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ABSTRACT Objectives Materials and Methods Results Conclusions This study aims to examine differences in trueness and precision between surgical guides with (S) and without sleeves (SL). A secondary aim was to assess the impact of the sleeve‐to‐bone distance.Mandible replicas (n = 120) were printed from an STL file obtained from a clinical CBCT. The mandibles were divided into sleeved (S, n = 60) and sleeveless (SL, n = 60) groups, each further divided into three categories (n = 20 each) with different heights from the guide to the implant platform: 2 mm (H2), 4 mm (H4), or 6 mm (H6). Digital planning and surgical guide design were done for a 4.1 × 10 mm implant for site #30. Post‐op positions were captured using a scan body and lab scanner. Angular deviation was the primary outcome, with 3D and 2D deviations as secondary parameters. Statistical analysis included two‐sample t‐tests, and one‐way and two‐way ANOVA.Group S (2.41 ± 1.41°) had significantly greater angular deviation than Group SL (1.65 ± 0.93°; p = 0.0001). Angular deviation increased with sleeve‐to‐bone distance. H2 deviations were 1.48 ± 0.80° (S) vs. 1.02 ± 0.45° (SL; p < 0.05), H4: 2.36 ± 1.04° (S) vs. 1.48 ± 0.79° (SL; p < 0.05), H6: 3.37 ± 0.67° (S) vs. 2.46 ± 0.89° (SL; p < 0.05). 3D deviation at the implant platform was 0.36 ± 0.17 mm (S) vs. 0.30 ± 0.15 mm (SL; p < 0.05) and at the apex 0.74 ± 0.34 mm (S) vs. 0.53 ± 0.31 mm (SL; p < 0.01). Group SL at H2 had the smallest inter‐implant distance (0.53 ± 0.37°), while Group S at H4 had the largest (1.20 ± 0.84°; p < 0.05).Sleeveless guides are more accurate than sleeved guides, and angular deviation is influenced by the distance from the guide to the implant platform. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the accuracy of conventional and automatic artificial intelligence (AI)‐based registration of cone‐beam computed tomography (CBCT) with intraoral scans and to evaluate the impact of user's experience, restoration artifact, number of missing teeth, and free‐ended edentulous area. Materials and Methods: Three initial registrations were performed for each of the 150 randomly selected patients, in an implant planning software: one from an experienced user, one from an inexperienced operator, and one from a randomly selected post‐graduate student of implant dentistry. Six more registrations were performed for each dataset by the experienced clinician: implementing a manual or an automatic refinement, selecting 3 small or 3 large in‐diameter surface areas and using multiple small or multiple large in‐diameter surface areas. Finally, an automatic AI‐driven registration was performed, using the AI tools that were integrated into the utilized implant planning software. The accuracy between each type of registration was measured using linear measurements between anatomical landmarks in metrology software. Results: Fully automatic‐based AI registration was not significantly different from the conventional methods tested for patients without restorations. In the presence of multiple restoration artifacts, user's experience was important for an accurate registration. Registrations' accuracy was affected by the number of free‐ended edentulous areas, but not by the absolute number of missing teeth (p <.0083). Conclusions: In the absence of imaging artifacts, automated AI‐based registration of CBCT data and model scan data can be as accurate as conventional superimposition methods. The number and size of selected superimposition areas should be individually chosen depending on each clinical situation. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the three‐dimensional stability and morphologic changes of tent space after the osteotome sinus floor elevation (OSFE) procedures without bone grafts. Materials and Methods: Forty‐six implants placed using the OSFE technique with simultaneous implant placement without bone grafts were included in this retrospective study. Cone‐beam computed tomography (CBCT) scans of the augmented sinuses were obtained pre‐ and postoperatively up to 48 months of follow‐up. The maxillary sinus cavity profiles were outlined using three‐dimensional virtual reconstruction and superimposition of CBCT scans. The three‐dimensional changes in the tent space were measured. A generalized estimating equation (GEE) was used to explore potential factors. Results: The implant survival rate was 97.8%. The mean volume of remaining tent space immediately after surgery was 96.8 ± 70.5 mm3, shrinking to 31.0 ± 24.9 mm3 after 48 months, while the mean percentage of remaining tent space volume decreased to 29.1 ± 20.7%. The tent space volume and the percentage of residual tent space volume only decreased significantly within 12 months after surgery (p =.008,.013). GEE results indicated positive correlations between the percentage of remaining tent space volume and implant protrusion length (p =.000) and apical height (p =.000), with a negative correlation between the sinus floor area immediately after surgery (p =.002) and the healing time (p =.022). Conclusions: The volume of the tent space rapidly shrank after OSFE without bone grafts. Several factors might influence the tent space stability. Long‐term clinical trials with larger sample sizes are necessary to further validate the results. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the accuracy of artificial intelligence (AI)‐based segmentation of the mandibular canal, compared to the conventional manual tracing, implementing implant planning software. Materials and methods: Localization of the mandibular canals was performed for 104 randomly selected patients. A localization was performed by three experienced clinicians in order to serve as control. Five tracings were performed: One from a clinician with a moderate experience with a manual tracing (I1), followed by the implementation of an automatic refinement (I2), one manual from a dental student (S1), and one from the experienced clinician, followed by an automatic refinement (E). Subsequently, two fully automatic AI‐driven segmentations were performed (A1,A2). The accuracy between each method was measured using root mean square error calculation. Results: The discrepancy among the models of the mandibular canals, between the experienced clinicians and each investigated method ranged from 0.21 to 7.65 mm with a mean of 3.5 mm RMS error. The analysis of each separate mandibular canal's section revealed that mean RMS error was higher in the posterior and anterior loop compared to the middle section. Regarding time efficiency, tracing by experienced users required more time compared to AI‐driven segmentation. Conclusions: The experience of the clinician had a significant influence on the accuracy of mandibular canal's localization. An AI‐driven segmentation of the mandibular canal constitutes a time‐efficient and reliable procedure for pre‐operative implant planning. Nevertheless, AI‐based segmentation results should always be verified, as a subsequent manual refinement of the initial segmentation may be required to avoid clinical significant errors. [ABSTRACT FROM AUTHOR]

Objectives: To analyze changes in bone dimensions and their modulating factor in bone dimensions 6 months after horizontal ridge augmentation using autogenous bone grafts. Materials and methods: Thirty‐eight patients with horizontally atrophic alveolar ridges of a single edentulous tooth at the maxillary anterior site were divided into two groups based on the fixation position of the bone block during ridge augmentation surgery (H0, vertical distance from the upper edge of the bone block to the alveolar crest). Patients were classified into a crestal level (CL) group if H0 ≤ 1 mm and a sub‐crestal level (SCL) group if H0 > 1 mm. The width and height of the alveolar ridge were recorded using CBCT both before and 6 months after the augmentation procedure. Results: The CL group comprised 20 patients with 23 implants, whereas the SCL group comprised 18 patients with 22 implants. All the augmentation sites exhibited vertical bone resorption. Vertical bone resorption in the SCL group (1.94 ± 2.11 mm) was significantly higher than that of the CL group (0.61 ± 0.64 mm). The SCL group showed significantly lower horizontal bone gain than the CL group (SCL: 1.02 ± 2.30 mm; CL: 3.19 ± 3.17 mm) at the cervical level. Peri‐implant marginal bone loss increased significantly in the SCL group (1.00 ± 2.71 mm) compared to the CL group (0.64 ± 0.40 mm). Conclusion: The bone height decreased after horizontal ridge augmentation using autogenous onlay grafting. The fixation position of the bone block was a modulating factor. The SCL group showed more vertical bone loss, less horizontal bone gain 6 months after surgery, and more marginal bone loss after restoration. [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusions The objective of this study is to assess accuracy, time‐efficiency and consistency of a novel artificial intelligence (AI)‐driven automated tool for cone‐beam computed tomography (CBCT) and intraoral scan (IOS) registration compared with manual and semi‐automated approaches.A dataset of 31 intraoral scans (IOSs) and CBCT scans was used to validate automated IOS‐CBCT registration (AR) when compared with manual (MR) and semi‐automated registration (SR). CBCT scans were conducted by placing cotton rolls between the cheeks and teeth to facilitate gingival delineation. The time taken to perform multimodal registration was recorded in seconds. A qualitative analysis was carried out to assess the correspondence between hard and soft tissue anatomy on IOS and CBCT. In addition, a quantitative analysis was conducted by measuring median surface deviation (MSD) and root mean square (RMS) differences between registered IOSs.AR was the most time‐efficient, taking 51.4 ± 17.2 s, compared with MR (840 ± 168.9 s) and SR approaches (274.7 ± 100.7 s). Both AR and SR resulted in significantly higher qualitative scores, favoring perfect IOS‐CBCT registration, compared with MR (p = .001). Additionally, AR demonstrated significantly superior quantitative performance compared with SR, as indicated by low MSD (0.04 ± 0.07 mm) and RMS (0.19 ± 0.31 mm). In contrast, MR exhibited a significantly higher discrepancy compared with both AR (MSD = 0.13 ± 0.20 mm; RMS = 0.32 ± 0.14 mm) and SR (MSD = 0.11 ± 0.15 mm; RMS = 0.40 ± 0.30 mm).The novel AI‐driven method provided an accurate, time‐efficient, and consistent multimodal IOS‐CBCT registration, encompassing both soft and hard tissues. This approach stands as a valuable alternative to manual and semi‐automated registration approaches in the presurgical implant planning workflow. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates effects of surgical guide manufacturing process on 3D transfer accuracy of planned dental implant position, using three production methods: additive 3D‐printed (3DF), subtractive milled (MF), and analog laboratory fabricated templates (LF). Material and Methods: Implant position for a single‐tooth gap (#26) planned digitally. 3DF and MF templates were designed digitally, while LF templates were analogously created. For each manufacturing type, 10 surgical guides were fabricated. Each guide was used for template‐guided implant placement in model replicas. For evaluation of implant placement, cone beam computed tomography scans of all implanted models were superimposed, and implant positions were determined. Deviations at implant shoulder/apex were measured, and median and inter‐quartile range (IQR) were determined for mesio‐distal, oro‐facial, coronal apico, 3D spaces, and angles. Results: At implant shoulder, vertical components dominated position deviations (up to 1.04 mm, IQR 0.28 mm for 3DF). Horizontal deviations were much lower (mesio‐distally up to 0.38 mm, IQR 0.36 mm (LF)). Implant apex shows similar vertical deviations, while horizontal deviations clearly increased compared to shoulder, especially in mesio‐distal direction. Median angular deviations were between 2.1° (IQR 2.0 mm, max. 4.2°) for 3DF and 3.3° (IQR 1.9 mm, max. 5.3°) for MF. No statistical differences were found between manufacturing types (Kruskal–Wallis test, p =.05). Conclusions: The study showed the method of implant guide fabrication did not affect the accuracy of implant placement within the limits of an in vitro environment. All methods resulted in implant placement which did not exceed the accepted safety deviation envelope (1.5–2.0 mm). [ABSTRACT FROM AUTHOR]

