Clark M. Stanford, DDS, PhD, MHA, University of Iowa

Serap Karakis Akcan, DDS, PhD1/Berceste Guler Ayyildiz, DDS, PhD2

Purpose: To compare the patient’s quality of life (QoL) after free gingival graft (FGG) application around teeth and implants and to evaluate the factors affecting it.

Materials and Methods: A total of 32 participants were included in the study, with FGG performed on 27 natural teeth in 16 patients (T-FGG group) and 24 implants in 16 patients (I-FGG group). QoL was assessed using the General Oral Health Assessment Index (GOHAI) at the following time points: preoperatively (T0), 7 days postoperatively (T7), and 1 month (T30) postoperatively. Patient satisfaction was evaluated at T30. Graft dimensions (height, width, thickness) and the operation time were recorded. Keratinized tissue width (KTW) was measured at baseline (T0) and at T30. Graft volume (GV) and vertical collapse rate (VCR) were also calculated for analysis.

Results: The GOHAI-total (GOHAI-T) scores were found to be higher at T7 and T30 in the I-FGG group than in the T-FGG group. Behavioral impact (GOHAI-BI) and functional limitation (GOHAI-FL) subscores were found to be significantly higher in the I-FGG than T-FGG group at 6 days postoperatively (T6) and T7. According to multiple linear regression analysis, the GOHAI score of female patients was 8.749 points higher than male patients at T7. Patients in the I-FGG group had a GOHAI score 5.488 points higher than that of the T-FGG group at T30 (P < .05). The VCR for the T-FGG and I-FGG groups was found to be 23.57% and 28.92%, respectively, and there was no statistically significant difference between the two (P > .05). VCR was positively correlated with GOHAI-BI for the T-FGG group and negatively correlated with GOHAI-FL for the I-FGG group at T30 (P < .05).

Conclusions: The negative effect of implant experience and female sex on QoL after FGG seems to be a stronger predictor than other clinical and intraoperative variables after the first month; however, the relationship with VCR and potential confounding factors still requires clarification. Int J Oral Maxillofac Implants 2025;40:670–682. doi: 10.11607/jomi.11118

Alessandro Pozzi, DDS, PhD1,2,3,4/Paolo Carosi, DDS, MSc, PhD1,5/Claudia Lorenzi, DDS, PhD1,5/James Chow, DDS6/Hom-Lay Wang, DDS, MS, PhD2/German O. Gallucci, DMD, PhD3

Purpose: To systematically analyze the accuracy of autonomous dental implant robotic (ADIR) surgery for dental implant placement.

Materials and Methods: PubMed, Embase, and Cochrane CENTRAL were searched on February 21, 2024. Any clinical studies, with the exception of case reports, assessing ADIR accuracy by superimposing preoperative digital planning with postoperative CBCT images were included. The risk of bias was assessed, and a meta-analysis was performed using a random-effects model to evaluate linear and angular deviations between planned and placed implants.

Results: Data from six clinical studies reporting ADIR accuracy in 96 patients with 299 dental implants were included (102 implants in 69 partially edentulous patients, 197 implants in 27 complete-arch scenarios). The meta-analysis at the implant level reported a mean overall accuracy of ADIR of 0.60 mm (95% CI [0.5133; 0.6965]) at the platform and 0.63 mm (95% CI [0.5663; 0.6909]) at the apex and 1.242 degrees (95% CI [1.2182; 1.6320]) of angular deviation. ADIR accuracy resulted in significantly higher values than static and dynamic computer-assisted implant surgery.

Conclusions: Within the limitations of this review, ADIR surgery has shown to be feasible for placing implants in both partially and completely edentulous patients, achieving consistent mean linear and angular deviations of approximately 0.6 mm and 1.40 degrees, respectively. However, clinical practicality of ADIR surgery remains cumbersome, with well-trained operators needed to plan and assist ADIR procedures as well as a technical expert providing backup control. Int J Oral Maxillofac Implants 2025;40:683–690. doi: 10.11607/jomi.11238.

