Search Results (279)

Background: The interaction between prosthetic restorations and periodontal health is a critical factor for the long-term success of dental treatments. A biologically compatible prosthetic design supports periodontal stability, whereas neglecting periodontal principles can compromise treatment outcomes. This study aimed to validate a questionnaire designed to assess dentists’ perceptions regarding the influence of prosthetic restorations on the periodontium. Material and Methods: An observational cross-sectional study was conducted using a self-administered questionnaire distributed to licensed dentists across Romania. The questionnaire underwent expert review, pilot testing (n = 50), and statistical validation, including the Content Validity Index (CVI), Cronbach’s alpha for internal consistency, and Exploratory Factor Analysis (EFA) using Principal Component Analysis (PCA) with Varimax rotation. The final sample included 39 respondents. Data was analyzed using SPSS v26.0. Results: The questionnaire demonstrated excellent internal consistency (Cronbach’s alpha = 0.900; standardized alpha = 0.917). Most items had corrected item-total correlations > 0.40. EFA revealed eight coherent factors explaining 81.68% of total variance, with high communalities (0.549–0.966), strong Kaiser–Meyer–Olkin test (KMO) values, and significant Bartlett’s test values, confirming construct validity. Descriptive statistics showed predominantly positive attitudes among dentists regarding the periodontal considerations in prosthetic treatment. The highest-rated items emphasized oral hygiene, periodontal stability, and biological adaptation of restorations. Lower scores were associated with routine use of periodontal indices and recognition of failures due to insufficient evaluation. Conclusions: The validated instrument proved reliable and demonstrated strong psychometric properties in this exploratory validation, supporting its use in research and education. Romanian dentists demonstrated a favorable perception of the role of periodontal health in prosthetic success. This tool can inform curriculum development and interdisciplinary clinical protocols in prosthodontics and periodontology. Full article

Background/Objectives: The rising demand for total joint arthroplasty (TJA) and increasing incidence of prosthetic joint infections (PJIs) significantly burden patients and healthcare systems. This retrospective study describes the epidemiology, clinical characteristics and outcomes of PJIs in Iceland from 2003 to 2020. Methods: PJI cases were identified through synovial fluid cultures and ICD codes, with classification per EBJIS criteria. Unlikely cases were excluded. Results: Among 293 cases with a mean age of 70 years, 60% (176/293) were males and 58% (171/293) involved the knee. Over half of infections occurred within two years post TJA, with an incidence rate of 0.94%, increasing significantly over time (p = 0.012). Males had significantly higher incidence rates than females (incidence rate ratio 0.42; p < 0.001). The most common pathogens were coagulase-negative staphylococci (30%, 88/293), and 9% (27/293) of cases were culture-negative. DAIR was the first-line treatment in about 50% (147/293) of cases but it failed in nearly half, contributing to an overall treatment failure rate of 38% (98/259). PJI-related mortality was 2% (6/293). Conclusions: The results indicate an increased incidence, with the highest risk within two years of TJA. Males are at greater risk, while females more commonly undergo TJA. DAIR success rates were lower than reported elsewhere but improved significantly over time. Better methods to prevent PJIs are needed. 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

(1) Background: This study aimed to evaluate the marginal and internal fit of ceramic crowns produced by various digital methods using microcomputed tomography (MCT) imaging. (2) Methods: The ceramic crown preparation was performed on typodont maxillary first premolar. The crown preparation was scanned with an intraoral scanner and a model scanner, and cone-beam computed tomography (CBCT) scans were performed with three different voxel sizes (0.075 mm, 0.1 mm, and 0.15 mm). The space between the crown and prepared teeth was measured at nine different points in both coronal and sagittal sections. Three different digital model acquisition techniques, namely, intraoral scanning, model scanning, and CBCT-based standard tessellation language (STL) reconstruction, were compared in terms of marginal and internal fit. (3) Results: Quantitative analyses revealed that model scanners exhibited the lowest marginal and internal gap values, indicating superior fit compared to intraoral scanners and CBCT-based models. The highest gap values were observed in the CBCT group with a voxel size of 0.15 mm. Overall, crowns obtained from model scanners demonstrated the highest success rates in both marginal and internal fit. (4) Conclusions: In conclusion, this study highlights the critical role of digital scanning accuracy in achieving clinically acceptable prosthetic fits and emphasizes the need for continued technological advancement. Full article