Objective: To identify the different uses and modalities of digital technologies to diagnose, plan and monitor peri‐implant soft tissue conditions and aesthetics. Methods: A comprehensive narrative review of pertinent literature was conducted, critically appraising key digital technologies that may assist peri‐implant soft tissue augmentation and assessment. An electronic search on four databases including studies published prior to 1st July 2023 was performed and supplemented by a manual search. Results: Predominantly, tools such as cone beam computed tomography (CBCT), intraoral scanning (iOS), intraoral ultrasonography and digital spectrophotometry were commonly to assess and monitor peri‐implant soft tissues. The main clinical and research applications included: (i) initial assessment of mucosal thickness, supra‐crestal tissue height and keratinized mucosa width, (ii) evaluation of peri‐implant soft tissue health and inflammation, (iii) monitoring profilometric changes and midfacial mucosal margin stability over time and (iv) aesthetic evaluation through colour assessment. While evidence for some digital tools may be limited, the integration of digital technologies into peri‐implant soft tissue management holds great promise. These technologies offer improved precision, comfort and speed in assessment, benefiting both patients and clinicians. Conclusion: As digital technologies progress, their full potential in peri‐implant soft tissue augmentation and their value will become more evident with ongoing research. Embracing these innovations and their potential benefits is recommended to ensure that during progress in implant dentistry, patient care is not hindered. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the accuracy and reliability of deep learning in automatic graft material segmentation after maxillary sinus augmentation (SA) from cone‐beam computed tomography (CBCT) images. Materials and Methods: One hundred paired CBCT scans (a preoperative scan and a postoperative scan) were collected and randomly allocated to training (n = 82) and testing (n = 18) subsets. The ground truths of graft materials were labeled by three observers together (two experienced surgeons and a computer engineer). A deep learning model including a 3D V‐Net and a 3D Attention V‐Net was developed. The overall performance of the model was assessed through the testing data set. The comparative accuracy and inference time consumption of the model‐driven and manual segmentation (by two surgeons with 3 years of experience in dental implant surgery) were conducted on 10 CBCT scans from the test samples. Results: The deep learning model had a Dice coefficient (Dice) of 90.36 ± 2.53%, a 95% Hausdorff distance (HD) of 1.59 ± 0.82 mm, and an average surface distance (ASD) of 0.38 ± 0.11 mm. The proposed model only needed 7.2 s, while the surgeon took 19.15 min on average to complete a segmentation task. The overall performances of the model were significantly superior to those of surgeons. Conclusions: The proposed deep learning model yielded a more accurate and efficient performance of automatic segmentation of graft material after SA than that of the two surgeons. The proposed model could facilitate a powerful system for volumetric change evaluation, dental implant planning, and digital dentistry. [ABSTRACT FROM AUTHOR]

Objectives: Diagnostic imaging is crucial for implant dentistry. This review provides an up‐to‐date perspective on the application of digital diagnostic imaging in implant dentistry. Methods: Electronic searches were conducted in PubMed focusing on the question 'when (and why) do we need diagnostic imaging in implant dentistry?' The search results were summarised to identify different applications of digital diagnostic imaging in implant dentistry. Results: The most used imaging modalities in implant dentistry include intraoral periapical radiographs, panoramic views and cone beam computed tomography (CBCT). These are dependent on acquisition standardisation to optimise image quality. Particularly for CBCT, other technical parameters (i.e., tube current, tube voltage, field‐of‐view, voxel size) are relevant minimising the occurrence of artefacts. There is a growing interest in digital workflows, integrating diagnostic imaging and automation. Artificial intelligence (AI) has been incorporated into these workflows and is expected to play a significant role in the future of implant dentistry. Preliminary evidence supports the use of ionising‐radiation‐free imaging modalities (e.g., MRI and ultrasound) that can add value in terms of soft tissue visualisation. Conclusions: Digital diagnostic imaging is the sine qua non in implant dentistry. Image acquisition protocols must be tailored to the patient's needs and clinical indication, considering the trade‐off between radiation exposure and needed information. growing evidence supporting the benefits of digital workflows, from planning to execution, and the future of implant dentistry will likely involve a synergy between human expertise and AI‐driven intelligence. Transiting into ionising‐radiation‐free imaging modalities is feasible, but these must be further developed before clinical implementation. [ABSTRACT FROM AUTHOR]

