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

Digital implant dentistry has emerged as one of the most transformative forces in oral healthcare because it crosses borders between imaging, predictive modeling, surgical intervention, manufacturing, and wellness monitoring. A week does not go by that I do not receive another article evaluating or emphasizing the newest changes in digital implant dentistry. From AI-assisted planning to 3D-printed prosthetics, the field is undergoing rapid changes that are dizzying. Yet below the surface of these innovations lie unresolved challenges, ethical dilemmas, and unanswered questions in my mind. As we move into 2026, it is essential to critically examine the ethical, legal and practical implications in clinical practice, education, and patient care.
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Thank you.
Clark M. Stanford, DDS, PhD, MHA, University of Iowa
Editor-in-Chief

Yu-Ting Yeh/ Lan-Lin Chiou/Hsuan-Hung Chen/Guo-Hao Lin/Richard T. Kao/Donald A. Curtis

Purpose: To analyze the risk of prosthesis complications for dental implants across different diameters.

Materials and Methods: An electronic search in PubMed (MEDLINE), Embase, Scopus, and Cochrane Central Register of Controlled Trials until December 2023 was performed. Studies that compared implant prosthesis complications among the following implant types were included: extra-narrow (EDNIs; < 3.0 mm), narrow (NDIs; ≥ 3.0 to < 3.75 mm), standard (SDIs; ≥ 3.75 to < 5 mm), and wide-diameter (WDIs; ≥ 5 mm) implants. Meta-analyses were performed to evaluate the risk ratio of prosthesis complications across different diameters, particularly in non-full-arch implant-supported fixed dental prostheses (ISFDPs).

Results: A total of 18 clinical studies were included. In non-full-arch ISFDPs, the most prevalent complication was screw loosening in NDIs, SDIs, and WDIs (1.73%, 4.08%, and 12.45%, respectively) and decementation (3.4%) in ENDIs. In implant overdentures, ENDIs, NDIs, and SDIs demonstrated high rates of retentive cap wear (58.33%, 80.49%, and 70%, respectively), whereas WDIs had 16.67% overdenture repair. The meta-analyses showed a risk ratio of 0.20 (95% CI = 0.04 to 0.94, P = .04) and 0.17 (95% CI = 0.06 to 0.45, P < .0004) for abutment fracture in single crowns and ISFDPs comparing NDIs and SDIs. No significant differences in risk ratios were observed for screw loosening, decementation, porcelain chipping, fracture, or screw fracture among the different diameter groups.

Conclusions: This systematic review highlights that screw loosening and retentive cap wear are the most common prosthesis complications in ISFDPs and overdentures, regardless of implant diameter. While NDIs have a lower risk of abutment fracture compared to SDIs, clinicians should carefully consider patient characteristics, implant locations, and abutment features when selecting the ideal implant diameter.

Int J Oral Maxillofac Implants 2025;40:529–546. doi: 10.11607/jomi.10964

Michael S. Block

Purpose: To provide clinicians with information to develop a treatment plan to use short implants as either single or splinted restorations.

Materials and Methods: The study design was an analytical review of articles that reported clinical data with at least a 1-year follow-up. PubMed was the main source of information, and the years reviewed included 1990 to 2023. The inclusion criteria for this analytical analysis included retrospective and prospective studies. The predictor variable was the use of short implants for fixed restorations. The primary outcome variable was implant status coded as survived or failed. The covariates were the type of restoration using either splinted short implants or short implants used as single-tooth replacements, and time to failure was either less than 1 year or at least 1 year. Bivariate statistics assessed the association between splinting or single implants and failure with a significance of P < .05.

Results: A total of 50 articles were collated and summarized to answer specific clinical situation questions. Of those, 18 articles had retrospective or prospective data available for analysis, 11 articles were found for single-implant restorations, and 7 articles were found for splinted implant restorations. After applying the exclusion criteria, the sample size was 1,683 implants as reported in these articles: 853 single implants (50.7%) and 830 splinted implants (49.3%). A total of 62 (7.3%) single short implants failed compared to 36 of 830 (4.3%) splinted short implants. There were 565 implants that were > 8 mm in length, with 11 (1.9%) implant failures. The comparison between splinted and single-implant restorations for short and long implants was significant (P < .05) for all comparisons except for splinted versus single long implants. The comparison of the covariates single and splinted for both short and long implants separating failure < 1 year to longer loading indicated that short implants had more failure after loading (P < .05). The longer implants had nonsignificant differences comparing early failure to failures after longer loading.

