Search Results (96)

Using ultra-short dental implants is a promising alternative to extensive bone grafting procedures for patients with atrophic posterior mandibles and vertical bone loss. However, the amount of insertion torque (IT) applied during implant placement significantly influences stress distribution in the peri-implant bone, which affects implant stability and long-term success. Materials and Methods: This study used finite element analysis (FEA) to examine how different insertion torques (35 N·cm and 75 N·cm) affect stress distribution in cortical and trabecular bone types D2 and D4 surrounding ultra-short implants. Von Mises equivalent stress values were compared with ultimate bone strength thresholds to evaluate the potential for microdamage during insertion. Results: The findings demonstrate that increasing IT from 35 N·cm to 75 N·cm led to a significant increase in peri-implant bone stress. Specifically, cortical bone stress in D4 bone increased from approximately 79 MPa to 142 MPa with higher IT, exceeding physiological limits and elevating the risk of microfractures and bone necrosis. In contrast, lower IT values kept stress within safe limits, ensuring optimal primary stability without damaging the bone. These results underscore the need to strike a balance between achieving sufficient implant stability and avoiding mechanical trauma to the surrounding bone. Conclusions: Accurate control of insertion torque during the placement of ultra-short dental implants is crucial to minimize bone damage and promote optimal osseointegration. Excessive torque, especially in low-density bone, can compromise implant success by inducing excessive stress, thereby increasing the risk of early failure. Full article

Objectives: In the animal model, we aim to evaluate the bone behavior in two innovative and different laser-treated (L1–L2) titanium implants compared to sandblasted and acid-etched (SBAE) used as control. Materials and Methods: A total of twenty-seven dental implants (8.5 × 3.3 mm) used for the study (Sweden & Martina, Due Carraie Padova-Italy) were placed in three Pelibuey female sheep. Implant surface profilometric, contact angle and EDX analysis were detected. After 15, 30 and 90 days, histological, histomorphometric, SEM-EDX analysis and Bone-to-implant Contact (BIC), Dynamic Osseointegration Index (DOI) and Bone Quality Index (BQI) (as Calcium and Phosphorous atomic percentages ratio) were performed. Results: All surfaces showed relevant profilometric and wettability differences. After 15 days, BIC₁₅ showed great differences in L2 (42.1 ± 2.6) compared to L1 (5.2 ± 3.1) and SBAE (23.3 ± 3.9) as well as after 30 days (L2 (82.4 ± 2.2), L1 (56.2 ± 1.3) and SBAE (77.3 ± 0.4)). After 90 days, relevant lower BIC₉₀ values were detected in L1 (68.4 ± 0.2) compared to L2 (86.4 ± 0.1) and SBAE (86.2 ± 0.6). The DOI showed higher rates of bone growth in L2 after 15 (DOI₁₅ = 2.81) and 30 days (DOI₃₀ = 2.83), compared to L1 (DOI₁₅ = 0.38, DOI₃₀ = 3.40) and SBAE (DOI₁₅ = 1.55, DOI₃₀ = 2.58). The DOI₉₀ drastic slowdown in SBAE (0.96), L1 (0.76), and L2 (0.95) confirmed the Early Osseointegration (EO) as a crucial phase. Moreover, before loading, the lower global BQI in L1 (Ca 44.43 ± 0.08–P 46.14 ± 5.15) and SBAE (Ca 45.31 ± 2.08–P 48.28 ± 1.12) compared to L2 (Ca 79.81 ± 2.08–P 81.85 ± 3.14) allows to assert that osseointegration process and bone healing could not be considered complete if compared to the native bone. Conclusions: The BIC, DOI, and BQI results showed that osseointegration is a dynamic process, confirming the crucial role of surface characteristics able to influence it, especially the early osseointegration (EO) phase. The short-time L2 implants’ higher bone quantity and quality results, compared to L1 and SBAE, suggested the fundamental role of this innovative laser-obtained surface in “secondary stability” and predictable long-term clinical outcomes. Full article