Aim: To introduce an objective method to evaluate the accuracy of implant position assessment in partially edentulous patients by comparing different techniques (conventional impression, intraoral scan, CBCT) to a reference 3D model obtained with an industrial scanner, the latter mimicking the clinical situation. Materials and Methods: Twenty‐nine implants were placed in four human cadaver heads using a fully guided flapless protocol. Implant position was assessed using (a) a conventional impression, (b) an intraoral scan, and (c) CBCT and compared to an industrial scan. Three‐dimensional models of intraoral scan body and implant were registered to the arch models and the deviation at implant shoulder, apex, and the angle of deviation were compared to each other as well as to the reference model. Results: The three assessment techniques showed statistically significant deviations (p <.01) from the industrial scan, for all measurements, with no difference between the techniques. The maximum deviation at the implant shoulder was 0.16 mm. At the implant apex this increased to 0.38 mm. The intraoral scan deviated significantly more than the CBCT (0.12 mm, p <.01) and the conventional impression (0.10 mm, p =.02). The maximum implant angle deviation was 1.0°. The intraoral scan deviated more than the conventional impression (0.3°, p =.02). Conclusion: All assessment techniques deviated from the reference industrial scan, but the differences were relatively small. Intraoral scans were slightly less accurate than both conventional impressions and CBCT. Depending on the application, however, this inaccuracy may not be clinically relevant. [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusion To investigate long‐term alveolar ridge bone changes in patients treated with the split‐crest technique (SCT) with simultaneous implant placement.Alveolar ridge width (ARW) was measured with a caliper immediately before (ARW1) and after SCT (ARW2) with a caliper. Existing CBCT scans taken at least 5 years postoperatively were used to assess the healed ARW (ARWF), buccal bone thickness (BBT), and lingual/palatal bone thickness (L/PBT) at 0, 3, and 5 mm apically from implant platform level (IPL). The distance between IPL and buccal bone crest (IPL‐BBC) was also measured. Findings were compared with Wilcoxon and Student's t tests (p < .05).Records of thirty patients with 85 implants were included. Eleven patients (31 implants) presented CBCT scans taken in two separate occasions, resulting in 116 measurements. Tomographic follow‐up ranged from 5 to 18 years (11.5 ± 4.18 years). Mean ARW increased from 3.2 ± 0.6 to 6.6 ± 0.48 mm after SCT, but significantly reduced overtime to 4.46 ± 0.83 mm (ARWF) (p < .0001). Mean BBT was 0.5 ± 0.9, 1.3 ± 0.9, and 2.0 ± 1.2 mm, while mean L/PBT was 0.9 ± 0.7, 1.6 ± 0.9, and 2.1 ± 1.0 mm at 0, 3, and 5 mm from IPL, respectively. IPL‐BBC distance varied up to 8.7 mm (1.4 ± 2.0 mm), with 56/116 measurements (51/85 implants) showing IPL‐BBC = 0 mm.Although SCT with simultaneous implant placement can predictably increase ARW postoperatively, ARW tended to significantly reduce over time, due to reductions in BBT and L/PBT, especially coronally. Nonetheless, 60% of the implants still presented some buccal bone at IPL. [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusions To evaluate the influence of multiplanar reconstruction thickness on the detection of peri‐implant bone defects with a standalone zirconia implant and compare it to when another implant is in the vicinity using cone‐beam computed tomography (CBCT).Five dry human mandibles were used to create twenty implant sites in the second premolar and first molar regions. The OP300 Maxio was used to acquire CBCT images (90 kVp, 6.3 mA, 5 × 5 cm FOV, and 0.125 mm3 voxel size) before and after creating 3 mm peri‐implant bone defects in the buccal aspect of the premolar region. Half of the scans featured a single zirconia implant in the premolar region, while the others had two implants in the premolar and molar regions. Three reconstruction thicknesses (0.125 mm, 1 mm, and 2 mm) were considered for the multiplanar reconstruction analyses. Five oral and maxillofacial radiologists assessed the detection of peri‐implant bone defects using a 5‐point scale. Diagnostic parameters were calculated and compared using Two‐way ANOVA (α = .05).The studied factors showed no significant influence on the diagnosis of peri‐implant bone defects (p > .05). Diagnostic performance was notably higher with a single implant, especially with a 2‐mm reconstruction thickness (AUC = 0.88, sensitivity = 0.68, specificity = 0.94). Although the differences were not statistically significant, the results were more modest when two implants were present (AUC = 0.80, sensitivity = 0.58, specificity = 0.82).The presence of an adjacent zirconia implant and variations in reconstruction thickness did not influence the detection of 3 mm buccal peri‐implant bone defects on CBCT images. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To assess the relative position of mini‐implants to retain a mandibular overdenture, according to the surgical protocol, technical and anatomical factors.Mandibular cone‐beam computed tomography (CBCT) scans were analyzed for 73 patients who received four one‐piece titanium‐zirconium mini‐implants. Drilling was performed using a 1.6 mm needle drill and a 2.2 mm Pilot Drill, according to the bone density with a surgical stent. Post‐insertion CBCT images in DICOM format were analyzed using the E‐Vol‐DX software with BAR filters. Divergence angle between implants and between implants and the overdenture path of insertion was measured using CliniView 10.2.6 software.Divergence between implants ranged from 0° to 22.3° (mean = 4.2; SD = 3.7) in the lateral and from 0° to 26.2° (mean = 5.3; SD = 4.1) in the frontal projections (p < .001). Only 1 (0.2%) and 3 (0.7%) of the measurements were higher than 20° in the lateral and frontal views, respectively. The mean angulations between the implant and the path of insertion for the overdenture were 9.3° (SD = 7.5) and 4.0° (SD = 2.9) for the lateral and frontal views, respectively (p < .001). Regression analyses showed a significant association between the divergence of implants and the frontal view projection (p < .001), greater distance between the paired implants (p = .017), the flapped surgical protocol (p = .002), higher final insertion torque (p = .011), and deeper preparation with the needle drill (p < .001).The mini‐implants were placed with low divergence angles and satisfactory parallelism. Factors including shorter distances between the implants, higher density bone, and a flapless surgical approach all contributed positively to improved parallelism of the mini‐implants. [ABSTRACT FROM AUTHOR]

Objective Materials and Methods Results Conclusions To compare bone volume and height changes of two types of deproteinized bovine bone mineral (DBBM) for lateral window sinus floor elevation (LSFE) with simultaneous implant placement.This retrospective cohort study involved 72 patients who underwent LSFE using low‐temperature sintered cancellous bone‐derived DBBM (C‐DBBM) or high‐temperature two‐step sintered epiphyseal‐derived DBBM (E‐DBBM). Cone‐beam computed tomography (CBCT) was acquired preoperatively, immediately postoperatively, 6 months and 1–4 years post‐surgery. Bone volume (BV), apical bone height (ABH), endo‐sinus bone gain (ESBG), and crestal bone level (CBL) were evaluated through three‐dimensional fitting and superimposition. Linear mixed models (LMM) were employed to analyze factors influencing the reduction of BV (ΔBV) and ESBG (ΔESBG).The E‐DBBM group showed no significant change in BV 1–4 years post‐surgery, while the C‐DBBM group demonstrated a significant reduction (p = .006) with volume stability of 85.86%. Bone height in the E‐DBBM group increased at 6 months and subsequently decreased at 1–4 years (p = .003). In the C‐DBBM group, it decreased at 6 months (p = .014), then further decreased at 1–4 years (p = .001). ΔESBG was lower in the E‐DBBM group than the C‐DBBM group from immediate postoperative to 1–4 years (p = .009). LMM showed graft material type was the primary factor influencing ΔBV (p = .026) and ΔESBG (p = .003).Within the limitations of this study, both types of DBBM could achieve favorable clinical outcomes. E‐DBBM demonstrated enhanced stability in maintaining bone volume and height. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusion To evaluate the performance of low‐dose cone beam computed tomography (CBCT) protocols with regard to linear bone measurements in the posterior mandible for implant planning compared with higher dose protocols.Forty‐two edentulous posterior sites in human cadaveric mandibles were imaged in three CBCT scanners using three or four protocols with varying exposure parameters to achieve lower dose. Co‐registration was performed to generate sagittal and cross‐sectional image sections representative of the implant site. Three observers measured bone height, from the alveolar crest to the mandibular canal, and width, three mm from the top of the alveolar crest. Intra‐ and interobserver reproducibility were assessed for the cases rated as nonmeasurable as well as for completed measurements. The measurements were analyzed using paired t‐tests for differences among the CBCT protocols and the frequency distribution of nonmeasurable cases with a Pearson Chi‐square test.Reproducibility for registering nonmeasurable cases varied among observers; however, no consistent significant differences were found in the frequency distribution of these cases among observers, units, and protocols. Intraclass correlation coefficients (ICC) were >0.9 for all measurements of bone height and width. Mean differences of <0.5 mm were found regardless of protocol; however, one observer did in some cases produce larger differences.Linear bone measurements did not differ significantly and could be performed with excellent reliability, using low‐dose CBCT protocols compared with standard and high‐resolution ones. Varying approaches for rating nonmeasurable cases were found, indicating differences in diagnostic strategies related to implant planning among observers. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate the association of peri‐implantitis (PI) and sinus membrane thickening and to assess the resolution of membrane thickening following intervention (implant removal or peri‐implantitis treatment) aimed at arresting PI. Materials and Methods: Forty‐five patients with 61 implants in the posterior maxillary region were retrospectively included in the study. Twenty‐four patients were diagnosed with peri‐implantitis (PI) and 21 had peri‐implant health (PH). Cone‐beam computed tomography (CBCT) scans were evaluated to assess maxillary sinus characteristics, including membrane thickening, sinus occupancy and ostium patency. The CBCT scans taken 6 months after intervention aimed at arresting disease (implant removal or treatment of PI) in the PI group were also appraised and compared to baseline scans. Results: At baseline, all parameters evaluating membrane thickness disorders yielded significant differences between groups (p <.001). Patients with posterior maxillary implants diagnosed with PI were 7× more likely to present membrane thickening compatible with pathology when compared to patients with healthy implants (OR = 7.14; p =.005). Furthermore, the likelihood was 6x greater in implants diagnosed with PI to exhibit moderate membrane thickening (OR = 6.75, p =.001). The patients receiving interventions aimed at arresting PI experienced significant enhancement in all radiographic parameters related to the sinus cavity at the 6‐month follow‐up (p <.001), though these variations were similarly independent of whether treatment consisted of PI treatment or implant removal. Conclusions: Maxillary sinus membrane thickening and the permeability/obstruction of the ostium are frequently associated with the presence of PI in posterior implants. Interventions targeting disease resolution effectively reduce membrane thickness to levels compatible with maxillary sinus health. [ABSTRACT FROM AUTHOR]

Objectives: The present study was conducted to evaluate the reproducibility of Lekholm and Zarb classification system (L&Z) for bone quality assessment of edentulous alveolar ridges and to investigate the potential of a data‐driven approach for bone quality classification. Materials and Methods: Twenty‐six expert clinicians were asked to classify 110 CBCT cross‐sections according to L&Z classification (T0). The same evaluation was repeated after one month with the images put in a different order (T1). Intra‐ and inter‐examiner agreement analyses were performed using Cohen's kappa coefficient (CK) and Fleiss' kappa coefficient (FK), respectively. Additionally, radiomic features extraction was performed from 3D edentulous ridge blocks derived from the same 110 CBCTs, and unsupervised clustering using 3 different clustering methods was used to identify patterns in the obtained data. Results: Intra‐examiner agreement between T0 and T1 was weak (CK 0.515). Inter‐examiner agreement at both time points was minimal (FK at T0: 0.273; FK at T1: 0.243). The three different unsupervised clustering methods based on radiomic features aggregated the 110 CBCTs in three groups in the same way. Conclusions: The results showed low agreement among clinicians when using L&Z classification, indicating that the system may not be as reliable as previously thought. The present study suggests the possible application of a reproducible data‐driven approach based on radiomics for the classification of edentulous alveolar ridges, with potential implications for improving clinical outcomes. Further research is needed to determine the clinical significance of these findings and to develop more standardized and accurate methods for assessing bone quality of edentulous alveolar ridges. [ABSTRACT FROM AUTHOR]

