Clinical Oral Implants Research最新文献

Aim

To synthesize evidence on the effect of clinicians' experience on the accuracy of implants placed using Dynamic Computer-Assisted Surgery systems (dCAIS).

Methods

PubMed, Scopus, EMBASE, and Cochrane Library were searched till April 19, 2025, for research reporting implant accuracy with dCAIS along with the influence of the operator's experience. Clinicians who had placed implants with dCAIS (dCAIS-Ex) were compared with those without any prior experience with dCAIS (dCAIS-IEx), irrespective of their experience with implant surgery; clinicians placing implants with dCAIS with or without prior experience in implant surgeries were also compared (IEx vs. I-InEx). The risk of bias was assessed with ROBINS-I for in vivo and QUIN tool for in vitro studies. Meta-analyses were performed to evaluate implant accuracy (coronal, apical, and angular deviations) and operating time.

Results

4 in vivo and 10 in vitro studies were included. Pooled analysis of in vivo and in vitro studies showed significant differences in angular deviation [SMD = −0.35 (−0.69, −0.01), p = 0.04; SMD = −0.39 (−0.62, −0.17), p = 0.0007], where dCAIS-Ex clinicians showed lower deviations than dCAIS-IEx clinicians. No statistical difference was observed in implant accuracy between I-Ex versus I-IEx clinicians. Data was highly heterogeneous to report conclusive evidence on operating time with dCAIS between respective groups.

Conclusions

The influence of clinicians' experience was significant only on angular deviation when implants were placed by dCAIS-Ex vs. dCAIS-InEx clinicians. However, the small magnitude of difference might not be clinically perceptible. More randomized clinical trials with high quality and standardized methodology are required to synthesize meaningful evidence.

Objectives

To develop and assess the performance of an anatomically based multitask deep learning radiomics nomogram (AMDRN) system to predict implant failure risk before maxillary sinus floor elevation (MSFE) while incorporating automated segmentation of key anatomical structures.

Materials and Methods

We retrospectively collected patients' preoperative cone beam computed tomography (CBCT) images and electronic medical records (EMRs). First, the nn-UNet v2 model was optimized to segment the maxillary sinus (MS), Schneiderian membrane (SM), and residual alveolar bone (RAB). Based on the segmentation mask, a deep learning model (3D-Attention-ResNet) and a radiomics model were developed to extract 3D features from CBCT scans, generating the DL Score, and Rad Score. Significant clinical features were also extracted from EMRs to build a clinical model. These components were then integrated using logistic regression (LR) to create the AMDRN model, which includes a visualization module to support clinical decision-making.

Results

Segmentation results for MS, RAB, and SM achieved high DICE coefficients on the test set, with values of 99.50% ± 0.84%, 92.53% ± 3.78%, and 91.58% ± 7.16%, respectively. On an independent test set, the Clinical model, Radiomics model, 3D-DL model, and AMDRN model achieved prediction accuracies of 60%, 76%, 82%, and 90%, respectively, with AMDRN achieving the highest AUC of 93%.

Conclusion

The AMDRN system enables efficient preoperative prediction of implant failure risk in MSFE and accurate segmentation of critical anatomical structures, supporting personalized treatment planning and clinical risk management.

Objectives

The effect of osteotomy overpreparation, and thus lack of primary stability, on implant osseointegration and crestal bone volume maintenance was investigated by comparing placement of dental implants with either a standard osteotomy preparation (NP) or an overprepared osteotomy (OP) where the final osteotomy drill was larger in diameter than the implant placed.

Methods

Bone-level implants (Ø3.3 mm diameter) were placed in the mandible of minipigs with two preparation techniques: an NP (Group 1) and an OP to a final osteotomy of 3.5 mm in diameter (Group 2) and submerged for 2 and 8 weeks. An Implant Stability Quotient (ISQ) was measured for each implant at placement. Implant survival, defined histologically as the absence of fibrous encapsulation and the presence of direct bone-to-implant contact, osseointegration and crestal bone formation were analysed histologically and histomorphometrically to compare the preparation techniques.

