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

Heba Elbelacy, PhD/Mona Samir Gaber, PhD/Gustavo Vicentis Oliveira Fernandes, PhD/Mohamed Rahhal, PhD

Purpose: To evaluate the bone level around implant-retained overdentures (IODs), comparing rehabilitations with three or four implants.

Materials and Methods: A total of 24 edentulous participants between 60 and 70 years old were selected for this study; the patents had adequate rounded ridges and bone-level height and width. The participants were divided into two groups: Group 1 received four mini-implants placed in the inter-foraminal area retaining mandibular overdentures, and Group 2 received three mini-implants placed in the inter-foraminal area. Patients underwent surgical procedures, postoperative care, and follow-up evaluations for over 1 year to assess implant stability and bone-level changes. Patients were recalled for reevaluation and adjustments at 6, 9, and 12 months for clinical assessment and analysis of the marginal bone height changes around the implants. The statistical analysis used for the comparison of groups was independent test; regarding the space between central and peripheral implants, paired t test was performed (significance level set at P ≤ .05).

Results: When comparing the results between central and peripheral implants at different time points (6, 9, and 12 months), it revealed a nonsignificant difference in Group 1 at all time points and a significant difference only after 12 months in Group 2, in which the peripheral implant bone level was significantly higher than the central implant (P = .03). The intergroup evaluation revealed that Group 2 demonstrated significantly greater bone height levels than Group 1 (P = .0001). The bone level between central and peripheral implants decreased significantly in every successive time interval for all implants except the central implant of Group 1.

Conclusions: The findings suggest distinct differences in bone-level changes between central and peripheral implants and between the two implant groups. Int J Oral Maxillofac Implants 2026;41:317–324. doi: 10.11607/jomi.11359

Jie Liang, DDS, MD/Yifan Kang, DDS, MD/Zichao Wang, DDS/Yanjun Ge, DDS, MD/Xiaofeng Shan, DDS, MD/Zhigang Cai, DDS, DMD

Purpose: To evaluate and compare the accuracy of dental implant placement on vascularized bone flaps (VBFs) reconstructed for dental arch defects using static computer-assisted implant surgery (s-CAIS) and dynamic computer-assisted implant surgery (d-CAIS).

Materials and Methods: This retrospective study included patients who under went-CAIS or d-CAIS implant placement following VBF reconstruction between October 2021 and October 2023. A total of 23 patients were included: 9 patients (33 implants) in the d-CAIS group and 14 patients (41 implants) in the s-CAIS group. Accuracy was assessed by comparing the preoperative design and postoperative results from CBCT. Key parameters—such as angulation deviation, global deviation at the platform and apex, and bidirectional deviations (mesiodistal, buccolingual, and apicocoronal)—were measured and compared between groups.

Results: The d-CAIS group demonstrated significantly lower global deviation (P < .01) and apicocoronal deviation at the apex (P < .05) compared to the s-CAIS group. Superior accuracy was also observed in the d-CAIS group for posterior implants, particularly in apicocoronal deviation at both the platform and apex levels (P < .01). Additionally, d-CAIS outperformed s-CAIS for mandibular implants, showing significantly lower buccolingual deviation at both the platform and apex levels (P < .05). For implants on iliac flaps, d-CAIS exhibited lower angulation deviation and global deviation at the platform and apex levels (P < .05).

Conclusions: When placing implants on VBF-reconstructed dental arches, dynamic guidance demonstrated superior precision, particularly in controlling depth and apex deviation. Int J Oral Maxillofac Implants 2026;41:325–332. doi: 10.11607/jomi.11330

Nilson Matias Pereira Júnior, DDS, PhD1/Daniel Nunes de Oliveira, DDS, MSc/Pedro Giorgetti Montagner, DDS, MSc1/Lucas Novaes Teixeira, DDS, PhD/Juliana Cama Ramacciato, DDS, PhD1/Elizabeth Ferreira Martinez, DDS, PhD

Purpose: To perform an in vivo assessment of the impact of two antidepressants with distinct mechanisms of action on the osseointegration of dental implants and their correlation with two different surface treatments.