Objectives: This study aimed to evaluate the effects of different titanium (Ti) anodized surfaces on soft tissue healing around dental implant abutments. Methods: Discs of machined (MC), pink anodized (PA) and yellow anodized (YA) surfaces were morphologically characterized and evaluated in vitro. Cell adhesion and collagen synthesis by human gingival fibroblasts (hGFs) were assessed to evaluate the regenerative potential of the surfaces under study. Their inflammatory potential was evaluated in THP-1 cell cultures by measuring cytokine secretion, and their proteomic adsorption patterns were characterized using nano-liquid chromatography mass spectrometry (nLC-MS/MS). Statistical significance was considered at 5%. In relation to proteomics, statistical differences were evaluated using the Student t-test with the Perseus application. Results: The anodization process resulted in a reduction in the surface roughness parameter (Ra) relative to the machined titanium (p < 0.05). No differences in hGF adhesion were found between the surfaces after one day. PA induced increased hGF collagen synthesis after 7 days (p < 0.05). The secretion of TNF-α was lower for anodized surfaces than for MC, and its concentration was lower for PA than for YA (p < 0.05). In turn, TGF-β was higher for PA and YA versus MC after one and three days of culture. A total of 176 distinct proteins were identified and 26 showed differences in adhesion between the anodized surfaces and MC. These differential proteins were related to coagulation, lipid metabolism, transport activity, plasminogen activation and a reduction in the immune response. Conclusions: Anodized Ti surfaces showed promising anti-inflammatory and regenerative potential for use in dental implant abutments. Anodization reduced surface roughness, increased collagen synthesis and lowered TNF-α secretion while increasing TGF-β levels compared to machined surfaces. Identified proteins related to coagulation and lipid metabolism supported these findings. Clinical relevance: Anodized surfaces could offer improved short-term peri-implant soft tissue healing over machined surfaces. The analysis of abutment surface, instead of implant surface, is a new approach that can provide valuable information. Full article

Dental implant papilla (DIP) is susceptible to bacterial adhesion and biofilm formation, and oral pathogenic biofilms can cause persistent oral infections. Enrichment of bacterial biofilms on implants can lead to soft tissue irritation and adjacent bone resorption, severely compromising dental health and potentially leading to periodontitis, implant loss and costly follow-up care. Nanozymes (NZs) are recently used in biofilm removal as they can induce the production of reactive oxygen species (ROS), which can kill bacteria. However, the short lifespan of ROS limits their diffusion distance, and affects their therapeutic efficacy. In this study, we prepared Fe₃O₄ nanoparticles (NZs) with different morphologies: flower-like (F-Fe₃O₄), hollow spherical (M-Fe₃O₄), octahedral (O-Fe₃O₄), and conventional nanoparticles (N-Fe₃O₄). The ferromagnetic properties of Fe₃O₄ NZs allow them to move and penetrate the biofilm under the action of a magnetic field. The saturation magnetic intensities of the four samples were as follows: F-Fe₃O₄ (23.1 emu g⁻¹), M-Fe₃O₄ (73.34 emu g⁻¹), O-Fe₃O₄ (96.06 emu g⁻¹), and N-Fe₃O₄ (52.15 emu g⁻¹). The synergistic combination of photothermal action and catalytic sterilization can effectively remove the biofilm. In addition, the prepared Fe₃O₄ nanozymes were able to maintain high biological activity on the implant surface with some osteogenic effect. Full article

