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This retrospective study compared clinical, radiological, and patient- and clinician-reported outcomes between immediate and delayed implants placed in patients with tooth agenesis as part of one-stage implant therapy with a split-mouth design. A total of 12 sites of permanent tooth agenesis in five patients received 12 implants (2.4 implants per patient), six being immediate implants in deciduous teeth post-extraction sites, and six being late implants replacing already extracted or spontaneously lost deciduous teeth. Data reporting was performed descriptively without statistical comparative analysis between study groups. Radiographic crestal bone level changes between the time of surgery and 1-year post-surgery did not indicate any marked difference between treatment groups. Patient-reported outcomes related to post-surgical pain and patient preference indicated less pain in immediately treated sites, resulting in a corresponding patient preference related to this treatment modality. Clinician-rated satisfaction levels did not differ. The results of this pilot study support the use of immediate implant placement as a suitable procedure in cases of tooth agenesis.

Purpose The aim of this study was to analyze the role and capacity of internal irrigation compared to external irrigation and, when applicable, combined irrigation to reduce and control bone heating during implant bed preparation. Methods This systematic review was conducted according to predefined inclusion and exclusion criteria. A comprehensive literature search was performed in PubMed, Embase, Cochrane, Web of Science, and Google Scholar up to September 2025. Studies evaluating irrigation methods during implant osteotomy were included. Screening, selection, and risk of bias assessment were performed following a standardized protocol. Results 201 records were found. After deduplication, screening, and full-text evaluation, 10 in vitro studies were included for qualitative analysis and evaluation of risk of bias. At the same time, no animal studies fully met the inclusion criteria, and no randomized clinical trials were identified. Reports show that the peak temperature changes (ΔT) varied substantially, from 1.48 to 75.4 °C. Conclusion In most studies, internal irrigation was shown to have superior cooling efficiency during the implant bed preparation compared to external irrigation, particularly in deeper osteotomies or when surgical guides were used. Combined irrigation also appeared to be a beneficial method. However, its performance varied depending on drill design and experimental setup. Risk of bias, assessed with the QUIN tool, was moderate to high, reflecting heterogeneity in study model, sampling, and reporting. Within the limitations of current evidence, internal irrigation emerges as an efficient method to control thermal and heat elevation during implant osteotomy.

Dental implant placement has evolved from conventional freehand techniques toward digitally guided workflows integrating cone-beam computed tomography (CBCT), computer-aided design/computer-aided manufacturing (CAD/CAM), and dynamic navigation systems. Although guided surgery improves positional accuracy, its clinical relevance compared with freehand placement remains debated. This narrative review, based on a systematic and structured literature search following predefined selection criteria, analyzes studies published between 2000 and 2025 comparing guided and freehand implant placement regarding accuracy, survival, complications, biological outcomes, and workflow efficiency. Searches of PubMed/MEDLINE, Embase, and Web of Science identified 40 eligible human clinical studies for qualitative synthesis. Guided placement consistently demonstrated greater positional accuracy, with angular deviations of approximately 2–4° versus 5–9° for freehand placement and linear deviations reduced by about 1 mm. Nevertheless, implant survival rates were high and comparable for both techniques, generally exceeding 95% across short- and medium-term follow-up. Overall complication rates were low; guided approaches reduced anatomical risk and improved prosthetic predictability in complex or multi-implant cases, while freehand placement allowed greater intraoperative flexibility and tactile feedback, potentially optimizing primary stability in variable bone conditions. Marginal bone loss and peri-implant tissue outcomes were similar between approaches. Guided workflows required additional planning time and costs but enhanced reproducibility in complex rehabilitations. Guided and freehand implant placement should therefore be considered complementary strategies, with optimal outcomes depending on case selection, surgical expertise, and the balanced integration of digital technologies into contemporary implant practice.