Mohammed A. El-Sawy, BDS, MSc, PhD1/Hazem M. Abd El-Aziz, BDS2/Marwa A. Aboelez, BDS, MSc, PhD3/ Mohamed T. Khater, BDS, MSc, PhD4

Purpose: To report the implant survival rates and clinical and radiographic outcomes of patients with a short-span fixed partial denture (FPD) supported by two immediately placed implants in the anterior mandible after 5+ years in function.

Materials and Methods: A total of 100 individuals who had a short-span FPD supported by two immediately placed implants (n = 200) in the lateral incisor region of the mandible for long-term functional life with different loading protocols were chosen for this study. The participants were divided into the following three groups according to loading protocol after implant placement: group 1 immediate implant placement with loading protocol type A; group 2—immediate implant placement with loading protocol type B; and group 3—immediate implant placement with loading protocol type C. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), radiographic crestal bone level (CBL), and implant survival rate were evaluated.

Results: Three implants failed out of 200. The implants were in function an average of 7 years, and the overall survival rate was 98.5%. The mean PI was 24.86 in group 1, 24.45 in group 2, and 24.77 in group 3. Group 1 had a mean BOP of 29.48, group 2 had a mean BOP of 29.03, and group 3 had a mean BOP of 29.12. Group 1 had a mean PD of 2.03, group 2 had a mean PD of 2.09, and group 3 had a mean PD of 2.11. Additionally, group 1 had a mean radiographic CBL of 1.69 mm, group 2 had 1.56 mm, and group 3 had 1.57 mm. There was no significant difference among the three groups regarding PI, BOP, PD, CBL, or implant survival.

Conclusions: Within the limitations of this retrospective study, immediate loading for immediately placed dental implants in the mandibular lateral incisor region is a reliable dental rehabilitation option and represents a valid alternative to traditional delayed loading. Immediate implant placement with immediate loading can be advantageous for both patients and physicians. It can save cost and treatment time, and it might be a good alternative for patients who have high esthetic standards for their anterior mandible. Int J Oral Maxillofac Implants 2025;40:691–702. doi: 10.11607/jomi.11219

Ernesto Vatteroni, DDS1/Paolo Toti, BSc, DDS1/Ugo Covani, MD, DDS2,3/Roberto Crespi, MD, MSc2/Saverio Cosola, DDS, MSc, PhD1,3/Giovanni-Battista Menchini-Fabris, DDS1,4

Purpose: To conduct a radiologic and clinical evaluation of patients who underwent fixed rehabilitation involving subperiosteal implants and to define not only the criteria for failure but also the criteria for survival and success.

Materials and Methods: Patients suffering from severe atrophy of the maxilla and/or mandible underwent immediate loading with fixed full-arch prostheses supported by custom-made 3D-printed subperiosteal implants. The evaluated outcomes included the success and survival rates of subperiosteal implant prosthetic therapy, surgical complications, and the 3D positions of osteosynthesis screws and sleeves used for implant adhesion to the bone. The Stability, Inflammation, and Offset (SIO) criteria were used for evaluating the success, survival, or failure of subperiosteal implant-prosthetic rehabilitation. Success required no clinical mobility, asymptomatic soft tissues without recession, and no intraoperative deviations from virtual implant planning, whereas survival allowed transient micromovements, tissue recession without inflammation, and minimal postsurgical implant modifications. Persistent micromotion and implant removal due to esthetic dissatisfaction or fabrication of a new implant were classified as failures. Nonparametric tests were applied to the datasets with a significance level of P = .01.

Results: A total of 18 patients were followed up for 2 years; 11 implants were placed in the maxilla and 15 in the mandible. Temporary instability was observed in four subperiosteal implants, accounting for a survival rate of 84.6% (based on the stability criterion). Two patients suffered from peri-implant soft tissue recession at 2 years (inflammation criterion). Preoperative virtual implant positions and the achieved postoperative position of 189 titanium osteosynthesis screws and sleeves were analyzed: 98 buccal, 69 linguopalatal, and 22 in other areas. The overall linear sleeve misalignment was 1.66 ± 0.99 mm. Horizontal misalignment (1.46 ± 1.03 mm) was approximately three times greater than vertical misalignment (0.59 ± 0.21 mm), with a significant difference (P = .0004). One patient exhibited horizontal and overall misalignments exceeding the maximum threshold suitable for implant success (approximately 5 mm), resulting in 25 successful implants and only 1 surviving implant (offset criterion). No prostheses failed during the entire follow-up time, and no mechanical or functional complications were recorded. The cumulative survival rate was 100% at the 2-year follow-up.

