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Clinical Advances in Implant Dentistry
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Clinical Advances in Implant Dentistry

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 (31 December 2020) | Viewed by 65675

Special Issue Editor

Prof. Dr. Hugo De Bruyn

E-Mail Website
Guest Editor
Faculty of Medicine and Health Sciences, Ghent University, Heymanslaan 10, 9000 Ghent, Belgium
Interests: implant treatment outcome; flapless surgery; peri-implant health; patient-centered outcomes

Special Issue Information

Dear Colleagues,

Edentulism (being toothless) can lead to significant functional impairment, as well as unfavorable aesthetic and psychological changes in patients. Edentulism is even classified as a physical handicap by the Word Health Organization (WHO). Dental implants were introduced more than half a century ago and are currently part of the normal treatment portfolio in dentistry. Over the last decade, novel developments in implant materials and improved 3-dimensional presurgical (virtual) planning and computer-guided implant placement and navigation systems have improved implant treatment outcomes. Exciting 3D-techniques have dramatically changed the workflow and allowed a reduction in costs. In conjuntion with a better understanding of bone and soft tissue biology treatment, indications for treatment have been enlarged and the prognosis over time has consistently improved, even in risk patients. Introduction of digital techniques for restorative rehabilitations has furthermore improved the aesthetic outcome and contributed to an improvement of oral function and patient aesthetics and well-being.

The current Special Issue seeks basic and clinical studies as well as review papers that can contribute to the current state-of-the-art in implant dentistry. Especially papers with a focus on digital methodologies, bone and soft tissue regenerative techniques, 3D-production techniques, as well as patient-centered outcomes are highly encouraged.

Prof. Dr. Hugo De Bruyn
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Implant treatment outcome
  • Implants in risk groups
  • 3D-planning
  • Computer-guided surgery
  • Bone and soft tissue regeneration
  • Peri-implant health
  • Patient-centered outcomes

Published Papers (16 papers)

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14 pages, 945 KiB  
Article
Long-Term Comparison of Survival and Marginal Bone of Implants with and without Sinus Augmentation in Maxillary Molars within the Same Patients: A 5.8- to 22-Year Retrospective Study
by Won-Bae Park, Ji-Young Han and Kyung-Lhi Kang
J. Clin. Med. 2021, 10(7), 1360; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10071360 - 25 Mar 2021
Cited by 5 | Viewed by 1475
Abstract
Maxillary sinus floor augmentation (MSFA) is widely used and considered a predictable procedure for implant placement. However, the influence of MSFA on implant survival and marginal bone loss (MBL) is still inconclusive. The purpose of this retrospective observational study is to evaluate the [...] Read more.
Maxillary sinus floor augmentation (MSFA) is widely used and considered a predictable procedure for implant placement. However, the influence of MSFA on implant survival and marginal bone loss (MBL) is still inconclusive. The purpose of this retrospective observational study is to evaluate the long-term genuine influence of MSFA on the survival and MBL of implants by comparing those with and without MSFA only in maxillary molars within the same patients. Thirty-eight patients (28 male and 10 female), with a total of 119 implants, received implants with and without MSFA, and were followed up for 5.8 to 22 years. Patient- and implant-related factors were assessed with a frailty model for implant survival and with generalized estimation equations (GEE) for MBL around the implant. No variables showed a statistical significance for implant failure in the frailty model. In GEE analysis for MBL, MSFA did not show any statistical significance. In conclusion, MSFA demonstrated no significant influence on implant failure and MBL in posterior maxilla in this study. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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14 pages, 15556 KiB  
Article
Impact of the 25-Hydroxycholecalciferol Concentration and Vitamin D Deficiency Treatment on Changes in the Bone Level at the Implant Site during the Process of Osseointegration: A Prospective, Randomized, Controlled Clinical Trial
by Jakub Kwiatek, Aleksandra Jaroń and Grzegorz Trybek
J. Clin. Med. 2021, 10(3), 526; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10030526 - 02 Feb 2021
Cited by 21 | Viewed by 3870
Abstract
Introduction: The most important factor which is responsible for the positive course of implant treatment is the process of osseointegration between the implant structure and the host’s bone tissue. The aim of this study was to assess what effect the 25-hydroxycholecalciferol concentration and [...] Read more.
