Clinical implant dentistry and related researchHadar Better, Thabet Asbi, Keren Better, Elazar Librush, Liat Barness-Hadar, Gavriel Chaushu, Doron Haim
AIM: To evaluate survival rates and identify temporally distinct risk factors for early and late failure of wide-diameter dental implants (≥ 5.0 mm) in a large real-world cohort using landmark analysis. MATERIALS AND METHODS: This retrospective cohort study analyzed 12 041 wide-diameter implants (≥ 5.0 mm), predominantly 5.0 mm, placed in 9247 patients at a single center between January 2014 and December 2023. Implant survival was defined as the fixture remaining in situ without clinical loss or replacement at the same site. Failures were classified as early (≤ 1 year) or late (> 1 year). Kaplan-Meier survival curves and a multivariable Cox proportional hazards model clustered by patient were generated. Schoenfeld residuals revealed time-varying effects for penicillin allergy, implant length, and kidney disease, prompting a landmark analysis at 365 days with separate multivariable logistic regression models for early and late failure. RESULTS: Overall implant survival was 97.5%. Kaplan-Meier estimates were 98.1% (95% CI: 97.9%-98.4%) at 1 year, 97.8% (95% CI: 97.5%-98.0%) at 3 years, and 97.6% (95% CI: 97.4%-97.9%) at 5 years. Of 301 failures, 225 (74.8%) were early and 76 (25.2%) were late. In the Cox model, short implants (≤ 8 mm; HR = 1.94, 95% CI: 1.43-2.62, p < 0.001), maxillary placement (HR = 2.13 vs. mandible, p < 0.001), male sex (HR = 1.39, p = 0.010), penicillin allergy (HR = 1.66, p = 0.014), and older age (HR = 0.84 per SD, p = 0.008) independently predicted failure; smoking was borderline (HR = 1.33, p = 0.065). Landmark analysis showed that early failure was driven by penicillin allergy (OR = 2.26, p < 0.001), maxillary placement (OR = 2.42, p < 0.001), male sex (OR = 1.40, p = 0.016), and short length (OR = 1.70, p = 0.007), whereas late failure was driven by short length (OR = 3.19, p < 0.001) and kidney disease (OR = 6.11, p = 0.003). CONCLUSIONS: Wide-diameter implants achieve excellent long-term survival. Early and late failures arise from distinct mechanisms: perioperative, anatomical, and sex-related factors predominate early, while short implant length and renal disease predominate late. These findings support tailored perioperative protocols, individualized risk stratification, and targeted long-term surveillance.
Clinical and experimental dental researchJulia Moeller, Tobias Meissner, Florian Fuchs, Andreas Koenig, Sebastian Hahnel, Laura Antonia Mayer, Lena Unterschuetz, Nadia Oberueck, Rainer Haak, Dirk Zieb…
OBJECTIVE: In vitro evaluation of substance loss at the restoration margin of veneers was conducted as a function of prophylaxis procedures, air polishing, or ultrasonic instrumentation. MATERIALS AND METHODS: Forty-eight extracted premolars were restored with CAD/CAM materials after veneer preparation (t0): lithium disilicate, zirconia-reinforced lithium silicate ceramics, and resin-based composite. Five cycles of prophylaxis treatment (air polishing or ultrasonic scaling) and thermocycling (tE) were conducted. The substance loss of the luting material at the restoration margin was evaluated regarding width, depth, and the veneer inclination angle using optical coherence tomography and contour analysis. Group differences were determined using two-factor analysis of variance, Tukey tests, and linear regression models. RESULTS: Both prophylaxis procedures lead to substance loss at the restoration margin. The material choice had a significant effect on width and depth at the veneer margin (p < 0.002), this was not observed for the prophylaxis procedures (p ≥ 0.445). Air polishing resulted in the largest reduction in width and depth in zirconia-reinforced lithium silicate. A cross-group influence of inclination angle on substance loss was not detected. CONCLUSIONS: Both prophylactic procedures cause substance loss at the margins of the investigated CAD/CAM ceramic as well as composite veneers in the area of adhesive bonding. CLINICAL SIGNIFICANCE: The choice of luting and veneer material seems to have a more significant influence on the extent of substance loss than the type of instrumentation of the prophylaxis procedure.
