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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (1 June 2023) | Viewed by 30347

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Special Issue Editors

Prof. Dr. Ralph Gunnar Luthardt

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Guest Editor

Department of Prosthetic Dentistry, Center of Dentistry, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
Interests: artificial gingivitis; biomolecular analysis of peri-implant crevicular fluid (PICF); clinical trials; computer-assisted surgery; computer-guided surgery; dental restauration failure; dental implants; gingival retraction; implant supported dentures; prosthesis survival; shortened dental arch; tooth loss; treatment outcome; three-dimensional analysis

Dr. Heike Rudolph

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Guest Editor

Department of Prosthetic Dentistry, Center of Dentistry, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
Interests: accuracy of dental impression materials; all-ceramic restorations; artificial aging; alveolar ridge preservation; bond strength of luting materials; ceramic dental implants; cyclic-loading; clinical trials; CAD/CAM technology; digitizing; gingival displacement; systematic review; three-dimensional analysis of fit

Special Issue Information

Dear Colleagues,

The constantly evolving field of dental implantology is being scientifically investigated, employing a wide variety of approaches. The aim of this Special Issue is to provide a broad representation of cutting-edge research results at the highest scientific level, and, thus, to provide comprehensive knowledge about the latest state of the art.

For this purpose, we are searching for the latest results of clinical studies on various topics, including, but not limited to, the following: osseointegration, healing strategies, new diagnostic and treatment concepts, as well as minimally invasive procedures.

Diagnostic procedures can be, for example, biomolecular, histological or immunohistochemical analyses of samples from clinical studies.

Innovative treatment concepts can be based on material aspects, variations in superstructures and fixation types on the one hand, but also on lean and/or digital workflows. The questions of how successful implant treatment can be further improved, and which possibilities of prevention arise to protect individuals against implant loss shall be addressed, as well as how successful therapy of peri-implant inflammation may look in the future, based on the current state of science.

Join us in describing and charting the path to the future of modern implant dentistry.

Prof. Dr. Ralph Gunnar Luthardt
Dr. Heike Rudolph
Guest Editors

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Keywords

implantological clinical trial
dental implantology
digital workflow
treatment concept
innovative materials
inflammation marker
superstructures
lean workflow
minimally invasive implant treatment

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Published Papers (12 papers)

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Research

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15 pages, 777 KiB

Open AccessArticle

Long-Term Effect of Guided Implant Surgery on Clinical Outcomes and Peri-Implantitis of Maxillary Implants—An Observational Cohort Study

by Emitis Natali Naeini, Hugo De Bruyn, Ewald M. Bronkhorst and Jan D’haese

J. Clin. Med. 2023, 12(13), 4432; https://doi.org/10.3390/jcm12134432 - 30 Jun 2023

Cited by 1 | Viewed by 1349

Abstract

(1) Although the accuracy of static computer-aided implant surgery (sCAIP) is well reported, information on its long-term effect on peri-implant health and complications is scarce. (2) Twenty-six patients initially treated were recalled. Implant survival, radiographic bone level, peri-implant health, and complications were registered. A multilevel regression model was applied to study the relationship between the research variables. (3) Sixteen patients participated in this study (average age 58.5 years; range 27.8–73.8). The mean follow-up time was 9.1 years (range 7.3–11.3). Two implants failed, resulting in a survival rate of 97.1%. The mean bone level change corresponded to a loss of 0.63 mm (SD 1.90) for the whole group, 0.17 mm (SD 1.46), and 0.91 mm (SD 2.09) for tooth- and mucosa-supported guides, respectively. The mean PPD for the total group was 4.24 mm (SD 1.25), and 3.79 mm (SD 0.97) and 4.51 mm (SD 1.33) for the tooth- and mucosa-supported guides, respectively. Four implants (6.3%) were diagnosed with peri-implantitis. Coronal deviation was slightly associated with having a negative impact on bone level at follow-up, but this was not statistically significant. Seven patients (43.8%) experienced technical complications. Biological complications were seen in 3/16 patients (18.75%). (4) SCAIP may contribute to more predictable implant placement; the long-term clinical outcome is similar to conventional nonguided surgery. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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13 pages, 2681 KiB