Introduction: The most important factor which is responsible for the positive course of implant treatment is the process of osseointegration between the implant structure and the host’s bone tissue. The aim of this study was to assess what effect the 25-hydroxycholecalciferol concentration and vitamin D deficiency treatment have on changes in the bone level at the implant site during the process of osseointegration in the mandible. Materials and Methods: The study was with 122 people qualified for implant surgery, who were assigned to three research groups (A, B, and C). Laboratory, clinical, and radiological tests were performed on the day of surgery, and after 6 and 12 weeks. The bone level in the immediate proximity of the implant was determined by radiovisiography (RVG). Results: The bone level after 12 weeks in Groups B and C was significantly higher than after 6 weeks. The bone level in the study Group B was significantly higher than in Group A. The study showed that the higher the levels of 25-hydroxycholecalciferol were observed on the day of surgery, the higher was the level of bone surrounding the implant after 6 and 12 after surgery. Conclusion: The correct level of 25-hydroxycholecalciferol on the day of surgery and vitamin D deficiency treatment significantly increase the bone level at the implant site in the process of radiologically assessed osseointegration. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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10 pages, 1372 KiB  
Article
Accuracy of Guided Implant Surgery in the Edentulous Jaw Using Desktop 3D-Printed Mucosal Supported Guides
by Rani D’haese, Tom Vrombaut, Geert Hommez, Hugo De Bruyn and Stefan Vandeweghe
J. Clin. Med. 2021, 10(3), 391; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10030391 - 20 Jan 2021
Cited by 8 | Viewed by 2992
Abstract
Purpose: The aim of this in vitro study is to evaluate the accuracy of implant position using mucosal supported surgical guides, produced by a desktop 3D printer. Methods: Ninety implants (Bone Level Roxolid, 4.1 mm × 10 mm, Straumann, Villerat, Switzerland) were placed [...] Read more.
Purpose: The aim of this in vitro study is to evaluate the accuracy of implant position using mucosal supported surgical guides, produced by a desktop 3D printer. Methods: Ninety implants (Bone Level Roxolid, 4.1 mm × 10 mm, Straumann, Villerat, Switzerland) were placed in fifteen mandibular casts (Bonemodels, Castellón de la Plana, Spain). A mucosa-supported guide was designed and printed for each of the fifteen casts. After placement of the implants, the location was assessed by scanning the cast and scan bodies with an intra-oral scanner (Primescan®, Dentsply Sirona, York, PA, USA). Two comparisons were performed: one with the mucosa as a reference, and one where only the implants were aligned. Angular, coronal and apical deviations were measured. Results: The mean implant angular deviation for tissue and implant alignment were 3.25° (SD 1.69°) and 2.39° (SD 1.42°) respectively, the coronal deviation 0.82 mm (SD 0.43 mm) and 0.45 mm (SD 0.31 mm) and the apical deviation 0.99 mm (SD 0.45 mm) and 0.71 mm (SD 0.43 mm). All three variables were significantly different between the tissue and implant alignment (p < 0.001). Conclusion: Based on the results of this study, we conclude that guided implant surgery using desktop 3D printed mucosa-supported guides has a clinically acceptable level of accuracy. The resilience of the mucosa has a negative effect on the guide stability and increases the deviation in implant position. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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12 pages, 1260 KiB  
Article
The Long-Term Effect of Adapting the Vertical Position of Implants on Peri-Implant Health: A 5-Year Intra-Subject Comparison in the Edentulous Mandible Including Oral Health-Related Quality of Life
by Ron Doornewaard, Hugo De Bruyn, Carine Matthys, Ewald Bronkhorst, Stefan Vandeweghe and Stijn Vervaeke
J. Clin. Med. 2020, 9(10), 3320; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103320 - 16 Oct 2020
Cited by 6 | Viewed by 1870
Abstract
Despite high success rates of dental implants, surface exposure may occur as a consequence of biologic width establishment associated with surgery. This prospective split-mouth study evaluated the effect of early implant surface exposure caused by initial bone remodeling on long-term peri-implant bone stability [...] Read more.