Clinical and experimental dental researchCristian Scognamiglio, Gülce Çakmak, Martin Schimmel, Alessandro Perucchi, Samir Abou-Ayash
OBJECTIVES: To compare tissue-level (TL) and bone-level X (BLX) implants regarding peri-implant bone level alterations, survival, and complication rates over a 3-years. MATERIALS AND METHODS: In this retrospective, non-interventional clinical study, patients that had received either TL or BLX implants (both: Straumann AG), with at least one clinical follow-up (minimum 6 months), were included. Bone-level alterations and bone peaks were evaluated at baseline (implant placement) and at follow-ups from dental radiographs. In addition, clinical follow-ups included the recording of the presence of keratinized mucosa and the registration of technical complications (e.g., chipping fractures). For statistics, descriptive analyses, t-tests, and a random-effects linear regression analysis were applied. RESULTS: A total of 146 implants (73 TL and 73 BLX) were included. TL implants showed a survival rate of 100%, whereas BLX implants showed a survival rate of 98% after 3 years. TL implants showed significant mesial bone gain (0.08 mm, p = 0.018) between 2- and 3-year follow-ups, with a notable difference (0.21 mm, p = 0.041) compared to BLX implants. At distal bone levels, TL implants showed initial bone loss (0.12 mm, p = 0.020) at 6 months but gained bone (0.07 mm, p < 0.001) between 2 and 3 years, whereas BLX implants showed significant distal bone loss (0.15 mm, p = 0.038) over 3 years. The number of complications was higher in BLX implants. BLX implants with a band of keratinized mucosa > 2 mm showed smaller bone level alterations. CONCLUSIONS: Both TL and BLX implants performed similarly in terms of clinical and radiological outcomes. However, at the mesial aspect, bone level alterations in TL implants were smaller than in BLX implants, and complications were less frequent. Keratinized mucosa seems especially beneficial in BLX implants. As implant selection was based on clinical indication, the two groups differed in baseline characteristics, and this should be considered when interpreting the between-group comparisons.
Clinical and experimental dental researchParisa Soltani, Mohammad Hossein Manouchehri, Sara Rostamian, Hugh Devlin, Amirhossein Moaddabi, Aida Ekhtiari, Mahsa Aeinehvand, Gianrico Spagnuolo, Reyhaneh …
INTRODUCTION: This study aims to evaluate the efficacy of a metal artifact reduction (MAR) algorithm in detecting contact between zirconia implants and inferior alveolar canal. MATERIALS AND METHODS: Twelve zirconia implants were placed in dry human mandibles using surgical guides, in two conditions: 1 mm above and within the canal. cone beam computed tomography (CBCT) was acquired with the MAR algorithm turned off and on. Three observers indicated whether canal damage was present using a 5-point Likert scale: 1. Definitely no contact, 2. Probably no contact, 3. Uncertain, 4. Probably contact, and 5. Definitely contact. Sensitivity and specificity were calculated and the ROC curve was used to compare the two conditions (α = 0.05). RESULTS: The area under curve (AUC) was higher in MAR On condition for all observers; however, the differences in AUC between the On and Off MAR states were not statistically significant (p > 0.05): for observer 1, AUC increased from 0.9916 (Off) to 1.0 (On); for Observer 2, it increased from 0.7666 to 0.8833; and for Observer 3, it increased from 0.95 to 1.0. Observers 1 and 3 displayed 100% sensitivity and specificity regardless of MAR activation, while for Observer 2, diagnostic sensitivity increased from 66.7% to 83.3% with MAR activation, while specificity remained constant at 80% in both conditions. CONCLUSION: For the detection of contact of the zirconia implants with the IAC, activating the MAR algorithm slightly increased the diagnostic performance metrics of CBCT images, but the differences were not statistically significant. CLINICAL RELEVANCE: Activating the MAR algorithm did not produce a statistically significant improvement in detecting contact between zirconia implants and the inferior alveolar canal.
Clinical and experimental dental researchJosé M Alegre, Jesús Peláez, Aránzazu Sánchez, Blanca Herrera, Seyed Ali Mosaddad, Pedro Diaz, María J Suárez
OBJECTIVES: To compare the initial cytotoxic response of additively manufactured (AM) and subtractively manufactured (SM) resin-based materials for interim fixed dental prostheses (FDPs) under indirect and direct in vitro exposure conditions. MATERIAL AND METHODS: A total of 216 standardized resin discs were fabricated from AM resins (Group P, n = 108) and SM polymethyl methacrylate (PMMA)-based resins (Group M, n = 108). L929 mouse fibroblasts were used as the biological model, with a negative control group (Group C, n = 36). After 24 h of cell attachment, cell viability was assessed after 72 h under two conditions: indirect exposure to resin eluates and direct contact with resin discs. Viability was quantified by crystal violet staining. Data were analyzed using Kruskal-Wallis tests followed by Dunn's pairwise post hoc comparisons (α = 0.05). RESULTS: In the indirect assay, Group M showed 87% cell survival relative to the control, whereas Group P showed 65%; in the direct assay, values were 89% and 48%, respectively. Significant differences were observed among pooled groups in both assays (p < 0.001). Based on ISO 10993-5 thresholds, Group P was classified as slightly cytotoxic in the indirect assay and moderately cytotoxic in the direct assay, whereas Group M remained within the non-cytotoxic to slightly cytotoxic range. Group P showed significantly lower cell viability than Group M in both assays (adjusted p < 0.001), while no statistically significant differences were detected within each manufacturing category (adjusted p > 0.05). CONCLUSIONS: At 72 h, the tested AM resins showed significantly lower cell viability than the tested SM PMMA-based resins under the present in vitro conditions. CLINICAL SIGNIFICANCE: The lower cell viability observed for the tested 3D-printed interim materials under short-term in vitro conditions highlights the need for caution when extrapolating 72-h cell-viability findings to clinical performance and supports further standardized long-term in vitro and in vivo investigations.