Open AccessArticle

Effects of Osseodensification on Primary Stability of Cylindrical and Conical Implants—An Ex Vivo Study

by Márcio de Carvalho Formiga, Helio Doyle Pereira da Silva, Bruna Ghiraldini, Rafael Shinoske Siroma, Lavinia Cosmina Ardelean, Adriano Piattelli and Jamil Awad Shibli

J. Clin. Med. 2023, 12(11), 3736; https://doi.org/10.3390/jcm12113736 - 29 May 2023

Cited by 2 | Viewed by 1814

Abstract

Primary stability is an important factor for dental implant success. In the past years, a new method for bone site preparation was introduced, named osseodensification (OD). OD produces a condensation of the trabecular portion of the bone, increasing bone-to-implant contact and primary stability. This study aims to compare the effect of OD in cylindrical and conical implants to conventional instrumentation. A total of forty implants, divided into four groups, were placed in porcine tibia: cylindrical conventional (1a), cylindrical OD (1b), conical conventional (2a) and conical OD (2b). Each implant was measured for implant stability quotient (ISQ), insertion torque (IT) and removal torque (RT). Group 2b showed the higher values for each of the evaluated parameters; groups 1b and 2b showed better results than 1a and 2a, respectively. Regarding the IT and RT, group 1b achieved higher values than group 2a, but not for ISQ. The inter-group comparison showed significant difference between groups 1a vs 2a, 1a vs 2b and 1b vs 2b for ISQ and 1a vs 1b and 1a vs 2b for RT analysis. OD resulted in improved ISQ, IT and RT of both cylindrical and conical implants. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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12 pages, 7165 KiB

Open AccessArticle

Minimally Invasive Treatment of Lateral Incisors with Guided One-Piece or Two-Piece Titanium-Made Narrow Diameter Implants: A Retrospective Comparative Study with Up to Two Years Follow-Up

by Łukasz Zadrożny, Bartłomiej Górski, Edoardo Baldoni, Aurea Immacolata Lumbau, Silvio Mario Meloni, Milena Pisano and Marco Tallarico

J. Clin. Med. 2023, 12(11), 3711; https://doi.org/10.3390/jcm12113711 - 27 May 2023

Cited by 1 | Viewed by 1931

Abstract

Restoring teeth with dental implants has become the gold standard in recent years, especially in the esthetic zone. However, limited amount of available bone as well as limited interdental space in the anterior zone may create problems for implant treatment. Narrow diameter implants (NDI) may be a treatment option to resolve the above-mentioned limitations and providing minimally invasive implant therapy without additional regenerative procedures. In this retrospective study, a comparison of clinical and radiographic outcomes between one-piece and two-piece titanium-made NDIs was done with the follow-up of two years after loading. Twenty-three NDI cases were analyzed, 11 in the one-piece implant group (group one) and 12 in the two-piece implant group (group two). The outcomes were implant and prosthetic failures, any complications occurred, peri-implant bone level changes, and as well as the Pink Esthetic score. No implant or prosthetic failures, as well as, no complications were reported at the two-year follow-up examination. At the same time the marginal bone loss was 0.23 ± 0.11 in the group one and 0.18 ± 0.12 in the group two. Difference was not statistically significant (p = 0.3339). The Pink Esthetic Score, recorded two years after definitive loading, was 12.6 ± 0.97 in the group one and 12.2 ± 0.92 in the group two, with no statistically significant difference between groups (p = 0.3554). With the limitations of the present study, including the small sample size and short follow-up, it is possible to conclude that either one and two-piece NDI can be successfully used to restore lateral incisors with comparable results within the two years of follow-up. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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17 pages, 2024 KiB