Results

A 100% survival for both preparation types was observed. The mean ISQ at insertion for Groups 1 and 2 was 69.35 a.u. (95% CI: 68.02–70.68) and 11.95 a.u. (95% CI: 10.53–13.37) respectively (p < 0.001). At 2 and 8 weeks, there was no difference between the two groups for total bone-to-implant contact (tBIC) (p > 0.05). Group 2 demonstrated significantly higher mean first bone-to-implant contact (fBIC), coronal bone-to-implant contact (cBIC) and bone-area-to-total-area (BATA) at 2 and 8 weeks compared to Group 1 (p < 0.05).

Conclusion

Implants inserted into an overprepared osteotomy with no primary stability successfully osseointegrated. At 2 and 8 weeks, OP resulted in significantly more coronal bone apposition and maintenance of coronal bone volume as measured by fBIC, cBIC and BATA.

Aim

To report clinical and radiographic changes at implants supporting Fixed Partial Dental Prostheses with Cantilever extensions (FPDPC's) after a loading time exceeding 10 years.

Materials and Methods

Patients with FPDPC's were reevaluated after a loading time of 10–21 years. A clinical and radiographic examination was conducted to assess Marginal bone level change (MBLc), biological, and prosthetic parameters. Pocket depth (PD), Attachment Level (CAL), Bleeding on Probing (BOP), and Presence of Plaque (PL) were also recorded.

Results

Nineteen patients with 21 FPDPC's supported by 47 implants were re-evaluated after a mean loading time of 13.3 ± 2.9 years (range: 10–21 years). Implant survival rate was 100% and implant success rate was 91.5%, accounting for 4 implants (8.5%) that presented with peri-implantitis. Twelve implants (25.5%) exhibited peri-implant mucositis. Three of the FPDPC's had to be replaced due to fracture of the cantilever teeth and one other FPDPC had abutment screw fracture which was corrected, leading to prosthetic survival and success rates of 86% and 81%, respectively. Mean MBLc from implant placement to time of re-evaluation was 0.99 ± 1.11 mm (95% CI: 0.67, 1.31, p-value < 0.001). Mean PD at re-evaluation was 3.9 ± 1.6 mm, mean CAL was 1.2 ± 1.6 mm. Percentages of BOP and PL were 14.89% ± 23.11% and 26.6% ± 30.625 respectively.

Conclusion

Fixed partial dental prostheses with cantilever extensions are a reliable option if extensive bone grafting or sinus lifts are to be avoided, with 10-year results showing 100% implant survival, 90% implant success, and 86% and 81% prosthetic survival and success rates, respectively.

Objectives

This study aimed to verify the release of neutrophil extracellular traps (NETs) in peri-implantitis and explore whether NETs induce pyroptosis and inflammatory responses in human gingival fibroblasts (HGFs).

Materials and Methods

Peri-implant soft tissue samples were collected from healthy individuals and patients with peri-implantitis. NETs and the expression of pyroptosis-related factors including NLRP3, Caspase1, GSDMD, and IL-1β were detected. In vitro, NETs induced from differentiated HL60 (dHL60) cells and human neutrophils were used to stimulate HGFs. Transcriptome sequencing analysis and functional enrichment analysis were performed to analyze the influence of NETs on programmed cell death and inflammatory-related signaling pathways in HGFs. Further investigations were conducted to explore the changes in cell viability, cell membrane permeability, and the expression levels of inflammatory factors and pyroptosis-related markers in HGFs treated with NETs in the presence or absence of DNase I.

Results

Compared to healthy samples, the release of NETs was significantly elevated in soft tissues with peri-implantitis, accompanied by increased expression of NLRP3, Caspase1, GSDMD, and IL-1β. Functional enrichment analyses revealed that NETs activated signaling pathways related to pyroptosis and inflammatory responses of HGFs. Meanwhile, the results of the in vitro study revealed that NETs reduced cell viability, increased cell membrane permeability, and upregulated expression of inflammatory cytokines and pyroptosis markers in HGFs, which were partially reversed by DNase I treatment.