Conclusions: Short implants, when splinted together, have similar success rates compared to longer implants based on evidence from the refereed reports. Single short implants did have an increased risk for failure.

Int J Oral Maxillofac Implants 2025;40:547–554. doi: 10.11607/jomi.11188

Mihal Tarce/Marc Quirynen

Purpose: To develop an online tool based on an evidence-based predictive model that allows clinicians to accurately predict the risk of peri-implantitis in candidates for dental implant therapy.

Materials and Methods: A retrospective study of patients attending the University Hospital Leuven in Leuven, Belgium, was performed at the Implant Review Clinic. The presence of peri-implantitis and related risk factors were recorded, and a predictive model for peri-implantitis was then developed based on this data.

Results: A total of 460 patients with 1,432 implants were included. Peri-implantitis was reported in 78 (17%) patients. For partially edentulous patients (n = 350; 60% female; average age 64.1 years), susceptibility to periodontitis (odds ratio [OR] = 0.48 [0.24;0.94]; P = .03), the number of sites with a probing pocket depth (PPD) of ≥ 5 mm (OR = 0.2 [0.10;0.40]; P < .01), and smoking (OR = 0.25 [0.09;0.66]; P < .01) were significantly associated with peri-implantitis. For fully edentulous patients (n = 50; 72% female; average age 72.2 years), implants placed in the maxilla displayed a greater risk (OR = 0.15 [0.02;0.87]; P = .03) of developing peri-implantitis. A predictive model for the development of peri-implantitis was created based on eight patient-related risk factors for partially edentulous patients (sensitivity = 90.2%; specificity = 55.0%) and four risk factors for fully edentulous patients (sensitivity = 100%; specificity = 51.3%).

Conclusions: The predictive model can be used for a preoperative risk assessment of partially edentulous patients. Further validation and refinement of the model with additional data could enable its use for fully edentulous patients and will improve its predictive power, thereby increasing its reliability.

Int J Oral Maxillofac Implants 2025;40:571–578. doi: 10.11607/jomi.11211

Rocharles C. Fontenele, DDS, MSc, PhD1,2/Nicolly Oliveira-Santos, DDS, MSc, PhD3,4/Eduarda H. L. Nascimento, DDS, MSc, PhD5/Hugo Gaêta-Araujo, DDS, MSc, PhD1/Thaísa P. Silva, DDS, MSc6/Deborah Q. Freitas, DDS, MSc, PhD6

Purpose: To investigate the effect of the number of basis images and metal artifact reduction (MAR) on an artifact’s expression and trabecular bone architecture assessment in a medullary bone area close to a zirconia (Zr) implant placed in different mandibular regions on CBCT.

Materials and Methods: CBCT volumes were acquired using the Picasso Trio unit with a Zr implant placed individually in either the anterior or posterior mandibular region, both with and without MAR, under two scanning modes: normal (450 basis images) and high (720 basis images). To measure the SD of gray values, a region of interest was placed mesial to the Zr implant site for artifact assessment. For trabecular bone architecture analysis, a volume of interest was established in the same area. The fractal dimension (FD), connectivity density (ConnD), trabecular thickness (TbTh), and trabecular spacing (TbSp) were calculated.

Results: The Zr implant increased the SD of gray values, especially in the posterior region without MAR, while activating MAR reduced these values regardless of the scanning mode (P < .05). The number of basis images generally had no impact on SD (P > .05), except in the posterior region without MAR, where the normal scanning mode showed higher SD values (P < .05). Implant presence reduced FD and ConnD in the posterior region; however, this effect was less pronounced with MAR enabled (P < .05). In the control group, the overall high scanning mode reduced FD and ConnD (P < .05), with a minimal effect on TbTh and TbSp (P > .05).

Conclusions: The Zr implant increased artifact expression, particularly in the posterior mandibular region without MAR, which also resulted in decreased FD and ConnD. While increasing the number of basis images had little effect on the parameters, MAR minimized artifact expression and the reductions in FD and ConnD values.

