Low-temperature plasma surface modification of titanium dental implants: mechanisms, biological effects and clinical perspectives.

Peri-implantitis represents a prevalent and significant biological challenge in oral implantology, and its etiology remains incompletely understood. The critical role of titanium particles in the progression of peri-implantitis has been largely overlooked, and a deeper understanding of their pathogenic mechanisms is essential for advancing biomaterial-based interventions. In this study, clinical samples were collected and cellular assays performed, along with the modified establishment of a titanium particle-induced animal model of peri-implantitis, to investigate the inflammatory mechanisms triggered by titanium particles. Results showed significantly elevated levels of titanium particles at diseased sites. Transcriptomic analysis revealed upregulation of inflammatory and osteoclast-related pathways and downregulation of osteogenic signaling. Further in vitro validation demonstrated that titanium particles under stimulatory conditions exacerbate inflammatory responses via hyperactivated autophagy. This study elucidates how titanium particles promote inflammation by modulating macrophage autophagy, highlighting their critical role in peri-implantitis and underscore the importance of targeting biomaterial-derived particles in future implant design and therapeutic strategies.

Building a better gingival seal in dental implants: hydrothermal ion incorporation into titanium abutment surfaces.

Doxycycline release from cyclodextrin oligomer-containing collagen gels.

Development of 3D in vitro mineralized bone model to reproduce dental implants osseointegration process

Peri-implantitis compromises soft and hard tissues around dental implants, often leading to implant failure. Antibacterial nanocoatings offer a promising infection control strategy, but maintaining biocompatibility is essential. This study investigated, through a range of assays and analytical techniques, the biocompatibility of antimicrobial silver and hydroxyapatite (HA) nanocoatings applied to titanium implants with human gingival fibroblasts (HGFs). Silver and hydroxyapatite nanocoatings were applied to the surface of titanium alloy specimens using electroplating, deposition and sintering techniques. The biocompatibility of the nanocoatings with HGFs was assessed by measuring cell metabolic activity (alamarBlue), lactate dehydrogenase (LDH) release, collagen production (Sircol assay), and cell morphology (scanning electron microscopy). Nanocoating stability was tested in ultrapure water, Modified Krebs and artificial saliva. Elevated total Ag+ concentrations were measured in the media released from the silver and HA nanocoatings (1.78 mg/l on day 4 and 1 mg/l by day 7). Electrolytes remained within physiological ranges. The HGFs cultured on the nanocoatings showed normal morphology, intact membranes (LDH < 60 nmol/min/ml), healthy collagen secretion (27.18 - 31.11 µg/ml), and aerobic metabolism at 80% of controls, consistent with biocompatibility. The silver and HA nanocoatings confirmed a sustained Ag+ release, necessary for a strong antimicrobial activity, while maintaining HGFs health and cell functionality. Our previous work has confirmed the strong antimicrobial activity of these nanocoatings when applied to dental implants, and the findings of this study have demonstrated that the implant biocompatibility is not compromised. This suggests that these silver and HA nanocoatings can be safely used to minimise peri-implantitis and prevent implant failure.

Dental Implants in Rehabilitation of Patients with Facial Trauma: a Review of Most Current Practices.

Design quality and time efficiency of AI-based versus human-based design for tooth- and implant-supported fixed dental restorations: A systematic review.

Cells residing in, and on, the calcified periodontal bone matrix experience numerous mechanical stimuli daily. The nature of the mechanical stimuli depends on whether the mechanical triggers are physiological, e.g., arising from masticatory forces, distributed via a healthy periodontal ligament to the alveolar bone, or represent "error-loads", e.g., arising during orthodontic tooth movement or around dental implants. Mechanosensitive osteocytes mediate osteoclast and osteoblast recruitment and activity in the presence of unloading, but "error loads" can directly activate signaling pathways in osteoblasts, thereby directing osteoblast activity and accumulating the bone mass essential for a functional masticatory system. Mitogen-activated protein kinases (MAPKs) play a pivotal role in regulating osteoblast growth, differentiation, and survival. This scoping review investigates which MAPKs are rapidly (within minutes) activated in osteoblasts in response to different types of mechanical stimuli. In the discussion, we tie the activation of MAPKs to altered osteoblast number and activity and the production of signaling factors. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we identified studies linking MAPKs, osteoblasts, and mechanical stress. The review included 33 in vitro studies. The findings revealed that extracellular signal-regulated kinases ERK1/2, p38, and JNK were rapidly activated in osteoblasts in response to various mechanical stimuli. Fluid flow forces, representing shear stress such as those present during mastication or orthodontic movement, activated all three MAPK branches. Substrate stretch, applied to simulate strain from mastication, induced a broad spectrum of responses. Hydrostatic pressure, often applied to reflect compression from implant loading or mastication, triggered all known MAPK pathways within an hour. In contrast, more selective stimuli such as low-intensity pulsed ultrasound and hypotonic pressure preferentially activated ERK1/2. Regardless of the stimulus, ERK1/2 was usually, and rapidly activated within minutes. In conclusion, diverse mechanical stimuli, including shear stress, substrate strain, and hydrostatic pressure, frequently, and rapidly, upregulate ERK1/2 signaling in osteoblasts. Given ERK1/2's established role in promoting osteoblast proliferation and differentiation, this early activation may help explain the localized bone formation observed under mechanical loading during orthodontic treatment, dental implant integration, or alveolar bone remodeling.