Clinical implant dentistry and related researchEmilio Couso-Queiruga, Andrea Roccuzzo, Clemens Raabe, Vivianne Chappuis, Daniel Buser, Manrique Fonseca, Giovanni E Salvi
OBJECTIVE: To assess 25-year implant survival, success rates, peri-implant conditions, and variables influencing peri-implant mucositis (PM), peri-implantitis (PI), and loss of osseointegration. METHODS: Partially edentulous patients rehabilitated with tissue-level implant-supported prostheses were evaluated. Calibrated examiners performed clinical and radiographic assessments, and potential variables for PM and PI were analyzed at the final follow-up. RESULTS: At the 10- and 25-year follow-ups, 303 and 159 patients with 511 and 252 implants, respectively, were included. Implant failure (IF) was 1.2% at 10 years and 6.0% at 25 years, with implant survival rates of 98.8% and 94.0%, respectively (p < 0.001). Implant success rates ranged from 97.0% at 10 years to 90.8% at 25 years (p < 0.001). IF due to loss of osseointegration increased from 0.6% to 3.6% at the implant level and from 1.0% to 2.5% at the patient level, and were located only in premolar or molar sites. At implant level, peri-implant health (PH) was 14.4% at 10 and 25 years (p = 1.00), while PM decreased from 82.1% to 76.5% (p = 0.08), and PI increased from 3.5% to 9.1% (p = 0.001). At patient level, PH remained stable between 10 and 25 years, ranging from 10.0% to 10.3% (p = 0.94), while PM decreased from 80.0% to 71.6% (p = 0.06), and PI increased from 10.0% to 18.1% (p = 0.01). In the multivariate analysis, history of periodontitis (OR = 3.87) and facial mucosal thickness (OR = 0.42) were associated with PM, whereas facial mucosal thickness was associated with PI (OR = 0.02). CONCLUSIONS: After 25 years, implant survival and success exceeded 90%. Loss of osseointegration accounted for approximately 60% of IF. While PI and IF increased over time, PM decreased but remained prevalent.
Clinical and experimental dental researchOttavia Cannatella, Biagio Matera, Francesca Rossi, Giovanni Passeri, Simone Lumetti, Ludovica Parisi, Benedetta Ghezzi
OBJECTIVE: Immune cells are the first to interact with implant surfaces, yet their contribution to osseointegration is often underestimated. Understanding how titanium-based and zirconia-enriched surface properties regulate macrophage polarization is essential for designing regenerative biomaterials. This study evaluates how these physicochemical characteristics modulate macrophage behavior and how macrophage-derived signals affect osteoblast mineralization, a key determinant of successful clinical outcomes. MATERIAL AND METHODS: Human monocytes were differentiated into pro-inflammatory (M1) or anti-inflammatory (M2) macrophages on hydrophobic and hydrophilic titanium (P, SLA/modSLA) or zirconia-enriched titanium (R/modR) surfaces. Macrophage polarization was assessed by Real Time-PCR, fluorescent immunoassays, and Luminex analysis of pro-/anti-inflammatory cytokines and bone-related markers. Conditioned media from M1/M2 macrophages cultured on each surface were used to culture human osteoblast-like cells, and their differentiation and mineralization were evaluated by gene expression analysis and Alizarin Red staining. RESULTS: The obtained results indicate that surface chemical composition, rather than hydrophilicity, is the main driver of early macrophage phenotype modulation. Zirconia incorporation induced effects comparable to titanium on macrophage activation while increasing transcription of pro- and anti-inflammatory genes. Moreover, zirconia enhanced M1 activation and the release of angiogenic and osteogenic mediators, including VEGF and OPN. Although seemingly contradictory, these effects contribute to an immune microenvironment favorable to bone formation by promoting a balanced macrophage response. Consistently, zirconia-enriched surfaces enhanced osteoblastic differentiation and mineralization, regardless of hydrophilic differences compared with conventional titanium surfaces. CONCLUSION: Our findings indicate that zirconia-supplemented titanium alloys may provide a useful model to elucidate the concept of osseointegration as an osteoimmune process rather than a conventional bone healing response. The data emphasize the critical role of early M1 macrophage activity controlling the release of specific cytokines, supporting the hypothesis that the use of titanium/zirconia alloys may provide an osteoiummunomodulatory advantage that may contrast peri-implant bone loss.