Materials and Methods: A total of 15 Wistar rats (Rattus norvegicus albinus specimens) received four titanium (Ti) implants: two exhibiting a double acid-etched (DAE) surface and two exhibiting a DAE surface coated in plasma-sprayed nanohydroxyapatite (NANO).
These four implants were distributed to the right and left tibiae. The rats were randomly assigned to three groups (5 rats per group) as follows: group 1 (G1) = no medication (saline solution); group 2 (G2) = amitriptyline intake; and group 3 (G3) = sertraline intake. Then the rats received a daily oral dose of 5 kg or 0.1 mL of their respective drug for 14 days prior to surgery and for an additional 21 days thereafter until they were euthanized. Removal torque (RT), bone-to-implant contact (BIC), and bone area (BA) were evaluated.

Results: The findings indicated that both the RT and the BA percentage decreased in the groups that were administered antidepressants. The BIC percentage was similar among the groups when the NANO-surface implant was used.

Conclusions: It can be concluded that the antidepressants studied were associated with a higher possibility of osseointegration failure. Implants featuring NANO surface treatment could be used as an alternative in these instances to mitigate the negative impact of antidepressant therapy on bone repair. Int J Oral Maxillofac Implants 2026;41:333–339. doi: 10.11607/jomi.11370

Claude Robert, PhD/Concepción Shimizu Wilson, PhD/Marc Dieb, PhD

Purpose: To review and analyze bibliometric studies published during the last few decades on dental implants.

Materials and Methods: A combined search on various databases (PubMed, ProQuest, Google Scholar, Scientific Electronic Library Online [SciELO], Web of Science [WoS], and Latin American and Caribbean Health Sciences Literature [LILACS]) and general Internet browsers (Google, Bing, and Qwant) was developed to collect bibliometric papers on dental implants. The search was performed using the following general keywords: “(dental implant) OR (implantology)” in the “Title/Abstract” fields.

Results: A total of 45 papers were collected, and each paper was reviewed according to one of the following categories: (1) techniques or biomaterials relating to dental implants (scientific and medical papers using zirconia and titanium dental implants constituted the most technical biomedical literature considered); (2) biologic or medical conditions resulting from dental implantology (peri-implantitis and peri-implant complications comprised most of the biologic and/or medical conditions studied, followed by implant overdenture and zygomatic implants); and (3) research funding highlighting the contribution of funding bodies in the selection and implementation of research projects (clinical studies and collaborative research were mainly supported by industry among high-income countries in North America and Europe, while government-funded research occurred mainly in Asian and South American countries).

Conclusions: The success of implant dentistry strongly relies on the cumulative and combined progress of various components: techniques, biomaterials, digital support, and more. Funding plays a key role in research, and the way it is implicated in research environments is highly variable, such as how it is considered, presented, and discussed. We hope that researchers, clinicians, institutions, politicians, and decision-makers involved or interested in research in implantology will find this study to be a useful guide to clarify their vision of the literature on dental implants. Int J Oral Maxillofac Implants 2026;41:340–350. doi: 10.11607/jomi.11341

Georgios E. Romanos, DDS, PhD, Prof Dr med dent/Tzicha Jessica Wang, DDS/Rafael Delgado-Ruiz, DDS, MSc, PhD

Purpose: To evaluate the presence of titanium (Ti) ions and particles after instrumentation of implant surfaces using different debridement methods in vitro.

Materials and Methods: Six debridement methods—including a stainless steel (SS) curette, Ti-curette, ultrasonic tip (CV), ultrasonic tip with plastic sleeve (CS), CO2-laser, and Er,Cr:YSGG (ECY) laser (WaterLase MD plus, Biolase)—were evaluated in this study. A simulated defect was created around an implant in a type 2 bone block, and irrigation was performed with water. For the laser groups, a CO2 laser (no contact, defocused beam, continuous wave, 2-W power) and an ECY laser tip were used (in contact with the implant; power of 2 W; 75 Hz; 40% water: 2% air). A total of 20 samples per method (120 samples total) were collected using paper points after 30 seconds of instrumentation. Chemical composition analysis of the bone block, water irrigation, and instruments (before the study
[baseline]) were evaluated for the presence of Ti ions and particles via liquid samples after instrumentation with an X-ray fluorescence spectrometer. Statistical analysis using sample t test was performed for each debridement method.

Results: Baseline measurements showed no Ti ions or particles. However, Ti ions and particles were found in the groups using SS curettes, CV ultrasonic inserts, and Ti curettes, with values of 0.0232 ± 0.0181 ppm, 0.0047 ± 0.0042 ppm, and 0.0072 ± 0.0037 ppm, respectively. Ti ions and particles were not observed in the CS ultrasonic insert group or either laser group. The semiquantitative data showed a higher presence of Ti ions and particles in the groups that used SS curettes, Ti curettes, and CV ultrasonic inserts in comparison to baseline (P < .0001).