Conclusion

NETs may exacerbate the pathological progression of peri-implantitis by inducing pyroptosis and inflammatory responses in HGFs. Targeting NETs may offer a potential therapeutic strategy to mitigate the inflammation in peri-implantitis.

Objective

To assess the impact of horizontal intraoral scan bodies (H-ISBs) on the trueness of complete-arch digital impressions compared to vertical ISBs (V-ISBs). To evaluate trueness among four intraoral scanners (IOS) and inter-operator variability across different ISB × IOS combinations.

Materials and Methods

Digital impressions were made from a dental cast with four multi-unit analogs using four H-ISBs: H-NB, H-NS, H-M6, H-SF, and a V-ISB (V-EA) as a comparison. Two operators performed 10 scans per ISB with four IOS devices (i5D, PS, T3, T4), generating 400 impressions. Reference scans were obtained with a desktop scanner, and trueness was analyzed using root-mean-square (RMS) error calculations (α = 0.05).

Results

H-NS and H-SF exhibited the highest trueness across IOSs, whereas H-NB and H-M6 showed lower trueness. V-EA outperformed H-NB and H-M6 but not H-NS and H-SF. Significant IOS-ISB interaction effects (p < 0.01) indicated H-SF as the most accurate, especially with PS. T4 and i5D displayed greater variability, particularly with H-NB. V-ISBs exhibited higher inter-operator variability compared to H-ISBs.

Conclusions

H-ISBs did not perform better than V-ISBs in all scenarios. The interactions among ISB design, IOS type, and operator significantly affect the digital impression trueness. The discrepancies measured among the systems remain well below the currently accepted threshold for clinically relevant misfit, supporting the suitability of the horizontal configuration for complete-arch impressions.

Objectives

To assess the accuracy and time efficiency of manual versus artificial intelligence (AI)-driven tooth segmentation on cone-beam computed tomography (CBCT) images, using AI tools integrated within implant planning software, and to evaluate the impact of artifacts, dental arch, tooth type, and region.

Materials and Methods

Fourteen patients who underwent CBCT scans were randomly selected for this study. Using the acquired datasets, 67 extracted teeth were segmented using one manual and two AI-driven tools. The segmentation time for each method was recorded. The extracted teeth were scanned with an intraoral scanner to serve as the reference. The virtual models generated by each segmentation method were superimposed with the surface scan models to calculate volumetric discrepancies.

Results

The discrepancy between the evaluated AI-driven and manual segmentation methods ranged from 0.10 to 0.98 mm, with a mean RMS of 0.27 (0.11) mm. Manual segmentation resulted in less RMS deviation compared to both AI-driven methods (CDX; BSB) (p < 0.05). Significant differences were observed between all investigated segmentation methods, both for the overall tooth area and each region, with the apical portion of the root showing the lowest accuracy (p < 0.05). Tooth type did not have a significant effect on segmentation (p > 0.05). Both AI-driven segmentation methods reduced segmentation time compared to manual segmentation (p < 0.05).

Conclusions

AI-driven segmentation can generate reliable virtual 3D tooth models, with accuracy comparable to that of manual segmentation performed by experienced clinicians, while also significantly improving time efficiency. To further enhance accuracy in cases involving restoration artifacts, continued development and optimization of AI-driven tooth segmentation models are necessary.

Objectives

The study aimed to evaluate the residual bone level of explanted implants and to report local and systemic characteristics observed in patients who underwent implant explantation.

Material and Methods

A total of 494 administrative records were initially retrieved from the database. After elimination of duplicates, 464 medical records of patients who underwent implant explantation between 2005 and 2021 in thirteen private clinics in Switzerland were screened. Information regarding implant history, local (oral health, periodontal and prosthetic status) and systemic (systemic diseases, medication, and smoking) characteristics was assessed through the medical records and the radiographic data. ISRCTN registry (ISRCTN10631004).

Results

In total, 399 patients and 521 implants were included in the analysis. Peri-implantitis was the most frequent reason for explantation (62%). Explantation was mainly performed in cases of advanced peri-implantitis with a mean bone loss of 62.92% of the implant length. Most patients had radiographic bone loss around the remaining dentition with a bone loss/age ratio of 0.74, presented compromised oral health, and 47.80% of them were smokers. Moreover, only 56.12% of patients reported being in good systemic health.