This cross-sectional observational study analyzed patterns of tooth loss across different population groups using National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2018, aiming to identify the teeth most at risk and the key contributing factors. Data from 24,945 adults aged 20 y and older were analyzed. Tooth presence/absence was modeled in relation to age, income, education, smoking history, and glycemic status. To improve robustness, missing covariate data were imputed using k-nearest neighbors, and survey weights were applied in regression analyses to account for NHANES's complex sampling design. A 2-step analytic approach was used: (1) survey-weighted quasi-Poisson regression estimated associations with total tooth count and (2) unweighted generalized estimating equations identified explanatory variables associated with individual tooth loss, accounting for intraoral clustering. Dental implants were excluded. Tooth-level models suggested distinct intraoral and demographic patterns. Males retained more posterior teeth but lost more mandibular incisors than females did. Older adults (≥60 y) exhibited markedly higher loss in mandibular anterior and premolar regions. High-income and high-education participants retained more teeth overall but were more likely to lack first premolars, likely reflecting orthodontic extractions. Smoking and diabetes were associated with anterior tooth loss, especially in visible, functionally important regions. Glycemic control showed a clear gradient, with low-normal HbA1c levels protective in posterior sites. Tooth-level modeling suggested anatomically and socially patterned vulnerabilities often masked in whole-mouth analyses. Findings underscore the need for site-specific prevention strategies that address biological risk and structural inequity, advancing more equitable approaches to oral health care and policy.Knowledge Transfer Statement:This study identified which specific teeth are most at risk of loss across age, health, and socioeconomic groups. Understanding these tooth-level patterns can help clinicians tailor preventive care to vulnerable patients, guide patient education, and inform public health strategies that target oral health disparities. These findings support more precise, equitable dental care to help people keep their natural teeth longer.

Research interests and trends in alveolar ridge augmentation and visualization of articles from 1990 to 2024: a bibliometric analysis.

The primary aim of this study was to compare the overall satisfaction and quality of life (QoL) up to 5 years after treatment in patients who underwent root canal treatment (RCT), re-treatment (re-RCT), or single tooth implant (STI) placement in the anterior zone. The secondary aim was to analyze factors influencing decision-making and patients' fear levels. This cross-sectional study entailed face-to-face personal interviews performed 5 years after treatment. The procedures were performed in private practice by two experienced dentists, specialists in Endodontics and Oral Surgery and Implantology, respectively. The Chi-squared test was used to evaluate the differences in treatment decision-making. Factors influencing treatment decisions were compared using the Kruskal-Wallis test, while ANOVA was employed to assess Oral Health Impact Profile (OHIP)-14 scores and overall satisfaction. Significance was set at p < 0.05. Most patients reported that decisions were made jointly with their dentist, with no differences among groups (p > 0.05). Esthetics were the most influential factor in decision-making (p < 0.05). No differences were found in overall satisfaction among the groups (p > 0.05). STI treatment induced the highest perceived fear and pain scores (p < 0.05). Significant differences were found in some domains of the OHIP-14 in the STI group compared with the RCT and re-RCT groups (p < 0.05). No differences were found between the RCT and re-RCT groups (p > 0.05). Endodontic treatments (RCT and re-RCT) yielded high patient QoL and satisfaction levels comparable to STI, while resulting in lower social disability, psychological discomfort, and physical disability. Esthetics were the most influential determinant across all procedures. In addition, STI resulted in significantly higher perceived fear and pain levels compared with endodontic procedures. The present study's findings underscore the importance of personalized, patient-centered approaches in dental practice to enhance long-term patient satisfaction and outcomes.

Dexamethasone-loaded nanoparticles promote angiogenesis and pro-regenerative macrophages polarization in the presence of titanium debris: a rabbit critical defect model.