Conclusions: Ti ions and particles were found after instrumentation using SS curettes, Ti curettes, and CV ultrasonic inserts, which may affect the disease etiology and outcomes of peri-implantitis therapy more prominently compared to irradiation methods such as CS ultrasonic inserts, CO2 lasers, or ECY lasers. Int J Oral Maxillofac Implants 2026;41:351–358. doi: 10.11607/jomi.11375

Mohammadjavad Shirani, DDS, MSc/Maryam Emami, DDS

Purpose: To compare computer-assisted implant surgery (CAIS) and freehand implant placement (FHIP) in terms of clinical and radiographic outcomes.

Materials and Methods: This systematic review and meta-analysis included a comprehensive search of five databases (PubMed, Embase, CINAHL, Scopus, and Web of Science), along with handsearching and cross-referencing, which identified randomized controlled trials (RCTs) comparing CAIS and FHIP literature published up to November 2024. Outcomes included marginal bone loss (MBL), implant survival rate, patient satisfaction, pink esthetic scores, probing depth, and complications. The Cochrane risk of bias (RoB) tool and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach were used to assess study quality and evidence certainty. Meta-analysis and sensitivity/subgroup analyses were also conducted.

Results: A total of 12 publications from 9 RCTs (395 participants, 1,242 implants) were included. Although overall differences in MBL and implant survival were not statistically significant, subgroup analyses revealed several significant findings. CAIS demonstrated significantly reduced MBL in fresh socket placements (P = .04), higher patient satisfaction (P = .03), and improved pink esthetic scores (P = .009). FHIP was associated with fewer biologic complications (P = .04) and lower MBL values when compared to tissuesupported
CAIS (P = .03). Sensitivity analyses confirmed robustness for most outcomes; however, evidence quality ranged from very low to moderate, and six studies showed a high RoB.

Conclusions: Considering the limitations related to the quality of the included studies, both CAIS and FHIP achieved high survival rates (> 98%). CAIS showed advantages in fresh socket cases and esthetic/patient-reported outcomes, while FHIP had fewer biologic complications and better outcomes when using an open-flap approach. Int J Oral Maxillofac Implants 2026;41:359–370. doi: 10.11607/jomi.11349

Virat Hansrani, BChD, MFDS (RCSEd), CAGS, CDT/Jeenarak Duangsuwan, DDS, CAGS, DScD/
Megha Shah, BDS, CAGS, DScD/Zeinab El Amami, DDS, CAGS, DScD/Ali Abdallah, BDS, CAGS, DScD/
Thaleia Filokyprou, DDS, MS/Dimitra Vasilaki, DDS, MSc/Konstantinos Michalakis, DDS, CAGS, MSc, MSc, PhD

Purpose: To evaluate whether biologic and technical complications differ when sinus elevation is used alone versus when used in combination with onlay grafting prior to implant placement in the severely resorbed posterior maxilla, with particular emphasis on the impact of crown-to-implant ratios (CIRs) on clinical outcomes.

Materials and Methods: An electronic search from January 2000 to December 2023 was performed in four databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with a focused Population/Problem, Intervention,
Comparison, and Outcome (PICO) question. The quality of the reports was established using a modified Cochrane Collaboration tool.

Results: Out of 1,199 studies, 20 articles were selected, including 16 articles on sinus augmentation (SA) and 4 articles on both SA and onlay grafts (SAOG). The studies involved 1,245 patients, with 81.8% of patients receiving SA and 18.1% receiving SAOG. Implant survival rates ranged from 80.25% to 100%, with an overall success rate of 91.5% to 100%. Complications included biologic issues (eg, membrane perforation) and mechanical issues (eg, graft loss). The average follow-up period was 60 months.

