In single-tooth replacement in the aesthetic zone, extensive bone defects require alveolar ridge reconstruction. A digital workflow involving CBCT and intraoral optical scanning enables a three-dimensional assessment, prosthetically driven implant positioning, computer-assisted implant surgery, and prefabrication of a temporary restoration for immediate provisionalization. The aim of this study was to assess the clinical, aesthetic, radiographic, and patient-reported outcomes of delayed implant placement and immediate provisionalization in reconstructed alveolar ridges using a digital workflow. In a prospective case series, 30 patients with a > 5 mm buccal bone defect underwent alveolar ridge reconstruction. After 4 months, implant placement was performed using a digital workflow, followed by immediate provisionalization with a prefabricated temporary restoration, and definitive restoration 3 months later. The clinical, aesthetic, radiographic, and patient-reported outcomes were assessed pre-treatment, 6 weeks after provisionalization, and 1 month and 1 year following definitive restoration. Wound healing was uneventful in 90% of cases (10% showed mild oedema). One early implant failure occurred (implant survival rate 97%). After 1 year, restoration survival and success rates were 100% and 97%. Peri-implant tissues were mainly healthy. The mean (SD) Pink and White Esthetic Score (scale 0-20) was 14.0 (2.9). The mean (SD) marginal bone level change was -0.25 mm (0.38) mesially and -0.21 mm (0.45) distally. The median buccal bone thickness was > 1.5 mm. Patient satisfaction (scale 0-10) was 9.3 (0.9). A digital workflow offers favorable short-term clinical, aesthetic, radiographic, and patient-reported outcomes for single-tooth implants after alveolar ridge reconstruction. Registered in the National Trial Register: NL8264.

To evaluate whether placing single dental implants either 0.5 or 1.5 mm subcrestally in healed bone crests confers any clinical benefits. Sixty partially edentulous patients requiring two single implant-supported crowns were enrolled in a split-mouth design across six centres. Each site was randomly assigned to receive an implant placed either 0.5 or 1.5 mm subcrestally. Patients were followed up to 10 years post-loading. Outcome measures included crown and implant failures, complications, aesthetics assessed using the Pink Esthetic Score (PES), peri-implant marginal bone level changes, and patient preference. Eight patients were lost to follow-up. No statistically significant differences were observed between groups regarding implant failures (7 vs. 3; p = 0.125), patients experiencing complications (10 [18.5%] vs. 7 [13%]; p = 0.508), PES (7.66 ± 3.14 vs. 7.46 ± 2.97, p = 0.510). Ten years post-loading, patients in the 0.5 mm group exhibited an average marginal bone loss of 0.38 ± 0.84 mm, while those in the 1.5 mm group showed 0.17 ± 0.45 mm, a difference that was not statistically significant (difference = -0.21 mm; 95% CI -0.47 to 0.04; p = 0.097). No patient preference for implant placement depth was noted. No significant differences in outcomes were found between centres. Subcrestal implant placement at either 0.5 or 1.5 mm, when at least 1 mm of surrounding bone is present, seems not to affect the long-term outcomes.

To evaluate the effect of a cellulose-based oral wound dressing (OWD) stabilized with flowable resin (FR), in combination with hemostatic sponges, on patient-reported outcomes (PROMs) after palatal graft harvesting. This randomized clinical trial included patients requiring soft tissue augmentation with dental implants. Participants were allocated to three groups: OWD and FR (OWDFR), cyanoacrylate (CY), or palatal plate (PP). The primary outcome was postoperative pain, assessed with a 10-cm visual analog scale (VAS) over 14 days. Secondary outcomes were analgesic consumption, oral health-related quality of life (OHIP-14), postoperative bleeding, and willingness to repeat the procedure. Sixty-one patients were enrolled. The OWDFR group reported lower VAS values on Days 1, 2, 3, and 7 compared with CY and PP (p < 0.05). On Day 2, VAS scores were significantly lower in OWDFR, with mean differences of -1.94 versus CY and -2.12 versus PP (p < 0.01). Analgesic intake differed significantly on Days 3 and 5; on Day 3, OWDFR consumed -0.89 tablets compared to PP and CY consumed -0.95 tablets compared to PP (both p < 0.05). OHIP-14 scores were similar across groups, but OWDFR patients reported greater early postoperative comfort. No bleeding or adverse events occurred. All OWDFR patients were willing to repeat the procedure, compared with 90% in CY and 85% in PP. The combination of a bioadhesive OWD with FR appears to be a safe and minimally invasive method for protecting palatal donor sites. It reduces postoperative pain and analgesic use while enhancing comfort, supporting its incorporation into routine clinical protocols. Protocol registered at clinicaltrials.gov (NCT06408792).