Despite high success rates of dental implants, surface exposure may occur as a consequence of biologic width establishment associated with surgery. This prospective split-mouth study evaluated the effect of early implant surface exposure caused by initial bone remodeling on long-term peri-implant bone stability and peri-implant health. Additionally, Oral Health-Related Quality of Life (OHRQoL) was assessed by means of the Oral Health Impact Profile-14 (OHIP-14). Twenty-six patients received two non-splinted implants supporting an overdenture in the mandible by means of locators. One implant was installed equicrestally (control) and the second one was installed subcrestally, taking at least 3 mm soft tissue thickness into account (test). During initial bone remodeling (up to 6 months postoperatively), equicrestal placement yielded 0.68 mm additional surface exposure compared to subcrestal placement (p < 0.001). Afterwards, bone level and peri-implant health were comparable in both treatment conditions and stable up to 5 years. The implant overdenture improved OHRQoL (p < 0.01) and remained unchanged thereafter (p = 0.51). In conclusion, adapting the vertical position of the implant concerning the soft tissue thickness prevents early implant surface exposure caused by initial bone remodeling, but in a well-maintained population, this has no impact on long-term prognosis. The treatment of edentulousness with an implant mandibular overdenture improves OHRQoL. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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14 pages, 1189 KiB  
Article
A Prospective Clinical Cohort Investigation on Zirconia Implants: 5-Year Results
by Ralf-Joachim Kohal, Benedikt Christopher Spies, Kirstin Vach, Marc Balmer and Stefano Pieralli
J. Clin. Med. 2020, 9(8), 2585; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9082585 - 10 Aug 2020
Cited by 40 | Viewed by 2490
Abstract
Mid-term data on zirconia oral implants is very rare. Therefore, the aim of this prospective clinical investigation was to evaluate the survival rate and the marginal bone loss of a one-piece zirconia implant after five years. Patient-reported outcomes were also recorded. Zirconia implants [...] Read more.
Mid-term data on zirconia oral implants is very rare. Therefore, the aim of this prospective clinical investigation was to evaluate the survival rate and the marginal bone loss of a one-piece zirconia implant after five years. Patient-reported outcomes were also recorded. Zirconia implants to support single crowns (SC) or a 3-unit fixed dental prosthesis (FDP) were placed and subsequently restored. After the insertion of the implants, at prosthetic delivery, and after five years, standardized radiographs were taken to evaluate marginal bone loss (MBL). For bone tissue evaluation, linear mixed models with random intercepts were fitted. Twenty-seven patients received one implant for an SC and 13 patients received two implants for a 3-unit FDP. Three patients each lost one implant for an SC before prosthetic delivery. Thirty-five patients were seen after five years, and no further implant was lost. The cumulative five-year implant survival rate was 94.3%. The MBL from implant installation up to five years was 0.81 mm. The MBL from implant installation to prosthetic delivery was statistically significant (p < 0.001). Patients perceived a significant improvement in function, esthetics, sense, speech, and self-esteem from pretreatment up to the five-year follow-up. The present findings substantiate the clinical applicability of this implant system. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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12 pages, 2309 KiB  
Article
Contour Changes Following Immediate Placement of Ultra-Wide Implants in Molar Extraction Sockets without Bone Grafting
by André Hattingh, Hugo De Bruyn, Manù Van Weehaeghe, Geert Hommez and Stefan Vandeweghe
J. Clin. Med. 2020, 9(8), 2504; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9082504 - 04 Aug 2020
Cited by 12 | Viewed by 3256
Abstract
The aim was to evaluate ridge reduction and mucosal recession following immediate placement of ultra-wide implants in molar sockets, without bone grafting. Impressions were taken prior to tooth extraction, 4 months and 1 year after implant placement. The casts were digitized and compared. [...] Read more.
The aim was to evaluate ridge reduction and mucosal recession following immediate placement of ultra-wide implants in molar sockets, without bone grafting. Impressions were taken prior to tooth extraction, 4 months and 1 year after implant placement. The casts were digitized and compared. Mucosal recessions and horizontal ridge reduction were measured. A total of 16 implants were in the maxilla and 11 in the mandible. At the buccal aspect, there was a mean reduction of 0.94 mm after 4 months and 0.89 mm after one year (p = 0.933). At the palatal/lingual aspect, this was 1.09 mm after 4 months and 0.69 mm after 1 year (p = 0.001). After 1 year, a recession of 0.59 mm was measured at the zenith, 1.04 mm at the mesial and 0.98 mm at the distal papilla. The mean midfacial horizontal ridge reduction was 1.23 mm after 4 months and 1.45 mm after 1 year. At the midpalatal/midlingual aspect, the mean horizontal reduction was 1.43 mm after 4 months and 1.16 mm after 1 year. Immediate implant placement without bone grafting in the posterior jaw yields a significant horizontal ridge reduction and minor mucosal recession. Clinicians should anticipate the amount of ridge reduction and consider augmentation at the time of implant placement. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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13 pages, 2026 KiB  
Article
Influence of Implant Connection, Abutment Design and Screw Insertion Torque on Implant-Abutment Misfit
by Jorge Vélez, Jesús Peláez, Carlos López-Suárez, Rubén Agustín-Panadero, Celia Tobar and María J. Suárez
J. Clin. Med. 2020, 9(8), 2365; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9082365 - 24 Jul 2020
Cited by 20 | Viewed by 4877
Abstract
Background: An accurate fit at the implant-abutment interface is an important factor to avoid biological and mechanical complications. The aim of this study was to evaluate the marginal misfit at the implant-abutment interface on external and Morse taper connection, with straight and angulated [...] Read more.
