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Background Implant placement in the posterior maxilla is challenging, so modifications of the surgical techniques were introduced to overcome these challenges. The undersized drilling technique uses a final drill smaller than the diameter of the implant. The single drilling technique is a simplified method where the osteotomy is made using a single drill without sequential widening. This study was directed to evaluate the peri-implant bone behavior of the undersized drilling technique versus the single drilling technique of immediately loaded dental implants inserted in the posterior maxilla. Patients and methods 32 patients were selected for prosthetic replacement of a missing maxillary posterior single tooth by an immediately loaded dental implant and divided randomly into two equal groups. In Group I: 16 patients received 16 implants using the undersized drilling technique, while in Group II: 16 patients received 16 implants using the single drilling technique. Insertion torque, implant stability, modified sulcus bleeding index (mBI), peri-implant probing depth, bone density, and marginal bone height were evaluated for both groups. Statistical analysis was made for clinical and radiographic data. Results 32 implants were inserted in the posterior maxilla. During a 12-month follow-up, every dental implant was successful with no complications. Both techniques showed high insertion torque (≥ 35 Ncm) and primary stability (> 70 ISQ) with no significant difference between the two groups ( P  > 0.05). Also, there were no significant differences between the study groups regarding peri-implant soft tissue health, bone density, and marginal bone loss ( P  > 0.05). Conclusion Both techniques revealed comparable, promising clinical and radiographic outcomes over a 12-month post-loading follow-up period when the immediate loading protocol was used in the posterior maxilla, where bone density is poor, but preparing the implant bed using the single drilling technique offers several merits for both the patient and clinician. In addition to avoiding excessive heat generation, mechanical damage, and high frictional forces during drilling procedures, surgical operations, and surgical site exposure take less time. Trial registration Clinical-Trials.gov PRS ( https://register.clinicaltrials.gov ) had this study registered under the identifier number. NCT06770231 on 01/01/2025.

Objectives To compare the implant stability quotient values (ISQ) of implants placed using implant‐specific drills (CD) and osseodensification drills (OD) at three different time points and to determine the effect of both drilling techniques on marginal bone levels. Material and Methods 38 subjects were recruited and ISQ values and radiographic marginal bone levels were recorded after surgery (T1), and also at 3 (T2) and 4–5 months (T3). Clinical and radiographic marginal bone levels were also recorded. Results At T1, mean ISQ values ranged from 65.5 to 81 for the CD group and 29 to 80 for the OD group. For the CD group, ISQ values were 72.20 ± 2.6 (95% CI) at T1, 75.0 ± 2.0 at T2, and 74.8 ± 2.3 at T3. The corresponding ISQ values for the OD group were 68.1 ± 5.6, 71.9 ± 1.6, and 72.2 ± 2.4, respectively. Implants placed using CD drills showed greater stability at 3 months but not at placement or at 4–5 months. No statistically significant differences were identified regarding marginal bone levels between the two groups. Conclusions There was a notable increase in implant stability over time for both treatment modalities. At T2, implants inserted into osteotomies made with standard drills exhibited significantly greater stability compared to those placed using OD drills. However, the clinical relevance of this difference is questionable, as it was not observed at T3. Marginal bone levels were comparable for both groups over all time points. Trial Registration ClinicalTrials.gov identifier: NCT05376020

DesignThe study conducted by Olmedo-Gaya et al. aimed to investigate the effects of various surgical techniques on the initial stability of implants placed in the posterior maxilla through a randomized controlled clinical trial. The study compared insertion torque (IT) and implant stability quotients (ISQ) among implants placed using under preparation, expanders, and standard surgical instrumentation.Case selectionThe study enrolled 108 patients, each receiving one implant in the posterior maxilla region. Patients were distributed into three groups: group 1 (n = 36) with the under preparation technique, group 2 (n = 36) using the expander technique, and group 3 (n = 36) with conventional drilling.Data analysisIT was measured using a torque indicator, while ISQ was recorded through resonance frequency analysis immediately post-surgery. The ISQ values were analyzed in relation to the patient’s bone quality, categorized into types II, III, and IV.ResultsISQ values varied significantly with bone quality, being highest in type II (76.65) and type III (73.60), and lowest in type IV (67.34) bone, with a significant difference (p < 0.0001). The conventional drilling technique yielded lower ISQ values (69.31) compared to under preparation (74.29) and expander techniques (73.99), with statistical significance (p = 0.008 and p = 0.005, respectively).ConclusionsSurgical technique significantly influences primary stability in low-quality bone. Conventional drilling results in lower ISQ values, suggesting that alternative techniques such as under preparation or expanders should be used in low-quality bone to achieve better primary stability.Clinical relevanceFor implants in low-quality bone, replacing the conventional drilling technique with under preparation or expander techniques can enhance primary stability.