This retrospective study primarily evaluated whether early radiographic bone loss (ERBL) predicts progressive bone loss (PBL), and secondarily assessed its association with implant survival and peri-implant diseases. Adults with dental implants who were followed for at least 5 years were included. Implants presenting ERBL, defined as apical migration of the interproximal marginal bone involving exposure of the implant rough surface before insertion of the final prosthesis, were classified as ERBL+; non-exposure group was defined as implants without evidence of ERBL (ERBL-). Regression analyses were performed to evaluate associations with PBL. A total of 259 implants, 87 ERBL+, and 172 ERBL- were included. Mean follow-up periods were 8.8 ± 3.0 years for the ERBL+ and 11.5 ± 1.7 years for the ERBL-. ERBL+ exhibited significantly greater PBL than ERBL- (-1.6 ± 1.0 mm to -2.3 ± 1.7 mm vs. -0.4 ± 1.2 mm to -0.5 ± 1.2 mm; p < 0.001). Implant survival was lower in ERBL+ (67.8%) compared with ERBL- (98.3%; p < 0.001). Peri-implantitis was diagnosed in 63.2% of implants in the ERBL- group versus 5.2% in ERBL- (p < 0.001), and 68.4% of patients versus 6.1% of ERBL- (p < 0.001). ERBL was the strongest predictor of greater PBL (+1.46 mm; p < 0.0001). Male sex (+0.40 mm; p = 0.02), smoking (+0.61 mm; p = 0.004), each additional implant (+0.17 mm; p < 0.0001), single-crown restorations (+0.66 mm; p = 0.005), and bone-level implants (+0.32 mm; p = 0.005) were associated with increased PBL. ERBL is a strong predictor of PBL and is associated with a higher risk of implant loss and peri-implantitis onset.

To investigate longitudinal changes in the submucosal peri-implant microbiome during early healing and long-term maturation, and their association with clinical and radiographic outcomes. This is the 3-year follow-up of a subset of individuals from a randomized controlled clinical trial. Marginal bone level changes (MBL) were measured at implant placement, loading, 12 months, and 3 years; clinical parameters were recorded at 12 months and 3 years. Submucosal plaque samples were collected at 1 week, 4 weeks, and 3 years post-implantation and analyzed by 16S rRNA gene sequencing. Microbial diversity, composition, and co-occurrence networks were evaluated. Twenty-seven patients (64 implants) completed the 3-year visit. At 3 years, peri-implant clinical conditions and MBL remained stable across visits, although early supracrestal remodeling was observed. The incidence of peri-implant mucositis was 14.8% and peri-implantitis 11.1% at patient-level. Microbiome richness and phylogenetic diversity increased over time (p < 0.0001). Early biofilms were dominated by facultative anaerobes (e.g., Haemophilus parainfluenzae, Neisseria elongata), which declined at 3 years, when anaerobic/proteolytic taxa (e.g., Prevotella, Porphyromonas gingivalis, Fusobacterium nucleatum) became more prominent. Presence/absence analyses at 3 years showed persistence of early colonizers alongside the integration of later-arriving species. Lactococcus lactis and Enterococcus italicus increased in abundance and occupied more central positions in co-occurrence networks. Over 3 years, the peri-implant microbiome matured into a more diverse and structured community, while MBL remained stable with physiological early supracrestal remodeling. These longitudinal findings suggest that early colonization and its subsequent evolution may influence long-term peri-implant health.

