tomography (CBCT), and virtual planning—was employed to design and fabricate a customized CAD/CAM titanium mesh for vertical guided bone regeneration. The grafting procedure utilized a composite mixture of autogenous bone and anorganic bovine bone (A-Oss). After nine months of healing, two implants with a hydrophilic surface (SOI) were placed using a fully guided surgical protocol (OneGuide system). Subsequent soft tissue grafting and final prosthetic rehabilitation with monolithic zirconia restorations resulted in stable functional and aesthetic outcomes. Conclusions: This case highlights how the integration of modern digital technologies with advanced regenerative procedures and innovative implant surfaces can enhance the predictability and long-term success of implant retreatment in compromised posterior sites. Full article

Background/Objective: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has affected more than 1700 women with textured breast implants. About 80% of patients present with fluid (seroma) around their implant. BIA-ALCL can be cured by surgery alone when confined to the seroma and lining of the peri-implant capsule. To address the need for early detection, we developed a rapid point of care (POC) lateral flow assay (LFA) to identify lymphoma in seromas. Methods: We compared 28 malignant seromas to 23 benign seromas using both ELISA and LFA. LFA test lines (TL) and control lines (CL) were visualized and measured with imaging software and the TL/CL ratio for each sample was calculated. Results: By visual exam, the sensitivity for detection of CA9 was 93% and specificity 78%, while the positive predictive value was 84% and negative predictive value 90%. Quantitative image analysis increased the positive predictive value to 96% while the negative predictive value reduced to 79%. Conclusions: We conclude that CA9 is a sensitive biomarker for detection and screening of patients for BIA-ALCL in patients who present with seromas of unknown etiology. The CA9 LFA can potentially replace ELISA, flow cytometry and other tests requiring specialized equipment, highly trained personnel, larger amounts of fluid and delay in diagnosis of BIA-ALCL. Full article

Background: Modification of diameter stability after the abutment retention can result in a decrease in the applied torque or affect the peri-implant tissue, compromising the longevity of the treatment. Therefore, this study aimed to investigate how different connection angles (11.5° and 16.0°) at the implant–abutment interface influence implant diameter stability under the manufacturer’s recommended torque. Methods: Eighty Morse cone-type implant specimens were divided into two groups, with different internal conicity angles: 11.5° (n = 40) and 16.0° (n = 40). Implants varied in diameter (mm): 3.5, 3.8, 4.5, and 5.0. Initial measurements of the implants’ external diameter were carried out. After these measurements, all implants received the abutment installation, and a final measurement of the external implant diameter was performed. Results: Considering the comparative analysis between the final and initial diameters, a non-significant increase in diameter, in the cervical implant region, after torque on the abutment, was observed. The torque applied to the abutments did not produce deformations in the cervical area of Morse taper implants. Conclusions: The torque applied to the abutment screw in implants with a Morse taper connection does not cause deformation in the cervical area of the implant body in implant with 11.5° and 16.0° conicity angles. Full article

Background/Objectives: The aim of the present study is to evaluate the influence of the healing abutment height on secondary implant stability measured by resonance frequency analysis. In this prospective observational clinical study of 30 implants, the secondary stability of the implant was measured via resonance frequency analysis of the abutment during the osseointegration process. Methods: Two groups were compared: a <4 group (n = 15), with a space between the healing abutment and the antagonist of <4 mm, and a ≥4 group (n = 15), with a space of ≥4 mm. Results: Statistically significant differences (p < 0.05) in the implant stability values obtained at surgery (T0) and at the eighth week of osseointegration (T8) were observed between the two groups, with higher values for the <4 group. Pearson’s correlation analysis revealed a trend towards a significant relationship with the mean force (−0.6546) and a linear inverse relationship, so that by decreasing the distance between the abutment and the contact with the antagonist, the secondary implant stability values increased. A comparison of the mesial and distal peri-implant marginal bone levels at T0 and T8 did not reveal statistically significant differences (p > 0.05). A greater healing abutment height, placing it closer to the antagonist, increases and accelerates secondary stability, as measured by resonance frequency analysis. Conclusions: The results of the study support the recommendation of using high healing abutments, placing the abutment close to the opposing occlusal plane, according to biomechanical criteria. Full article