Conclusions: Limited evidence exists on implant outcomes following SA versus onlay grafting in the atrophied maxilla. Further randomized controlled trials are needed to compare these techniques, emphasizing prosthetically driven augmentation for optimal implant positioning. Int J Oral Maxillofac Implants 2026;41:371–379. doi: 10.11607/jomi.11339

Paola C. Saponaro, DDS, MS/Lisa A. Lang, DDS, MS, MBA/Hanin Hammoudeh, DDS, MS/Scott Barnett, PhD, MSPH/Leonardo Mohamad Nassani, DMD, MBA, MSc/Yuan-Lynn Hsieh, DDS, MS/Shereen S. Azer, BDS, MSc, MS

Purpose: To understand the clinical performance of dental implants via surgical and prosthetic failure rates and potential
correlations with patient-level and procedure-level factors.

Materials and Methods: A retrospective cohort study was conducted with patients aged 18 years or older who received at least one dental implant at The Ohio State University College of Dentistry between January 1, 2016, and October 31, 2021. The following measurements were collected for analyses: procedure date, patient age, sex, race, body mass index, medical comorbidities, cardiovascular disease,
autoimmune diseases, osteoporosis, cancer, oral conditions, periodontal condition, tobacco or alcohol use, parafunctional habits, tooth number and location, implant type and manufacturer, implant diameter and length, abutment type and manufacturer, definitive restoration type, provider demographics, type of postprocedure complication(s), and treatment notes.

Results: A total of 1,282 implants from 732 patients were analyzed. Comorbidities of interest in the patient population included obesity (27%), diabetes mellitus (10%), cancer (9%), and hypertension (28%). In addition, 208 implants experienced some adverse event during the study period. Implant failures included failure to osseointegrate (2.9%) and loss of osseointegration (2.7%). Mechanical complications included abutment screw loosening (5.3%), abutment screw fractures (0.8%), and prosthesis fracture (1.0%). Soft tissue complications included peri-implantitis (2.6%) and peri-implant mucositis (7.2%). Among the 208 implants that experienced adverse events, 47 (3.6%) implants were removed. Ten (21.3%) of the failed implants were single crowns, and 3 (6.4%) were fixed dental prostheses or assisted a removable partial dental prosthesis. The remaining 34 implant failures (72%) occurred prior to prosthesis placement. The overall incidence rate of implant adverse events was low (7.5 ⁄ 100; 95% confidence interval [CI]: 6.4 to 8.5). The incident rates for implant failure, mechanical complications, and soft tissue complications were 1.6 ⁄ 100 (95% CI: 1.2 to 2.1), 3.3 ⁄ 100 patient-years (95% CI: 2.6 to 4.1), and 3.6 ⁄ 100 patient-years (95% CI: 3.0 to 4.3), respectively.

Conclusions: Soft tissue complications, such as periimplantitis and peri-implant mucositis, were the most commonly observed complications over time and appear to be associated with length of follow-up. Int J Oral Maxillofac Implants 2026;41:380–390. doi: 10.11607/jomi.11345

Shing-Zeng Dung, DDS, PhD/Jui Wang, PhD/Yung-Ting Hsu, DDS, PhD/Tzu-Hsuan Weng, BS/Shale M. Ninneman, DDS, MSD/Yu-Kang Tu, DDS, PhD

Purpose: To evaluate the efficacy of one-step lateral sinus floor elevation (LSFE) in patients with severely atrophic posterior
maxillae and to identify the accompanying risk factors for peri-implantitis.

Materials and Methods: In this long-term retrospective case series study, clinical data were obtained from the Periodontic Department at Taipei Tzu Chi Hospital. The one-step, nonsubmerged LSFE procedure enabled simultaneous implant placement in sites with a residual bone height (RBH) < 5 mm. In total, 54 patients and 65 sinuses received 107 implants to support fixed reconstructions over a period of 4 to 16 years. Healing abutments were simultaneously placed at the time of implant placement. Clinical and radiographic outcomes were assessed, including marginal bone loss (MBL) and implant survival rates. Information on all implants and patients were recorded. Univariate and multivariate analyses were performed via the generalized estimating equation method to assess possible patient- and implant-related risk factors for MBL and peri-implantitis.

Results: The overall implant survival rate was 97.2%. A total of 29 implants (27%) had MBL > 0.5 mm. A history of periodontitis was not significantly associated with MBL (P > .05). Poor oral hygiene (P < .001), diabetes (P = .010), or a keratinized mucosa width < 2 mm (P = .011) were identified as potential risk factors for peri-implantitis.