Open AccessArticle

Incidence of Peri-Implantitis, Technical and Biological Complications of Single Implants Placed with Flap or Flapless Surgery—A 10–12-Year Case-Series

by Emitis Natali Naeini, Mandana Atashkadeh, Wolfgang Jacquet, Jan D’Haese and Hugo De Bruyn

J. Clin. Med. 2023, 12(11), 3668; https://doi.org/10.3390/jcm12113668 - 25 May 2023

Cited by 3 | Viewed by 1320

Abstract

Background: Long-term follow-up of single implants and crowns is scarce, especially when inserted using flapless surgery. Aim: Evaluate survival, peri-implantitis incidence, and technical/biologic complications of solitary implants/crowns after 10–12 years of function. Material and methods: 49 patients with 53 single implants, initially operated with a one-stage flap (F) or flapless (FL) surgery and delayed loading, were recalled. Implant survival, radiographic bone-level changes compared to baseline, peri-implant health, and soft tissue aesthetics were registered. Differences in implant level between and within groups were statistically tested using the Mann–Whitney U-Test and Wilcoxon Signed Ranks Test, respectively. Results: 36 patients with 40 implants were reassessed, yielding 100% implant and 97.5% crown survival. The bone loss in F (n = 19) was 0.56 mm (SD 0.89; range −0.9–2.02) and −0.85 mm (SD 0.98; range −2.84–0.53) in FL (n = 21), indicative of bone gain in FL (p = 0.003), the latter due to a difference at baseline but bone-level was comparable (p = 0.126). Groups were comparable for probing pocket depth (PPD); (3.32 vs. 3.19 mm), Bleeding Index (BI); (0.15 vs. 0.22), and gingival recession; (0.38 vs. 0.17 mm). According to international criteria, the peri-implantitis incidence was 0%, but 32.5% of the implants/crowns experienced biological or technical complications irrespective of surgical technique. Conclusions: Solitary implants and crowns show good long-term clinical outcomes and peri-implant health. Flapless surgery is a good alternative to conventional in straightforward cases with sufficient bone volume and proper treatment planning. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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14 pages, 2659 KiB

Open AccessArticle

Soft-Tissue Augmentation around Dental Implants with a Connective Tissue Graft (CTG) and Xenogeneic Collagen Matrix (CMX)—5-Year Follow-Up

by Jakub Hadzik, Artur Błaszczyszyn, Tomasz Gedrange and Marzena Dominiak

J. Clin. Med. 2023, 12(3), 924; https://doi.org/10.3390/jcm12030924 - 24 Jan 2023

Cited by 6 | Viewed by 5635

Abstract

Proper horizontal and vertical thickness of the gingival connective tissue has been proven to be one of the success criteria in dental implant and reconstructive surgery. When thin tissue is found, gingiva augmentation methods can be used to increase the quality and volume of the tissue. Many methods have been described, among them pedicle soft-tissue flaps or autogenic tissue grafts. As an alternative to patients’ own tissue, xenogenic materials can be used for grafting. The fundamental issue is to choose a material that will ensure the maximum therapeutic effect, while also minimizing the negative influence on the patient’s health. The aim of this study was to compare gingival augmentation procedures using a palatal connective tissue graft (CTG) and an xenogenic soft-tissue substitute, Geistlich Mucograft (xenogeneic collagen matrix; CMX), and assess whether the timing of the graft surgery influences the clinical outcomes. The original study was a randomized control trial with a total of 75 implants placed. The patients received the soft-tissue thickening 3 months before the implant placement or 3 months after the implant placement (depending on the group). A connective tissue graft (CTG) or Geistlich Mucograft were used (depending on the group). For both the CTG and Geistlich Mucograft, better clinical outcomes were observed for maintaining the alveolar bone level and the thickness of the attached gingiva compared to the control group with no gingival augmentation. The Geistlich Mucograft showed good clinical performance in comparison to the control. Soft-tissue augmentation with the CTG before the implant placement was found to be most efficient method in terms of a stable increase of the tissue thickness since, throughout the entire observation period, the greatest increase of 1.035 mm (SD = 0.73 mm) in thickness was observed. Statistically important differences in the tissue thickness baseline compared after 5 years were observed for groups G1 vs. G2b (no augmentation vs. CTG before), G1 vs. G3b (no augmentation vs. CTG after) and for groups G2b vs. G3a (CTG before vs. CMX after). Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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11 pages, 476 KiB