To improve implant osseointegration while preventing infection, we developed a strontium (Sr)-doped Ti₃C₂T_x MXene coating on titanium, aiming to synergistically enhance bone integration and antibacterial performance. MXene is a family of two-dimensional transition-metal carbides/nitrides whose abundant surface terminations endow high hydrophilicity and bioactivity. The coating was fabricated via anodic electrophoretic deposition (40 V, 2 min) of Ti₃C₂T_x nanosheets, followed by SrCl₂ immersion to incorporate Sr²⁺. The coating morphology, phase composition, chemistry, hydrophilicity, mechanical stability, and Sr²⁺ release were characterized. In vitro bioactivity was assessed with rat bone marrow mesenchymal stem cells (BMSCs)—with respect to viability, proliferation, migration, alkaline phosphatase (ALP) staining, and Alizarin Red S mineralization—while the antibacterial efficacy was evaluated against Staphylococcus aureus (S. aureus) via live/dead staining, colony-forming-unit enumeration, and AlamarBlue assays. The Sr-doped MXene coating formed a uniform lamellar structure, lowered the water-contact angle to ~69°, and sustained Sr²⁺ release (0.36–1.37 ppm). Compared to undoped MXene, MXene/Sr enhanced BMSC proliferation on day 5, migration by 51%, ALP activity and mineralization by 47%, and reduced S. aureus viability by 49% within 24 h. Greater BMSCs activity accelerates early bone integration, whereas rapid bacterial suppression mitigates peri-implant infection—two critical requirements for implant success. Sr-doped Ti₃C₂T_x MXene thus offers a simple, dual-function surface-engineering strategy for dental and orthopedic implants. Full article

Peri-implantitis is an inflammatory disease-causing bone loss around dental implants, often requiring reconstructive surgical therapies to reduce probing depth and regenerate bone. However, such surgeries are frequently complicated by postoperative issues. This retrospective case series aimed to identify the main postoperative complications following the reconstructive treatment of peri-implant bone defects in peri-implantitis patients. Data from 14 patients with 21 affected implants were analyzed, including demographics, oral hygiene, surgical techniques, and complications such as wound dehiscence, membrane exposure, and infections. Wound dehiscence was measured using Image J^® software version 1.54. Descriptive and bivariate analyses were performed. The results showed that 11 implants (52.4%; 95% confidence interval (95%CI): 29% to 76%) in nine patients (57.1%; 95%CI = 27% to 87%) developed soft tissue dehiscence after one week, with membrane exposure observed in 4 implants. Dehiscence was significantly associated with mandibular implant location (p = 0.003), poor interproximal hygiene (p = 0.008), and membrane exposure (p = 0.034). No postoperative infections were recorded. In conclusion, more than half of peri-implantitis patients undergoing reconstructive surgery experience wound dehiscence, particularly in cases involving mandible, poor hygiene, and membrane exposure. This complication might compromise bone regeneration and reduce the treatment success rate. These results should be interpreted cautiously due to study design limitations (retrospective design, lack of a control group, and small sample size). Full article

Background/Objectives: Full-arch implant-supported prostheses have become a widely accepted solution for edentulous patients, yet long-term biological and mechanical complications remain a clinical concern. Methods: This retrospective study included 70 fully edentulous patients (362 implants) rehabilitated with either fixed or removable implant-supported prostheses. Data were collected on demographics, medical status, type and location of prostheses, implant type, abutments, method of fixation, and complications. Statistical analysis included Fisher’s exact test, the Mann–Whitney U test, and chi-squared tests, with a significance level set at p < 0.05. Results: Mechanical complications occurred in 41.4% of patients (29 out of 70), with framework fractures reported in eight cases (27.6%), ceramic chipping in six cases (20.7%), and resin discoloration in four cases (13.8%). The prostheses were fabricated using monolithic zirconia, metal–ceramic crowns, zirconia on titanium bars, and hybrid resin/PMMA on cobalt–chromium frameworks. Gingival inflammation was also noted in 41.4% of cases (n = 29), predominantly in posterior implant regions. Younger patients and those without systemic diseases showed a significantly higher incidence of mechanical complications. Conclusions: Two years post-treatment, mechanical and biological complications appear to be independent phenomena, not significantly associated with most prosthetic variables. Patient-specific factors, particularly age and general health status, may have greater predictive value than prosthetic design. Limitations of the study include its retrospective design and the lack of radiographic data to assess peri-implant bone changes. Full article