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a significant challenge for clinicians with limited treatment options. In this case series, a CO2 laser (9.3µm) was utilized in conjunction with platelet-rich fibrin (PRF) mixed with allograft to create sticky Bone. Materials &amp; Methods: Four consecutive patients with MRONJ at implant sites were treated at a private practice setting. The necrotic bone was removed, and the sites were irradiated with a CO2 laser and ethelylenediaminetetraacetate (EDTA). Platelet-rich fibrin (PRF) mixed with BioOss Collagen particulate to create sticky bone to graft in the defect sites and secured with a solid-PRF membrane. Herbal-based mouthrinses in place of chlorehexidine was utilized as a post-surgical rinse. Follow-up time for the cases ranged from 6 months to 7 years. Results: All patients healed uneventfully without any post-operative complications. In one case, a new implant was placed without any post-operative complications with a 2-year follow-up. Conclusion: This case series demonstrates successful outcomes of treating MRONJ at implant sites utilizing CO2 laser to decontaminate the implant surface and sticky bone for regenerative therapy. Additional controlled clinical studies are necessary to validate this technique.

Restoration of dental rehabilitation is the ultimate goal of functional jaw reconstruction, which is called "occlusion-driven jaw reconstruction", whereas fibular mandibular reconstruction (FMR) in the Asian population fails to adequately provide adequate bone volume for subsequent dental implantation. This study proposed a preoperative occlusion-driven design of FMR and compared the peri-implant bone thickness in fibular-reconstructed mandibles with or without preoperative occlusion-driven design. The patients underwent FMR and following dental implantation were reviewed, consisting of 10 cases with preoperative occlusion-driven design of free fibular flap (FFF) as the experimental group and the other 12 cases as the control group. A total of 82 endosseous implants were radiographically evaluated and the cross-sectional buccal, lingual, and bottom distances between implant and fibula were calculated. The lingual bone thickness at the crown third of the peri-implant in the premolar region and at the middle third of the peri-implant in the molar region was 2.36±0.36 and 4.90±0.43mm in the experimental group, significantly greater than 1.57±0.15 and 3.73±0.32mm in the control group, respectively (P=0.04, P=0.032). The bone thickness at the root of the peri-implant in the experimental group was significantly greater than that in the control group (P=0.007). Specifically, the anterior and premolar regions in the experimental group were 4.31±0.24 and 4.29±0.30mm, significantly greater than 3.21±0.40 and 4.16±0.30mm in the control group, respectively (P=0.019 and P=0.009). No significant difference was found in the buccal bone thickness at the crown, middle, and root third of the peri-implant between the experimental and control groups. On the basis of the results of limited cases, this study demonstrated preoperative occlusion-driven design of the intended fibula segment for implant placement could provide adequate bone volume for endosseous implants, contributing to maximize successful osseointegration and minimize complications for FMR patients.

Edentulism, a common condition, may be congenital or acquired later in life as a result of dental caries, periodontitis, aging, craniofacial trauma, or tumor resection. The rehabilitation of missing teeth can be achieved with dental implants. In cases of insufficient alveolar bone, several treatment options have been described in the literature, including maxillary sinus augmentation with bone grafting, the Le Fort I osteotomy, the angulated placement of conventional implants, and the use of specialized implants, such as zygomatic implants, which are anchored in the zygomatic bone. The aim of this retrospective study was to compare 2 surgical approaches - intrasinus and extrasinus - for the placement of zygomatic implants in patients with severe maxillary atrophy. The study was based on the medical records of patients who underwent zygomatic implant treatment conducted by the same surgeon at 2 dental facilities in Poland between 2004 and 2021. A total of 190 zygomatic implants placed in 69 patients of varying age and sex were included in the analysis. The follow-up period was 5 years. Two surgical approaches for zygomatic implant placement - intrasinus and extrasinus - were evaluated. Statistical analysis was performed using a significance level of 0.05. Differences between the groups were assessed using the χ2 test or Fisher's exact test, as appropriate. The zygomatic implants placed using the intrasinus approach demonstrated a 100% survival rate. In the extrasinus group, the osseointegration rate was 94.27%, with implant loss occurring in 7 patients. Maxillary sinusitis was observed in 7 patients. Soft-tissue atrophy occurred in 4 patients (8.33%) and involved 14 zygomatic implants placed using the extrasinus technique. Cutaneous fistulas developed in 2 patients treated with the extrasinus approach. One case of zygomatic bone fracture was reported in the extrasinus group. No statistically significant differences in the complication rates were observed between the intrasinus and extrasinus techniques for zygomatic implant placement. Both approaches appear to be equally effective for the rehabilitation of patients with severe maxillary atrophy.