Objectives: To systematically analyze the accuracy of robotic surgery for dental implant placement. Materials and Methods: PubMed, Embase, and Cochrane CENTRAL were searched on October 25, 2023. Model studies or clinical studies reporting the accuracy of robotic surgery for dental implant placement among patients with missing or hopeless teeth were included. Risks of bias in clinical studies were assessed. Meta‐analyses were undertaken. Results: Data from 8 clinical studies reporting on 109 patients and 242 implants and 13 preclinical studies were included. Positional accuracy was measured by comparing the implant plan in presurgery CBCT and the actual implant position in postsurgery CBCT. For clinical studies, the pooled (95% confidence interval) platform deviation, apex deviation, and angular deviation were 0.68 (0.57, 0.79) mm, 0.67 (0.58, 0.75) mm, and 1.69 (1.25, 2.12)°, respectively. There was no statistically significant difference between the accuracy of implants placed in partially or fully edentulous patients. For model studies, the pooled platform deviation, apex deviation, and angular deviation were 0.72 (0.58, 0.86) mm, 0.90 (0.74, 1.06) mm, and 1.46 (1.22, 1.70)°, respectively. No adverse event was reported. Conclusion: Within the limitation of the present systematic review, robotic surgery for dental implant placement showed suitable implant positional accuracy and had no reported obvious harm. Both robotic systems and clinical studies on robotic surgery for dental implant placement should be further developed. [ABSTRACT FROM AUTHOR]

Objectives: To introduce a modified guided bone regeneration (GBR) technique using intact periosteum and deproteinized bovine bone mineral (DBBM) for peri‐implant augmentation and compare the clinical outcomes with those of conventional GBR. Materials and Methods: Patients who received peri‐implant augmentation in posterior sites between 2015 and 2021 were reviewed in this study. Group A was treated with a modified GBR technique, and Group B was treated with conventional GBR. For group comparison, propensity score matching was performed with a sensitivity analysis. The implant survival rate, dimensional changes in hard tissue, marginal bone loss (MBL), and peri‐implant parameters were evaluated. Results: In total, 114 implants from 98 patients were included. The implant survival rates were 95.74% in Group A and 95.00% in Group B during the follow‐up period. At 6 months, the median horizontal thickness was recorded at 0.87 mm (IQ1–IQ3 = 0.00–1.75 mm) in Group A, exhibiting a relatively lower value compared to the corresponding measurement of 0.98 mm (IQ1–IQ3 = 0.00–1.89 mm) in Group B (p =.937). Vertical height displayed no statistically significant intergroup difference between the two groups (p =.758). The mean follow‐up period was 25.83 ± 12.93 months after loading in Group A and 27.47 ± 21.29 months in Group B (p =.761). MBL and peri‐implant parameters were comparable between the two groups. Conclusions: Within the limitations of this study, the modified GBR technique using intact periosteum and DBBM grafting might be a viable alternative to correct bone defects around implants in molar and premolar sites. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the esthetic outcome, as well as clinical, radiographic, and volumetric tissue alterations 1 year after immediate implant placement (IIP) with connective tissue grafting (CTG) versus dual‐zone concept (DZ) at sites with thin labial bone in the esthetic zone. Materials and Methods: This randomized clinical trial included 30 patients treated with IIP simultaneous with either CTG or DZ (n = 15 each). Pink esthetic score (PES) was assessed 6 months after crown placement as the primary outcome. Amount of bone labial to the implant, labio‐palatal ridge reduction, and crestal bone changes were measured via CBCT after 1 year. Volumetric analysis of linear labial soft tissue contour, interdental, and mid‐facial soft tissue level changes, and total volume loss (mm3) were measured after 1 year. Results: Similar PES was observed in the CTG (12.53 ± 1.13) and DZ (12.13 ± 1.55) groups, with no significant difference (p = 0.42). Likewise, there were no statistically significant differences found between the two groups in labio‐palatal bone reduction (mm&%), interdental papillae, and mid‐facial gingival levels (p > 0.05). However, the mean vertical crestal bone changes in the CTG and DZ groups were −1.1 ± 0.6 mm and 0.2 ± 1.0 mm, respectively, with a statistically significant difference (p = 0.0002). Moreover, CTG revealed less linear and total volume (mm3) loss in the labial soft tissue which was statistically significant compared to DZ (p = 0.007). Conclusion: Both groups demonstrated the same PES, nevertheless, volumetric analysis revealed twice total labial volume loss in DZ compared to CTG. It might be concluded that the use of CTG with IIP caused less horizontal reduction in the supra‐implant complex compared to the DZ. [ABSTRACT FROM AUTHOR]

Objective: To assess the radiological and histological outcome after horizontal guided bone regeneration (GBR) with deproteinized bovine bone mineral (DBBM) alone or in combination with particulate autogenous bone (PAB). Materials and Methods: Eighteen edentulous patients with an alveolar ridge of ≤4 mm were included in this split‐mouth randomized controlled trial. Horizontal GBR with a graft composition of 100% DBBM (100:0) on one side and 90% DBBM and 10% PAB (90:10) on the other side were conducted in all patients. Cone beam computed tomography (CBCT) was obtained preoperatively, immediately postoperative, and after 10 months of healing. Width and volumetric changes in the alveolar process were measured on CBCT. Implants were placed after 10 months of graft healing where biopsies were obtained for histomorphometrical evaluation. Results: The gained widths were 4.9 (±2.4) mm (100:0) and 4.5 (±2.0) mm (90:10) at 3 mm from the top of the crest, and 5.6 (±1.3) mm (100:0) and 4.6 (±2.1) mm (90:10) at 6 mm from the top of the crest. The mean volumetric reductions were 32.8% (±23.8) (100:0) and 38.2% (±23.2) (90:10). Histomorphometry revealed that mean percentages of bone were 50.8% (±10.7) (100:0) and 46.4% (±11.3) (90:10), DBBM were 31.6% (±12.6) (100:0) and 35.4% (±14.8) (90:10), and non‐mineralized tissue were 17.6% (±11.7; 100:0) and 18.2% (±18.2) (90:10). No significant differences were evident between in any evaluated parameters. Conclusions: There were no additional effects of adding PAB to DBBM regarding bone formation, width changes, or volumetric changes after 10 months of graft healing. [ABSTRACT FROM AUTHOR]

Aim: To compare measurements on images obtained by magnetic resonance imaging (MRI) and cone beam CT (CBCT) for height, width, and area in alveolar bone sites in human jaw specimens. Material and Methods: Forty edentulous alveolar posterior sites in human cadaver specimens were imaged using CBCT scanners, and with zero‐echo‐time MRI (ZTE‐MRI). Semi‐automatic volume registration was performed to generate representative coronal sections of the sites related to implant planning. ZTE‐MRI sections were also presented after grayscale inversion (INV MRI). Three observers measured bone height, bone width 5 mm from the alveolar crest, and bone area stretching from the width measurement to the top of the alveolar crest in the images. Interobserver agreement was assessed by intra‐class correlation coefficients (ICC). The measurements were analyzed using two‐way repeated measures ANOVA factoring observer and image type. Results: ICC was >0.95 for bone height, width, and bone area. No significant differences among observers (p = 0.14) or image type (p = 0.60) were found for bone height. For bone width, observer (p = 0.14) was not a significant factor, while ZTE‐MRI produced width estimates that were significantly different and systematically smaller than CBCT‐based estimates (p ≤ 0.001). Observer (p = 0.06) was not a significant factor regarding the bone area measurements, contrary to the imaging type where ZTE‐MRI led to significantly smaller area estimates than CBCT (p ≤ 0.001). Conclusion: Bone height measurements were essentially equivalent using CBCT and MRI. This was found regardless of grayscale choice for the MRI. However, ZTE‐MRI resulted in smaller estimates of bone width and area. [ABSTRACT FROM AUTHOR]