Clinical implant dentistry and related researchYulan Wang, Jian Zhang, Runfa Wu, Gang Fu, Yan Xu, Zhe Yi, Qiang Li, Yangsheng Zhao, Ming Shen, Yufeng Zhang
OBJECTIVES: This multicenter prospective cohort study follows a 1-year period after a previously published randomized controlled trial, comparing the radiographic and clinical outcomes of implants placed with simultaneous guided bone regeneration (GBR) using bioceramic (BC) versus xenograft (BO). MATERIALS AND METHODS: Patients from the previous trial were recalled 1 year after crown delivery. The follow-up data focused on the buccal bone stability evaluated by CBCT and implant survival rate, Probing Depth (PD), Bleeding on Probing (BOP), Plaque Index (PI), and patient satisfaction through Oral Health Impact Profile-5 (OHIP-5). RESULTS: Out of 150 enrolled patients in a previous trial, a total of 97 patients completed the 1-year follow-up: 44 in the BC group and 53 in the BO group. The implant survival rate was 100% in both groups. Change in horizontal buccal bone thickness (△HBBT) at 1 year post-crown delivery versus immediately post-surgery was -0.28 ± 0.10 mm for the BC group and -0.91 ± 0.09 mm (mean ± standard error) for the BO group, with the BC group exhibiting less bone resorption along the implant than the BO group (p = 0.0000). No significant differences were observed in PI, BOP, or PD. Patient satisfaction remained high in both groups. CONCLUSIONS: GBR with bioceramic demonstrated stable radiographical bone on the buccal side of the implant 1 year after crown delivery.
Clinical implant dentistry and related researchAdrienne Fetner, Nathalia Vilela, Xinlin Lu, Guogen Shan, Poliana M Duarte
INTRODUCTION: The effects of self-reported penicillin allergy and alternative antibiotic regimens on implant outcomes remain poorly investigated. Therefore, the aim of this study was to evaluate the association between self-reported penicillin allergy and the use of alternative antibiotics with post-implant placement surgical complications, early implant failure, and preloading crestal bone loss (PLCBL). METHODS: This retrospective cohort study examined dental records of patients who received at least one dental implant. Patients who reported a penicillin allergy were identified as the exposed group, whereas patients without a reported penicillin allergy were selected as unexposed in a 1:2 exposed-to-unexposed ratio. Relevant patient- and implant-related factors were recorded. Implants were evaluated for postsurgical complications, PLCBL, and early failure. Data were analyzed using bivariate analyzes and mixed-effects regression models. RESULTS: A total of 179 subjects and 374 implants were evaluated. Early implant failure and surgical complications occurred in 6.1% and 8.0% of implants, respectively, while PLCBL was observed in 32.5% of implants. A higher prevalence of surgical complications and implant failure was observed among patients who reported a penicillin allergy compared with those without a reported allergy (p < 0.05). Implants prescribed azithromycin showed a higher prevalence of surgical complications, and those prescribed azithromycin or clindamycin had higher early failure rates compared with penicillin (p < 0.05). Regression analyzes showed that self-reported penicillin allergy was not independently associated with surgical complications, PLCBL, or early implant failure (p > 0.05). In exploratory multivariable analyzes, azithromycin and other alternative antibiotics were associated with higher odds of surgical complications compared with penicillin (p < 0.05). No significant associations were found between antibiotic type and PLCBL or early implant failure (p > 0.05). CONCLUSION: Self-reported penicillin allergy was not independently associated with early implant outcomes in this cohort. Certain alternative antibiotics were associated with a higher prevalence of early surgical complications, warranting further investigation in larger studies.