Conclusions: This study demonstrates that, with careful case selection and adherence to proper implant protocols, one-step implant placement in severely atrophic maxillary sinuses using the LSFE procedure is predictable and can be maintained long-term. Int J Oral Maxillofac Implants 2026;41:391–403. doi: 10.11607/jomi.11348

Henrique Tadeu do Rego Ferreira, DDS, PhD1/Emmanuel João Nogueira Leal da Silva, DDS, PhD2/Bruno Salles Sotto Maior, DDS, PhD3/Plinio Mendes Senna, DDS, PhD4

Purpose: To evaluate the effects of an oscillatory drilling technique on bone densification, heat generation, and implant
stability.

Materials and Methods: An in vitro study was conducted using pig rib segments to simulate low-density bone. Drilling protocols were performed using three techniques: clockwise (CW) cutting, counterclockwise (CC) densifying, and oscillatory movement (OM) at 60 degrees clockwise and 240 degrees counterclockwise. There were six drilling sites and six implants per group to ensure sufficient statistical reliability. Drilling was performed with an automated handpiece under controlled conditions. Thermal changes were recorded using a laser thermometer and infrared imaging, and bone densification was assessed using microCT analysis. The final insertion torque (IT) was measured to determine the primary stability, and removal torque (RT) was recorded to assess the stability loss for each implant.

Results: The CC and OM groups demonstrated significantly higher bone volume, intersection surface, and reduced trabecular separation compared to the CW group (P < .05). Although the CC group exhibited the highest temperature increase, all final temperatures remained
below the critical threshold of 47ºC. Infrared imaging showed less overall heat retained within the body of the drill in the CW group compared to the CC and OM groups. The OM drills exhibited lower heat generation than the CC group, with a peak temperature at approximately 5 mm above the drill tip. The OM and CC groups showed significantly higher IT than the CW group (P < .05). Implant removal revealed a stability reduction of 27.8% ± 10.2%, 24.8% ± 13.6%, and 20.2% ± 8.2% for CW, CC, and OM groups, respectively (P > .05).

Conclusions: During implant site preparation, the OM group enhanced bone densification, improved primary stability, and maintained safe thermal levels. These findings suggest that OM could serve as a promising alternative to conventional drilling techniques, particularly in low-density bone. Further studies are needed to explore its clinical applicability and long-term outcomes. Int J Oral Maxillofac Implants 2026;41:404–409. doi: 10.11607/jomi.11356

Samira Salmeron, PhD/Marcelo Oliveira Freire, PhD/Carlos Ferreira dos Santos, PhD/Rodrigo Cardoso de Oliveira, PhD/Paulo Noronha Lisboa-Filho, PhD/Larisa Baldo Arruda, PhD/Luciana Daniele Trino, PhD/Adriana Campos Passanezi Sant’Ana, PhD/Homayoun Hossein Zadeh, PhD/Maria Lúcia Rubo de Rezende, PhD

Purpose: To investigate the role of bone structural changes on cell biology after demineralization with different
concentrations of citric acid.

Materials and Methods: Under aseptic conditions, bicortical samples of calvarial bone were harvested from 28 adult male isogenic Wistar rats (Rattus norvegicus). Of the 55 total samples obtained, 45 bone samples were placed in 24-well culture plates that were randomly distributed into treatment groups (n = 15 per group): demineralization with 10% citric acid (CA.10), demineralization with 50% citric acid (CA.50), or washing with saline solution (control). MC3T3-E1 cells (Subclone 4-CRL-2593, ATCC) cultured on treated bone surfaces were analyzed regarding morphology and spreading. Scanning electron microscopy (SEM) and confocal microscopy were used in 10 remaining samples, before and after demineralization with CA.10 (n = 5) or CA.50 (n = 5), to assess the chemical composition (%A) and surface parameters: roughness of a line (Ra) and roughness of an area (Sa).

Results: Cells grown on demineralized bone surfaces were flatter, more spread out, and presented with more elongated filopodia than those cultured on nondemineralized surfaces. The surface area covered by cells was significantly larger after 24 hours of culture in CA.10 and CA.50 than in the control group. Demineralization had no effect on Ra and Sa parameters, but the distance between consecutive peaks and the distance between a peak and a consecutive valley decreased significantly. Chemical composition was not affected by demineralization.

Conclusions: Both citric acid concentrations produced bone surface changes that can promote preosteoblast growth and morphology compatible with advanced stages of differentiation. Int J Oral Maxillofac Implants 2026;41:410–418. doi: 10.11607/jomi.11334