Open AccessArticle

Factors Influencing the Survival Rate of Teeth and Implants in Patients after Tumor Therapy to the Head and Neck Region—Part 2: Implant Survival

by Ramona Schweyen, Waldemar Reich, Peter Jevnikar, Thomas Kuhnt, Andreas Wienke and Jeremias Hey

J. Clin. Med. 2022, 11(21), 6319; https://doi.org/10.3390/jcm11216319 - 26 Oct 2022

Cited by 2 | Viewed by 1634

Abstract

During prosthetic rehabilitation after tumor therapy (TT) in the head and neck region, the dentist must assess whether the prognosis of the remaining teeth is sufficiently good or whether implants should be used to anchor dentures. Thus, the aim of the present study was to compare the survival rate of teeth and implants after TT and to evaluate factors potentially influencing implant survival. One hundred fifteen patients (male: 70.3%; mean age: 63.2 ± 12.4 years) having received dental treatment before and after TT at the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination including assessment of dental status and stimulated salivary flow rate was performed. Information about disease progression and therapy was retrieved from medical records. After TT, from a total of 1262 teeth, 27.2% had to be extracted. Of 308 implants inserted after TT, 7.0% were lost. Teeth exhibited lower 5-year survival probability (76.8%) than implants (89.9%; p = 0.001). The risk of loss (RL) of implants increased with age, nicotine use, intraoral defects, and RCT. Radiotherapy did not independently increase the RL. Thus, implants seem to be a reliable treatment option in case of progressive tooth decay after TT, particularly after RT. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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15 pages, 712 KiB

Open AccessArticle

Factors Influencing the Survival Rate of Teeth and Implants in Patients after Tumor Therapy to the Head and Neck Region—Part 1: Tooth Survival

by Ramona Schweyen, Waldemar Reich, Dirk Vordermark, Thomas Kuhnt, Andreas Wienke and Jeremias Hey

J. Clin. Med. 2022, 11(20), 6222; https://doi.org/10.3390/jcm11206222 - 21 Oct 2022

Cited by 1 | Viewed by 1608

Abstract

We aimed to evaluate possible factors influencing the long-term survival of teeth after tumor therapy (TT) to the head and neck region with and without radiation. Between January 2019 and January 2020, patients who underwent TT for head and neck cancer and received dental treatment before and after TT at the Department of Prosthetic Dentistry of the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination with assessment of dental status and stimulated salivary flow rate (SFR) was performed and information about disease progression and therapy was retrieved from medical records. Of 118 patients (male: 70.3%; mean age: 63.2 ± 12.4 years), 95 received radiotherapy (RT), and 47 were administered radio-chemotherapy (RCT). The teeth of irradiated patients exhibited a lower 5-year survival probability (74.2%) than those of non-irradiated patients (89.4%). The risk of loss (RL) after RT increased with nicotine use, presence of intraoral defects, reduced SFR, RCT and regarding mandibular teeth, and decreased with crowning following TT. Lower SFR increased the RL even without RT. Consideration of patient’s treatment history, individual risk profile, and clinical findings during the prosthetic planning phase could enable earlier, more targeted dental treatment after TT (e.g., timely crowning). Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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15 pages, 1937 KiB

