To assess the clinical validity of artificial intelligence (AI)-driven virtual implant placement compared to human intelligence (HI)-based virtual and actual single implant placement in the posterior mandible.
Thirty-two patients for whom experts performed single implant placement in the posterior mandible were included, each with preoperative and postoperative cone-beam computed tomography (CBCT) scans. The preoperative scans were registered to the corresponding postoperative scans and used for both AI- and HI-driven virtual implant planning at the implant site. From each case, three implants' scenarios (i.e., HI-placed, AI-planned, and HI-planned) were exported and compared. The analysis focused on angular deviation and the spatial relationship of each implant to adjacent anatomical structures and the expert-designed prosthetic wax-up. In addition, pairwise comparisons were performed to quantify angular and linear deviations at both the coronal and apical levels. Implant length and diameter from planned versus placed implants were evaluated, and planning time and consistency were compared between AI- and HI-based approaches.
AI-based planning showed no statistically significant differences compared to HI-based methods observed in angular deviation relative to adjacent tooth (HI-placed: 7.7° ± 5.6°, AI: 6° ± 4.7°, HI-planned: 5.2° ± 5.7°) and coronal deviation (AI vs. HI-placed: 0.9 ± 0.8 mm, AI vs. HI-planned: 0.8 ± 0.4 mm, HI-planned vs. HI-placed: 1.0 ± 1.1 mm), all with p > 0.05. Implant diameter and length were also consistent across the different approaches, with HI-placed (4.3 ± 0.3 mm; 9.7 ± 1.3 mm), AI (4.3 ± 0.4 mm; 9.9 ± 1.2 mm), and HI-planned (4.3 ± 0.4 mm; 9.8 ± 1.3 mm) showing no significant differences (p > 0.05). However, AI planning was significantly faster (36.3 ± 7.3 s vs. 373 ± 113 s) and more consistent, with a median surface deviation of 0 mm compared to 0.39 mm for HI (p < 0.05).
The AI tool showed clinically valid implant selection, matched expert placement and planning in virtual implant positioning for missing mandibular premolars and molars while being highly consistent and 10 times faster compared to human expert planning.
To evaluate the accuracy of dental implant placement using fully guided static computer-assisted implant surgery (s-CAIS) and autonomous robotic computer-assisted implant surgery (r-CAIS) technology in patients with transcrestal sinus floor elevation.
Patients with posterior teeth loss and transcrestal sinus floor elevation using s-CAIS or r-CAIS technology for implant surgery were included in this study. A total of 34 patients with 42 implants were included in the study (17 patients with 19 implants in the autonomous r-CAIS group, 17 patients with 23 implants in the fully guided s-CAIS group). Postoperative cone-beam computed tomography (CBCT) scans were used to determine the discrepancies between the planned and actually placed implants. The preoperative and postoperative CBCT were utilized to estimate the linear deviations and angular deviations in two-dimensional (2D) and three-dimensional (3D) space.
A total of 42 implants were included, with significant differences between the autonomous r-CAIS group and fully guided s-CAIS group (p < 0.001). No adverse surgical events occurred. The 3D deviations at the implant platform were 0.484 ± 0.218 mm for the autonomous r-CAIS group and 1.179 ± 0.776 mm for the fully guided s-CAIS group, respectively. The mean linear deviations at the implant apex were 0.527 ± 0.247 and 1.196 ± 0.830 mm, respectively. The mean angular deviation was 0.882° ± 0.967° for the autonomous r-CAIS group and 2.478° ± 1.524° for the fully guided s-CAIS group.
Autonomous r-CAIS technology provided a more accurate surgical approach for implant placement in patients with transcrestal sinus floor elevation than fully guided s-CAIS.
This prospective multicenter study evaluated the 5-year clinical performance of one-piece, long, smooth-necked narrow-diameter implants (NDIs) in rehabilitating patients with congenital maxillary lateral incisor agenesis and limited alveolar bone.
Patients aged ≥ 18 years with unilateral or bilateral agenesis and mesiodistal spaces of 3.5–5.5 mm were recruited. Flapless implant placement of Ø2.7 mm, smooth-necked implants was performed, followed by immediate loading with lithium disilicate crowns. Radiographic assessments of marginal bone levels, peri-implant soft tissue parameters, and esthetic outcomes were conducted at baseline, 1 month, 1 year, and 5 years. Implant survival, success, and mechanical/biological complications were systematically recorded. Statistical analyses employed Kaplan–Meier survival curves and ANOVA with significance set at p < 0.05.