Clinical implant dentistry and related researchNa Chen, Na Deng, Tian He, Huafeng Zhang, Tingting Shu, Tao Chen, Hong Huang, Yuanding Huang
OBJECTIVE: This study aims to evaluate the application of an autonomous dental implant robot combined with osseodensification drills for transcrestal maxillary sinus floor elevation (ADIR-OD-TSFE) and simultaneous implant placement. The following parameters, such as maxillary sinus elevation volume (MSV), maxillary sinus elevation area (MSA), membrane elevation height (MEH), implant protrusion length (IPL), implant placement accuracy, intraoperative Schneiderian membrane perforation rate, and operative time, were evaluated. In addition, the force feedback characteristics associated with different maxillary sinus floor morphologies were preliminarily investigated. MATERIALS AND METHODS: This study enrolled patients treated at the Stomatological Hospital of Chongqing Medical University between January and November 2024, with a residual bone height (RBH) of 4.00-8.00 mm, who underwent simultaneous implant placement using ADIR-OD-TSFE. Postoperative CBCT scans were imported into the design software to evaluate implant placement accuracy. The software's AI segmentation function was used to calculate the sinus floor augmentation outcome immediately after surgery (P1) and at 6 months postoperatively (P2). Force feedback characteristics were analyzed for two sinus floor morphologies (flat and sloped). The total operative time for osteotomy, sinus floor elevation, and implant placement performed with robotic assistance was recorded; the surgeon's learning curve was plotted, and the intraoperative complications were documented. RESULTS: A total of 18 implants were placed, with 9 in flat sinus floors and 9 in sloped sinus floors. The mean preoperative RBH was 5.92 ± 1.01 mm. Schneiderian membrane perforation occurred in 1 case (5.6%). The mean surgery time was 25.5 ± 9.8 min, and the surgeon's learning curve plateaued as case numbers increased. The coronal global deviation (CG), apical global deviation (AG), and angular deviation (AD) were 0.69 ± 0.36, 0.76 ± 0.41, and 1.64° ± 0.91°, respectively. The maxillary sinus floor elevation volume was 351.54 ± 151.74 mm3 immediately after surgery (P1) and 253.68 ± 160.60 mm3 at 6 months postoperatively (P2). Force feedback analysis showed that the breakthrough force was higher in flat sinus floors (Ff0) than in sloped sinus floors (Fs0), with a mean difference of 6.86 N, a 95% CI of 0.82 to 12.90 N, and a large effect size (Hedges' g = 1.08). CONCLUSION: The ADIR-OD-TSFE technique is effective for sinus floor elevation and implant placement, with the learning curve improving as the surgeon's experience increases. It demonstrates high implant placement accuracy and maintains relatively stable bone augmentation outcomes at 6 months postoperatively. Flat sinus floors require significantly higher breakthrough forces compared to sloped sinus floors. Overall, the ADIR-OD-TSFE system proves to be a safe and clinically reliable approach.
Clinical and experimental dental researchAdria Jorba-Garcia, Shengchi Fan, Feng Wang, James Chow, Atiphan Pimkhaokham, Nikos Mattheos, Alessandro Pozzi
Computer-assisted implant surgery (CAIS) represents a comprehensive digital workflow integrating prosthetically driven planning with various execution modalities. Among these, dynamic (d-CAIS) and robotic (r-CAIS) systems constitute two distinct yet interrelated approaches, sharing core technological principles as well as operative differences. This white paper aims to provide a structured overview of the fundamental concepts and workflows underpinning d- and r-CAIS, focusing on their shared components, procedural steps, and system-specific characteristics. Both approaches rely on accurate digital treatment planning, spatial positioning systems, registration protocols, and real-time feedback mechanisms to guide implant placement. However, while d-CAIS enables operator-controlled freehand execution under real-time navigation, r-CAIS introduces robotic assistance or task autonomy, integrating mechanical actuation into the surgical workflow. Rather than providing exhaustive technical instructions, this work aims to establish a conceptual framework to support clinicians in understanding and evaluating emerging CAIS technologies and their role in contemporary implant dentistry. Furthermore, it discusses current advantages, limitations, and challenges related to clinical implementation, cost, and training requirements.
Medical science monitor : international medical journal of experimental and clinical researchEbru Sümer Ekin, Sozdar Başkan Uyar, Merve Güler, Emrah Ayna
BACKGROUND This study compared the accuracy of different scan body geometries under different implant angulation and interimplant distance conditions. Evidence regarding full-arch digital implant scanning under these conditions remains limited. MATERIAL AND METHODS In this in vitro study, 5 implants were placed in maxillary edentulous plaster models representing 3 implant systems (Bioinfinity, Meisinger, and Mode). The reference implant was positioned perpendicular to the ridge crest at the midline. Implant angulations (5° and 10°) and interimplant distances (5 mm and 10 mm) were standardized. Scan bodies were attached to the master model, and each model was scanned 10 times using an intraoral scanner (TRIOS 5). Three-dimensional deviations were calculated. Data were analyzed using 1-way ANOVA and Tukey HSD tests (alpha=0.05). RESULTS No significant differences were observed among the groups at 5° angulation (P>0.05), whereas significant differences were detected at 10° angulation for implants 1 and 5 (P<0.01). Bioinfinity showed higher deviation values at implant 1, while Meisinger demonstrated higher deviations at implant 5. At a 10-mm interimplant distance (implants 1 and 2), significant differences were found among the groups (P<0.001), with Bioinfinity exhibiting lower deviation values. At a 5-mm distance, no significant difference was observed at implant 4 (P>0.05), whereas a significant difference was found at implant 5 (P<0.001), with the highest deviation in the Meisinger group. CONCLUSIONS Increased implant angulation and interimplant distance are associated with reduced accuracy and higher deviation values in digital full-arch scans. The influence of scan body geometry varies depending on implant position.