Primary stability is a determinant of early implant success and becomes critical in low-density bone, where reduced trabecular support may increase micromotion risk. Undersized osteotomy and osseodensification are two commonly discussed site-preparation strategies aimed at improving initial stability through different biomechanical mechanisms. An analytical experimental in vitro study was performed using 76 cylindrical implants (4.0×10mm) (n=38 per group) placed in type IV polyurethane blocks with a dense cortical shell. Group OS underwent an undersized osteotomy drilling sequence, while Group OD underwent osseodensification using Densah® burs operated in counterclockwise rotation. In Group OD, the final osteotomy diameter was intentionally overprepared by 0.3mm (4.3mm) relative to the implant diameter. Maximum insertion torque (Ncm) was recorded during placement. Primary stability was measured as implant stability quotient (ISQ) using the Penguin® resonance frequency analysis device (two perpendicular readings per implant; mean value used). Between-group comparisons were performed using Student's t-test for independent samples (α=0.05). Group OS showed higher mean insertion torque than Group OD (30.66±1.71 vs 26.58±2.63 Ncm; p<0.0001). Group OD showed higher mean ISQ than Group OS (56.80±2.90 vs 52.92±3.57; p=0.00000227). Undersized osteotomy increased insertion torque, consistent with higher rotational resistance during insertion, whereas osseodensification increased ISQ, suggesting higher construct stiffness. Both protocols may be clinically useful in low-density bone depending on the primary objective (torque-driven mechanical engagement vs RFA-derived stiffness).

Optimized surface properties are a pivotal factor for dental ceramic implants and overall implant success. After grit-blasting and spray-coating Aluminum Toughened Zirconia (ATZ) ceramic samples with a glass solder, the biological cell response was examined and compared to uncoated and solely grit-blasted samples of the same ceramic. In this study, a silica-based glass solder was evaluated for cytocompatibility, osteogenic differentiation, and hemocompatibility using L929 mouse fibroblasts and human dental pulp cells (HDPCs). No toxic effects were observed for either coated or uncoated ATZ samples in direct or indirect tests, as assessed by live/dead staining. Differentiation and viability assays with HDPCs and L929 mouse fibroblasts showed no toxicity, and osteogenic differentiation was not impaired by the coating. Hemocompatibility testing with human whole blood revealed similar results for coated and uncoated ceramic specimens, with no hemolysis or adverse effects on standard hematological parameters. The glass solder coating was cytocompatible and hemocompatible under the tested in vitro conditions and did not impede osteogenic differentiation. These findings indicate that it can serve as a suitable substrate for the proliferation and spreading of L929 fibroblasts and HDPCs, with potential benefits for improving dental ceramic implant surfaces.

Animal models are needed to further investigate the osseointegration process after dental implant placement. The aim of this study was to introduce a proof-of-concept for a novel preclinical mandibular dental implant in mice. Morphometric analyses of maxillaries from C57BL/6 mice were performed using micro-computed tomography (micro-CT) to identify suitable implant site. The bone surrounding the mandibular first molar was selected due to its similarity to human bone characteristics (cortical/trabecular bone and crown/root ratio), and vertical shape which allows for implant complete bone coverage. Considering dental development and alveolar bone density, mandibular first molars were extracted 5 weeks postnatally. Implants were designed based on the characteristics of the alveolar bone healing site and manufactured in medical Ti-6Al-4V. One implant was placed per mouse at the tooth extraction site and maintained to 35 days post-extraction. Bone-to-implant contact was measured by longitudinal micro-CT imaging. Following morphometric evaluation, the mandibular first molar site was selected for implant placement based on its sufficient bone volume. Five weeks after extraction, the surgical site showed a bone volume-to-total volume ratio similar to that of native bone (83% vs. 84%, respectively). Implant follow-up showed that peri-implant bone volume plateaued from day 28 and indicated intimate contact between bone and implant surfaces (84.6%) at day 35 after implantation, confirmed through histological analyses. This proof-of-concept study establishes a reliable preclinical mouse model for mandibular dental implantation. Beyond implantology, this model offers promising applications for investigating how systemic or genetic conditions influence bone healing and implant success.

To compare fascia lata allograft (FLA) and subepithelial connective tissue graft (SCTG) for peri-implant mucosal augmentation performed simultaneously with implant placement. This prospective, randomized, examiner-blinded pilot clinical trial enrolled 16 patients requiring single-tooth implant placement with a thin peri-implant soft-tissue phenotype. Participants were randomly allocated (1:1) to SCTG or FLA. The primary outcome was peri-implant mucosal thickness (PMT) measured by using a customized stent-guided transmucosal method at standardized buccal reference points. Secondary outcomes included keratinized mucosal width (KMW), postoperative pain (VAS), and modified wound healing index (MWHI). Follow-up was 24 weeks. Both groups demonstrated significant improvements in PMT and KMW over time. Between-group differences were generally non-significant, except localized PMT differences at the intermediate reference level, favoring SCTG at later visits. FLA showed lower postoperative pain at selected time points. Healing outcomes were comparable. Both SCTG and FLA were effective for peri-implant mucosal augmentation. FLA may represent a viable alternative that avoids donor-site morbidity. Larger long-term trials are required. FLA can be considered a viable alternative for enhancing peri-implant mucosal thickness around simultaneously placed dental implants. ClinicalTrials.gov NCT04679922, registered on December 22, 2020, and retrospectively registered.