Purpose To evaluate whether there are clinical benefits by preparing dental implant sites using piezosurgery instead of conventional rotary drills in healed bone crests and if initial crestal soft tissue thickness could have an impact on marginal bone loss. Methods Twenty-five partially edentulous patients requiring two single implants in molar/premolar areas had each site randomly allocated to either piezosurgery or to conventional rotary drill preparation according to a split-mouth design. Definitive screw-retained metal-ceramic crowns were delivered after 6 months. All patients were followed to 5 years after placement. Outcome measures were: implant/crown failures, complications, peri-implant marginal bone level changes, resonance frequency analysis (RFA), and time required to complete site preparation, recorded, when possible, by blinded assessors. Results No patients dropped-out and no implant failed. Five years after placement, there were no statistically significant differences for complications (only one complication in the piezo group: difference = 0.04; P = 1), for peri-implant bone loss (difference = −0.11 mm; 95% CI −0.24 to 0.01; P = 0.083), and for RFA changes (6 months) (difference = −0.35; 95% CI −1.95 to 1.25; P = 0.672 between groups). Significantly more time was needed to prepare implant sites with piezosurgery (difference = 236.8 s; 95% CI −286.12 to −187.48; P < 0.0001). Initial soft tissue thickness had no effect on peri-implant bone loss (estimate = 0.05; 95% CI −0.03; 0.12; P = 0.239). Conclusions No clinically appreciable differences were noticed when placing implants using piezosurgery or conventional instrumentation with rotary drill, however, the preparation with rotary drills was on average 4 min faster. No effect of initial crestal soft tissue thickness was observed on peri-implant bone loss.

Background Implant placement in the posterior maxilla is often complicated by the insufficient bone volume. While transalveolar sinus floor elevation (TSFE) has been proven as a predictable surgical procedure to increase the bone height in the posterior maxilla, questions in regard to the necessity of the bone grafting during the sinus lift and the question of whether TSFE could be performed when the residual bone height is below 5 mm are still debated. Furthermore, high-quality evidence comparing the clinical outcome of transalveolar sinus floor elevation with osteotome and modified sinus floor elevation with crestal non-cutting drills is limited. Methods/design One hundred twenty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology First Clinical Division (Beijing, China). All patients are assigned to one of four groups according to a table of random numbers. Participants will receive (1) TSFE using osteotomes with bone grafting, (2) TSFE using osteotomes without bone grafting, (3) modified TSFE with bone grafting, or (4) modified TSFE without bone grafting. In a one-year follow-up period, implant survival rates, complications, implant stability, bone remodeling around the implant, and patient-reported outcome (visual analog scale for intraoperative discomfort and postoperative pain) will be observed and documented. The implant stability will be gauged by the resonance frequency analysis six times (at baseline and weeks 6, 8, 12, 16, and 26), and the bone remodeling will be observed and compared via radiographic examinations. Discussion The result of the trial will potentially contribute to better decision making in atrophic posterior maxilla when implant placement is needed. Therefore, if the outcome is deemed favorable, the use of the modified TSFE would achieve an outcome equivalent to that of the traditional TSFE while introducing less trauma and postoperative discomforts. Separately, whether the bone graft procedure is necessary for the TSFE will also be discussed. Trial registration The study has been registered in ClinicalTrials.gov under the identifier number NCT03445039 . Registered on 26 February 2018.

Implant position is a key determinant of esthetic and functional success. Achieving the goal of ideal implant position may be affected by case selection, prosthodontically driven treatment planning, site preparation, surgeon's experience and use of a surgical guide. The combined effect of surgical guide design, surgeon's experience, and size of the edentulous area on the accuracy of implant placement was evaluated in a simulated clinical setting. Twenty-one volunteers were recruited to participate in the study. They were divided evenly into 3 groups (novice, intermediate, and experienced). Each surgeon placed implants in single and double sites using 4 different surgical guide designs (no guide, tube, channel, and guided) and written instructions describing the ideal implant positions. A definitive typodont was constructed that had 3 implants in prosthetically determined ideal positions of single and double sites. The position and angulation of implants placed by the surgeons in the duplicate typodonts was measured using a computerized coordinate measuring machine and compared to the definitive typodont. The mean absolute positional error for all guides was 0.273, 0.340, 0.197 mm in mesial-distal, buccal-lingual, vertical positions, respectively, with an overall range of 0.00 to 1.81 mm. The mean absolute angle error for all guides was 1.61° and 2.39° in the mesial-distal and buccal-lingual angulations, respectively, with an overall range of 0.01° to 9.7°. Surgical guide design had a statistically significant effect on the accuracy of implant placement regardless of the surgeon's experience level. Experienced surgeons had significantly less error in buccal-lingual angulation. The size of the edentulous sites was found to affect both implant angle and position significantly. The magnitude of error in position and angulation caused by surgical guide design, surgeon's experience, and site size reported in this study are possibly not large enough to be clinically significant; however, it is likely that errors would be magnified in clinical practice. Future research is recommended to evaluate the effect of surgical guide design in vivo on implant angulation and position error.