Background/Objectives: the precise application of torque during prosthetic screw tightening is essential to the long-term success and mechanical stability of implant-supported restorations. This study aimed to evaluate the influence of practitioner experience, glove material, screwdriver length, and hand moisture on the maximum torque value (MTV) generated during manual tightening. Methods: thirty participants, comprising 10 experienced professors and 20 senior dental students, performed tightening tasks under six hand conditions (nitrile gloves, latex gloves, and bare hands, each in dry and wet environments) using two screwdriver lengths (21 mm and 27 mm). The torque values were measured using a calibrated digital torque meter, and the results were analyzed using a linear mixed model. Results: professors applied significantly higher torque than students (16.92 Ncm vs. 15.03 Ncm; p = 0.008). Nitrile gloves yielded the highest torque (17.11 Ncm), surpassing bare hands significantly (p = 0.003). No statistically significant differences were found for screwdriver length (p = 0.12) or hand moisture (p = 0.11). Conclusions: these findings underscore the importance of clinical proficiency and glove material in torque delivery, providing evidence-based insights to enhance procedural reliability and training standards in implant prosthodontics. Full article

The dimensional accuracy of 3D-printed edentulous jaw models is critical for successful prosthetic treatment outcomes. This study investigated the accuracy of 3D-printed working models of a completely edentulous jaw through comparative analysis of digital images generated by three laboratory scanners. A reference plaster model of a mandibular edentulous arch was digitized and used to produce ten resin models via digital light processing (DLP) technology. Each model was scanned using three different laboratory scanners: AutoScan-DS-EX, AutoScan-DS-EX Pro(H), and Optical 3D Scanner Vinyl. Digital comparison was performed using specialized software, evaluating the root mean square (RMS) deviation and percentage of values within an acceptable deviation range ±0.05 mm. All printed models showed significant deviations from the reference model (p < 0.05), with RMS values ranging from 109.2–139.7 µm and acceptable deviation percentages ranging from 29.34 to 32.31%. The mean precision RMS value was 66.37 µm. The mean intraclass correlation coefficient of 0.544 indicated moderate precision. Optical 3D Scanner Vinyl demonstrated the highest consistency, while AutoScan-DS-EX Pro(H) showed maximum variability. No statistically significant differences were found between scanners (p = 0.075). While the investigated scanners demonstrated reliable performance and sufficient accuracy, the additive manufacturing process introduced clinically significant deviations, highlighting the importance of verification between printed models and their digital originals before proceeding with clinical stages. Clinical practice should prioritize scanning systems with advanced software algorithms over those with superior hardware specifications alone. Full article