Background/Objectives: Intermittent parathyroid hormone (PTH) administration increases bone quantity. Existing animal studies have revealed improvements in tissue healing around implants after PTH administration. It is still unclear whether PTH has a beneficial short-term effect on the early healing of bone and soft tissue around implants in individuals with osteoporosis. The current study aims to examine whether short-term intermittent PTH administration accelerates and improves early tissue healing around implants in ovariectomized rats. Methods: Ovariectomized rats received implants at the healed sites of extracted maxillary first molar sockets 12 weeks after the ovariectomy surgery. A daily dose of PTH was subcutaneously administered in the test group, whereas saline was administered for the control group. Long bones and maxillae were harvested 1 week after PTH administration. The following criteria were assessed: quantity and quality of long bones and peri-implant bone, bone healing around the implants, and soft tissue healing. Results: PTH significantly increased the bone parameters of long bones. Moreover, the bone volume around the implant increased significantly compared to controls. Improved bone quality was indicated through PTH administration by increased numbers of osteoblasts and osteoclasts, as well as decreased quantities of sclerostin + osteocytes. Furthermore, PTH administration significantly improved soft tissue healing, promoted collagen production and angiogenesis, and increased the numbers of macrophages in the connective tissue around the implants. Conclusions: Short-term intermittent PTH administration significantly accelerates soft tissue healing, which could lead to enhanced early osseous healing and bone formation around implants. Thus, Intermittent PTH administration might be considered as an available treatment modality for dental implants in osteoporosis patients. Full article

Background/Objectives: This in vitro study investigated the retention of three different geometrical designs of short titanium base (Ti-base) abutments used in implant-supported zirconia crowns. The advent of digital technology has facilitated the integration of Ti-base abutments into implant dentistry by improving time efficiency, precision, and patient comfort. Methods: Three types of short Ti-base abutments were evaluated: Geo SRN multibase^® (Group A), Herilink^® (Group B), and TS Link^® (Group C), each with a height of 4 mm and gingival height of 1 mm (n = 20 per group). Zirconia crowns (LUXEN^® Smile S2, DentalMax, Republic of Korea) were modified for the testing setup and fabricated using CAD/CAM technology, then bonded to the abutments with RelyX^® Luting 2 resin-modified glass ionomer cement. Pull-out tests were conducted at a crosshead speed of 1 mm/min to assess retention. Results: One-way ANOVA and post hoc Tukey tests revealed significant differences in retention values among the different abutment shapes (p < 0.05). The mean retention forces were 194.65 N for Group A, 241.33 N for Group C, and 360.20 N for Group B. Conclusions: The geometrical design of Ti-base short abutments significantly affects the retention of CAD/CAM zirconia crowns, with hexagonal shapes (Group B) demonstrating superior retention. Clinically, selecting an abutment design with enhanced mechanical retention may improve the long-term success of implant-supported restorations. Full article

Background/Objectives: Dental implant success is influenced by a range of systemic and local factors. Emerging evidence suggests that metabolic markers such as lipid profiles and vitamin D levels may play a role in osseointegration and implant survival. The aim of this study was to evaluate the influence of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and vitamin D levels on the short-term survival rate of dental implants. Materials and Methods: A prospective observational study was conducted on patients receiving dental implants. Preoperative serum levels of LDL, HDL, triglycerides, and vitamin D were recorded. A total of 556 conical, platform-switching implants were placed in 166 patients, smokers and no smokers with mean age 48 years ± 4.7. Implant survival was evaluated from 14 to 21 days after placement, at 6- and at a 12-month follow-up. Spearman’s rank correlation was performed to assess potential correlations between the abovementioned systemic factors and implant loss. Results: Out of 556 implants, 13 (2.34%) were lost from 14 to 21 days after placement, a further two (0.35%) were lost after 6 months after surgery and a further eight (1.44%) were lost 12 months after placement. No significant correlation was found between HDL levels, cholesterol levels, triglyceride levels and implant loss. Spearman’s correlation analysis revealed a strong negative correlation between vitamin D levels and implant loss with no statistical significance. Conclusions: Within the limitations of this study, no statistically significant associations were found between lipid profile markers or vitamin D levels and early dental implant loss. Further large-scale and long-term studies are warranted to validate these findings and better understand the interplay between systemic biochemical markers and implant survival rate. Full article