Background: An accurate fit at the implant-abutment interface is an important factor to avoid biological and mechanical complications. The aim of this study was to evaluate the marginal misfit at the implant-abutment interface on external and Morse taper connection, with straight and angulated abutments under different insertion torque loads. Materials and Methods: A total of 120 implants were used, 60 with external connection (EC) and 60 with Morse taper connection (IC). Straight (SA) (n = 60) and angulated abutments (AA) (n = 60) were randomly screwed to each connection at different torque levels (n = 10 each): 10, 20 and 30 Ncm. All specimens were subjected to thermal and cyclic loading and the misfit was measured by scanning electron microscopy. Data were analyzed with one-way ANOVA, t-test and Kruskal-Wallis test. Results: Significant differences (p < 0.001) were found between connections and abutments regardless of the torque applied. Morse taper connections with straight and angulated abutments showed the lowest misfit values (0.6 µm). Misfit values decreased as torque increased. Conclusions: The misfit was affected by the type of connection. The type of abutment did not influence the fit in the Morse taper connection. The higher the tightening torque applied the increase in the fit of the implant-abutment interface. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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14 pages, 3188 KiB  
Article
Three-Dimensional Radiographic Outcome of Free-Handed Flaplessly Placed Mini Dental Implants in Edentulous Maxillae after 2-Years Function
by Luc Van Doorne, Pedram Gholami, Jan D’haese, Geert Hommez, Gert Meijer and Hugo De Bruyn
J. Clin. Med. 2020, 9(7), 2120; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9072120 - 05 Jul 2020
Cited by 7 | Viewed by 2349
Abstract
Background: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical [...] Read more.
Background: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical outcome and carried out 3D- cone-beam computerized tomography (CBCT) analysis of free-handed flaplessly placed one-piece maxillary MDIs by an experienced maxillofacial surgeon. Methods: Thirty-one patients suffering from an ill-fitting maxillary denture relating to compromised bone volume (as confirmed on CBCT), with a dentate mandible, were selected. They received 5–6 MDIs free-hand flaplessly placed and mentally guided with preoperative CBCT. Final connection and attachment activation took place six months later. After two years each implant was individually assessed with CBCT for perforations on eight sites. Implant survival, prosthetic failure, clinical stability and sinus/nasal complaints were registered after three years. Results: 32/185 (17.3%) MDIs failed during the provisional loading with non-activated attachments; 17 replacements in 10 patients were performed. Of the 170 actively loaded 170 MDIs, 82.3% survived and 27/31 prostheses (87%) were fully functional. In total 98/170 MDIs showed no perforation. Based on 1360 CBCT observations, 231 perforations (16.9%) were registered. Of most perforations 37 (25%) were observed at the apical tip and 37 were positioned (21%) into the sinus/nasal cavity, although without clinical complaints. Conclusions: Given the compromised population, the minimally invasive procedure and the low treatment cost involved, a failure rate of 17% is substantial, however clinically acceptable given the critical bone condition. However, even in experienced surgical hands, freehanded and flapless placement yield a high risk for implant perforation, although this did not necessarily lead to complications. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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14 pages, 2920 KiB  
Article
A 3-Year Prospective Study on a Porcine-Derived Acellular Collagen Matrix to Re-Establish Convexity at the Buccal Aspect of Single Implants in the Molar Area: A Volumetric Analysis
by Célien Eeckhout, Eline Bouckaert, Dagmar Verleyen, Thomas De Bruyckere and Jan Cosyn
J. Clin. Med. 2020, 9(5), 1568; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9051568 - 22 May 2020
Cited by 21 | Viewed by 3029
Abstract
Background: Xenogeneic soft tissue substitutes are currently being investigated as an alternative to subepithelial connective tissue grafts (CTG) with the intention to avoid postoperative morbidity associated with autologous grafting. The aim of the present study was to volumetrically evaluate the effectiveness and mid-long-term [...] Read more.
