Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
The International journal of oral & maxillofacial implants
Comparison Between Computer-Assisted and Freehand Dental Implant Placement: A Systematic Review and Meta-analysis
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.
13 June 2026
Read appraisal →Clinical oral investigations
Partially demineralized allogeneic cancellous bone plug versus deproteinized bovine bone mineral for guided bone regeneration: a pilot randomized controlled clinical trial
OBJECTIVES: To compare a partially demineralized allogeneic cancellous bone plug (ACBP) with deproteinized bovine bone mineral (DBBM) for guided bone regeneration (GBR), focusing on CBCT-based dimensional outcomes and histomorphometric tissue composition at implant placement. MATERIALS AND METHODS: In this prospective randomized controlled clinical trial, 25 adults requiring GBR for two common indications-posterior maxillary sinus floor elevation or mandibular posterior extraction socket preservation-were randomized to ACBP (n = 12) or DBBM (n = 13), with collagen membrane coverage in both groups. Radiographic endpoints were indication-specific and were reported separately for sinus and socket sites. CBCT was obtained at baseline and 6 months to assess augmented height (sinus sites) and ridge dimensions at standardized levels (socket sites). At 6 months (implant placement), a 3-mm trephine core was harvested for H&E staining and histomorphometric quantification of vital bone (VB, %) and residual graft material (RG, %). Between-group comparisons used independent-samples t tests (two-sided P < 0.05). RESULTS: All participants completed the 6-month follow-up. VB did not differ significantly between ACBP and DBBM (38.84 ± 8.37% vs. 32.18 ± 11.04%, P = 0.105), whereas RG was significantly lower with ACBP (11.18 ± 5.48% vs. 19.80 ± 8.23%, P = 0.006). CBCT outcomes were comparable between groups, with no significant differences in sinus height gain (7.82 ± 1.52 mm vs. 8.21 ± 4.30 mm, P = 0.852) or socket-related ridge dimensional changes (all P > 0.05). CONCLUSION: Within a 6-month healing interval, ACBP showed CBCT-based dimensional outcomes comparable to DBBM and a lower residual graft fraction with a similar vital bone fraction at implant placement, suggesting that the observed difference was more related to graft turnover than to greater bone formation. CLINICAL RELEVANCE: At routine implant timing (~ 6 months), use of ACBP was associated with a lower residual graft fraction at re-entry while maintaining short-term CBCT-based dimensional stability.
15 May 2026
Read appraisal →Journal of prosthodontic research
AI-driven innovations for dental implant treatment planning: A systematic review
PURPOSE: This systematic review evaluates the effectiveness of artificial intelligence (AI) models in dental implant treatment planning, focusing on: 1) identification, detection, and segmentation of anatomical structures; 2) technical assistance during treatment planning; and 3) additional relevant applications. STUDY SELECTION: A literature search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for studies published in English until July 31, 2024. The included studies explored AI applications in implant treatment planning, excluding expert opinions, guidelines, and protocols. Three reviewers independently assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies, resolving disagreements by consensus. RESULTS: Of the 28 included studies, four were high, four were medium, and 20 were low quality according to the JBI scale. Eighteen studies on anatomical segmentation have demonstrated AI models with accuracy rates ranging from 66.4% to 99.1%. Eight studies examined AI's role in technical assistance for surgical planning, demonstrating its potential in predicting jawbone mineral density, optimizing drilling protocols, and classifying plans for maxillary sinus augmentation. One study indicated a learning curve for AI in implant planning, recommending at least 50 images for over 70% predictive accuracy. Another study reported 83% accuracy in localizing stent markers for implant sites, suggesting additional imaging planes to address a 17% miss rate and 2.8% false positives. CONCLUSIONS: AI models exhibit potential for automating dental implant planning with high accuracy in anatomical segmentation and insightful technical assistance. However, further well-designed studies with standardized evaluation parameters are required for pragmatic integration into clinical settings.
13 Apr 2026
Read appraisal →The International journal of oral & maxillofacial implants
Histologic and Immunohistochemical Analysis of Peri-implant Tissue Regeneration at the Interface of Prosthetic Abutments Treated with Anodizing: A Prospective, Randomized Controlled Clinical Trial on the Early Postoperative Period
PURPOSE: To assess the effects of anodized prosthetic abutments versus machined abutments on peri-implant connective tissue. MATERIALS AND METHODS: Following dental implant placement and osseointegration, custom healing abutments with machined surfaces (G1) and anodized surface treatment (G2) were attached to 28 dental implants. After a soft tissue healing period of approximately 30 days (± 7 days), 5-mm circular biopsy samples were taken from the peri-implant tissue and the area adjacent to the prosthetic abutment. Histologic analysis was conducted on the stained specimens using hematoxylin-eosin (H&E), focusing on parameters such as vascular proliferation as well as the presence of polymorphonuclear and mononuclear cells, collagen fibrils, and reepithelialization. A grading scale from 0 to 3 evaluated the extent of the inflammatory response. Masson's trichrome staining was used to analyze collagen fiber presence and organization, while immunohistochemical staining assessed the expression of beta-catenin (β-catenin) and Cluster of Differentiation 34 (CD34). The prosthetic abutments were evaluated through scanning electron microscopy and 3D roughness analysis. RESULTS: Histologic findings revealed that peri-implant tissue adjacent to anodized surfaces exhibited epithelial stratification and a parakeratin layer in the lamina propria. Both groups displayed a typical mononuclear lymphocytic inflammatory infiltrate, but the intensity was significantly higher adjacent to the machined abutment (P < .05). Quantification of blood vessels indicated increased immunopositivity for CD34 in G2 compared to G1 (P < .05). Immunolabeling of β-catenin was detected in the epithelial tissue, showing weak intensity in G1 and strong intensity in G2. The average surface roughness measurements were determined to be 0.097 ± 0.006 μm for G1 and 0.182 ± 0.008 μm for G2. CONCLUSIONS: Anodized surfaces are a promising treatment option and exhibit beneficial effects on peri-implant tissue healing. They play an important role in preserving the epithelial mucosal integrity and functionality near the prosthetic abutment, thereby potentially minimizing the risks of mucositis, peri-implantitis, and implant failure.
5 Apr 2026
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