Objective: Optimal implant planning and placement allows the prosthesis to be well designed to achieve a satisfactory aesthetic and functional outcome. We aimed to compare deviations between implant planning and placement with the assistance of dynamic computer‐assisted implant surgery (d‐CAIS) or autonomous robotic computer‐assisted implant surgery (r‐CAIS) methods in a clinical setting. Methods: The retrospective analysis of medical records between 2021 July and 2022 December was conducted to compare the implantation accuracy of the d‐CAIS and r‐CAIS system in partially edentulous patients through cone‐beam computed tomography. Patient‐reported outcomes (PROs) were recorded using a visual analogue scale (VAS). The Kolmogorov–Smirnov test was used to check the data distribution. Student's t‐test or Mann–Whitney U‐test was used as appropriate, with a defined significant difference (p <.05). Results: Seventy‐seven patients were analysed (124 implants), with 38 patients (62 implants) in the d‐CAIS group and 39 patients (62 implants) in the r‐CAIS group. The differences between d‐CAIS and r‐CAIS were 4.09 ± 1.79° versus 1.37 ± 0.92° (p <.001) in angular deviation; 1.25 ± 0.54 versus 0.68 ± 0.36 mm (p <.001) in coronal global deviation; 1.39 ± 0.52 versus 0.69 ± 0.36 mm (p <.001) in apical global deviation; the results of the PROMs showed no statistical difference between the two groups. Conclusions: r‐CAIS allows more accurate implant placement than the d‐CAIS technology. And both groups achieved overall satisfactory outcomes via VAS (Chinese Clinical Trial Registry ChiCTR2300072004). [ABSTRACT FROM AUTHOR]

Objectives: To assess in a prospective randomized trial two phycogenic bone substitutes—biphasic calcium phosphate (BCP) versus almost pure hydroxyapatite (HA)—for their volume stability and clinical implications after sinus floor elevation (SFE). Materials and Methods: Twenty patients requiring lateral‐window SFE 6 months prior to implant surgery were randomized to a BCP or HA group. As primary outcome, the grafts were analyzed for volume stability, using four cone‐beam computed tomography scans obtained immediately/6/12/24 months after SFE. Secondary outcomes were implant survivval, success, periotest values, oral‐health‐related quality of life (OHIP‐G14), and pain (VAS). Results: Kolmogorov–Smirnov goodness‐of‐fit test revealed normal distribution of samples (p =.200). At 6/12/24 months, the augmented volumes decreased to 96/92/90% (HA) or 99/96/96% (BCP). Volume changes were significantly a factor of time (p <.001; generalized linear model with repeated measures) and reached significantly lower values in HA group (p =.018). Significant intergroup difference in volume losses was notable at 24 months (p =.021; t‐test for independent samples). Periotest values decreased from −3/−4.1 (HA/BCP) after implant placement to −6.3/−4.5 (HA/BCP) after 6 months. OHIP scores diverged at 2 months (HA: 9.5; BCP: 5.2) and largely resolved by 24 months (HA: 1.3; BCP: 1.9). VAS scores were comparable, 2.2 at 1 week after SFE being their highest mean level. Conclusions: After 2 years, both groups experienced no biological or technical complications, demonstrating a consistent healing trajectory without notable symptoms. Although no significant differences were observed in implant stability and survival, BCP demonstrated higher volume stability than HA. [ABSTRACT FROM AUTHOR]

Introduction: The radiographic examination of alveolar bone using 3D radiographic examination is essential in dental implant treatment planning. Our study aimed to systematically review and quantitatively analyze the correlation between alveolar bone parameters, specifically bone density and cortical bone thickness, assessed using cone beam computed tomography (CBCT) and/or multidetector computed tomography (MDCT); and primary implant stability (PIS) determined using implant stability quotient (ISQ), Periotest® value (PTV), and insertion torque value (ITV). Methods: This review was registered in the PROSPERO database (registration number CRD42022307245). An electronic literature search was conducted on the PubMed, SCOPUS, and Web of Science databases for papers published until February 2022. The Quality Assessment in Prognostic Studies (QUIPS) tool was used to assess risk of bias. Meta‐analyses were conducted to calculate the estimated average correlation coefficient based on a multilevel random‐effects model, followed by subgroup analysis. Results: Twenty‐six studies were included in this review, consisting of 17 prospective cohort studies, eight retrospective cohort studies, and one nonrandomized controlled trial. A total of 3109 implants placed in 1171 subjects were analyzed. Twenty‐three studies were evaluated using meta‐analysis. The alveolar bone condition was significantly correlated with ISQ (r = 0.60; p <.001), IT (r = 0.52; p <.001), and PTV (r = −0.42; p <.05). Conclusion: Alveolar bone condition is significantly associated with PIS. Low bone density and thin cortical bone can lead to low PIS; therefore, modification of treatment planning and surgical procedures might be needed to avoid poor osseointegration. [ABSTRACT FROM AUTHOR]

Objectives: To compare implant placement accuracy and patient‐centered results between the dynamic computer‐assisted implant surgeries (d‐CAISs) using marker‐based and marker‐free registration methods. Materials and Methods: A double‐armed, single‐blinded randomized controlled trial was conducted, in which 34 patients requiring single implant placement at the esthetic zone were randomly assigned to the marker‐based (n = 17) or marker‐free (n = 17) groups. The marker‐based registration was performed using a splint containing radiopaque markers, while the marker‐free registration used natural teeth. The primary outcome assessed implant positioning accuracy via angular and linear deviations between preoperative and postoperative implant positions in CBCT. Patients were also surveyed about the intraoperative experience and oral health impact profile (OHIP). Results: The global linear deviations at the implant platform (0.82 ± 0.28 and 0.85 ± 0.41 mm) and apex (1.28 ± 0.34 and 0.85 (IQR: 0.64–1.50) mm) for the marker‐based and marker‐free groups respectively showed no significant difference. However, the angular deviation of the marker‐free group (2.77 ± 0.92°) was significantly lower than the marker‐based group (4.28 ± 1.58°). There was no significant difference in the mean postoperative OHIP scores between the two groups (p =.758), with scores of 2.74 ± 1.21 for marker‐based and 2.93 ± 2.18 for marker‐free groups, indicating mild oral health‐related impairment in both. Notably, patients in the marker‐free group showed significantly higher satisfaction (p =.031) with the treatment procedures. Conclusions: D‐CAIS with a marker‐free registration method for single implantation in the anterior maxilla has advantages in improving implant placement accuracy and patients' satisfaction, without generating a significant increase in clinical time and expenses. [ABSTRACT FROM AUTHOR]