Background: Tooth agenesis, particularly hypodontia, poses a clinical and esthetic challenge in growing patients due to limitations in definitive implant placement before skeletal maturity. Traditional solutions such as removable prostheses or orthodontic space closure often fail to provide adequate long-term stability, function, and tissue preservation. In recent years, orthodontic mini-implants have emerged as a promising interim solution. This narrative review aims to synthesize current clinical evidence on the use of orthodontic mini-implants as temporary prosthetic abutments in children and adolescents with hypodontia or post-traumatic tooth loss. Methods: A literature search was conducted using PubMed and Google Scholar databases, covering studies published between January 2004 and March 2025. Inclusion criteria were clinical reports involving skeletally immature patients with congenital or traumatic tooth loss treated with mini-implants, with mandatory radiographic diagnostics and outcome data. Data extracted included patient demographics, etiology, implant site, imaging, follow-up, complications, and outcomes. A total of 17 studies comprising 42 cases were analyzed and summarized in tabular form. Results: Patients aged 6 to 16 years were treated primarily for agenesis of maxillary lateral or central incisors. The mean follow-up duration was 36.9 months. CBCT was used in 28.6% of cases. Mini-implants demonstrated high clinical success with stable soft tissue contours and preservation of alveolar volume. Complications were reported in 21.4% of cases and included crown debonding, minor infraocclusion, soft tissue irritation, and rare instances of osseointegration. Conclusions: Orthodontic mini-implants may provide a minimally invasive and reversible approach to interim tooth replacement in growing patients. Preliminary evidence suggests favorable outcomes in terms of stability, esthetics, and tissue preservation, but further prospective research is needed to validate their long-term effectiveness and standardize clinical application. Full article

Background and Clinical Significance: Prosthetic rehabilitation in the aesthetic zone of periodontally compromised patients presents a complex clinical challenge, requiring a careful coordination of aesthetic, functional, and biological demands. This case highlights the benefits of digital dentistry, interdisciplinary collaboration, and regular maintenance in achieving long-term success in complex rehabilitations of periodontally compromised patients. Case Presentation: This case report describes the digital minimally invasive rehabilitation of a 39-year-old male patient with Stage III periodontitis, occlusal discrepancies, tooth mobility, and an interincisal diastema. A fully digital workflow—including intraoral scanning, aesthetic previewing, and mandibular motion analysis—was employed to guide diagnosis, treatment planning, and prosthetic execution. Conservative tooth preparations using a biologically oriented approach (BOPT) were combined with customised provisional restorations to support soft tissue conditioning and functional control throughout the provisional phases. Mandibular motion tracking facilitated the design of a personalised anterior guidance to improve occlusion and correct the deep bite. The interincisal diastema was initially maintained then closed during the advanced phase of treatment based on aesthetic simulations and patient preference. One unplanned endodontic treatment was required during the provisional phase, but no other complications occurred. Conclusions: At the four-year follow-up, the patient demonstrated stable periodontal and occlusal conditions, improved clinical indices, and high satisfaction with the aesthetic outcome. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

Background and Objectives: Conventional methods for removing cemented fixed prosthetic restorations (FPRs) are unreliable and lead to unsatisfactory outcomes. At their best, they allow the tooth to be saved at the expense of a laborious process that also wears down rotating tools and handpieces and occasionally results in abutment fractures. Restorations are nearly never reusable in any of these situations. Erbium-doped yttrium-aluminum-garnet (Er:YAG) and erbium-chromium yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers casafely and effectively remove FPRs, according to scientific studiesre. This study sets out to examine the impact of Er:YAG laser radiation on the debonding of different ceramic restorations, comparing the behavior of various ceramic prosthetic restoration types under laser radiation action and evaluating the integrity of prosthetic restorations and dental surfaces exposed to laser radiation. Materials and Methods: The study included a total of 16 removed teeth, each prepared on opposite surfaces as abutments.y. Based on the previously defined groups, four types of ceramic restorations were included in the study: feldspathic (F), lithium disilicates (LD), layered zirconia (LZ), and monolithic zirconia (MZ). The thickness of the prosthetic restorations was measured at three points, and two different materials were used for cementation. The Er:YAG Fotona StarWalker MaQX laser was used to debond the ceramic FPR at a distance of 10 mm using an R14 sapphire tip with 275 mJ, 20 Hz, 5.5 W, with air cooling (setting 1 of 9) and water. After debonding, the debonded surface was visualized under electron microscopy. Results: A total of 23 ceramic FPRs were debonded, of which 12 were intact and the others fractured into two or three pieces. The electron microscopy images showed that debonding took place without causing any harm to the tooth structure. The various restoration types had the following success rates: 100% for the LZ and F groups, 87% for the LD group, and 0% for the MZ group. In terms of cement type, debonding ceramic FPRs cemented with RELYX was successful 75% of the time, compared to Variolink DC’s 69% success rate. Conclusions: In summary, the majority of ceramic prosthetic restorations can be successfully and conservatively debonded with Er:YAG radiation. Full article