To identify patient-reported outcomes (PROs) and clinician-reported outcomes (ClinROs) and their outcome measures (PROMs and CROMs) used in prospective studies comparing immediate, early, and delayed implant loading protocols in edentulous maxilla patients receiving implant-supported prostheses. Protocol-driven electronic searches were conducted across MEDLINE, Embase, Scopus, Web of Science, Cochrane databases-January 2014 to May 2024-to identify prospective interventional and observational studies comparing immediate, early, delayed implant loading in maxillary edentulous patients. Zygomatic implants were excluded. Risk of bias was performed using Cochrane RoB 2 and ROBINS-I, and results were reported descriptively. Five studies were included, of which four compared immediate versus delayed loading and one study compared immediate versus early loading. PROMs like visual analog scale (VAS) tool (reported in 80%) to evaluate 7 PROs: pain, overall satisfaction, comfort, speech, masticatory function, esthetics, and self-esteem. Three studies reported Oral Health Impact Profile (OHIP-19, OHIP-20), McGill Pain Questionnaire, and condition-specific instruments assessing two outcomes: chewing ability and muscular activity during oral functions. ClinROs varied considerably between studies, demonstrating significant methodological diversity. ClinROs included implant stability, accuracy, occlusal parameters, periodontal health metrics, surgical outcomes, and esthetic evaluation via VAS. PROs were predominantly assessed using VAS to evaluate patient satisfaction, pain, function, and esthetics, followed by the OHIP Questionnaire for quality-of-life assessment in immediate versus early/delayed loading protocols. ClinROs showed no standardized approach, creating significant heterogeneity in the reported outcomes. Standardization of assessment methods and reporting of PROMs/CROMs is needed to optimize analyzing patient-centered outcomes.

To identify patient- and clinician-reported outcomes (PROs and ClinROs) and methods of assessment in clinical trials involving short and/or standard-length and/or zygomatic implants supporting maxillary implant overdentures (IODs). A systematic search was conducted in PubMed, EMBASE, Scopus, Web of Science CENTRAL, and National clinical trial register for articles published between January 1, 2014, and March 23, 2024. Studies that included PROs and ClinROs for implant therapy in patients with edentulous maxillae were eligible, and study quality was appraised using the Cochrane Risk of Bias 2 tool, Newcastle-Ottawa Scale, or Joanna Briggs Institute Critical tool. A total of 2331 articles were screened, resulting in 21 studies representing 14 patient cohorts with 462 participants and 2140 implants. Two studies used short implants (6 mm) with standard-length implants, while the remaining 19 studies focused exclusively on standard-length implants (7-14 mm); none included zygomatic implants. Patient-reported outcome measures (PROMs) varied widely: Oral Health Impact Profile questionnaires and visual analogue scales were each used in eight studies, and eleven studies relied on unstandardized questionnaires. Implant survival rate was the most frequently used ClinRO, included in all but one study. Subjective ClinROs based on clinician perception were absent in all studies. Although PROMs were frequently employed in clinical trials, the lack of standardization hinders meaningful comparisons across studies. While objective ClinROs were commonly reported, subjective ClinROs reflecting clinicians' perceptions were notably absent.

The objective of this RCT was to compare clinical and radiographic outcomes after immediate implant placement and temporization of two neck geometries: a traditional round neck (RN) and an innovative triangular neck (TN). Thirty-six patients were enrolled and randomly assigned to TN (test) or RN (control) groups for an immediate implant placement and provisionalization protocol in the anterior maxilla. Buccal bone width (BBW) was assessed by cone-beam computed tomography (CBCT) immediately after implant placement and 4 months later, when the definitive crown was placed. The following parameters were measured on the day of surgery: insertion torque (IT), implant stability quotient (ISQ), crestal width (CW), and soft tissue thickness (STT) at 3 and 5 mm from the gingival margin. Postoperatively, at 4 and 12 months, the MBL, pocket depth (PD), bleeding on probing (BOP), CW, and STT at 3 and 5 mm were recorded. Two implants per group failed to integrate; in both groups, 1 year implant survival and success rates were 88.9%. At 4 months, BBW was not significantly different between groups (p > 0.05). At 12 months, no significant differences were found in MBL, PD, BOP, CW, or STT (p > 0.05). This randomized trial did not demonstrate superiority of the triangular neck over the round neck at 12 months. Estimates and confidence intervals are compatible with small between-group differences. As the study was not designed or powered for equivalence, no equivalence claims are made. ClinicalTrials.gov identifier: NCT05944419.