Recent advancements in dental implant materials, designs, and surgery have increased their use, especially for challenging local conditions. As guidelines for individualized risk assessment are increasingly emphasized, implant treatment has become available to patients with diverse medical backgrounds. However, clinical research with large patient groups is needed to investigate the effects of patient-related factors associated with early implant failure.
This paper investigates patient factors in two patient cohorts associated with early implant complications and failures.
The collected data were analyzed and presented in two studies. Both studies followed the same data collection methodology and compared cohorts treated in 2007 and 2017. The same patient-level dataset was analyzed, although the second study included additional analyses of diseases and allergies. Data were analyzed univariately (p < 0.20) to select variables for the multivariable logistic regression model (p < 0.05), with early implant failures and complications as dependent variables.
In total, 1875 patients with 4670 implants were included. There were 74 (3.7%) dropouts, mainly due to lack of data. The 2007 cohort comprised 799 patients with 2473 implants, and the 2017 cohort comprised 1076 patients with 2287 implants. Differences were observed between the two cohorts for the number of implants per patient, exposed implant threads, and preoperative antibiotics. In the 2007 cohort, 23 (2.9%) patients had early implant failure. In the 2017 cohort, 40 (3.7%) had early implant failure (p > 0.30). Significantly more implants failed in the 2017 cohort (n = 56, 2.4%) than in the 2007 cohort (n = 26, 1.1%) (p < 0.001). Early complications were reported for 56 (7.0%) patients in 2007 and 145 (13.5%) patients in 2017 (p < 0.001). Three patient-related variables were associated with an increased risk of early failure—food allergy, exposed implant threads, and increased number of implants. Seven variables were related to an increased risk of complications: smoking, exposed threads, no preoperative antibiotics, number of implants, sinus perforations, food allergy, and metal allergy.
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This retrospective study compares the clinical outcomes of analog impressions versus intraoral scanning in full-arch immediate loading rehabilitations. Specifically, it evaluates peri-implant marginal bone level (MBL) changes at different time intervals (implant placement, loading, and at 2 and 5 years), as well as rates of mechanical and prosthetic complications.
The study included 62 patients who underwent full-arch rehabilitation with immediate implant placement between 2019 and 2020. Patients were divided into two groups: analog impression and digital intraoral scanning. All patients were rehabilitated with fixed titanium-PMMA screw retained restorations. Bone level was assessed through standardized intraoral radiographs at key time points. Additional parameters recorded included procedural time, prosthetic complications, and implant failures. Statistical analyses involved repeated measures ANOVA and post hoc Bonferroni tests.
The follow-up period was 5 years. Implant survival was 99.6%. No significant differences were found in prosthetic complications. MBL was slightly higher in the analog group at baseline (mean = 0.21, SD = 0.04 vs. digital mean = 0.17, SD = 0.04, t-test p-value < 0.001) than in the digital group. Despite this, the overall bone loss remained within clinically acceptable limits during the follow-up period. Digital impressions significantly reduced procedural time compared to analog methods.
Both impression techniques provided satisfactory clinical outcomes. Digital impressions demonstrated efficiency advantages but were associated with slightly greater bone loss over time. Analog impressions remain a reliable standard for full-arch immediate loading rehabilitations, though digital methods show promise for improved patient experience. Further randomized, long-term studies are needed.
Digital impressions offer a faster and more comfortable workflow for full-arch immediate loading rehabilitations, potentially improving patient compliance. However, their association with slightly greater bone loss warrants further investigation to optimize long-term stability.
To assess the clinical and radiographic outcomes of computer-aided design–computer-assisted manufacturing (CAD-CAM) zirconia bars supporting mandibular implant overdentures (IODs) up to a follow-up period of 3 years.
A prospective cohort observational single-center study involving 30 edentulous patients rehabilitated with two dental implants (Ø4.3 × 10 mm) at the crestal bone level and an IOD supported by a zirconia bar with distal extensions (maximum length 10.6 mm). At the 1- and 3-year follow-up, implant, prosthetic survival, marginal bone level (MBL) changes, biological, and technical complications were recorded.
A total of 25 patients were assessed at the 12-month (dropout of 19.4%), and 14 patients completed the 36- month follow-up (dropout of 54.8%). Implant survival and success rates were both 100%, while prosthetic survival was 100% with a success rate of 96%. No biological complications were observed during the follow-up period; however, one patient exhibited generalized mucosal hyperplasia around the zirconia bar at the 12-month evaluation. No prosthetic prosthodontic maintenance needs were reported. A mean marginal MBL of −1.28 mm (SD ± 0.37) was recorded at the initial 12-month follow-up, and − 1.32 mm (SD ± 0.32) at the 36-month follow-up. The difference in MBL between the two time points was not statistically significant (p = 0.529).