Conclusions: The proposed SIO criteria defined success, survival, and failure for subperiosteal implant rehabilitation. Transient movements or infection events were classified as survival indicators, while negative offset results led implant survival but not success. The present virtual design and planning approach achieved a 73.1% success rate over 2 years, according to the SIO classification. Int J Oral Maxillofac Implants 2025;40:703–714. doi: 10.11607/jomi.11210

Khushboo Kalani, BDS1/Sandra Stuhr, DMD, MS1/Abdusalam Alrmali, BDS, MDS1,3/Dhiraj Mallela, BDS1/Jessica Latimer, DDS2/Hom-Lay Wang, DDS, MSD, PhD1/Muhammad H. A. Saleh, BDS, MSD, MS, PhD1

Purpose: To evaluate the frequency, timing, and financial implication of regenerative hard or soft tissue augmentation procedures (ReP) before and after implant placement, alongside the influence of systemic conditions on the need for additional interventions.

Materials and Methods: This cohort included patients who received implants with or without ReP at the University of Michigan Graduate School of Dentistry from 2011 to 2023. Data on demographics and systemic health conditions were collected and analyzed using univariate and multivariate logistic regression.

Results: A total of 4,803 patients (10,247 implants) were included—48.9% of the patients and 21.7% of the implants received at least one ReP, and ancillary ReP was needed for 14.7% of the implants. The most common of these was alveolar ridge augmentation (ARA) simultaneous with implant placement (42.1%) and alveolar ridge preservation (ARP) (26.4%). Patients with diabetes showed significantly higher odds of repeating procedures preoperatively (OR = 5.47; P = .016) and required more frequent hard tissue augmentations after implant placement (OR = 3.58; P = .006). The cost analysis revealed that ReP constituted 12.9% of the total implant procedure cost. Notably, the mandibular anterior area was the most likely to undergo ReP (OR = 2.08; P = .001).

Conclusions: One of every two patients received an ReP, and almost half of these patients received ARA (simultaneous or staged), whereas one-fourth received ARP. Diabetic patients exhibited significantly higher odds of requiring hard tissue augmentation pre implant site preparation (pre-ISP) and post–implant site preparation (post- ISP). Trends showed a shift toward soft tissue augmentation over hard tissue procedures for managing peri-implant deficiencies. Int J Oral Maxillofac Implants 2025;40:715–724. doi: 10.11607/jomi.11162

Darcio Fonseca, MS, PhD1/Ramón Pons, MS, PhD2/Beatriz de Tapia, MS, DMD2/Alberto Monje, MS, DMD2/José Nart, MS, DMD2/Conrado Aparicio, MS, MEng, PhD3/Javier Gil, MS, MEng, PhD, HC3,4

Purpose: To evaluate the effect of the electrolytic cleaning method on the mechanical properties of dental implants.

Materials and Methods: A total of 90 dental implants were studied, of which 30 were control, 30 were treated with GalvoSurge (Dental Implant Cleaning System GS 1000, Straumann), and 30 were treated with concentrated hypochlorous acid. The amount of hydrogen in the titanium (Ti) interior was determined for each of the samples via spectroscopy to obtain an elemental analysis of hydrogen TCH600 LECO. Electrochemical corrosion tests were performed on 30 dental implants to determine the corrosion potentials and corrosion intensity for the different treatments. One important factor for the fatigue behavior is residual stress, which was studied by Bragg-Bentano X-ray diffraction. Fatigue tests were performed using a servohydraulic machine that determines the S-N curves by performing triaxial tests (tensioncompression and 5 degree torsion) at different loads to simulate human mastication. A study of the dental implant fractures was carried out by scanning electron microscopy, and the samples were observed by transmission electron microscopy to see the possible appearance of hydrides in the Ti microstructure.