Background: Xenogeneic soft tissue substitutes are currently being investigated as an alternative to subepithelial connective tissue grafts (CTG) with the intention to avoid postoperative morbidity associated with autologous grafting. The aim of the present study was to volumetrically evaluate the effectiveness and mid-long-term stability of a porcine-derived collagen matrix (PDCM) (Mucoderm®, Botiss gmbh, Berlin, Germany) in increasing soft tissue volume at the buccal aspect of molar implant sites. Methods: Periodontally healthy non-smoking patients with a single tooth gap in the molar area were selected for a prospective case series. All sites had a bucco-oral bone dimension of at least 8 mm and demonstrated a horizontal alveolar defect. A wide diameter implant was placed under the elevated buccal flap and a PDCM was applied. The primary outcome was the linear increase in buccal soft tissue profile (BSP) within a well-defined area of interest. This was performed with designated software (SMOP; Swissmeda AG, Zurich, Switzerland) on the basis of superimposed digitalized study casts taken before surgery (T0), immediately after surgery (T1), at three months (T2), one year (T3) and three years (T4). Secondary outcomes were alveolar process deficiency and clinical parameters. Results: Fourteen out of 15 treated patients attended the three-year re-assessment (four females; mean age 51.4 years). Mean linear increase in BSP at T1 was 1.53 mm (p = 0.001). The PDCM showed substantial resorption at T2 (1.02 mm or 66.7%) (p = 0.001). Thereafter, a 0.66 mm volume gain was observed (p = 0.030), possibly due to the installation of a permanent crown displacing the soft tissues to the buccal aspect. This resulted in a linear increase in BSP of 1.17 mm (76.5%) at T4. Alveolar process deficiency significantly reduced over time (p = 0.004). However, 50% of patients still demonstrated a slight (6/14) or obvious (1/14) alveolar process deficiency at study termination. Implants demonstrated healthy clinical conditions. Conclusions: The PDCM demonstrated marked resorption during the early stages of healing. Due to the matrix thickening the tissues, and the permanent crown displacing the tissues, 76.5% of the initial increase in BSP could be maintained over a three-year period. Half of the patients failed to show perfect soft tissue convexity at the buccal aspect. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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13 pages, 1478 KiB  
Article
Tissue Expansion Improves the Outcome and Predictability for Alveolar Bone Augmentation: Prospective, Multicenter, Randomized Controlled Trial
by Soo-Hwan Byun, Sun-Hyun Kim, Sura Cho, Ho Lee, Ho-Kyung Lim, Ju-Won Kim, Ui-Lyong Lee, Wan Song, Sun-Jong Kim, Min-Kyoung Kim and Jin-Woo Kim
J. Clin. Med. 2020, 9(4), 1143; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9041143 - 16 Apr 2020
Cited by 5 | Viewed by 4026
Abstract
Objectives: The purpose of this study was to evaluate the effectiveness of the intraoral use of subperiosteally placed self-inflating tissue expanders for subsequent bone augmentation and implant integrity. Material and methods: A prospective, multicenter, randomized controlled trial was performed on patients requiring alveolar [...] Read more.
Objectives: The purpose of this study was to evaluate the effectiveness of the intraoral use of subperiosteally placed self-inflating tissue expanders for subsequent bone augmentation and implant integrity. Material and methods: A prospective, multicenter, randomized controlled trial was performed on patients requiring alveolar bone graft for dental implant insertion. Patients were assigned to three groups: tissue expansion and tunneling graft (TET group), tissue expansion and conventional bone graft (TEG), and control group without tissue expansion. Dimensional changes of soft tissue and radiographic vertical bone gain, retention, and peri-implant marginal bone changes were evaluated and secondary outcomes; clinical complications and thickness changes of expanded overlying tissue were assessed. Results: Among 75 patients screened, a total of 57 patients were included in the final analysis. Most patients showed uneventful soft tissue expansion without any inflammatory sign or symptoms. Ultrasonographic measurements of overlying gingiva revealed no thinning after tissue expansion (p > 0.05). Mean soft vertical and horizontal tissue measurements at the end of its expansion were 5.62 and 6.03 mm, respectively. Significantly higher vertical bone gain was shown in the TEG (5.71 ± 1.99 mm) compared with that in the control patients (4.32 ± 0.97 mm; p < 0.05). Hard tissue retention— measured by bone resorption after 6 months—showed that control group showed higher amount of vertical (2.06 ± 1.00 mm) and horizontal bone resorption (1.69 ± 0.81 mm) compared to that of the TEG group (p < 0.05). Conclusion: The self-inflating tissue expander effectively augmented soft tissue volume and both conventional bone graft and tunneling techniques confirmed their effectiveness in bone augmentation. With greater amount of bone gain and better 6 month hard tissue integrity, the TEG group compared to the control group—without tissue expansion—showed that the combined modality of tissue expander use and guided bone regeneration (GBR) technique may improve the outcome and predictability of hard tissue augmentation. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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11 pages, 2425 KiB  
Article
Transfer Learning via Deep Neural Networks for Implant Fixture System Classification Using Periapical Radiographs
by Jong-Eun Kim, Na-Eun Nam, June-Sung Shim, Yun-Hoa Jung, Bong-Hae Cho and Jae Joon Hwang
J. Clin. Med. 2020, 9(4), 1117; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9041117 - 14 Apr 2020
Cited by 63 | Viewed by 5903
Abstract
In the absence of accurate medical records, it is critical to correctly classify implant fixture systems using periapical radiographs to provide accurate diagnoses and treatments to patients or to respond to complications. The purpose of this study was to evaluate whether deep neural [...] Read more.