Conclusion

Implant explantations were typically performed once bone loss reached approximately 60% of the implant length. They were most often observed in advanced cases of peri-implantitis and in patients with high-risk profiles for periodontal breakdown, such as a history of periodontal disease or heavy smoking habits.

Objectives

This prospective longitudinal case series investigated changes in functional, radiographic, and patient-centered outcomes in users of two narrow-diameter implant-retained mandibular overdentures (IMO) over a 5-year follow-up.

Materials and Methods

Twenty-four patients from a previous 3-year study (8 man, 16 women, 71.58 ± 7.03 years, mean mandibular edentulism duration 23.9 ± 14.4 years) were invited for a 5-year follow-up evaluation of radiographic and functional parameters. Masticatory function (MF) was assessed using the Swallowing Threshold Test (ST), with X50 and B cut-off values indicating satisfactory performance. Oral health-related quality of life (OHRQoL) was evaluated using the OHIP-Edent questionnaire. The Posterior Mandibular Area Index (PAI) was analyzed using digital panoramic radiographs. Data was analyzed using multilevel mixed-effects linear regression.

Results

Twenty participants completed the 5-year follow-up evaluation. ST_X50 (4.00–3.70; p ≤ 0.01; 95% CI: 0.47–1.82) reached a significant reduction along with an increased number of masticatory cycles (59.33–65.60; p ≤ 0.01; 95% CI: 0.32–1.11) between years. The number of IMO wearers presenting satisfactory mastication increased but persisted as unsatisfactory in nine participants by year 5. Declines in the Functional Limitation and Physical Disability domains of OHRQoL were noted, with unsatisfactory mastication correlating with higher pain (coef: 2.5; p: 0.03; 95% CI: 0.25–4.74) and psychological disability scores (coef: 0.94; p ≤ 0.01; 95% CI: 0.19–1.68). PAI increased significantly (1.13–1.68; p ≤ 0.01; 95% CI: 0.24–0.56), indicating ongoing bone remodeling.

Conclusions

Although MF and bone parameters improved over 5 years, persistent unsatisfactory mastication continued to negatively affect quality of life. These findings underscore the interdependence between functional and patient-centered outcomes in IMO users.

Trial Registration

The Brazilian Registry of Clinical Trials (ReBEC), Trial identification: UTN code: U1111-1259-4127

Objectives

This study assessed 12-month post-loading 3D peri-implant radiographic bone changes in osteoporotic women receiving a single titanium-zirconium bone-level tapered dental implant with a hydrophilic surface.

Materials and Methods

This was a prospective case series involving 18 post-menopausal osteoporotic women in need of a single dental implant. A standardized CBCT scan was performed after implant placement and at 12 months post-loading to assess peri-implant bone changes. The Implant Stability Quotient (ISQ) was recorded after implant placement, at implant impression, loading, and 12 months post-loading. Peri-implant clinical parameters were recorded at 6 and 12 months post-loading and during the last visit implant survival and success were also evaluated.

Results

Seventeen patients completed all study visits, and implant placement was uneventful for all participants. A statistically significant difference (reduction) from implant placement to 12 months post-loading was observed in terms of radiographic buccal bone width and palatal/lingual width (ΔBw-0: 0.53 mm, p < 0.001 and ΔPw-0: 0.47 mm, p = 0.006), as well as in terms of vertical distance between the implant shoulder and the first bone to implant contact on the buccal and palatal/lingual aspect (ΔBICb: −0.26 mm, p = 0.005 and ΔBICp: −0.46 mm, p = 0.018). ISQ increased during osseointegration, and a high implant survival (100%) and success rate (from 81.3% to 100% based on 3 different sets of criteria) were recorded at 12 months post-loading.

Conclusion

In this case series, osteoporotic patients treated with single titanium-zirconium implants showed high survival rates, predictable 12-month implant outcomes, and physiologic peri-implant bone remodelling.

Trial Registration: NCT02884401