Results: The results showed that the electrolytic technique reduces the presence of hydrogen in the dental implant and the acid treatment increases it, causing the presence of hydrides at the grain boundaries of the Ti. It has been shown that galvanic treatments do not affect the corrosion resistance of dental implants. However, attacks with hypochlorous acid increase the corrosion rate due to the fact that acid attack on a Ti surface favors pitting points. Fatigue tests show that dental implants treated with GalvoSurge have a longer fatigue life than the control due to the lower hydrogen content. It was shown that the increase of hydrogen in the acid-treated implants reduces the fatigue life of the dental implant.

Conclusions: The formation of hydrogen via electrolysis does not cause a diffusion of this element to Ti nor does it affect corrosion resistance, but it reduces the level of hydrogen, which favors its mechanical properties in the long term. Int J Oral Maxillofac Implants 2025;40:725–734. doi: 10.11607/jomi.11082

Amr A. Mahmoud, BDS1/Sara M. Zayed, BDS, MSc1/Mohamed G. Aly, BDS, MSc, PhD1/Moustafa N. Aboushelib, BDS, MSc, PhD2

Purpose: To examine and compare the strain distribution around long and short implants retaining mandibular overdentures via either by ball or self-aligning stud (Positioner) attachments.

Materials and Methods: Two completely edentulous mandibular models made of epoxy resin were used with implants placed equidistant in the canine region. In the first model, two long implants were placed, while two short implants were placed in the second model. Two attachment mechanisms were examined for each model. A total of 24 identical mandibular overdentures were constructed and divided into two groups for each model (n = 12). Each model had two subgroups: ball attachments (n = 6) and Positioner attachments (n = 6). Two linear strain gauges were bonded to the epoxy at their corresponding prepared sites around each implant, where the microstrain was measured under bilateral and unilateral vertical loads of 100 N. One-way analysis of variance (ANOVA) with post-hoc pairwise comparison and an independent t-test were used to analyze the microstrain value data (α = .05).

Results: When comparing ball and Positioner attachments, the Positioner showed significantly higher microstrain than the ball attachment (P < .001) for both bilateral and unilateral loading. When long and short implants were compared, no statistically significant difference was found in bilateral loading (P = .22) or unilateral loading (P = .19; P = .16) on both loading and nonloading sides.

Conclusions: A higher strain distribution around implants was induced by the Positioner attachment than the ball attachment, regardless of the implant length. Increasing the implant length was not advantageous. Thus, the use of short implants for retaining mandibular overdentures can be a viable alternative treatment option. Int J Oral Maxillofac Implants 2025;40:735–742. doi: 10.11607/jomi.11090

Jaafar Abduo, BDS, DClinDent, PhD, MRACDS (Pros)1/Douglas Lau, BDSc, Grad Dip Clin Dent, DCD2

Purpose: To evaluate the seating accuracy of interim crowns for immediate restorations of immediate implants (I-Imps) and delayed implants (D-Imps) placed via static computer-assisted implant surgery (sCAIS).

Materials and Methods: A maxillary training model was modified by removing the central incisors and simulating a fresh extraction socket at one site and a healed ridge at the other site. An I-Imp was planned in the extraction socket and a D-Imp was planned in the healed site. The planned implants were used to design the sCAIS surgical template and interim crowns for immediate restoration of the implants. A total of 14 surgical models received sCAIS implants and then the interim crowns were placed. Subsequently, the models with the seated crowns were scanned by a laboratory scanner. The virtual planning model was superimposed against every surgical model to measure the vertical, horizontal, and proximal contact errors of each crown.

Results: All the crowns were positioned more incisally than the planned crowns. This was significantly more noticeable for the D-Imp crowns (0.81 mm) than for the I-Imp crowns (0.55 mm). The two crown groups had similar horizontal errors (I-Imp = 0.35 mm, D-Imp = 0.36 mm). The D-Imp crowns had minimal proximal contact error (0.14 mm), but the I-Imp crowns had significantly greater proximal contact error (0.74 mm) in the form of open distal contacts. This pattern of error appears related to the relationship between the socket morphology and the planned implant position.