In the absence of accurate medical records, it is critical to correctly classify implant fixture systems using periapical radiographs to provide accurate diagnoses and treatments to patients or to respond to complications. The purpose of this study was to evaluate whether deep neural networks can identify four different types of implants on intraoral radiographs. In this study, images of 801 patients who underwent periapical radiographs between 2005 and 2019 at Yonsei University Dental Hospital were used. Images containing the following four types of implants were selected: Brånemark Mk TiUnite, Dentium Implantium, Straumann Bone Level, and Straumann Tissue Level. SqueezeNet, GoogLeNet, ResNet-18, MobileNet-v2, and ResNet-50 were tested to determine the optimal pre-trained network architecture. The accuracy, precision, recall, and F1 score were calculated for each network using a confusion matrix. All five models showed a test accuracy exceeding 90%. SqueezeNet and MobileNet-v2, which are small networks with less than four million parameters, showed an accuracy of approximately 96% and 97%, respectively. The results of this study confirmed that convolutional neural networks can classify the four implant fixtures with high accuracy even with a relatively small network and a small number of images. This may solve the inconveniences associated with unnecessary treatments and medical expenses caused by lack of knowledge about the exact type of implant. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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18 pages, 1661 KiB  
Article
The Long-Term Effect of Smoking on 10 Years’ Survival and Success of Dental Implants: A Prospective Analysis of 453 Implants in a Non-University Setting
by Simon Windael, Stijn Vervaeke, Stefanie De Buyser, Hugo De Bruyn and Bruno Collaert
J. Clin. Med. 2020, 9(4), 1056; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9041056 - 08 Apr 2020
Cited by 15 | Viewed by 3715
Abstract
Background: The purpose of this study was to compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and non-smokers. Material and Methods: All patients referred for implant treatment between November 2004 and 2007 were scrutinized. All implants [...] Read more.
Background: The purpose of this study was to compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and non-smokers. Material and Methods: All patients referred for implant treatment between November 2004 and 2007 were scrutinized. All implants were placed by the same surgeon (B.C.). The single inclusion criterion was a follow-up time of at least 10 years. Implant survival, health, and bone loss were evaluated by an external calibrated examiner (S.W.) during recall visits. Radiographs taken at recall visits were compared with the post-surgical ones. Implant success was based on two arbitrarily chosen success criteria for bone loss (≤1 mm and ≤2 mm bone loss after 10 years). Implant survival in smokers and non-smokers was compared using the log-rank test. Both non-parametric tests and fixed model analysis were used to assess bone loss in both groups. Results: A total of 453 implants in 121 patients were included for survival analysis, and 397 implants in 121 patients were included for peri-implant bone-loss analysis. After a mean follow-up time of 11.38 years (SD 0.78; range 10.00–13.65), 33 implants out of 453 initially placed had failed in 21 patients, giving an overall survival rate of 92.7% and 82.6% on the implant and patient level, respectively. Cumulative 10 years’ survival rate was 81% on the patient level and 91% on the implant level. The hazard of implant loss in the maxilla was 5.64 times higher in smokers compared to non-smokers (p = 0.003). The hazard of implant loss for implants of non-smokers was 2.92 times higher in the mandible compared to the maxilla (p = 0.01). The overall mean bone loss was 0.97 mm (SD 1.79, range 0–17) at the implant level and 0.90 mm (SD 1.39, range 0–7.85) at the patient level. Smokers lost significantly more bone compared to non-smokers in the maxilla (p = 0.024) but not in the mandible. Only the maxilla showed a significant difference in the probability of implant success between smokers and non-smokers (≤1 mm criterion p = 0.003, ≤2 mm criterion p = 0.007). Taking jaw into account, implants in smokers experienced a 2.6 higher risk of developing peri-implantitis compared to non-smokers (p = 0.053). Conclusion: Dental implants with a fluoride-modified surface provided a high 10 years’ survival with limited bone loss. Smokers were, however, more prone to peri-implant bone loss and experienced a higher rate of implant failure, especially in the upper jaw. The overall bone loss over time was significantly higher in smoking patients, which might be suggestive for a higher peri-implantitis risk. Hence, smoking cessation should be advised and maintained after implant placement from the perspective of peri-implant disease prevention. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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Review