Optimizing stress distribution at the bone–implant interface is critical to enhancing the long-term biomechanical performance of dental implant systems. Vertical misalignment between splinted implants can result in elevated localized stresses, increasing the risk of material degradation and peri-implant bone resorption. This study employs three-dimensional finite element analysis (FEA) to evaluate the mechanical response of peri-implant bone under oblique loading, focusing on how variations in vertical implant platform alignment influence stress transmission. Four implant configurations with different vertical placements were modeled: (A) all crestal, (B) central subcrestal with lateral crestal, (C) lateral subcrestal with central crestal, and (D) all subcrestal. A 400 N oblique load was applied at 45° simulated masticatory forces. Von Mises stress distributions were analyzed in both cortical and trabecular bone, with a physiological threshold of 100 MPa considered for cortical bone. Among the models, configuration B exhibited the highest cortical stress, exceeding the physiological threshold. In contrast, configurations with uniform vertical positioning, particularly model D, demonstrated more favorable stress dispersion and lower peak values. Stress concentrations were consistently observed at the implant–abutment interface across all configurations, identifying this area as critical for design improvements. These findings underscore the importance of precise vertical alignment in implant-supported restorations to minimize stress concentrations and improve the mechanical reliability of dental implants. The results provide valuable insights for the development of next-generation implant systems with enhanced biomechanical integration and material performance under functional loading. Full article

Background/Objectives: The formation of oral biofilms in periodontal pockets and around dental implants with induction of periodontitis or peri-implantitis is an increasing problem in dental health. The intelligent design of a biofilm makes the bacteria embedded in the biofilm matrix highly tolerant to antiseptic therapy, often resulting in tooth or implant loss. The question therefore arises as to which mouthwashes have eradication potential against oral biofilm. Methods: A human oral biofilm model was developed based on donated blood plasma combined with buffy coats, inoculated with oral pathogenic bacterial species found in periodontal disease (Actinomyces naeslundii, Fusobacterium nucleatum, Streptococcus mitis, and Porphyromonas gingivalis). Over a span of 7 days, we tested different mouth rinsing and antiseptic solutions (Chlorhexidine, Listerine^®, NaOCl, Octenisept^®, and Octenident^®) covering the matured biofilm with 24 h renewal. Phosphate-buffered saline (PBS) was used as a control. Bacterial growth patterns were detected via quantitative polymerase chain reaction (qPCR) after 2, 4, and 7 days of treatment. Results: While all groups showed initial bacterial reduction, the control group demonstrated strong regrowth from day 2 to 4. Listerine showed a near-significant trend toward bacterial suppression. Additionally, strain-specific efficacy was observed, with Octenisept^® being most effective against Streptococcus mitis, Octenident^® and NaOCl showing superior suppression of Actinomyces naeslundii, and Listerine^® outperforming other solutions in reducing Fusobacterium nucleatum. Donor-specific, individual variability further influenced treatment outcomes, with distinct trends in bacterial suppression and regrowth observed across donors. Conclusions: These findings underscore the complexity of biofilm-associated infections and highlight the importance of targeted therapeutic approaches for managing bacterial biofilms. In this experiment, the donor-specific outcomes of the antimicrobial effects of the solutions may indicate that genetic predisposition/tolerance to oral infections appears to play a critical role in the control of oral biofilms. Full article

Peri-implantitis (PI) presents a growing challenge in implant dentistry, with regenerative surgical approaches often incorporating barrier membranes despite the uncertainty of their clinical value. This systematic review and meta-analysis of in vivo studies aimed to evaluate the efficacy of barrier membranes in the reconstructive surgical treatment of PI. A comprehensive electronic search was performed in PubMed, Scopus, Google Scholar, and the Cochrane Library, covering studies published from 1990 to 2024. The protocol followed PRISMA guidelines and was registered in PROSPERO (CRD42025625417). Eligible studies included in vivo investigations comparing regenerative procedures with and without membrane use, with a minimum follow-up of 6 months and at least 10 implants per study. Risk of bias (RoB) was assessed using the Cochrane RoB tool. The meta-analysis was conducted using a random-effects model and included 15 studies comprising 560 patients. Although not consistently statistically significant, the findings suggested that membrane use may offer enhanced outcomes in terms of probing pocket depth (PPD) reduction and marginal bone level (MLB) gain. The evidence was limited by high clinical heterogeneity, variability in outcome definitions, and short follow-up durations. While membranes are commonly utilized, current evidence does not justify their routine use. Further well-designed, long-term clinical trials are needed to establish specific indications and optimize treatment strategies. Full article