Background/Objectives: One of the most serious complications following implant placement in the atrophic posterior mandible is injury to the inferior alveolar nerve (IAN), which can also happen during occlusal loading of the implants. This study investigates the effects of 4 mm implant stress transmission to the inferior alveolar nerve during occlusal loading in cases of severe posterior mandibular atrophy. Methods: The computer-aided design (CAD) model was created and modified through Direct Modeling techniques. The structure of cortical and trabecular bones was simplified, and it was modeled as a cylinder block. Finite element analysis (FEA) was carried out in 3D to investigate the pressure distribution over the IAN at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm), and stress and strain deformations were simulated in the mandibular model. Results: The results of the pressure analysis on the inferior alveolar nerve indicate that the pressure distribution at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm) is consistently below 0.026 MPa, which corresponds to the maximum pressure range that may block nerve impulses. This occurs even at the theoretical and simulated distance of 0.1 mm, suggesting that cortical bone stiffness plays a crucial role in mitigating stress at reduced implant-to-nerve proximities. Conclusions: Within the limits of this study, ultra-short implants can be placed even less than 0.5 mm (up to 0.1 mm under the 3D-FEA hypothesis) above the inferior alveolar nerve under the 3D-FEA hypothesis, while maintaining pressure below the threshold value. This is due to the rigidity of the cortical bone, which helps to reduce pressure transmission to the nerve. These findings may expand the indications for ultra-short implants, even in mandibles with a residual bone height of just 4 mm. Full article

Background/Objectives: Digital workflows for implant-supported full-arch restorations remain challenging. This study evaluated the accuracy and precision of digital impressions using reverse scan body (RSB) prototypes and intraoral scanners (IOSs) for rehabilitating fully edentulous patients following the All-on-4 protocol. Secondary objectives included comparing accuracy between expert clinicians and beginners, as well as desktop scanners and various RSB designs. Methods: An in vitro study was conducted using a fully edentulous mandible model with four Osstem TSIII implants. A final-year dental student and an expert clinician captured digital impressions using IOSs and desktop scanners. Four groups were analyzed: (A) original scan bodies with the IOS, (B) short RSBs with the IOS, (C) RSBs with desktop scanners (short sandblasted, long sandblasted, long coated), and (D) a control group using original scan bodies with a desktop scanner. Root mean square (RMS) values measured dimensional differences, with statistical analysis performed using the Wilcoxon signed-rank test and one-way ANOVA (α = 0.05). Results: A total of 42 scans were analyzed. No significant difference was found between expert and student for original scan bodies using the IOS (p = 0.220), while RSB prototypes showed significant differences (p = 0.008). No significant accuracy differences were noted between original scan bodies and RSBs with the IOS, but IOSs outperformed desktop scanners. Among RSBs scanned with desktop scanners, no significant differences were observed between designs. Conclusions: RSB prototypes are a viable alternative to original scan bodies for fully digital workflows in All-on-4 rehabilitations, with IOSs offering superior accuracy. However, proper training is crucial for optimizing RSB accuracy. Variations in height and coating did not impact overall accuracy. Full article

Background: Digital planning and the use of a static surgical guide for implant placement provide predictability and safety for patients and practitioners. The aim of this study was to investigate differences in the accuracy and fit of long and short guides. Methods: In patients with at least one missing tooth, long (supported by the entire dental arch) and short templates (supported by two teeth, mesial and distal) were compared via intraoral scans and the superimposition of the STL files of the initial planning and the actual position in the patient’s mouth along the X-, Y- and Z-axes. Furthermore, this study evaluated the conditions (e.g., mouth opening, the implant position) under which fully guided implantation can be realized. Results: The largest deviation was observed in the Z-axis, although this deviation was not as high for the short templates (0.2275 mm) as it was for the long templates (0.4007 mm). With respect to the 3D deviation (dXYZ), the average deviation from the mean value was 0.2953 mm for the short guides and 0.4360 mm for the long guides (p = 0.002). The effect size (Cohen’s d) was 0.709, which was between the medium (0.50) and large effect sizes (0.80). The shorter templates showed a smaller deviation from the actual plan by 80%. With a mouth opening ≥50 mm, fully guided surgery can be performed in the molar region. In the premolar region, the lower limit was 32 mm. Conclusions: The 3D accuracy was significantly higher for the shorter template, which could therefore be favored. Full article