Forty-six patients completed the 5-year follow-up. Implant survival and success rates were 97.8% and 93.5%, respectively. Mean marginal bone loss was 0.43 ± 0.06 mm at 1 year and 0.84 ± 0.11 mm at 5 years. Probing depths and bleeding indices remained within normal limits (2.96 ± 0.1 mm at 5 years). Papilla preservation was achieved in 89% of cases, and pink esthetic scores indicated stable soft tissue integration. Mechanical complications were minimal, with two cementation failures and one minor ceramic chipping; no implant or abutment fractures occurred.
One-piece NDIs represent a reliable, esthetic, and cost-effective treatment option for maxillary lateral incisor agenesis in patients with limited alveolar dimensions. High survival, minimal bone loss, stable soft tissue, and low complication rates support their use as a minimally invasive, patient-centered solution.
This study aimed to systematically compare the efficacy and resorption of in-situ and ex-situ bone onlay grafting in reconstructing horizontal alveolar ridge defects of anterior teeth.
One-hundred and twenty five patients receiving autogenous bone onlay grafts in the anterior tooth region were included in this study, which comprised 55 patients with 66 implants receiving in-situ bone grafts (in-situ group) and 70 patients with 77 implants receiving ex-situ bone grafts (ex-situ group). All patients were examined by CBCT scanning before bone augmentation (T0), immediately after bone augmentation (T1), at 5–8 months after bone augmentation (T2), immediately after implant placement (T3), and 5–8 months after implant placement (T4). Horizontal bone width (HBW) and bone volume (BV) were measured at different postoperative time points after automated image registration of consecutive CBCT imaging.
The resorption rate of HBW from T1 to T2 in the in-situ group (23.84% ± 17.07%) was significantly lower than that in the ex-situ group (38.77% ± 19.94%) (p < 0.0001). However, from T3 to T4, no significant difference was observed between the two groups. Additionally, from T1 to T2, there were significant differences in the resorption rate of BV between the in-situ group (20.03% ± 16.14%) and the ex-situ group (28.20% ± 17.58%) (p < 0.05). In contrast, no significant differences between the two groups from T3 to T4 were noted.
Both in-situ and ex-situ onlay graftings showed a satisfactory outcome in bone augmentation, yet in-situ bone graft had more bone augmentation and better stability than ex-situ bone graft.
To investigate patients' awareness, trust, and acceptance of robot-assisted dental implant surgery in South China, identify the influencing factors, and evaluate the opportunities and challenges to clinical use.
A cross-sectional survey was conducted from November 2024 to August 2025 in three public hospitals in South China. Electronic questionnaires were distributed to patients who had or were scheduled to undergo implant surgery or were considering dental implant treatment. Participants were assigned to Questionnaire A (patients who underwent robot-assisted implantation) or Questionnaire B (patients without such experience). The questionnaire covered the demographic characteristics, awareness level, trust, acceptance, and experience of those treated with robot assistance.
Three hundred and ninety six valid questionnaires were administered. Among these, 26.51% accepted robot-assisted implants, 27.78% rejected, and 45.70% were uncertain. In the inexperienced group (n = 382), 61.00% expressed distrust, which was associated with the age, humanistic care, safety, and emergency capabilities of the new technique. In the experienced group (n = 14), 78.60% of patients expressed their willingness to undergo robotic surgery again. The regression analysis revealed that preoperative information negatively affected satisfaction (β = −0.239, p = 0.019), whereas intraoperative experience exhibited a positive effect (β = 0.268, p = 0.014).
Patients in South China demonstrated limited awareness of robot-assisted dental implant surgery. Trust was mainly influenced by demographics and safety perceptions, whereas satisfaction relied on intraoperative experiences and recovery. The promotion of robot-assisted implant technology should emphasize technical reliability, doctor–patient communication, improved patient experience, and tailored management for different groups.
Crestal bone level (CBL) changes following implant placement may result from both physiological and pathological processes. Although early marginal bone remodeling is generally regarded as a physiological response, its progression must be carefully monitored. Identifying long-term risk factors is essential for preserving peri-implant bone stability. This study aims to assess changes in CBL and crestal bone remodeling (CBR) over a 4-year period in periodontally healthy patients undergoing regular supportive care.