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12 pages, 2888 KiB  
Review
Peri-Implantitis: A Clinical Update on Prevalence and Surgical Treatment Outcomes
by Andrea Roccuzzo, Alexandra Stähli, Alberto Monje, Anton Sculean and Giovanni E. Salvi
J. Clin. Med. 2021, 10(5), 1107; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051107 - 06 Mar 2021
Cited by 47 | Viewed by 7824
Abstract
Dental implants may be considered a reliable routine procedure in clinical practice for the replacement of missing teeth. Results from long-term studies indicate that implant-supported dental prostheses constitute a predictable treatment method for the management of fully and partially edentulous patients. Implants and [...] Read more.
Dental implants may be considered a reliable routine procedure in clinical practice for the replacement of missing teeth. Results from long-term studies indicate that implant-supported dental prostheses constitute a predictable treatment method for the management of fully and partially edentulous patients. Implants and their restorations, however, are not free from biological complications. In fact, peri-implantitis, defined as progressive bone loss associated to clinical inflammation, is not a rare finding nowadays. This constitutes a concern for clinicians and patients given the negative impact on the quality of life and the sequelae originated by peri-implantitis lesions. The purpose of this narrative review is to report on the prevalence of peri-implantitis and to overview the indications, contraindications, complexity, predictability and effectiveness of the different surgical therapeutic modalities to manage this disorder. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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16 pages, 4151 KiB  
Review
Clinical Behavior of Short Dental Implants: Systematic Review and Meta-Analysis
by Andrea Torres-Alemany, Lucía Fernández-Estevan, Rubén Agustín-Panadero, José María Montiel-Company, Carlos Labaig-Rueda and José Félix Mañes-Ferrer
J. Clin. Med. 2020, 9(10), 3271; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103271 - 12 Oct 2020
Cited by 19 | Viewed by 3607
Abstract
Short implants are an increasingly common alternative to other surgical techniques in areas where bone availability is reduced. Despite the advantages they offer, a variety of biological repercussions have been described in the literature that can even lead to the loss of these. [...] Read more.
Short implants are an increasingly common alternative to other surgical techniques in areas where bone availability is reduced. Despite the advantages they offer, a variety of biological repercussions have been described in the literature that can even lead to the loss of these. The aim of this systematic review and meta-analysis was to analyze the impact of the use of short implants on their survival and on peri-implant bone loss, evaluating the influence that length, diameter, and crown-to-implant ratio (C/I) have on these parameters. This systematic review was based on guidelines proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An electronic search was conducted using terms related to the use of short implants in partially or totally edentulous patients. A total of five databases were consulted in the literature search: PubMed, Embase, Cochrane, Scopus, and Web of Science. After eliminating the duplicate articles and assessing which ones met the inclusion criteria, 15 articles were included for the qualitative analysis and 14 for the quantitative study. Through meta-analysis, the percentage of implant loss and peri-implant bone loss was estimated. Relating these parameters to length, diameter, and C/I ratio, no significant differences have been found for implant loss (values of p = 0.06, 0.10, and 0.9, respectively for length, diameter, and C/I ratio), nor for peri-implant bone loss (values of p = 0.71, 0.72, and 0.36, respectively for length, diameter, and C/I ratio). In conclusion, the use of short implants does not seem to have a significant influence on marginal bone loss or the survival rate of implants. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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21 pages, 1051 KiB  
Review
3D Printing Approach in Dentistry: The Future for Personalized Oral Soft Tissue Regeneration
by Dobrila Nesic, Birgit M. Schaefer, Yue Sun, Nikola Saulacic and Irena Sailer
J. Clin. Med. 2020, 9(7), 2238; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9072238 - 15 Jul 2020
Cited by 44 | Viewed by 8836
Abstract
Three-dimensional (3D) printing technology allows the production of an individualized 3D object based on a material of choice, a specific computer-aided design and precise manufacturing. Developments in digital technology, smart biomaterials and advanced cell culturing, combined with 3D printing, provide promising grounds for [...] Read more.