Open AccessArticle

A Retrospective Observational Study Assessing the Clinical Outcomes of a Novel Implant System with Low-Speed Site Preparation Protocol and Tri-Oval Implant Geometry

by Giacomo Fabbri, Tristan Staas and Istvan Urban

J. Clin. Med. 2022, 11(16), 4859; https://doi.org/10.3390/jcm11164859 - 18 Aug 2022

Cited by 4 | Viewed by 4060

Abstract

A novel, biologically friendly implant concept system introduces low-speed (50 rpm) site preparation instruments used without irrigation and a tri-oval, tapered implant designed to reduce stress on cortical bone without sacrificing mechanical stability. This retrospective, observational, multicenter study (clinicaltrials.gov NCT04736771) collected data from consecutive patients treated with at least one novel concept system implant to evaluate clinical outcomes after 1 year in function. The primary endpoint was a marginal bone level change (MBLC) from loading to 1 year, and secondary endpoints included implant survival and clinician feedback. Ninety-five patients (54 women and 41 men, mean age: 58 ± 12 years) were treated with 165 implants. For 94.5% of implants, site preparation was performed in two steps. The mean follow-up from implant insertion was 1.8 ± 0.2 years. Mean MBLC from implant loading to 1-year follow-up was +0.15 ± 0.85 mm (n = 124 implants). At the last follow-up, the implant survival rate was 98.0%. Clinician satisfaction with the novel concept system was high. The novel concept system offers an easy-to-use implant placement protocol, with most implants placed using two steps. The minimal bone remodeling and high survival rate observed across a variety of indications and treatment protocols demonstrate broad versatility and confirm the clinical benefits of this biologically friendly innovation. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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11 pages, 1169 KiB

Open AccessArticle

Effect of Sinus Perforation with Flaplessly Placed Mini Dental Implants for Oral Rehabilitation: A 5-Year Clinical and Radiological Follow-Up

by Luc Van Doorne, Geert Hommez, Ewald Bronkhorst, Gert Meijer and Hugo De Bruyn

J. Clin. Med. 2022, 11(15), 4637; https://doi.org/10.3390/jcm11154637 - 8 Aug 2022

Cited by 2 | Viewed by 4437

Abstract

Background: Flaplessly placed one-piece mini dental implants (MDI) are an option to support maxillary overdentures. Evenly distribution of the implants over the atrophic alveolar process implies a risk of accidental sinus perforation in the posterior area which could induce sinus-related pathology. Methods: Thirty-one patients received 5–6 maxillary MDIs. Schneiderian membrane swelling was assessed with CBCT at the deepest point of the sinus in the mid-sagittal plane prior to surgery (baseline), after 2 and 5 years. Additionally, subjective patient-reported rhinosinusitis complaints, the effect of smoking, and gender differences were investigated. Results: Mean thickness of the Schneiderian membrane was 2.87 mm at baseline, 3.15 mm at 2 years, and 4.30 mm at 5 years in 27 of 31 initially treated patients. MDI perforation was detected in 21/54 sinuses. At 2 years, perforation length does not affect membrane thickness whereas baseline swelling does. In smokers, each perforated mm induced 0.87 mm additional swelling. After 5 years, the effect of baseline swelling becomes smaller whereas perforation length became statistically significant, with 0.53 mm increase for every perforated mm. The effect of smoking lost its significance. No relations between gender, membrane thickness changes, or subjective clinical sinus complaints and MDI perforation were found. Conclusion: Accidental MDI sinus perforation induces Schneiderian membrane swelling but does not interfere with clinical sinusal outcome after 5 years. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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Review

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11 pages, 282 KiB

Open AccessReview

The Single Midline Implant in the Edentulous Mandible—Current Status of Clinical Trials

by Nicole Passia and Matthias Kern

J. Clin. Med. 2023, 12(11), 3773; https://doi.org/10.3390/jcm12113773 - 31 May 2023

Cited by 5 | Viewed by 1670

Abstract

The single midline implant in the edentulous mandible is a treatment concept that has often been controversially discussed. Nearly 30 years ago, the first available clinical results revealed high implant survival rates and remarkable improvements in oral comfort, function, patient satisfaction and oral health-related quality of life for edentulous patients compared to the situation with no implant. However, the clinical trials were predominantly conducted with a small number of patients over a short to medium follow-up period. Today, numerous clinical investigations on the single midline implant in the edentulous mandible, which increasingly include longer-term observation periods, are available. It is the aim of this overview to present the current literature and to highlight the clinical problems. This article is a 2023 update of a review published by the authors in the German language in 2021 in the German journal Implantologie. In total, 19 prospective clinical trials with a follow-up period of 0.5–10 years were analyzed. Over this observation period, single implants with modern rough implant surfaces in the edentulous mandible reveal high implant survival rates of between 90.9 and 100% when a conventional delayed loading protocol was applied. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