Zirconia bars with distal extensions for mandibular IODs appear to be a reliable treatment option for the rehabilitation of edentulous patients, demonstrating favorable clinical outcomes up to 3 years of follow-up. A 100% implant and prosthetic survival rate was achieved, along with stable MBLs.
Clinicaltrials.gov identifier: NCT06471881.
Immediate implant placement and provisionalization in the maxillary aesthetic zone necessitates meticulous treatment planning. The integration of intraoral scanning with cone beam computed tomography allows for three-dimensional prosthetic-driven planning of the implant. Additionally, it facilitates static computer-assisted implant surgery and prefabrication of a temporary restoration, enabling chairside restoration of the immediate implant. This study aimed to evaluate the clinical, aesthetic, radiographic, and patient-reported outcomes after immediate implant placement and restoration.
In a prospective case series, 30 patients with a failing tooth in the maxillary aesthetic zone were included and received immediate implant placement with a bone graft and a prefabricated temporary restoration. The definitive restoration was placed 3 months later. The clinical, aesthetic, radiographic, and patient-reported outcomes were collected prior to implant treatment, 6 weeks after the temporary restoration, and 1 month and 1 year after the definitive restoration.
The prefabricated temporary restoration could be placed in all patients. Three cases of early implant failure were observed (implant survival rate 90%); hence, 27 patients were evaluated after 1 year. The survival and success rates were 100% for the temporary and 100% and 96%, respectively, for the definitive restorations. Plaque, bleeding on probing, and peri-implant inflammation were absent in most cases. At the 1-year follow-up, the mean (SD) Pink Esthetic Score and White Esthetic Score (scale 0–20) was 15.4 (2.5). The mean (SD) marginal bone level change between implant placement and the 1-year follow-up was −0.18 mm (0.57) on the mesial side and −0.44 mm (1.23) on the distal side. The median buccal bone thickness remained stable after immediate implant placement and grafting. The mean (SD) patient satisfaction (scale 0–10) was 9.2 (0.8) at the 1-year evaluation.
The digital workflow has the potential to enable the manufacture of prefabricated temporary restorations, leading to satisfactory clinical, aesthetic, radiographic, and patient-reported outcomes after immediate placement of single-tooth implants in the aesthetic zone.
Registered
This randomized clinical trial aimed to compare changes in soft tissue height, probing depth, and buccal contour volume loss following immediate implant placement using either chairside composite or prefabricated zirconia Sealing Socket Abutments (SSAs) in the posterior region.
47 patients requiring posterior tooth extraction and immediate implant placement were randomly assigned to one of two groups: the composite Sealing Socket Abutment (CS) group (n = 24), receiving chairside-fabricated abutments, or the zirconia Sealing Socket Abutment (ZR) group (n = 23), receiving prefabricated abutments. Implants were placed immediately after extraction, using static computer-assisted implant surgery (sCAIS). Supra-Platform Tissue Height (SPTH) and total horizontal tissues (THT) were assessed using cone-beam computed tomography (CBCT) over a 3-month healing period. Implant survival, probing pocket depths (PPD), bleeding on probing (BOP) and plaque index (PI) were recorded clinically, while volumetric analysis was performed using digital impressions.
SPTH remained stable from baseline to the 3-month follow-up, with a mean change of −0.17 mm in the CS group and −0.44 mm in the ZR group. These differences were not statistically significant (p > 0.05). THT exhibited significant horizontal shrinkage in both groups over the 3-month period. In the CS group, THT decreased by 1.00 mm, while the ZR group showed a reduction of 1.17 mm (p < 0.001). PPD increased in the CS group from 2.8 mm to 3.7 mm on the palatal/lingual aspect and from 2.5 mm to 3.2 mm on the buccal aspect (p = 0.026). In contrast, the ZR group showed a decrease from 3.1 mm to 2.7 mm palatally/lingually and remained stable buccally at 2.6 mm to 2.7 mm (p = 0.001). BOP in the CS group decreased from 42.3% to 7.7% (p = 0.009), while the ZR group maintained low BOP levels, decreasing slightly from 17.4% to 4.4% (p = 0.346).