Fungal prosthetic joint infection (fPJI) is one of the orthopaedic pathologies where there is no clear evidence, guidelines or algorithm to guide the surgeon in its management. This is in addition to the difficulty with which these infections are diagnosed, isolated and treated. Fungi form notorious biofilms that are difficult to eradicate once formed and that display resistance to antimicrobial agents. These biofilms have been shown to act synergistically with biofilms of bacteria, further adding to medical treatment resistance. We have reviewed the literature for reports that describe the results of different methods in surgically treating fPJI. We found that surgical management with two stages remains the gold standard for treatment of fPJI, as is the case for bacterial PJI (bPJI). We have investigated medical treatment, debridement with implant retention (DAIR) and staged revisions and whether a reasonable recommendation can be made based on the best knowledge and practice available. From the data on bPJI, there exists a role for conservative management of acute PJI with debridement, antibiotics and implant retention (DAIR). While fPJI and bPJI both represent infections, the differences in our ability to detect these infections clinically, culture the pathogens and treat them with proper antimicrobial agents, along with the difference in the reported results of the surgical treatment, make us believe that these two types of infections should not be treated in the same manner. With all this in mind, we reviewed several reports in the literature on fPJI to determine the efficacy of current treatment modalities, including DAIR, which followed current guidelines for PJI. Data show an overall treatment success rate of 64.4% [range 17.4–100%]. Subgroup analysis revealed a success rate of 11.6% [range 0–28.7%] in patients treated with DAIR. There is no doubt that DAIR should not be encouraged as it consistently has a bad record. Although there are not enough studies or numbers of patients to show an evidence-based preference over one- or two-staged revisions, the two-stage revision of fPJI consistently shows better results and should be considered as the gold standard of management in cases of revision fPJI. This should also be coupled with proper expertise, follow-ups and recommended lengths of medical treatment, which should not be less than six months. From the review of these data, we have developed reasonable recommendations for the management of fPJI. These recommendations center on staged surgical debridement along with medical management. Medical treatment should be for at least 6 months under the guidance of an infectious disease team and based on intraoperative cultures. In the case of local antimicrobial treatment reported in the literature, many patients with fPJI were found to have a polymicrobial infection. As a result, it is our recommendation that antifungals as well as antibacterials should be incorporated into the cement spacer mix of these cases. Fungal PJI remains an exceedingly difficult pathology to treat and should be managed by experienced surgeons in a well-equipped institution. Full article

Sonomyography (SMG) is a method of controlling upper-limb prostheses through an innovative human–machine interface by monitoring forearm muscle activity through ultrasonic imaging. Over the past two decades, SMG has shown promise, achieving over 90% accuracy in classifying hand gestures when combined with artificial intelligence, making it a viable alternative to electromyography (EMG). However, up to now, there are few reports of a system integrating SMG together with a prosthesis for testing on amputee subjects to demonstrate its capability in relation to daily activities. In this study, we developed a highly efficient human–machine interface algorithm for controlling a prosthetic hand with 6-DOF using a wireless and wearable ultrasound imaging probe. We first evaluated the accuracy of our model in classifying nine different hand gestures to determine its reliability and precision. The results from the offline study, which included ten healthy participants, indicated that nine different hand gestures could be classified with a success rate of 100%. Additionally, the developed controlling system was tested in real-time experiments on two amputees, using a variety of hand function test kits. The results from the hand function tests confirmed that the prosthesis, controlled by the SMG system, could assist amputees in performing a variety of hand movements needed in daily activities. Full article