Background: Dental implantology has undergone significant advancements with the integration of digital workflows, transforming the processes of planning, designing, surgical delivery, and prosthetic rehabilitation. Among these innovations, intraoral optical scanning (IOS) has emerged as a preferred method over traditional analogue impressions. This preference is due to its cost-effectiveness, efficiency, and streamlined patient-friendly use while producing clinically acceptable results in terms of trueness and precision, particularly for short-span implant prostheses. Methods: However, the clinical utility of intraoral scanning is significantly affected by the lack of reference points and difficulties in moisture and bleeding control at the time of immediate implant placement surgery in the fully edentulous arch. Current evidence supports the general consensus that the traditional analog impression technique still provides superior trueness and precision compared to IOS, specifically in full-arch implant cases. Results: The continuous quest for precision in dental implantology has led to the introduction of photogrammetry, which is now considered the most accurate technique for the digital scanning of dental implants. Photogrammetry has demonstrated superior results compared to those obtained using the analog technique. Conclusions: The aim of this case report is to provide an overview of analog techniques, digital intraoral optical scanning, and photogrammetry, setting the stage for the introduction of a novel technique involving a dedicated optical scan-transfer device (IPD^®) that can be scanned with ease using IOS, either intra- or extra-orally, due to its unique design features and digital properties. Full article

Background and Clinical Significance: Dental implants are widely used; however, tooth extraction often results in alveolar bone loss and gingival recession, necessitating bone and connective tissue reconstruction, especially in the esthetic anterior regions. To address these issues, implants are occasionally connected to adjacent teeth, but this remains controversial, as complications (e.g., intrusion of natural teeth) have been observed. This report demonstrates the long-term success of implants replaced after removing maxillary bilateral central incisors and connecting them to lateral incisors with reduced supportive bone due to periodontitis. Case Presentation: A 57-year-old woman with root fractures in maxillary bilateral central incisors, periodontitis, and malocclusion was treated with connecting implants and natural teeth. Bone levels surrounding maxillary bilateral lateral incisors were diminished due to root fractures in adjacent central incisors and periodontitis. After initial periodontal therapy, hopeless maxillary central incisors were extracted, replaced with implants using a digitally simulated surgical guide, and guided bone regeneration and connective tissue grafting were performed. Implants were connected to lateral incisors with provisional restorations, and orthodontic treatment was initiated following digital set-ups incorporating implants into the overall strategy. Final porcelain-fused-to-zirconia restorations were placed after orthodontic treatment. At the 5-year follow-up, gingival morphology, coloration, and position of lateral incisors remained stable. Conclusions: This case demonstrates that connecting implants to natural teeth in the anterior region can effectively maintain periodontal tissues around natural teeth and allow for minimally invasive, short-term, and esthetic treatment. However, careful long-term observation through maintenance is necessary due to limited evidence for this approach in the anterior region. Full article

Objectives: This review aimed to compare the effectiveness of using a dental water jet (WJ) to manual tooth brushing (MTB) alone or when combined with flossing (MTB + F) in improving plaque index (PI), bleeding index (BI), and gingival index (GI) in regular and orthodontic patients. Materials and Method: This review was registered with the PROSPERO registry (CRD42022296752). Three reviewers conducted a comprehensive search of MEDLINE, the Cochrane Library, and Google Scholar for studies published between 1990 and July 2022. Eligible studies were randomized clinical trials, excluding those involving peri-implantitis, patients with impaired manual dexterity, or powered brushes. The outcomes of interest (PI, BI, and GI) were measured across short-, intermediate-, and long-term periods. Results: Eighteen RCTs were included in this review. PI: in regular patients, use of a WJ showed no additional improvement over flossing, and the results were inconsistent when compared to MTB alone. For orthodontic patients, use of a WJ provided a slight improvement over flossing in the short term and MTB alone in the intermediate term. BI: use of a WJ demonstrated a slight improvement over flossing and MTB alone in both patient groups at different time points. GI: use of a WJ was comparable to flossing but showed slight benefits over MTB alone in the short term for regular patients and in the intermediate term for orthodontic patients. Conclusions: use of a WJ may provide slight benefits in BI and GI compared to flossing or MTB alone, especially for orthodontic patients. Clinical relevance: incorporating a WJ into the daily oral hygiene routine is recommended due to its potential benefits over brushing alone and its user-friendly alternative to flossing. Full article