PURPOSE: to assess whether implant mucosal tunnel depth is associated with differences in cultivable microbial diversity in clinically healthy peri-implant tissues. METHODS: fifty-two patients with single molar implants were included after a standardized 3-month healing period and stratified into three groups according to implant mucosal tunnel depth: <3 mm, 3-5 mm, and > 5 mm. Microbial samples from the inner lining of the implant mucosal tunnel were cultured under aerobic and anaerobic conditions and identified using MALDI-TOF mass spectrometry. As a secondary exploratory outcome, TNF-α expression in peri-implant mucosa was quantified using real-time PCR. RESULTS: a total of 262 cultivable isolates representing 46 species were identified, with facultative anaerobic species predominating (81.68%). The highest Shannon diversity index was observed in the 3-5 mm group, whereas tunnels > 5 mm demonstrated reduced cultivable diversity, with clinically significant growth predominantly represented by streptococci. TNF-α expression showed a progressive increase with increasing implant mucosal tunnel depth, reaching approximately 38-fold higher levels in the > 5 mm group compared with < 3 mm (p < 0.017). CONCLUSIONS: within the limitations of this exploratory cross-sectional study, implant mucosal tunnel depth was associated with differences in cultivable microbial composition and local TNF-α expression in clinically stable peri-implant tissues. Deeper mucosal tunnels (> 5 mm) demonstrated reduced cultivable species diversity without a consistent predominance of cultivable periodontal pathogens under the applied culture conditions. The observed increase in TNF-α expression should be interpreted as a biologic association rather than evidence of active inflammation or disease. Due to the culture-based methodology and the absence of longitudinal clinical data, no conclusions regarding disease risk or progression can be drawn. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05870774. Registered on 20,230,425.
Microbial pathogenesisSyed Ali Danish Kazmi, Bushra Jabeen, Noor Ul Huda, Shaista Urooj, Fouzia Zeeshan Khan, Tanveer Abbas, Zulfiqar Ali Mirani
Dental prosthesis failure is often associated with biofilm-mediated infections, yet the combined roles of surface roughness and material chemistry remain underexplored. This observational, retrospective study investigated associations between these factors and biofilm density, pathogen selection, and prosthesis longevity. Surface roughness (Ra) and microbial colonization were analyzed for 85 explanted prostheses (fixed, removable, implant-supported, and orthodontic) and compared to control samples (polished enamel, sealants). Biofilm formation was quantified via optical density (OD) and colony-forming units (CFU/cm2), while pathogen profiles were identified using selective culture and biochemical assays. A strong positive correlation (R2 = 0.84, interpreted as a very strong correlation according to Evans' (1996) classification) was observed between surface roughness and biofilm accumulation. Smooth surfaces like zirconia (Ra ∼320 nm) exhibited low biofilm (OD 0.45), whereas rougher surfaces, particularly removable PMMA dentures (Ra ∼1100 nm), showed dense biofilms (OD up to 1.85) dominated by Candida spp. and Pseudomonas aeruginosa. Material chemistry was associated with distinct pathogen profiles: PMMA favored fungal and Gram-negative adhesion, while titanium promoted staphylococcal colonization. In this cohort, biofilm-associated infections were associated with reduced functional longevity; for example, implant crowns designed for 15+ years were removed after a mean of 5.4 years due to peri-implantitis. The study concludes that prosthetic failure is associated with the synergistic effect of surface topography, which correlates with biofilm quantity, and material composition, which is associated with distinct microbial ecology. These findings underscore the need for prostheses engineered with optimized surface smoothness and antimicrobial material chemistry. However, the observational, retrospective design limits causal inference; the culture-based methodology likely underestimates the full microbial diversity, particularly of anaerobic species; and the heterogeneity of device types limits direct comparability between groups.
International dental journalJiajin Shen, Xi Yang, Junbiao Zhang, Xiaohuan Lu, Guangneng Chen, Yin Liu, Bin Ye, Minxian Ma
INTRODUCTION AND AIMS: This study aimed to devise a deep learning-based model for the automated identification of anatomical mandibular lingual concavities in the posterior mandible and the prediction of biologically guided three-dimensional implant positions. METHODS: Cone-beam computed tomography (CBCT) images with single-tooth posterior mandibular edentulism were included. A deep learning framework was constructed utilizing 3D U-Net and Swin-Transformer. This framework was designed to perform automated segmentation of teeth, mandible, and the mandibular nerve canal; to classify morphological types of lingual concavities; and to identify implant key points with coordinate prediction. Model performance was assessed via five-fold cross-validation. RESULTS: The proposed model achieved Dice similarity coefficients ranging from 0.87 to 0.91 for dental segmentation. In the classification of mandibular lingual concavities, an accuracy of 0.92 to 0.97 was attained. Regarding the prediction of three-dimensional implant positions, the automatically generated plans maintained a safety margin of 3.20 to 3.89 mm from the mandibular nerve canal. Furthermore, sufficient bone volume was preserved at both cervical and apical implant levels, with buccal/lingual cervical bone widths averaging 4.94 to 5.78 mm. CONCLUSION: The deep learning model in this experiment performed well across different views and learning tasks in a retrospective internal validation setting. Furthermore, it demonstrated the ability to accurately identify relevant anatomical structures, and the predicted three-dimensional implant positions showed clinically acceptable safety margins in the internal validation cohort. CLINICAL RELEVANCE: This model provides a preliminary AI-assisted framework for identifying critical mandibular anatomical structures and generating biologically guided preliminary implant position suggestions, thereby helping to mitigate intraoperative complications and reduce the risk of postoperative mechanical and biological complications in preclinical evaluation.
