This 3D analysis assessed the accuracy of zygomatic implant (ZI) placement using a static surgical guide in correlation with ZAGA classification and the rehabilitation type.
Pre-surgical CT scans were used to create a virtual surgical plane, exported as .stl files, and to define the ZAGA classification of each implant. A CT scan was taken 6 months post-surgery, and segmentation of the zygomatic implants was performed. The 3D analysis on 3DSlicer software compared planned and placed zygomatic implants, measuring linear and angular displacements at the apex and base of each model. Displacements were correlated with the ZAGA classification and the type of rehabilitation (if quad, twin, or mono zygomatic implant).
The study included 45 patients and 150 zygomatic implants, all placed using bone-supported surgical guides with no bone modifications. The implant survival rate was 100% at 6 months. Most patients received quad rehabilitation with 4 implants, and there was strong overlap between planned and placed implants. The mean surface displacement was 0.43 mm on the right and 0.45 mm on the left. The angular deviation between the planned and placed implant orientations was lower than 1° for both the anterior and posterior implants. According to ZAGA classification, surface displacement increased from class 0 to 4. No significant differences were found among the type of rehabilitation (p > 0.289).
The study highlights the accuracy of fully guided surgery for zygomatic implant placement, recommending its consideration in clinical decision-making. It also shows greater accuracy in lower ZAGA classes and no significant difference across rehabilitation types.
Perforation is the most common complication of sinus floor elevation (SFE) surgery, and is closely associated with the thickness of the maxillary sinus membrane. This study aimed to evaluate the relationship between maxillary sinus membrane thickness and anatomical variations in the osteomeatal complex (OMC).
Cone beam computed tomography scans were retrospectively analyzed, encompassing 1957 sinuses. Mucosal thickness (MT) and mucosal appearance (MA) were classified as normal, flat thickening, polypoid thickening, or ostium obstruction. Ostium width (OW), infundibulum length (IL), and ethmoidal bulla diameter (EBD) were measured. The presence of Haller cells (HC), concha bullosa (CB), and superior attachment of the uncinate process (UPSA) was recorded. Kruskal–Wallis, Mann–Whitney U, Chi-square, and GEE models were used.
Mucosal thickening was observed in 54% of the sinuses, with flat thickening (23.5%) being the most prevalent pattern. A significant association was found between ostium obstruction and MT greater than 10 mm. MT, IL, OW, and EBD values were significantly higher in men than in women. Significant correlations were also identified between MT and IL, OW, EBD, and HC. No significant relationship was found between CB and MT. However, UPSA types 3, 4, and 6 were significantly associated with polypoid thickening and ostium obstruction.
The findings demonstrate that anatomical variations in the OMC influence maxillary sinus membrane thickness. A comprehensive evaluation of these variations should be performed before planning for SFE procedures. Dentists should be proficient in identifying and assessing the osteomeatal region during routine radiographic examinations to prevent potential complications.
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.
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