Three-dimensional (3D) printing technology allows the production of an individualized 3D object based on a material of choice, a specific computer-aided design and precise manufacturing. Developments in digital technology, smart biomaterials and advanced cell culturing, combined with 3D printing, provide promising grounds for patient-tailored treatments. In dentistry, the “digital workflow” comprising intraoral scanning for data acquisition, object design and 3D printing, is already in use for manufacturing of surgical guides, dental models and reconstructions. 3D printing, however, remains un-investigated for oral mucosa/gingiva. This scoping literature review provides an overview of the 3D printing technology and its applications in regenerative medicine to then describe 3D printing in dentistry for the production of surgical guides, educational models and the biological reconstructions of periodontal tissues from laboratory to a clinical case. The biomaterials suitable for oral soft tissues printing are outlined. The current treatments and their limitations for oral soft tissue regeneration are presented, including “off the shelf” products and the blood concentrate (PRF). Finally, tissue engineered gingival equivalents are described as the basis for future 3D-printed oral soft tissue constructs. The existing knowledge exploring different approaches could be applied to produce patient-tailored 3D-printed oral soft tissue graft with an appropriate inner architecture and outer shape, leading to a functional as well as aesthetically satisfying outcome. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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28 pages, 1527 KiB  
Review
Bioactive Surfaces vs. Conventional Surfaces in Titanium Dental Implants: A Comparative Systematic Review
by Nansi López-Valverde, Javier Flores-Fraile, Juan Manuel Ramírez, Bruno Macedo de Sousa, Silvia Herrero-Hernández and Antonio López-Valverde
J. Clin. Med. 2020, 9(7), 2047; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9072047 - 29 Jun 2020
Cited by 43 | Viewed by 4201
Abstract
Animal studies and the scarce clinical trials available that have been conducted suggest that bioactive surfaces on dental implants could improve the osseointegration of such implants. The purpose of this systematic review was to compare the effectiveness of osseointegration of titanium (Ti) dental [...] Read more.
Animal studies and the scarce clinical trials available that have been conducted suggest that bioactive surfaces on dental implants could improve the osseointegration of such implants. The purpose of this systematic review was to compare the effectiveness of osseointegration of titanium (Ti) dental implants using bioactive surfaces with that of Ti implants using conventional surfaces such as sandblasted large-grit acid-etched (SLA) or similar surfaces. Applying the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the MEDLINE, PubMed Central and Web of Science databases were searched for scientific articles in April 2020. The keywords used were “dental implants”, “bioactive surfaces”, “biofunctionalized surfaces”, and “osseointegration”, according to the question: “Do bioactive dental implant surfaces have greater osseointegration capacity compared with conventional implant surfaces?” Risk of bias was assessed using the Cochrane Collaboration tool. 128 studies were identified, of which only 30 met the inclusion criteria: 3 clinical trials and 27 animal studies. The average STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) and ARRIVE (Animal Research: Reporting of In Vivo Experiments) scores were 15.13 ± 2.08 and 17.7±1.4, respectively. Implant stability quotient (ISQ) was reported in 3 studies; removal torque test (RTT)—in 1 study; intraoral periapical X-ray and microcomputed tomography radiological evaluation (RE)—in 4 studies; shear force (SF)—in 1 study; bone-to-implant contact (BIC)—in 12 studies; and BIC and bone area (BA) jointly—in 5 studies. All animal studies reported better bone-to-implant contact surface for bioactive surfaces as compared to control implants with a statistical significance of p < 0.05. Regarding the bioactive surfaces investigated, the best results were yielded by the one where mechanical and chemical treatment methods of the Ti surfaces were combined. Hydroxyapatite (HA) and calcium–phosphate (Ca–Ph) were the most frequently used bioactive surfaces. According to the results of this systematic review, certain bioactive surfaces have a positive effect on osseointegration, although certain coating biomolecules seem to influence early peri-implant bone formation. Further and more in-depth research in this field is required to reduce the time needed for osseointegration of dental implants. Full article
(This article belongs to the Special Issue Clinical Advances in Implant Dentistry)
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