Int J Oral Maxillofac Implants 2025;40:562–570. doi: 10.11607/jomi.10569

Marc Quirynen, DDS, MSc, PhD/Mihai Tarce, DDS, MSc, MEng, PhD/Manoetjer Siawasch, DDS, MSc/Ana B. Castro, BDS MSc PhD/Andy Temmerman, DDS, MSc, PhD/Wim Coucke, BSc, MSc, PhD/Wim Teughels, DDS, MSc, PhD

Purpose: To develop an online tool based on an evidence-based predictive model that allows clinicians to accurately predict the risk of peri-implantitis in candidates for dental implant therapy.

Materials and Methods: A retrospective study of patients attending the University Hospital Leuven in Leuven, Belgium, was performed at the Implant Review Clinic. The presence of peri-implantitis and related risk factors were recorded, and a predictive model for peri-implantitis was then developed based on this data.

Results: A total of 460 patients with 1,432 implants were included. Peri-implantitis was reported in 78 (17%) patients. For partially edentulous patients (n = 350; 60% female; average age 64.1 years), susceptibility to periodontitis (odds ratio [OR] = 0.48 [0.24;0.94]; P = .03), the number of sites with a probing pocket depth (PPD) of ≥ 5 mm (OR = 0.2 [0.10;0.40]; P < .01), and smoking (OR = 0.25 [0.09;0.66]; P < .01) were significantly associated with peri-implantitis. For fully edentulous patients (n = 50; 72% female; average age 72.2 years), implants placed in the maxilla displayed a greater risk (OR = 0.15 [0.02;0.87]; P = .03) of developing peri-implantitis. A predictive model for the development of peri-implantitis was created based on eight patient-related risk factors for partially edentulous patients (sensitivity = 90.2%; specificity = 55.0%) and four risk factors for fully edentulous patients (sensitivity = 100%; specificity = 51.3%).

Conclusions: The predictive model can be used for a preoperative risk assessment of partially edentulous patients. Further validation and refinement of the model with additional data could enable its use for fully edentulous patients and will improve its predictive power, thereby increasing its reliability.

Int J Oral Maxillofac Implants 2025;40:571–578. doi: 10.11607/jomi.11211

Rutger A.L. Dhondt, PhD/Marc Quirynen, DDS, MSc, PhD/Pierre Lahoud, PhD/Simone Cortellini/Andy Temmerman, DDS, MSc, PhD

Purpose: To assess the differences between using leukocyte- and platelet-rich fibrin (L-PRF) with a deproteinized bovine bone mineral block versus a combination of 50% autogenous bone (AB) and 50% deproteinized bovine bone mineral (DBBM) as grafting material for horizontal guided bone regeneration (GBR).

Materials and Methods: This randomized double-blind split-mouth clinical trial included 13 patients requiring bilateral horizontal bone augmentation. Each patient received both treatment modalities: one side of the jaw was treated via GBR with L-PRF and deproteinized bovine bone mineral block, and the other side was treated with a 50/50 mixture of AB and DBBM. CBCT scans were used to evaluate horizontal bone width (HBW) and buccal bone thickness (BBT) at the following time points: baseline (T0), immediately post-augmentation (T1), at implant placement (T2), and 1 year after abutment connection (T4). Bone sounding (BS) was also used to verify CBCT measurements.

Results: No statistically significant differences were found in HBW gain between test (L-PRF) and control (AB/DBBM) sites at any time point. Both sites showed significant HBW loss after implant placement, with more bone volume lost at higher crestal levels (at the implant shoulder level [Sh0], > 2 mm from the implant shoulder [Sh2], and > 4 mm from the implant shoulder [Sh4]). At the Sh2 level, 48.8% of the HBW gain at T1 was lost by T4 in test sites, and 46.2% of HBW gain was lost at the same time point in control sites. Similarly, BBT at Sh2 reduced from 4.7 ± 1.0 mm to 1.3 ± 1.5 mm in test sites and from 2.1 ± 1.0 mm to 0.9 ± 0.8 mm in control sites. Both groups of sites had one complication, resulting in a 91.6% success rate for both treatments. The cumulative survival rate of implants was 100% at 16 months, with a mean interproximal bone level (IBL) loss of 0.2 ± 0.9 mm and 0.1 ± 0.6 mm for test and control sites, respectively.