Objectives: To radiographically evaluate the stability of the bone substitute augmented outside the buccal bony arch contour in the maxillary esthetic zone. Materials and Methods: Patients who missed a single anterior tooth and received simultaneous GBR in implant surgery were included. The contralateral homonymous area of the implant site was horizontally mirrored as the individual bone arch contour. According to the relative position of the postoperative buccal grafts and bone arch contour at the implant shoulder, 62 patients were allocated into the outside‐contour (OC) and inside‐contour (IC) groups. Cone‐beam computed tomography was performed before surgery, after implant insertion, before re‐entry surgery, and at follow‐up. The profilometric changes of the buccal bone plate were analyzed via the bone distance to the mirrored bony contour. Results: At the implant shoulder, the bone distance in the OC group was higher than that in the IC group, with statistically significant differences at re‐entry surgery and follow‐up. However, the bone grafts outside the bone arch contour were reduced into the contour after remodeling and showed more bone resorption than the IC group. At other vertical levels below the implant shoulder, bony grafting of overcontour 1–2 mm range was favorable to regenerate stable bone plates reaching the individual contour at follow‐up. Conclusions: The overaugmented bone outside the buccal bone arch contour tended to remodel into the original contour, which indicates that the anterior bone arch contour is worthy of careful observation for deciding buccolingual implant position and bone augmentation width. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the accuracy of dental implant placement using the robotic computer‐assisted implant surgery (r‐CAIS) technology in fully edentulous patients. Materials and Methods: Fully edentulous and terminal dentition patients were enrolled for r‐CAIS technology. Based on the cone‐beam computed tomography (CBCT) examination, a customized positioning marker and a preoperative surgical plan were created before surgery. During the implant surgery, the implant osteotomy and placement were automatically performed using an autonomous robotic surgery system under the surgeon's supervision. A postoperative CBCT scan was used to determine the discrepancies between the planned and placed implants. Results: Ten patients with 59 implants underwent autonomous robotic surgery. No adverse surgical events occurred. The deviations of global coronal, global apical, and angular were 0.67 ± 0.37 mm (95% CI: 0.58–0.77 mm), 0.69 ± 0.37 mm (95% CI: 0.59–0.78 mm), and 1.27° ± 0.59° (95% CI: 1.42°–1.11°), respectively. Conclusions: The autonomous r‐CAIS technology proved an accurate surgical approach for implant placement in fully edentulous patients due to the control of the angular deviation. Autonomous robotic surgery seems promising as an accurate technology for treating fully edentulous patients. However, further trials are required to provide more hard clinical evidence. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the possible interference of image artifacts (IA) generated by dental implants in the evaluation of furcation involvement (FI) in molars. Methods: Tomographic scans of first molars (1M) were performed in dry skulls in the absence and presence of titanium (TI) and zirconia (ZI) dental implants. FI grades were simulated in the alveoli of the 1Ms. Diagnostic accuracy of FI and level of difficulty were verified. Chi‐squared test and logistic regression analysis were used. Results: There was no difference in the diagnostic accuracy of FI between the arches (p =.117). The highest diagnostic accuracy value for the implant variable was found in the absence of implants (88.3%) and the lowest in the presence of two ZI implants (66.7%). The highest diagnostic accuracy value for FI was observed in grade 0 (G0). There was no significant difference between the arches regarding the evaluators' perception of difficulty (p >.05). Assessments were considered difficult in 12.7% of the TI implants and in 29% of the ZI implants. Regarding the number of dental implants, assessments were considered difficult in 24.4% cases including one implant and 17.4% cases including two implants. The logistic regression model showed a significant p‐value only for one and two ZI implants (p =.0061 and p =.0096, respectively). Conclusion: The presence of dental implants in the region adjacent to the area of investigation of FI decreased the diagnostic accuracy while increasing the perception of difficulty by the examiners, especially in cases with ZI implants. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study, which included a 5‐year follow‐up, was to compare peri‐implant soft tissue health, crestal bone loss (CBL), and buccal bone thickness (BBT) around triangular cross‐section neck (TN) or round neck (RN) implants, using cone‐beam computed tomography. Materials and Methods: This study was initially designed as a prospective 1‐year randomized controlled study and then extended with a 5‐year retrospective evaluation of clinical and radiographic records. In the initial 1‐year study, a total of 20edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN or TN groups using a split‐mouth design. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were recorded at postoperative month 12. CBL and BBT at three levels (0, −2, and −4 mm) were evaluated 1 year after insertion. Five years after insertion, PPD, PI, GI, CBL, and BBT were recorded as patients were recalled for clinical and radiographic monitoring. Results: Nineteen patients completed the study. After 5 years, no significant differences in PPD, PI, and GI scores and BBT values between the two groups (p >.05). The mean ± SD CBL values at the final follow‐up visit were −0.71 ± 0.69 mm for TN and −1.03 ± 0.86 mm for RN (p <.01). Conclusions: These results suggest better crestal bone preservation using implants with TN when compared to RN after a 5‐year follow‐up. However, TN showed similar results to RN regarding peri‐implant soft tissue health and BBT. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the accuracy of implant placement using a dynamic navigation system in fully edentulous jaws and to analyze the influence of implant distribution on implant position accuracy. Materials and Methods: Edentulous patients who received implant placement using a dynamic navigation system were included. Four to six mini screws were placed in the edentulous jaw under local anesthesia as fiducial markers. Then patients received CBCT scans. Virtual implant positions were designed in the planning software based on CBCT data. Under local anesthesia, implants were inserted under the guidance of the dynamic navigation system. CBCTs were taken following implant placement. The deviation between the actual and planned implant positions was measured by comparing the pre‐ and postsurgery CBCT. Results: A total of 13 edentulous patients with 13 edentulous maxillae and 7 edentulous mandibles were included, and 108 implants were placed. The average linear deviations at the implant entry point and apex were 1.08 ± 0.52 mm and 1.15 ± 0.60 mm, respectively. The average angular deviation was 2.85 ± 1.20°. No significant difference was detected in linear and angular deviations between the maxillary and mandibular implants, neither between the anterior and posterior implants. Conclusions: The dynamic navigation system provides high accuracy for implant placement in fully edentulous jaws, while the distribution of the implants showed little impact on implant position accuracy. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effect of restoration artifact ('metal artifact') on registration accuracy of an intraoral scan and cone‐beam computed tomography (CBCT) scan, comparing fiducial marker‐based registration with markerless registration. Materials and methods: A maxillary model was fitted with multiple configurations of zirconia crowns to simulate various states of oral rehabilitation. Intraoral scans and CBCT scans (half and full rotation) were acquired. Registration was performed using markerless (point‐based registration with surface‐based refinement) and fiducial marker‐based registration. Each experimental condition was repeated 10 times (n = 320). The absolute deviation was measured at the canines and first molars, and the average and maximum values were analysed using multiple linear regression. Results: R2 was 0.874 for average error and 0.858 for maximum error. For markerless registration, there were 0.041 mm (p <.001) and 0.045 mm (p <.001) increases in average and maximum error per crown, respectively. For fiducial marker‐based registration, the effect of additional crowns was not statistically significant for average (p =.067) or maximum (p =.438) error. For a full arch of crowns, the regression model predicted average and maximum errors of 0.581 and 0.697 mm for the markerless technique, and 0.185 and 0.210 mm for the fiducial marker‐based technique. Overall, the fiducial marker‐based technique was more accurate for four or more crowns. The half rotation scan increased average error by 0.021 mm (p =.001) and maximum error by 0.029 mm (p <.001). Conclusions: Under the present study's experimental conditions, the fiducial marker‐based technique should be considered if four or more full‐coverage highly radiopaque restorations are present. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to retrospectively evaluate the long‐term clinical outcomes of lateral sinus floor elevation (LSFE) in patients with sinus floor defects. Materials and Methods: Between 2008 and 2020, patients with sinus floor defects were recruited after confirmation on preoperative cone‐beam computed tomography (CBCT). The split‐thickness flap technique with a palatal crestal incision was used to manage tissue adhesion in the bone defects area. A resorbable collagen membrane was used to close the sinus floor defects from the crestal side before bone substitute placement. Of 58 implants, 47 (81.0%) were placed after an 8‐month healing period, whereas 11 were placed simultaneously. Patients were followed up by radiography and clinical examination for 1–9 years. Finally, the cumulative survival rate (CSR) of implants, surgical complications, and marginal bone loss (MBL) were recorded and analyzed. Results: In total, LSFE was performed in 36 sinuses (35 patients) with sinus floor defects, of which surgery was completed in 35 sinuses (97.2%) in the first attempt. Schneiderian membrane perforations (SMP) occurred in 10/36 (27.8%) sinuses; nine were repaired carefully, whereas one surgery was suspended due to complicated SMP, and successful re‐entry LSFE was performed 4 months later. After a follow‐up period of 1–9 years, the CSR was 96.5% at the 1‐year, 3‐year, 5‐year, and 7‐year follow‐ups and 64.3% at the 8‐year follow‐up. Conclusion: Within the limitations of this study, sinus floor defects seem not to compromise LSFE therapy after appropriate management and long‐term clinical outcomes are predictable. [ABSTRACT FROM AUTHOR]

This document provides summaries of various research studies related to dental implants and bone regeneration. The studies cover a range of topics, including surgical guides, mylohyoid line width, electrolytic cleaning, microbial and cytokine changes, extra-short implants, autologous dentin graft, antidepressant medication, and biomechanical analysis. The studies offer valuable insights for clinicians and researchers in the field. One study found that both cemented and screw-retained crowns had similar clinical outcomes, but screw-retained crowns had a higher incidence of technical complications. Clinicians should consider these potential complications when choosing a method for single implant restorations in the maxilla. Overall, the studies demonstrate positive outcomes and provide valuable insights into dental implant procedures. [Extracted from the article]

Objective: The aims of this clinical trial were to evaluate the radiographic dimensional changes in alveolar ridge and patient‐reported outcomes following tooth extraction and alveolar ridge preservation (ARP) using either deproteinized bovine bone mineral (DBBM) with EMD or DBBM alone. Methods: Participants requiring at least one posterior tooth extraction and ARP were randomly allocated into two treatment groups: ARP using either DBBM with EMD or DBBM alone. Cone‐beam computed tomography (CBCT) images were recorded immediately prior to extraction and at 6 months. Changes in alveolar ridge height (ARH) and alveolar ridge width (ARW) at 1, 3, and 5 mm were recorded. Results: A total of 18 participants with 25 preserved sites were evaluated. ARH and ARW changed significantly from baseline to 6 months for both treatment groups but the difference between the groups was not statistically significant over the 6‐month follow‐up period (ARH: DBBM/EMD 1.26 ± 1.53 mm vs. DBBM 2.26 ± 1.60 mm; ARW‐1 DBBM/EMD 1.98 ± 1.80 mm vs. DBBM 2.34 ± 1.89 mm). A significant difference, favoring DBBM with EMD group, was observed in percentage of sites that had less than 1 mm loss in ARH (54.5% sites in DBBM/EMD group vs. 14.3% sites in DBBM alone group). The participants' perception of bruising, bleeding, and pain in the first two postoperative days was significantly in favor of DBBM alone group. Conclusions: There were no significant differences in radiographic mean measurements of ARH and ARW following ARB with DBBM and EMD or DBBM alone. [ABSTRACT FROM AUTHOR]