The choice of augmentation material is a crucial factor in sinus augmentation surgery. Bovine-derived hydroxyapatite (BHA) and beta-tricalcium phosphate (β-TCP) have been used successfully in sinus augmentation procedures. Choosing one of these materials for sinus augmentation is still controversial. The aim of this clinical study was to compare the biological performance of the new BHA graft material and the well-known synthetic β-TCP material in the sinus augmentation procedure. The study consisted of 23 patients (12 male and 11 female) who were either edentulous or partially edentulous in the posterior maxilla and required implant placement. A total of 23 two-step sinus-grafting procedures were performed. BHA was used in 13 patients, and β-TCP was used in 10 patients. After an average of 6.5 months of healing, bone biopsies were taken from the grafted areas. Undecalcified sections were prepared for histomorphometric analysis. The mean new bone formation was 30.13% ± 3.45% in the BHA group and 21.09% ± 2.86% in the β-TCP group ( P = .001). The mean percentage of residual graft particle area was 31.88% ± 6.05% and 34.05% ± 3.01% for the BHA group and β-TCP group, respectively ( P = .047). The mean percentage of soft-tissue area was 37.99% ± 5.92% in the BHA group and 44.86% ± 4.28% in the β-TCP group ( P = .011). Both graft materials demonstrated successful biocompatibility and osteoconductivity in the sinus augmentation procedure. However, BHA appears to be more efficient in osteoconduction when compared with β-TCP.

Objectives. The goal of this study was to evaluate bone changes around endosseous implants in partially edentulous patients. Materials and Methods. A total of 632 two-stage implants were placed in 252 patients. The implants had straight emergence profile, ZirTi surface, 3.3 to 5 mm diameter, and 8.5 to 13 mm length. Bone levels were assessed on orthopantomography immediately after surgery and after 36 months and marginal bone loss (MBL) was calculated from their difference. Results. Cumulative survival rate was 98.73%. Overall MBL was 0.8 mm ± 0.03 (mean ± SEM). Higher MBL was observed around implants in the maxilla than in the mandible (P<0.007). A relation between implant diameter and MBL (P<0.0001) was observed in male and, more limitedly, female patients. Older patients had higher MBL in the maxilla, but not in the mandible (P<0.0001). MBL progressively increased with age in male patients, but reached a peak already in the 50–60 years age group in the female subset (P<0.001). Conclusions. The overall MBL is consistent with the available literature. Site difference and patient age and gender appear to significantly affect MBL, representing important factors to be considered during implant placement.

Background Against the background of increasing use of dental implants, and thus an increasing prevalence of implant-associated complications, a deeper understanding of the biomolecular mechanisms in the peri-implant tissue is needed. Peri-implant soft tissue is in direct contact with transmucosal dental implant abutments. The aim of this trial is to distinguish the biomolecular and histological interactions of various dental abutment materials with peri-implant soft tissue. Methods/Design The study is designed as a prospective, randomized, investigator-initiated clinical pilot trial with blinded assessment. We will ultimately include 24 eligible patients who opt for implant treatment to replace a single missing posterior tooth. Three months after implantation (submerged procedure), the study begins with the second-stage surgery. Each of the 24 patients will be given three different transmucosal abutments (zirconia, lithium disilicate, titanium) consecutively. The sequence in which the three materials are used is randomized. Peri-implant crevicular fluid is sampled weekly around the respective abutment for biomolecular analyses. After one month of wearing time, the stamping press from the second-stage surgery is used to gain a narrow gingival ring biopsy around the abutment for immunohistochemical analyses. The next abutment is then inserted. The same procedure is used for all three abutments. After sampling is completed, the patients will receive a definitive crown. The primary outcome measure of the trial is biomolecular detection of specific markers in the peri-implant crevicular fluid: matrix metalloproteinase 8, interleukin- 1β, polymorphonuclear elastase, and myeloid-related protein MRP8/14 (calprotectin). Secondary outcome measures include immunohistochemical analyses and clinical parameters. Discussion The study design will allow us to perform correlation analyses between the clinical indices with biomarkers’ expression in the interface of the transmucosal abutments and the peri-implant soft tissue. A deeper understanding of the three abutment materials’ interactions with peri-implant soft tissue will help us understand the formation mechanisms of implant-associated complications and then develop prevention strategies. Trial registration The trial is registered at the German Clinical Trial Register and the International Clinical Trials Registry Platform by the WHO under DRKS00006555 (Registered on 27 October 2014).