Both approaches showed comparable outcomes. ZR abutments resulted in shallower probing depths, while CS abutments showed less volumetric shrinkage. SPTH remained stable in both groups.
This trial was registered prior to patient enrollment at ClinicalTrials.gov identifier: NCT05748379
To compare the clinical/radiographic outcomes and the rate of disease resolution of the adjunctive use of electrolysis (GS) or hydrogen peroxide (HP) for mechanical decontamination in the reconstructive treatment of peri-implantitis-related intrabony defects.
A multicenter randomized clinical trial was designed to compare the effectiveness and safety of two strategies for the surface decontamination of crater-like and circumferential intrabony defects subjected to reconstructive therapy. Clinical evaluation was made at baseline (T0), 6 months (T1) and 12 months (T2), while radiographic assessment was carried out at T0 and T2. Disease resolution was the primary outcome. Supportive therapy was administered following surgical treatment. Simple and multiple generalized estimating equations (GEE) models were applied to compare the outcomes achieved and to explore potential confounders. Post hoc power calculation was performed to validate the statistical power of the findings.
Overall, 58 patients completed the study. All the clinical parameters/indices, namely probing pocket depth, modified sulcular bleeding index, suppuration grading index, and width of keratinized mucosa, showed a significant reduction (p < 0.001) from T0 to T2 in both tested groups. Mucosal recession increased (p < 0.001) from T0 to T2. Marginal bone level and radiographic defect angle increased (p < 0.001) from T0 to T2. The disease resolution rate was 87.5% for the GS group and 64.5% for the HP group at T2 (p = 0.08). No major postoperative complications were reported.
Both tested surface decontamination methods are effective in resolving peri-implantitis, in gaining radiographic marginal bone levels, and in enhancing clinical peri-implant conditions in the surgical reconstructive therapy (NCT05615051).
To investigate the accuracy of robotic computer-assisted implant surgery (r-CAIS) for transcrestal sinus floor elevation (TSFE) with simultaneous implant placement.
Virtual sinus elevation and a stepwise drilling plan were created on the robotic operating system before surgery. Robotic arm automatically executed drilling tasks during procedure. Fourteen implants in ten patients with missing teeth in the posterior maxilla were placed by robotic computer-assisted implant surgery through TSFE. Deviations between the planned and placed implants were evaluated with an immediate postoperative CBCT scan. The coronal, apical, and angular deviations between the planned and actual implant placement were measured.
A total of 10 patients with edentulism in the posterior maxilla were included, and 14 implants were placed. The robot-assisted TSFE with simultaneous implant surgery exhibited a mean global coronal deviation of 0.72 mm (range: 0.32–1.57 mm, 95% CI: 0.52–0.92 mm), a mean global apical deviation of 0.78 mm (range: 0.33–1.50 mm, 95% CI: 0.60–0.96 mm), and an angular deviation of 2.20° (range: 0.16°–8.70°, 95% CI: 0.82°–3.60°), respectively. Throughout the surgical intervention, no immediate or significant complications were noted, and no evidence of complications such as tissue perforation or premature implantation failure was documented in the postoperative phase.
The r-CAIS-assisted TSFE demonstrated potential techniques for implant osteotomy and placement. Nevertheless, further clinical trials are necessary to reinforce evidence-based clinical outcomes.
The study aimed to compare the biomechanical behaviors in the all-on-four and all-on-six concept prostheses of different framework materials (cobalt-chromium Co-Cr, titanium Ti, and polyetheretherketone PEEK) and posterior implant angulation in the completely edentulous maxilla.
According to the all-on-four and all-on-six concepts, four different three-dimensional (3D) models were created for the completely edentulous maxilla. The posterior implants were positioned in the premolar region, 30° and 45° angled distally. The frameworks were designed and simulated using the material properties of Co-Cr, Ti, and PEEK. A load of 200 N in the palatobuccal direction was applied to the occlusal surface of the posterior implants bilaterally. The von Mises, maximum, and minimum principal stresses were obtained.
In both concepts, the stress values of the PEEK framework were significantly higher than the stress values of Co-Cr and Ti frameworks in terms of implant, cortical bone, and abutment. The highest von Mises value between frameworks was determined in the Co-Cr framework in the all-on-six concept. Implants with a 45° angle in the posterior showed higher stress values than implants with a 30° angle.
As the number of implants increased, the stress on the implant and cortical bone decreased, while it increased on the abutment and prosthetic framework. The increase in the tilt angle of the posterior implants was directly proportional to the rise in stress concentration.
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