Aim: To compare, at different levels from the alveolar crest, the radiographic outcomes of equine‐derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone blocks (ABB) used for lateral alveolar ridge augmentation. Materials and Methods: Sixty‐four patients with tooth gaps in atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. The lateral bone thickness (LBT) was measured 2, 4, 6, 8, and 10 mm below the alveolar crest using CBCT scans obtained before augmentation surgery and at 30 weeks, prior to implant placement. Statistical analysis was performed using Shapiro–Wilk, Fisher's exact, Mann–Whitney, and Wilcoxon signed‐rank tests. Results: Both CXBB and ABB resulted in significant total and buccal LBT gains at 2, 4, 6, 8, and 10 mm. LBT gains were similar between CXBB‐ and ABB‐augmented sites, except for greater buccal LBT gains at 8 mm at CXBB‐augmented sites. While ABB‐augmented sites gained vertical bone height, CXBB‐treated sites suffered vertical bone loss (CXBB: −0.16 mm; ABB: 0.38 mm, p <.0009). Conclusions: CXBB and ABB were both associated with significant and similar LBT gains at 30 weeks. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of metal artefact reduction (MAR) in the diagnosis of dental implant contact with the mandibular canal (MC) using cone beam computed tomography (CBCT). Methods: Dental implants were installed with surgical guides in the posterior hemiarches of 10 dry human mandibles: 0.5 mm above to the MC cortex (G1/n = 8) and 0.5 mm inside the MC (G2/n = 10). The experimental set‐up was scanned with two CBCT equipment using 85 kV and 90 kV, MAR ON or OFF, and different tube currents (4 mA, 8 mA and 10 mA). Two dentomaxillofacial radiologists (DMFRs) and two dentists (DDS) scored the relation between the dental implant and MC. Descriptive statistics were used to observe the absolute frequency of scores. Sensitivity, specificity and accuracy were calculated considering the known relation between the dental implant and the MC interior. McNemar's test (α =.05) was applied to compare the diagnostic efficacy of MAR ON versus MAR OFF. Results: Overall specificity was higher than sensitivity for both DDS and DMFR (97% vs. 50% and 92.0% vs. 78.0% respectively). There was a significant effect of MAR (p =.031) for DMFR in the case of contact between the dental implant with the MC interior, in which sensitivity decreased with MAR activation from 90% to 40%. DMFR observers showed a better diagnostic performance compared with the DDS observers (accuracy of 84.0% and 71.0%, respectively). Conclusions: Due to the limited efficacy of MAR, it should not be used when conducting CBCT scans for the evaluation of contact between the implant and the mandibular canal. [ABSTRACT FROM AUTHOR]

Aim: To assess in vitro the workflow for alveolar ridge augmentation with customised 3D printed block grafts and simultaneous computer‐assisted implant planning and placement. Methods: Twenty resin mandible models with an edentulous area and horizontal ridge defect in the region 34–36 were scanned with cone beam computed tomography (CBCT). A block graft for horizontal ridge augmentation in the region 34–36 and an implant in the position 35 were digitally planned. Twenty block grafts were 3D printed out of resin and one template for guided implant placement were stereolithographically produced. The resin block grafts were positioned onto the ridge defects and stabilised with two fixation screws each. Subsequently, one implant was inserted in the position 35 through the corresponding template for guided implant placement. Optical scans of the study models together with the fixated block graft were performed prior to and after implant placement. The scans taken after block grafting were superimposed with the virtual block grafting plan through a best‐fit algorithm, and the linear deviation between the planned and the achieved block positions was calculated. The precision of the block fixation was obtained by superimposing the 20 scans taken after grafting and calculating the deviation between the corresponding resin blocks. The superimposition between the scans taken after and prior to implant placement was performed to measure a possible displacement in the block position induced by guided implant placement. The (98–2%)/2 percentile value was determined as a parameter for surface deviation. Results: The mean deviation in the position of the block graft compared to the virtual plan amounted to 0.79 ± 0.13 mm. The mean deviation between the positions of the 20 block grafts measured 0.47 ± 0.2 mm, indicating a clinically acceptable precision. Guided implant placement induced a mean shift of 0.16 ± 0.06 mm in the position of the block graft. Conclusions: Within the limitations of this in vitro study, it can be concluded that customised block grafts fabricated through CBCT, computer‐assisted design and 3D printing allow alveolar ridge augmentation with clinically acceptable predictability and reproducibility. Computer‐assisted implant planning and placement can be performed simultaneously with computer‐assisted block grafting leading to clinically non‐relevant dislocation of block grafts. [ABSTRACT FROM AUTHOR]

Objectives: To develop and assess the performance of a novel artificial intelligence (AI)‐driven convolutional neural network (CNN)‐based tool for automated three‐dimensional (3D) maxillary alveolar bone segmentation on cone‐beam computed tomography (CBCT) images. Materials and Methods: A total of 141 CBCT scans were collected for performing training (n = 99), validation (n = 12), and testing (n = 30) of the CNN model for automated segmentation of the maxillary alveolar bone and its crestal contour. Following automated segmentation, the 3D models with under‐ or overestimated segmentations were refined by an expert for generating a refined‐AI (R‐AI) segmentation. The overall performance of CNN model was assessed. Also, 30% of the testing sample was randomly selected and manually segmented to compare the accuracy of AI and manual segmentation. Additionally, the time required to generate a 3D model was recorded in seconds (s). Results: The accuracy metrics of automated segmentation showed an excellent range of values for all accuracy metrics. However, the manual method (95% HD: 0.20 ± 0.05 mm; IoU: 95% ± 3.0; DSC: 97% ± 2.0) showed slightly better performance than the AI segmentation (95% HD: 0.27 ± 0.03 mm; IoU: 92% ± 1.0; DSC: 96% ± 1.0). There was a statistically significant difference of the time‐consumed among the segmentation methods (p <.001). The AI‐driven segmentation (51.5 ± 10.9 s) was 116 times faster than the manual segmentation (5973.3 ± 623.6 s). The R‐AI method showed intermediate time‐consumed (1666.7 ± 588.5 s). Conclusion: Although the manual segmentation showed slightly better performance, the novel CNN‐based tool also provided a highly accurate segmentation of the maxillary alveolar bone and its crestal contour consuming 116 times less than the manual approach. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the effect of aging on the changes in implant stability over time following implant placement. Materials and methods: A total of 104 patients in four age ranges (group 1: <60 years, group 2: 61–70 years, group 3: 71–80 years, and group 4: >80 years) were included. Bone‐level tapered implants were placed without implementing any bone augmentation procedure. The final torque value displayed on the implant engine during implant insertion was recorded. Cone‐beam computed tomography (CBCT) was performed immediately after surgery to analyze the bone quality around the implant. Implant stability was measured immediately after surgery and 2, 4, and 8 weeks after surgery. Results: In the CBCT image, higher grayscale values were observed in the order of group 1, group 2, and groups 3/4, with statistical significance (p <.05). There was no significant difference in the insertion torque values between age groups (p ≥.05). Groups 1 and 2 showed lower implant stability values after 2 and 4 weeks compared to immediately and 8 weeks after surgery (p <.05); however, groups 3 and 4 showed no significant difference between the results measured at different timepoints (p ≥.05). Conclusions: Implant treatment in elderly patients is successful showing a settled implant stability over time following implant placement when the implant is appropriately engaged in the alveolar bone in the absence of bone augmentation. [ABSTRACT FROM AUTHOR]

Objective: To present the results of guided bone regeneration (GBR) with three‐dimensional printing individualized titanium mesh (3D‐PITM) applied to alveolar bone defects with different Terheyden classifications and the factors affecting the osteogenic outcome. Materials and Methods: Fifty‐nine patients, presenting with 61 defect sites, were enrolled between 2018 and 2021. GBR+3D‐PITM was obtained with simultaneous or second stage implant placement. The complication rate, the success rate of the bone grafting procedure and the survival rate of the implant were documented. Bone gain, thickness of pseudo‐periosteum and peri‐implant marginal bone loss (MBL) were measured through digital methods by imaging data (CBCT and X‐ray). Results: Out of 61 sites, 20 were exposed (exposure rate: 32.8%). The width, height, and volume bone gain at P3 (mesh removal) were 5.22 ± 3.19 mm, 5.01 ± 2.83 mm, and 588.91 ± 361.23 mm3, respectively. From P2 (3D‐PITM+GBR) to P3, changes in bone gain were not statistically different in the different Terheyden classifications, the occurrence of exposure (p <.001 for all dimensions) and the different type of pseudo‐periosteum (p =.030 for width and p =.002 for height) were significantly correlated with the reduction of bone gain. Terheyden classification of the defect sites was significantly associated with the occurrence of exposure (p =.014) and types of the pseudo‐periosteum (p =.015). Conclusion: The 3D‐PITM can be used in alveolar bone defects with different Terheyden classification, but cases with severe vertical bone defects have a greater chance of the 3D‐PITM exposure and the exposure can affect the outcome of bone augmentation. [ABSTRACT FROM AUTHOR]