Conclusions: No statistically significant differences were found between the AB/DBBM composite graft and the L-PRF and bovine bone mineral block for horizontal GBR. Significant resorption of grafted volume occurs within 25 months, continuing after implant placement. Further research with larger sample sizes is needed to confirm these findings and optimize GBR techniques.

Int J Oral Maxillofac Implants 2025;40:579–590. doi: 10.11607/jomi.11095

Claudia Ros-Alcaraz, DDS/Maria Camila Erazo-Puentes, DDS/Octavi Camps-Font, DDS, MS, PhD/Marta García-García, DDS, MS, PhD/Rui Figueiredo, DDS, MS, PhD/Eduard Valmaseda-Castellón, DDS, MS, PhD

Purpose: To assess the risk of recurrence or disease progression in patients with peri-implantitis who underwent surgical treatment.

Materials and Methods: A retrospective cohort study was carried out in patients subjected to peri-implant surgery between 2015 and 2021 with a minimum follow-up of 12 months. Data were analyzed using simple binary logistic regression models at the patient level and generalized estimation equations at the implant level.

Results: A total of 34 patients and 103 implants were analyzed (70 of the implants received resective techniques and 33 of the implants received regenerative procedures). Fifteen patients (44.12%) experienced peri-implantitis recurrence and one patient (2.9%) lost an implant. No differences were found between the surgical techniques (P = .56). The following factors were found to increase the risk of recurrence: a history of periodontitis (OR = 4.62; 95% CI: 1.14–18.75) (P = .032), maxillary location (OR = 9.69; 95% CI: 1.81– 51.87) (P = .008), and two implants treated per procedure (OR = 31.68; 95% CI: 3.91– 256.54) (P = .001).

Conclusions: Almost half of all patients (44%) undergoing surgical treatment of peri-implantitis will present disease progression or recurrence. This risk seems to be higher in patients with several treated implants, with a history of periodontal disease, or with implants placed in the maxilla.

Int J Oral Maxillofac Implants 2025;40:591–598. doi: 10.11607/jomi.11018

Yuriy Garaev, DDS/Nina K. Anderson, PhD/Rafael Delgado-Ruiz, DDS, MS, PhD/Georgios E. Romanos, DDS, PhD, Prof, Dr Med Dent

Purpose: To examine the presence of titanium (Ti) nanoparticles at the bone-implant interface during implant placement using the bone condensation technique in vitro.

Materials and Methods: Artificial Type 4 bone slices (4 mm thick) were securely held in place with a vise, and two groups of implants were placed. In the test group, implants were placed using the condensation technique with cylindrical osteotomes. In the control group, implants were placed following the traditional surgical protocol. Implants were placed in parallel between the bone slices held in the vise. Further, three groups of implant designs (six implants in each group) were placed into the bone. Two implant designs consisted of implants made of pure Ti (grade 4), while the third implant design group was constructed of Ti alloy (Ti6Al4V). Subsequently, the blocks were separated, and the peri-implant bone interface was qualitatively evaluated for Ti presence using X-ray fluorescence spectrometry at the coronal, middle, and apical thirds of osteotomies (n = 12 per implant system). A descriptive statistical
analysis showing the mean values (± SD) of Ti nanoparticles was performed.

Results: No detectable Ti levels were identified in the control group of Ti-alloy implants compared to pure-Ti implants. In contrast, the test group for all implant systems showed the presence of Ti nanoparticles in the coronal, middle, and apical thirds.

Conclusions: The present results indicate that the bone condensation technique is associated with Ti release during implant placement in vitro. These findings were shown for both pure-Ti and Ti-alloy dental implants.

Int J Oral Maxillofac Implants 2025;40:599–604. doi: 10.11607/jomi.11080

Aritza Brizuela-Velasco, PhD/Daniel Robles, PhD/Saray Fernández-Hernández, DDS/José Manuel Mendes, PhD/Ignacio Sanz, PhD3/Javier Gil, PhD

Purpose: To compare heat generation during osteotomy for dental implant placement using a conventional (sequential drilling) drill protocol versus a single- drill protocol in digitally guided surgery and to clarify differences in thermal exposure time.