Journal of dentistryMarco Ferrari, Ovidiu Ionut Saracutu, Denise Irene Karin Pontoriero, Giorgio Gastaldi, Giulia Verniani, Daniele Manfredini, Edoardo Ferrari Cagidiaco
AIM: To compare the outcome of short fiber reinforced composites, as a core material, with respect to conventional fiber post, for the reconstruction of anterior endodontically treated teeth (ETT), covered by a lithium disilicate crown. MATERIALS AND METHODS: Patients in need of endodontic treatment and a single-unit full crown restoration for anterior teeth (incisors or canines) were recruited. Only teeth with >50% of residual tooth structure were included. The teeth were required to be in occlusal function with a natural antagonist tooth and in interproximal contact with two adjacent natural teeth. A simple randomized design with 2 arms was adopted to evenly allocate patients to the two experimental groups. The fluctuation of oral behaviors was assessed via the Oral Behavior Checklist. For the assessment of the prosthodontic outcome, the modified US Public Health Service criteria were used. Statistical analysis was set at p<0.05. RESULTS: The statistical analysis showed no significant association between the type of build-up material, the high risk for oral behaviors (p = 0.197), and the prosthodontic failures (p = 0.471). CONCLUSION: This randomized clinical trial shows no significant difference in the outcome of anterior ETT with >50% of residual tooth structure restored with fiber post or fiber-reinforced composite, covered by a lithium disilicate crown, at 5 years of follow-up. CLINICAL SIGNIFICANCE: Short fiber-reinforced composites represent a valid alternative material to fiber post, for the build-up of anterior endodontically treated teeth, with at least 50% of residual tooth structure, covered by a lithium disilicate crown.
Journal of dentistryMark-Steven Howe, Derek Richards
OBJECTIVE: Restorative dentistry lacks an integrated prognostic framework linking restorability assessment to long-term survival evidence. This study evaluates whether published 10-year survival data can be systematically anchored to an existing multi-domain restorability index to develop a structured Restorative Dental Prognosis Index (RDPI). METHODS: A theory-driven, five-stage conceptual methodology was applied. A structured literature search identified validated restorability or risk indices as a conceptual anchor. Prognostic features were classified by relevance to restorative outcomes. Published 10-year survival estimates and uncertainty intervals were extracted from systematic reviews and re-analysed to characterise dispersion. Estimates were mapped onto an ordinal prognostic structure to minimise overfitting in heterogeneous evidence. Scenario modelling explored internal coherence, recognising differences between whole-mouth and tooth-level risk. No empirical validation was undertaken. RESULTS: A single multidomain index met eligibility criteria. Across 13 domains, 10-year survival estimates showed wide variation (74-93%), very broad prediction intervals, and high heterogeneity (I²=74.8-99.8%). Despite this, survival data aligned with a three-category ordinal structure, generating a coherent prognostic scaffold. Scenario modelling demonstrated non-linear increases in whole-mouth risk and integration of biological risk with financial exposure. CONCLUSIONS: By mapping long-term survival evidence onto a validated multidomain restorability framework, this proof-of-concept framework provides a structurally consistent prognostic scaffold. While not a predictive model, it offers a foundation for future empirical parameterisation, validation, and integration into restorative treatment planning, teaching, and practice. CLINICAL SIGNIFICANCE: This framework integrates multi-domain restorability assessment with long-term survival evidence to support whole-mouth prognostic reasoning. By simplifying heterogeneous data into ordinal risk states and enabling aggregation, it may help clinicians compare strategies, anticipate failure risk, and align decisions with proportionality, cost exposure, and patient-centred outcomes.
Premature failure of dental crowns is frequently associated with bacterial colonization, secondary caries, and persistent biofilm formation at restoration interfaces. In this study, Sn-Ag-Al trimetallic nanohybrids were synthesized through a novel hybrid sonochemical-pressure-assisted approach and ultrasonically embedded onto metal and resin dental crowns to develop durable antibacterial and antibiofilm coatings. Structural and surface characterization using XRD, FE-SEM-EDX, BET, and Raman analyses confirmed the formation of crystalline nanohybrids with homogeneous elemental distribution, nanoscale morphology, and favorable surface properties for crown adhesion. Antibacterial evaluation revealed a concentration-dependent inhibitory effect against Escherichia coli and Staphylococcus aureus, with zones of inhibition increasing from 12.6 and 9.5 mm at 50 µg/mL to 23.4 and 21.9 mm at 250 µg/mL, respectively. The coated crowns exhibited strong antibiofilm activity, achieving up to 85.4 % inhibition against E. coli and 81.3 % against S. aureus. Cytocompatibility studies using human gingival fibroblasts demonstrated high cell viability at clinically relevant concentrations, confirming the biocompatible nature of the coating. Furthermore, FESEM-EDX analysis showed that the ultrasonically deposited trimetallic layer remained structurally intact after repeated saline-washing cycles, retaining significant antibacterial functionality and indicating excellent coating durability under simulated oral conditions. The enhanced performance is attributed to the synergistic antibacterial action of Sn, Ag, and Al combined with cavitation-assisted nanoparticle anchoring generated during ultrasonic processing. This work introduces a multifunctional, wash-resistant trimetallic coating platform that integrates sonochemistry and pressure-assisted synthesis for long-term protection of dental restorations. The findings highlight the potential of ultrasonic surface engineering in developing next-generation infection-resistant dental biomaterials and advanced restorative devices.