Other

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13 pages, 6494 KiB

Open AccessCase Report

Digital Evaluation of Vertical Ridge Augmentation with the Modified Shell Technique Using a Xenogeneic Bone Lamina: A Case Series

by Arndt Happe, Sarah M. Blender, Ralph G. Luthardt, Heike Rudolph and Katharina Kuhn

J. Clin. Med. 2023, 12(22), 7013; https://doi.org/10.3390/jcm12227013 - 9 Nov 2023

Viewed by 1904

Abstract

Vertical ridge augmentation is a demanding and technique-sensitive surgical procedure. In the present case series, cone beam CT (CBCT) scans from the clinical routine of patients treated using a novel approach for vertical bone augmentation were assessed. All patients showed a single-tooth class 5 defect and were treated using a modification of the original shell technique. Cortical bone plates were replaced with a lamina composed of a partially demineralized porcine xenograft. CBCT scans of six consecutive patients were treated with the lamina and particulate bone from the mandibular ramus prior to a single tooth implant in the anterior maxilla were included. Pre- and postsurgical CBCT data sets were superimposed and analyzed digitally using surface matching and Boolean subtraction. The volume of the grafted area was calculated with and without the xenograft. The vertical gain of the ridge height measured in this case series varied from 7 to 11.3 mm. The mean vertical gain was 8.97 mm. The mean volume including the xenograft was 382.59 mm³ (SD 73.39) and 250.84 mm³ (SD 53.67) without the lamina. The modified shell technique used in this case series for the vertical augmentation of single-tooth class 5 defects provided sufficient bone for single implant restorations. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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15 pages, 2581 KiB

Open AccessSystematic Review

Clinical Effects of Photofunctionalization on Implant Stability and Marginal Bone Loss: Systematic Review and Meta-Analysis

by Xinrui Lang, Bo Qiao, Ziyu Ge, Jiahui Yan and Yanzhen Zhang

J. Clin. Med. 2022, 11(23), 7042; https://doi.org/10.3390/jcm11237042 - 28 Nov 2022

Cited by 4 | Viewed by 1715

Abstract

Background: Several clinical trials have recently been conducted to elucidate the effectiveness of photofunctionalization. The aim of this review was to systematically analyze the clinical effects of photofunctionalization on implant stability and marginal bone loss (MBL). Methods: An electronic search in four databases and a manual search were conducted in September 2022. Randomized controlled trials (RCTs), clinical controlled trials (CCTs), and cohort and case-control studies evaluating the effects of photofunctionalization on implant stability or marginal bone loss (MBL) in humans were included. The methodological quality assessment using RoB 2.0 and the ROBINS-I tool was performed based on different study designs. Results: Seven studies were included for a qualitative analysis, and five of them were chosen for a meta-analysis. The meta-analysis revealed that photofunctionalization significantly improved the stability of the implant 2 months after implantation (p = 0.04; MD = 3.48; 95% CI = −0.23 to 6.73) and increased the osseointegration speed index (OSI) (p = 0.007; MD = 2.13; 95% CI = 0.57 to 3.68). However, no significant improvements of implant stability were observed 2 weeks (p = 0.62), 4 weeks (p = 0.31), nor 4 months (p = 0.24) after implantation. The evaluation presented no significant reductions in MBL. Conclusions: Based on the positive effect of photofunctionalization on the rate of establishing implant stability, photofunctionalization may provide an effective and practical strategy to achieve faster osseointegration and reduce the overall healing time. Photofunctionalization appears to improve the implant stability. However, the clinical effect of photofunctionalization on MBL remains unclear due to the shortage of available studies. Full article

(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)

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