Materials and Methods: In this study, we used a bovine rib ex vivo model with a surgical splint and a type K thermocouple to measure temperature and time. The conventional protocol (n = 20) involved sequential drilling using six drills of increasing diameter, while the simplified protocol used a single drill (n = 20). Four implant beds were prepared in the tibia of a New Zealand rabbit to compare the mean temperature values between the in vivo and ex vivo models.

Results: Student’s t-test revealed no significant differences (P = .1688) in temperature elevation between the conventional (mean = 1.977ºC; SD = 1.165) and single-drill (mean = 2.634ºC; SD = 1.734) protocols. However, significant differences between the groups were found in the exposure time: conventional drilling protocol—107.105 seconds (SD = 29.196); single-drill protocol—16.842 seconds (SD = 8.101). The mean temperature increases due to drilling were 0.365ºC (SD = 0.204) and 0.378ºC (SD = 0.381) in the rabbit tibia and bovine rib, respectively; however, no significant differences (P = .926) were found between the in vivo and ex vivo models.

Conclusions: Conventional and single-drill guided surgery protocols for implant bed preparation generate similar temperatures in vitro. Exposure time is longer with conventional protocols than with single-drill protocols.

Int J Oral Maxillofac Implants 2025;40:605–612. doi: 10.11607/jomi.11066

Berceste Guler Ayyildiz, DDS, PhD/Ayse Kocak, MSc, PhD/Emirhan Bozoglan, MSc

Purpose: To evaluate the effect of gradually and nongradually surface-roughened dental implants with identical macro designs and anodized surface topography on osteogenic differentiation in vitro in 3D cell culture.

Materials and Methods: This study compared two groups of implants: (1) gradually (TiUltra) and (2) nongradually (TiUnite) anodized implant surfaces. Mouse-derived bone marrow stem cells (MSCs) were cultivated up to passage three. Subsequently, the GelXA BONE bioink (Cellink), which had been homogeneously combined with the cells, was transferred into polylactic acid cages that had been previously rinsed in phosphate-buffered saline. To assess cell viability and proliferation, metabolic activity was measured. The adhesion of cells was evaluated through the use of a DNA-binding probe. The expression of osteogenic differentiation genes was analyzed through quantitative polymerase chain reaction (qPCR) analysis on days 7, 14, and 21. The osteogenic gene expression markers were type 1 collagen, fibronectin, alkaline phosphatase (ALP), osteopontin (OSP), and osteocalcin (OC), with β-actin serving as the housekeeping gene.

Results: No statistically significant differences were observed in cell viability and proliferation values. Nevertheless, the qPCR values for osteogenic differentiation markers were notably elevated in the TiUltra group compared to both the TiUnite group and the control group (P < .05). ALP values were significantly lower in the TiUltra group (P < .05).

Conclusions: It can be concluded that the TiUltra surface demonstrated higher osteogenic gene expression than the TiUnite surface. However, further experimental and clinical studies are required.

Int J Oral Maxillofac Implants 2025;40:613–624. doi: 10.11607/jomi.11079

Brent Allan, BDS, MDSc/Rudolf Boeddinghaus, MBChB/Andrew Whyte, BDS (Hons), MBBCh/Mithran Goonewardene, BDS, MSc/Anh Thi Mai Nguyen, DDS, MPhil/Christopher A. Mitchell, BSc, PhD

Purpose: To compare the clinical and radiographic outcomes of patients receiving two different healing strategies for their guided bone regeneration (GBR) procedures using a novel collagen membrane to support the implant placement.

Materials and Methods: A total of 20 patients (27 implants) were included. They received either transmucosal (10 patients, 11 teeth) or submerged (10 patients, 16 teeth) GBR procedures. A standardized CBCT scan protocol was performed immediately posttreatment and in a follow-up visit at 4 to 6 months posttreatment. The distance from the implant shoulder to the first bone-to-implant contact on the sides of the implant (distance from implant to bone [DIB]), the horizontal dimension of the buccal alveolar crests, the quality of newly formed bone in the submerged group, the complication rate, and the pain score were reported.

Results: Healing at all implant sites was uneventful, with mild swelling and inflammation within normal postoperative limits. The between-group quantitative analysis of CBCT images obtained immediately postoperatively (CBCT1) and 4 to 6 months postoperatively (CBCT2) showed no statistical difference in any parameter. Facial bone wall thickness at 1, 3, and 5 mm below the implant shoulder significantly decreased in both submerged and transmucosal procedure participants in CBCT2 compared to CBCT1.