Background: Vertical atrophy of the maxilla has traditionally been treated with sinus lift procedures and implant placement, performed in one or two surgical stages. Subsequently, the transcrestal sinus lift technique was introduced, offering distinct advantages in terms of indications and reduced morbidity. Most recently, short implants have emerged as a valid alternative to these procedures, even in cases of severe horizontal resorption, allowing for direct placement in many cases. This study was designed to assess the clinical outcomes of short implant placement in alveolar ridges with severe bone atrophy, compared with conventional-length implants placed in areas undergoing conventional sinus elevation. Methods: A retrospective split-mouth study was conducted to compare conventional sinus elevation with standard-length implants versus short implants for addressing vertical bone atrophy in the posterior maxilla. The primary variable was the variation in the marginal bone level. The secondary variables were implant survival and complications. The evaluation of the statistical significance of the difference in categorical variables was accomplished by Chi-squared test or Fisher’s exact test. The comparison between the study groups in continuous variables was performed using Wilcoxon test. The statistical significance was set at p-value < 0.05. Results: The study sample consisted of 24 patients and a total of 73 dental implants. The lateral sinus elevation group (LSEG) included 39 implants, while the short implants group (SIG) included 32 implants. All prostheses were screw-retained. Changes in marginal bone levels indicated a marginal bone loss of less than 0.5 mm in both groups, with no statistically significant difference. In the LSEG, two cases of mucositis were identified, attributed to improper use of an interdental brush. Additionally, two cases of prosthetic screw fracture were reported in the LSEG as technical complications. Conclusions: Long-term outcome data have provided evidence that the use of short implants is comparable to a state-of-the-art procedure (sinus grafting and placement of implants) regarding implant survival, marginal bone remodeling, and complication rates. Full article

Background/Objectives: In the last decades, dental implant surfaces have been evolving to increase success and implant survival rates. More studies evaluating outcomes with implants with ultra-hydrophilic multi-zone anodized surfaces are necessary. The aim of this study is to evaluate the short-term outcome of implants of conical connection with anodized ultra-hydrophilic surfaces for support of single teeth and partial rehabilitations. Methods: In this retrospective study, patients received parallel-walled implants with a gradually anodized surface. The primary outcome measure was implant survival. Secondary outcome measures were marginal bone loss and mechanical and biological complications. This study included 253 conical connection implants with anodized ultra-hydrophilic surfaces, placed in 145 patients (71 males and 74 females; average age: 55.8 years). Sixty patients presented comorbidities, and 19 patients presented smoking habits. Results: Ten patients (15 implants) were lost to follow-up. Two implants failed in two patients, resulting in a cumulative survival rate of 99.2%, with 98.5% and 100% for males and females, respectively, and 99.1% and 100% for single teeth and partial rehabilitations, respectively. The average marginal bone loss was 0.52 mm at 1 year, with 0.60 mm and 0.42 mm for males and females, respectively, and 0.52 mm and 0.50 mm for single teeth and partial rehabilitations, respectively. The rate of mechanical complications was 4.8% and 3.2% at patient and implant levels, respectively. Biological complications occurred in one patient (0.7%) at one implant (0.4%). Conclusions: These results indicate that the use of implants with ultra-hydrophilic multi-zone anodized surfaces for single teeth and partial rehabilitations is viable in the short term. Full article