Background: While dental implants have become a reliable solution for tooth loss, their long-term success is increasingly challenged by biological and technical complications such as impact fracture and peri-implantitis. These complications significantly impact implant longevity and patient satisfaction. Aim: This consensus conference aimed to identify and standardize clinical guidelines to prevent implant fractures and peri-implant diseases based on current evidence and expert opinions. Methods: A panel of 10 expert clinicians and researchers in prosthodontics participated in the Osstem Global Consensus Meeting. This paper focuses on the prosthetic division. A structured literature review was conducted, and evidence was synthesized to formulate consensus-based clinical recommendations. Participants answered structured questions and discussed discrepancies to achieve consensus. Results: The panel reached consensus on several key prosthetic risk factors, including (1) the role of biomechanical overload in implant fracture, (2) the impact of emergence profile design on peri-implant tissue stability, (3) the influence of implant positioning and connection geometry on marginal bone loss, and (4) the importance of occlusal scheme and restorative material selection, particularly in high-risk patients such as bruxers. Guidelines to prevent implant fracture and peri-implantitis were developed, addressing these factors with practical preventive strategies. Conclusions: Despite the limitations of narrative methodology and reliance on retrospective data and expert opinion, this consensus provides clinically relevant guidelines to aid in the prevention of mechanical failures and peri-implant diseases. The recommendations emphasize prosthetically driven planning, individualized risk assessment, and early intervention to support long-term implant success. Full article

Objectives: This study aims to investigate the underlying causes of dental implant failure, focusing on implant-related complications and associated risk factors. Understanding these factors will help improve treatment planning and enhance implant success rates. Methods: A retrospective case-control study was conducted using clinical, medical, surgical, and radiographic records of patients who underwent dental implant removal due to complications. Key factors analyzed included patient-related variables (age, gender, medical conditions, periodontal disease), implant-related factors (implant site, implant system, restoration status), and procedural aspects (previous surgical interventions and reasons for implant removal). Results: The findings revealed that implant type (p = 0.004) and type of restoration (p = 0.001) significantly influenced implant survival. Gender (p = 0.001), medical conditions, smoking status (p = 0.004), and restoration status (p = 0.005) were significantly associated with specific failure mechanisms. Lack of osseointegration (36.4%) and absence of primary stability (22.4%) were the predominant causes of implant failure. Prior surgical interventions (p = 0.001) and decisions for re-implantation (p = 0.005) significantly affected implant removal frequency. Conclusions: Implant survival is influenced by multiple factors, with implant type, restoration type, and gender playing key roles in failure outcomes. Patient-specific risk assessment, particularly regarding medical conditions and smoking, meticulous surgical technique, and appropriate prosthetic planning, is vital for improving implant longevity and minimizing failure rates. Full article

The success of orthopedic implants critically depends on achieving mechanical and biological compatibility with bone tissue. Traditional titanium implants often suffer from high stiffness, which induces stress shielding, a phenomenon that compromises implant integration and accelerates prosthetic loosening. This study introduces an innovative approach to mitigate these limitations by engineering a porous titanium substrate with a controlled microstructure. Utilizing sodium chloride as a spacer holder, an elution and sintering process was applied at 1250 °C under high vacuum conditions to reduce the material’s elastic modulus. By manipulating NaCl volume fractions (20%, 25%, 30%, and 35%), porous titanium samples were created with elastic moduli between 16.37 and 22.56 GPa, closely matching cortical bone properties (4 to 20 GPa). A hydroxyapatite coating applied via plasma thermal spraying further enhanced osseointegration of the material. Comprehensive characterization through X-ray diffraction, scanning electron microscopy, and compression testing validated the material’s structural integrity. In vitro cytotoxicity assessments using osteoblast cells demonstrated exceptional cell viability exceeding 70%, confirming the material’s biocompatibility. These findings represent a significant advancement in biomaterial design, offering a promising strategy for developing next-generation joint prostheses with superior mechanical and biological adaptation to bone tissue. Full article