Objective: The present study was conducted to evaluate the effect of soft tissue augmentation using a self‐inflating soft tissue expander when performed before horizontal alveolar ridge augmentation on the outcomes of the bone augmentation procedure. The primary outcome is the bucco‐palatal radiographical changes in alveolar ridge width, while the secondary outcome is the quality of the augmented bone assessed histomorphometrically. Materials and Methods: Sixteen patients underwent horizontal alveolar ridge augmentation using autogenous bone. For the test group, soft tissue expanders were used in a separate surgery before bone grafting surgery. For the control group, patients received treatment including single surgery of bone grafting associated with periosteal releasing incision. Implants were placed in both groups 6 months after bone augmentation. Bucco‐palatal changes in alveolar ridge width were evaluated via cone‐beam computed tomography. Augmented bone quality was assessed histomorphometrically. Results: After 6 months, regarding radiographic bone width, there was no statistically significant difference between the two groups, as mean bone width in group I and group II were 8.57 mm and 8.75 mm, respectively. Regarding histomorphometric analysis, Group I showed significantly higher mean bone surface area fraction, higher median mature collagen area fraction, and higher median blood vessel count than Group II (p‐value =.012), (p‐value =.004), and (p‐value =.014), respectively. Conclusion: Within the limitations of the present study, soft tissue expander has no influence on bone width gain after horizontal alveolar ridge augmentation with an autogenous bone block but may have a positive effect on the quality of augmented bone. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the associations between the cortical bone‐to‐implant contact (CBIC), bone microstructure derived from cone‐beam computed tomography (CBCT), and the primary stability of the implant. Materials and Methods: Twenty‐two patients with 65 implants were enrolled in this study. The peak insertion torque values (ITVs) were measured during implant insertion, and the implant stability quotient (ISQ) values were measured immediately after implant placement and 3 months after surgery. The profiles of the peri‐implant bone structure were outlined using the volumetric reconstruction of the CBCTs and superimposition of the virtual models, and the features of CBIC and bone microstructure parameters were measured. The linear mixed effects model and generalized estimating equation were used to explore the predictors for implant primary stability. Results: The average ITV, baseline, and secondary ISQ values were 31.44 ± 6.54 N·cm, 73.34 ± 7.39, and 80.32 ± 4.58, respectively. Statistically significant correlations were found between ITV and surface area of CBIC (r =.340, p =.006), bone volume fraction (r =.294, p =.017), and bone surface fraction (r = −.278, p =.039). Implants with buccolingual CBIC had a higher ITV than implants without CBIC (p =.016). None of the parameters were associated with baseline and secondary ISQ values in generalized estimating equation analysis (all p >.05). Conclusions: Within the limitations of the study, preoperative CBCT measurements might enable the prediction of ITV and therefore of implant primary stability values. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the accuracy of a miniaturized dynamic navigation system with intraoral markers and two different workflows for dental implantation and to compare with static computer‐assisted implant surgery (sCAIS) surgery. Materials and Methods: Two operators performed a total of 270 implant insertions in polyurethane mandibular models under simulated clinical conditions. Implants were placed after CBCT‐based virtual planning in three different groups: two workflows utilizing dynamic computer‐assisted implant surgery (dCAIS; DG1: marker in CBCT; DG2: 3D‐printed marker) and the others with sCAIS (TG: template guided). Postoperative surface scans were matched to the planning data and allowed an evaluation of the angular and spatial deviation between the planned and the actually achieved implant position. Descriptive statistics were followed by a Mixed Model Analysis to determine the influence of the operator, the method, and operating area on different accuracy parameters and the random effect of the model number. Results: The mean angular deviation ranged from 2.26° (DG1) to 2.96° (TG). The mean 3D deviation at the implant's tip ranged from 1.08 mm (TG) to 1.51 mm (DG2) and at the implant's base from 0.69 mm (TG) to 1.49 mm (DG2). The operator showed no significant influence on the accuracy. The method showed significant influence on singular parameters and the operating area on all spatial accuracy parameters. Conclusions: Dynamic navigation systems with intraoral markers enable accurate implant positioning, which is comparable to the static‐guided implant surgery. 3D‐printed markers provide less accurate results compared to prefabricated markers, attached before CBCT scan. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to evaluate the radiographic changes in sinus mucosal thickness (SMT) in patients with mucosal thickening of odontogenic origin after maxillary molar extraction and lateral sinus augmentation with simultaneous surgical drainage and implant placement. Materials and Methods: Forty‐six patients were included in this study. The changes in SMT were evaluated using cone‐beam computed tomography images produced at four time points: before extraction (T0), before surgery (T1), immediately after surgery (T2), and after prosthesis delivery (T3), and statistical differences between time points were analyzed. The changes in SMT and augmented bone height (ABH) regarding the reason of extraction, smoking, ostial patency, and the presence of postoperative sinusitis were also evaluated. Results: Over time points, SMT gradually decreased (T0: 19.44 ± 9.22 mm, T1: 15.10 ± 8.89 mm, T2: 8.42 ± 6.01 mm, and T3: 4.16 ± 4.91 mm) (p <.05). Five out of 6 patients with ostial obstruction at T1 presented ostial patency at T3. Two patients developed postoperative sinusitis but recovered with medication. Ostial patency at T1, SMT at T1, and reason of extraction did not statistically significantly influence SMT at T3. SMT at T1 had no statistically significant impact on ABH change between T2 and T3. Conclusion: Sinus mucosal thickness was gradually reduced by extraction of compromised teeth and drainage during lateral sinus augmentation. The drainage contributed more to the reduction in SMT. [ABSTRACT FROM AUTHOR]

Objectives: Registration of intra‐oral surface scans to cone beam computer tomography (CBCT) is critical in the digital workflow for static computer‐aided implant surgery (sCAIS). This study aimed to assess the impact of CBCT field of view (FoV) on the precision of digital intra‐oral scan registration. Materials and Methods: Cone beam computer tomography data and intra‐oral scans from 20 patients were included. Small FoV CBCT's were created by digitally segmenting a large FoV into three sextants. Virtual implant planning was performed. Digital intra‐oral scans were repeatedly registered onto their corresponding large and small FoV CBCT datasets. The distances and angulations between the matching implant positions of each repeated registration were used to determine the precision of the registration process. Wilcoxon Signed Rank Paired Tests were used to compare the differences between large FoV and small FoV. The threshold for statistical significance was set at p =.05. Results: Differences in 3D implant position based on the registration precision between small FoV and large FoV present at both the implant entry point (0.37 ± 0.25 mm vs 0.35 ± 0.23 mm, p =.482) and implant tip (0.49 ± 0.34 mm vs 0.37 ± 0.24 mm, p <.001). Differences in overall angular precision were observed between small FOV and large FoV (1.43 ± 1.36° vs 0.51 ± 0.38°, p <.001). Conclusion: CBCT with a small FoV is accompanied by greater precision errors in intra‐oral scan registration. However, when sufficient well‐distributed teeth are visible in small FoV CBCT, the precision of digital intra‐oral scan registration appears to be within clinically acceptable limits for sCAIS. [ABSTRACT FROM AUTHOR]

Aim: To assess, in vitro, variables potentially influencing implant blooming using a human‐like imaging phantom and 3D‐printed mandibles. Material and Methods: Sixty implants were inserted in 3D‐printed mandibles in 26 different configurations in order to examine the impact of implant diameter, presence of a cover screw, implant design/material, implant position, and the presence of additional implants on implant blooming using two cone‐beam computed tomography (CBCT) devices (Accuitomo [ACC] and NewTom [NWT]). Two observers measured the amount of implant blooming in both buccolingual and mesiodistal directions. Inter‐rater agreement and descriptive statistics, grouped by implant characteristic and CBCT device, were calculated. Results: Both CBCT devices increased implant diameter (a mean increase of 9.2% and 11.8% for titanium, 20.3% and 24.4% for zirconium, for ACC and NWT, respectively). An increase in implant diameter did not increase the amount of blooming, whereas placing a cover screw did (from 8.0% to 10.9% for ACC, and from 10.0% to 15.6% for NWT). Moreover, implant design, anatomical region, and the presence of another implant also affected the extent of the blooming. Conclusions: Dental implants show a clear diameter increase on CBCT, with the effect being more pronounced for zirconium than for titanium implants. Similar effects are likely to occur in the clinical setting, potentially masking nonosseointegration, reducing the dimensions of peri‐implant defects, and/or causing underestimation of the buccal bone thickness. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of reducing the radiographic field of view (FOV) on the trueness and precision of the alignment between cone beam computed tomography (CBCT) and intraoral scanning data for implant planning. Materials and Methods: Fifteen participants presenting with one of three clinical scenarios: single tooth loss (ST, n = 5), multiple missing teeth (MT, n = 5) and presence of radiographic artifacts (AR, n = 5) were included. CBCT volumes covering the full arch (FA) were reduced to the quadrant (Q) or the adjacent tooth/teeth (A). Two operators, an expert (exp) in virtual implant planning and an inexperienced clinician, performed multiple superimpositions, with FA‐exp serving as a reference. The deviations were calculated at the implant apex and shoulder levels. Thereafter, linear mixed models were adapted to investigate the influence of FOV on discrepancies. Results: Evaluation of trueness compared to FA‐exp resulted in the largest mean (AR‐A: 0.10 ± 0.33 mm) and single maximum discrepancy (AR‐Q: 1.44 mm) in the presence of artifacts. Furthermore, for the ST group, the largest mean error (−0.06 ± 0.2 mm, shoulder) was calculated with the FA‐FOV, while for MT, with the intermediate volume (−0.07 ± 0.24 mm, Q). In terms of precision, the mean SD intervals were ≤0.25 mm (A‐exp). Precision was influenced by FOV volume (FA < Q < A) but not by operator expertise. Conclusions: For single posterior missing teeth, an extended FOV does not improve registration accuracy. However, in the presence of artifacts or multiple missing posterior teeth, caution is recommended when reducing FOV. [ABSTRACT FROM AUTHOR]