Conclusions: Outcomes of GBR treatment were consistent with established clinical and preclinical evidence for the safety and performance of collagen barrier membranes in either submerged or transmucosal GBR procedures. In addition, these two different healing strategies exhibited similar clinical and radiographic outcomes.

Int J Oral Maxillofac Implants 2025;40:625–635. doi: 10.11607/jomi.11043

Georgios E. Romanos, DDS, PhD, Prof Dr Med Dent/Mohit Varma, DDS

Purpose: To investigate the free surface energy before and after CO2 irradiation on rough titanium (Ti) surfaces.

Materials and Methods: Sandblasted, large grit, acid-etched (SLA) implant surfaces were used for this study. Contact angle evaluations were performed for saline, albumin, and artificial blood using a contact angle goniometer at 25°C and 37°C (20 droplets in each group, 120 in total). The Ti disks were then irradiated with a CO2 laser (10,600 nm) using a noncontact, defocused, 2-W continuous wave for 30 seconds. Contact angle measurements for saline, albumin, and artificial blood were evaluated immediately after irradiation (new 120 in total contact angle measurements) and compared with the measurements before laser irradiation. A paired t-test using SPSS statistics (IBM) was performed for 5% statistical significance level.

Results: Lower numbers of contact angle measurements were found after CO2 irradiation, and these changes were statistically significant (P < .05) for all groups, except for albumin at 25°C, as follows: saline at 25°C—(pre) 111.97°C ± 13.67°C and (post) 79.29°C ± 10.83°C (P < .0001); albumin at 25°C—(pre) 89.04°C ± 12.02°C and (post) 83.29°C ± 20.71°C (P = .297); blood at 25°C—(pre) 97.79°C ± 14.44°C and (post) 86.29°C ± 10.82°C (P = .019); saline at 37°C—(pre) 104.12°C ± 13.138°C and (post) 92.66°C ± 4.777°C (P = .001); albumin at 37°C—(pre) 89.04°C ± 12.02°C and (post) 83.29°C ± 20.71°C (P =.297); blood at 37°C—(pre) 80.42°C ± 19.00°C and (post) 58.62°C ± 24.34°C (P = .012).

Conclusions: CO2 laser irradiation in general positively affected the wettability and hydrophilicity of rough Ti SLA surfaces.

Int J Oral Maxillofac Implants 2025;40:636–642. doi: 10.11607/jomi.11097

Merve Çakır, DDS, PhD/Gül Merve Yalçın Ülker, DDS, PhD/Sina Saygılı, DDS, PhD/Mehmet Akif Durgun, DDS/Süleyman Çağatay Dayan, DDS, PhD/Bahadır Kan, DDS, PhD/Onur Geçkili, DDS, PhD

Purpose: To investigate the effect that clinical experience has on implant primary stability using insertion torque (IT) and resonance frequency analysis (RFA) from two different drilling protocols: (1) implant-specific osteotomy protocol and (2) conventional drilling.

Materials and Methods: A total of 60 tri-oval and 60 parallel-walled implants were placed in fresh bovine ribs by three clinicians (B.K., M.Ç., and M.A.D), who were classified according to the total number of implants they had previously placed. Tri-oval implants were placed with an implant-specific osteotomy protocol, and parallel implants were placed with conventional drilling. The ITs of the implants were measured by the same clinician who performed the operation. An independent examiner (O.G.) measured the RFA of all implants after placement via a resonance frequency analyzer.

Results: In the IT evaluation, no statistical significance was observed between the clinicians and both tri-oval implants and parallel implants (P = .293 and P = .98, respectively); in all experience levels, the ITs were significantly lower in parallel implants. Additionally, across all experience levels, tri-oval implants demonstrated greater RFA values than parallel implants (P = .001). Within-group comparisons of RFA by experience level for the tri-oval implants did not show a statistically significant difference (P = .950). However, in parallel implants, there was a significant difference between the moderately experienced and inexperienced groups (P = .019).

Conclusions: The implant-specific osteotomy procedure with tri-oval implants offers greater primary stability compared to conventional osteotomy with parallel-walled implants, regardless of the clinician’s experience.

Int J Oral Maxillofac Implants 2025;40:643–649. doi: 10.11607/jomi.11371