Journal of dentistryKay-Arne Walther, Mehmet Ali Akdeniz, Bernd Wöstmann, Jonas Adrian Helmut Vogler
OBJECTIVES: The study aimed to evaluate the long-term correlation between periodontal parameters at implants and contra-lateral natural teeth over a follow-up period of up to 20 years in periodontitis patients undergoing supportive periodontal care (SPC). MATERIALS AND METHODS: This observational cohort study involved systemically healthy, non-smoking patients who received periodontal and implant therapy, followed by regular SPC. The following parameters were assessed at baseline (i.e. implant loading) and at 5, 10, 15 and 20 years: clinical attachment level (CAL), pocket probing depth (PPD), gingival margin (GM) and bleeding on probing (BOP). Intra- and inter-group differences over time between implants and teeth were analysed. Survival rates were calculated. RESULTS: 167 patients with 419 implants were included. Mean CAL increased significantly over time at implants and teeth (p ≤ 0.015), approximately doubling every five years. After 20 years, CAL loss amounted to 4.47±2.45 mm at implants and 4.38±2.64 mm at teeth. Implants demonstrated significantly greater PPD increases after 10 and 15 years compared with teeth (p ≤ 0.027), whereas differences in CAL between implants and teeth were largely non-significant beyond 5 years. Differences in GM and BOP were small and inconsistent. No association was observed between SPC frequency and changes in CAL or PPD. Implant survival was 100% and three contra-lateral teeth were lost over 20 years. CONCLUSIONS: In patients with treated periodontitis under regular SPC, implants and natural teeth exhibited comparable long-term clinical stability and survival. However, a non-linear progression of CAL loss occurs at teeth and implants, which SPC effectively limits but does not completely prevent. CLINICAL SIGNIFICANCE: For systemically healthy, non-smoking patients with treated periodontitis who attend SPC programme twice per year, implants can provide durable tooth replacement. Survival is comparable to that of contra-lateral teeth over 20 years. Clinicians should prioritise maintenance and monitoring, as CAL and PPD may progress despite overall excellent long-term survival.
International dental journalMonika Werdiningsih, En-Chih Weng, Yoko Hasegawa, Ma Therese Sta Maria, Kazuhiro Hori, Yasuyuki Nagasawa, Ken Shinmura
Dental prostheses not only restore oral function but may also impact systemic health outcomes. This scoping review sought to synthesize evidence on the association between dental prostheses, hypertension, and physical function, including frailty, in adults with established cardiovascular disease (CVD) or elevated cardiovascular risk. This review was conducted following the PRISMA-ScR guidelines and Joanna Briggs Institute methodology. Literature searches were performed in PubMed and Google Scholar up to November 10, 2024. Eligible studies were observational investigations involving adults with established CVD or elevated cardiovascular risk who used dental prostheses. An exploratory quantitative approach was used to summarize the direction and patterns of association. Seven studies met the inclusion criteria: 5 assessed hypertension and 2 examined physical function. Exploratory pooled analysis based on unadjusted data indicated that individuals with dental prostheses had a lower odds of hypertension (odds ratio = 0.69; 95% confidence interval, 0.52-0.91), although substantial heterogeneity (I² = 95%) and the use of unadjusted estimates imply a high risk of residual confounding. Limited evidence suggests that dental prosthesis use may help preserve mobility and mitigate frailty in patients with CVD; however, differences in frailty definitions and limited adjustment for confounding factors reduce comparability and indicate that these findings should be interpreted as exploratory and hypothesis-generating. Current evidence suggests that dental prosthesis use may offer benefits beyond oral rehabilitation, potentially linked to better hypertension-related outcomes and physical function in adults with CVD or elevated cardiovascular risk, but certainty is limited by the small number of studies and methodological heterogeneity. These exploratory, hypothesis-generating findings highlight the need for well-designed longitudinal studies to clarify potential associations and underlying mechanisms. Beyond restoring oral function, prosthodontic rehabilitation may have broader systemic implications, contributing to better cardiovascular-related outcomes in aging populations.