Conclusions: Prefabricated interim I-Imp crowns suffered from more errors that affected the proximal contact quality than D-Imp crowns. The observed deviation of the I-Imp crowns can be attributed to the socket morphology and its relation to the planned implant position. The deviations of the I-Imp crowns are clinically significant and would require clinical adjustments; therefore, caution is advised when using prefabricated interim crowns on I-Imps. Int J Oral Maxillofac Implants 2025;40:743–750. doi: 10.11607/jomi.11157

Rong Lan, BDS, MDS1/Meisha Gul, BDS1,2/Xinke Jiang, BDS, MDS1/Yiqun Wu, BDS, MDS, PhD1/Feng Wang, BDS, MDS, PhD1,3

Purpose: To integrate the medium-term outcomes of four-implant-supported overdentures (IODs) and full-arch fixed restorations (IFRs) in the maxilla.

Materials and Methods: The search was performed in PubMed, Embase, and Cochrane databases, complemented by manual search. The inclusion criteria were at least 10 maxillary edentulous patients restored by IOD or IFR with at least 5 years of follow-up. Risk of bias (RoB) 2 and Newcastle-Ottawa Scale (NOS) tools were used to assess RoB. The implant survival rate (ISR) was calculated as the primary outcome. Prothesis survival rate, marginal bone loss (MBL), and complications were the secondary outcomes.

Results: A total of 16 studies with 5,568 implants met the criteria (9 implants on IODs, 7 implants on IFRs). The weighted ISR of IODs was 94.5% (95% CI [92.1%, 96.9%]; I2 = 84.22%), and subgroup analysis was performed on the attachment system and study type. The weighted ISR of IFRs was 98.5% (95% CI [97.4%, 99.5%]; I2 = 77.88%). For prosthesis survival, the rate of 85.0% in IODs was lower than that of 99.9% in IFRs. MBL after 5 years was –0.27 ± 1.31 mm in IODs and –1.20 ± 0.76 mm in IFRs. Retention loss (0.34 per patient) and dislodgment/fracture of the acrylic teeth (0.09 per patient) were the most common complications in IODs and IFRs, respectively.

Conclusions: Despite the variance of baseline, IFRs had a relatively higher implant and prothesis survival rate than IODs, whereas IODs had less MBL at the 5th year and a higher incidence of complications. Both maxillary IODs and IFRs have predictable medium-term clinical results. Int J Oral Maxillofac Implants 2025;40:751–765. doi: 10.11607/jomi.11175

Michael A. J. Silva, DDS, MSc (Perio)1/Eszter Somogyi-Ganss, DMD, MSc (Prosth), PhD1,2/Vanessa C. Mendes, DDS, MSc (Perio), PhD1/Neena L. D’Souza, BDS, MDS, Dip (Prosth), MSc, GCSRT1,4

Purpose: To explore the association between specific implant site locations and early and late implant failure when replacing single teeth and to investigate possible local and systemic risk factors that could influence these failures.

Materials and Methods: The study design was a retrospective cohort study. A chart review was conducted based on records of patients who had received implants replacing single teeth at the University of Toronto, Faculty of Dentistry, between January 2005 and December 2021. In addition to implant location, systemic, local, and prosthetic factors were evaluated as potential risk factors contributing to implant failure.

Results: A total of 78 (2.3%) implant failures were identified from a total of 3,460 single implants. The prevalence of early implant failure (1.4%) was significantly higher than late implant failure (0.9%; z = 2.05) (P = .040). The maxillary lateral incisor location (12/22) demonstrated the highest site-specific early implant failure rate (3.4%) relative to all other locations (Fisher exact test; P = .026). All implants placed in the anterior region of the jaw (2.3%), especially those placed in the maxilla (2.4%), had significantly higher rates of early failure when compared to posterior sites (1.1%; χ²[1] = 6.21) (P = .013). Early implant failures were significantly associated with patients whose health history was positive for a systemic condition other than type 2 diabetes (Fisher exact test, P = .034). There was a significantly higher late implant failure rate in mandibular implants (1.3%) compared to maxillary implants (0.6%; χ²[1] = 5.17) (P = .023). There was a significant association of late implant failures with wide-platform sites (≥ 4.6 mm) (χ²[2] = 11.57; P = .003) or wider-diameter implants (4.51 ± 0.6 mm) (t[76] = 3.19, P = .002).