This retrospective study included 97 patients with a total of 142 implants who received implant-supported restorations and consistently attended supportive maintenance therapy. Patients with a history of periodontitis were excluded. Radiographic evaluation was conducted at four time points: T0 (implant placement), T1 (prosthetic loading), T2 (1 year after loading), and T3 (4 years after loading). CBL and CBR were assessed using calibrated digital measurements. The effects of systemic, surgical, site-related, and prosthetic variables on CBL and CBR were analyzed using linear regression and Pearson correlation tests.
Smoking was the only consistent predictor of increased CBL loss across all intervals (p < 0.001). In the early phases (T1–T0, T2–T1), subcrestal placement was associated with significantly less bone loss (p ≤ 0.003). In the late phase (T3–T2), implant diameter became a significant predictor (p = 0.002). Prosthetic factors were not significant in the overall analysis. However, within the subcrestal subgroup, screw-retained prostheses, platform-switched connections, and anterior placement were associated with reduced CBR during specific intervals. Strong correlations were observed between CBL changes across all intervals, indicating progressive and cumulative bone dynamics.
The primary factor for initial bone stability is the depth of implant placement, whereas long-term results are mainly affected by implant geometry and prosthetic design. Smoking continues to be a significant, modifiable risk factor. These insights emphasize the importance of individualized treatment plans and maintenance strategies to ensure long-term implant success.
Dental implants are widely utilized to manage both partially and completely edentulous older patients. However, such patients often present with multiple systemic diseases and may be at an increased risk of complications before and after implant surgery. Nevertheless, population-level data on systemic diseases and medication use in these patients remain limited.
This retrospective, cross-sectional study analyzed 36 957 patients who underwent 43 171 insurance-covered implant surgeries between 2014 and 2019 using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. Patients aged 65 years or older were included. Sociodemographic characteristics, diagnosis of systemic diseases within 1 year before implant surgery, medication history, and type of medical institution were evaluated. Additionally, logistic regression analysis was performed to investigate factors associated with implant removal.
Among 36 957 patients who underwent 43 171 implant surgeries, implant removal occurred in 803 patients. Within 1 year before surgery, 89.33% had at least one systemic disease, including hypertension (57.92%), arthritis (43.39%), and diabetes (34.62%). Antithrombotic and antiresorptive agents were prescribed to 6.77% and 5.05% of patients, respectively. The use of intravenous (IV) bisphosphonates, denosumab, and direct oral anticoagulants (DOACs) increased, whereas the use of oral bisphosphonates and warfarin decreased. Logistic regression analysis showed that cerebrovascular and kidney disease increased the risk of implant removal, whereas osteoporosis and antiresorptive agents decreased the risk.
Most older patients who underwent implant surgery had systemic diseases, and approximately 10% were prescribed medications. Cerebrovascular and kidney diseases increased the risk of implant removal, whereas osteoporosis or antiresorptive therapy decreased the risk. With the increasing use of DOACs, IV bisphosphonates, and denosumab, clinicians carefully review the medical histories of older implant patients.
This study assesses the effects of different three-dimensional (3D) print offsets of sleeves on sleeve and implant placement trueness in guided implant surgery.
Twenty-five sleeves were installed on 3D-printed surgical guides, with sleeve offsets of 0.02, 0.04, 0.06, 0.08, and 0.10 mm (five groups with five sleeves per group). The actual surgical guides were scanned to generate digital files, which were compared with the reference group based on design positions. The experimental verification and evaluation method involves assessing sleeve installations and measuring the deviations between the actual position of the sleeve and implant compared with the reference group.
The sleeve installations in the 0.02-mm offset group were not acceptable, as there were visible cracks in the sleeve; in the case of the 0.04-mm offset group, there were also installation difficulties. At the sleeve position level, there were larger deviations in the 0.10-mm offset group, whereas the 0.08-mm group had smaller deviations in the labial and palatal directions (p < 0.05). At the implant level, the 0.10-mm offset group showed a significantly larger deviation (labial: 0.453 ± 0.165 mm; palatal: 0.399 ± 0.160 mm; p < 0.05). As for the mesial–distal direction, there were no significant differences between the groups.
Print offsets of sleeves had a significant effect on the ease of installation and the placement accuracy of sleeves and implants. Under the printer and sleeves conditions used in this experiment, smaller offsets (0.02 and 0.04 mm) caused installation difficulties and misalignments. Larger offsets (0.10 mm) created noticeable deviations. Sleeve offsets of 0.06 and 0.08 mm provided a balance between ease of installation and high placement trueness, making them more suitable in this experiment. Excessive or insufficient print offsets of sleeves can affect installation conditions and positional trueness of sleeves and implants.
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