Conclusions: The prevalence of implant failure was 2.3%, with maxillary lateral incisor sites demonstrating the highest rate of site-specific early implant failure. Early implant failures were associated with patients with a systemic medical condition, whereas late implant failures were associated with healthy individuals, mandibular implants overall, and in sites with wide-diameter implants. Int J Oral Maxillofac Implants 2025;40:766–776. doi: 10.11607/jomi.11226

Darcio Fonseca, MS, PhD1/Ramón Pons, MS, PhD2/Beatriz de Tapia, MS, DMD2/Alberto Monje, MS, DMD2/José Nart, MS, DMD2/Conrado Aparicio, MS, MEng, PhD3/Javier Gil, MS, MEng, PhD, HC3,4

Purpose: To evaluate the effect of the electrolytic cleaning method on the mechanical properties of dental implants.

Materials and Methods: A total of 90 dental implants were studied, of which 30 were control, 30 were treated with GalvoSurge (Dental Implant Cleaning System GS 1000, Straumann), and 30 were treated with concentrated hypochlorous acid. The amount of hydrogen in the titanium (Ti) interior was determined for each of the samples via spectroscopy to obtain an elemental analysis of hydrogen TCH600 LECO. Electrochemical corrosion tests were performed on 30 dental implants to determine the corrosion potentials and corrosion intensity for the different treatments. One important factor for the fatigue behavior is residual stress, which was studied by Bragg-Bentano X-ray diffraction. Fatigue tests were performed using a servohydraulic machine that determines the S-N curves by performing triaxial tests (tensioncompression and 5 degree torsion) at different loads to simulate human mastication. A study of the dental implant fractures was carried out by scanning electron microscopy, and the samples were observed by transmission electron microscopy to see the possible appearance of hydrides in the Ti microstructure.

Results: The results showed that the electrolytic technique reduces the presence of hydrogen in the dental implant and the acid treatment increases it, causing the presence of hydrides at the grain boundaries of the Ti. It has been shown that galvanic treatments do not affect the corrosion resistance of dental implants. However, attacks with hypochlorous acid increase the corrosion rate due to the fact that acid attack on a Ti surface favors pitting points. Fatigue tests show that dental implants treated with GalvoSurge have a longer fatigue life than the control due to the lower hydrogen content. It was shown that the increase of hydrogen in the acid-treated implants reduces the fatigue life of the dental implant.

Conclusions: The formation of hydrogen via electrolysis does not cause a diffusion of this element to Ti nor does it affect corrosion resistance, but it reduces the level of hydrogen, which favors its mechanical properties in the long term. Int J Oral Maxillofac Implants 2025;40:725–734. doi: 10.11607/jomi.11082

Amr A. Mahmoud, BDS1/Sara M. Zayed, BDS, MSc1/Mohamed G. Aly, BDS, MSc, PhD1/Moustafa N. Aboushelib, BDS, MSc, PhD2

Purpose: To examine and compare the strain distribution around long and short implants retaining mandibular overdentures via either by ball or self-aligning stud (Positioner) attachments.

Materials and Methods: Two completely edentulous mandibular models made of epoxy resin were used with implants placed equidistant in the canine region. In the first model, two long implants were placed, while two short implants were placed in the second model. Two attachment mechanisms were examined for each model. A total of 24 identical mandibular overdentures were constructed and divided into two groups for each model (n = 12). Each model had two subgroups: ball attachments (n = 6) and Positioner attachments (n = 6). Two linear strain gauges were bonded to the epoxy at their corresponding prepared sites around each implant, where the microstrain was measured under bilateral and unilateral vertical loads of 100 N. One-way analysis of variance (ANOVA) with post-hoc pairwise comparison and an independent t-test were used to analyze the microstrain value data (α = .05).

Results: When comparing ball and Positioner attachments, the Positioner showed significantly higher microstrain than the ball attachment (P < .001) for both bilateral and unilateral loading. When long and short implants were compared, no statistically significant difference was found in bilateral loading (P = .22) or unilateral loading (P = .19; P = .16) on both loading and nonloading sides.

Conclusions: A higher strain distribution around implants was induced by the Positioner attachment than the ball attachment, regardless of the implant length. Increasing the implant length was not advantageous. Thus, the use of short implants for retaining mandibular overdentures can be a viable alternative treatment option. Int J Oral Maxillofac Implants 2025;40:735–742. doi: 10.11607/jomi.11090