Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 10 appraisals
Journal of prosthodontic research
Peri-implant soft-tissue responses to tooth-colored abutment materials: A systematic review.
PURPOSE: This systematic review aimed to investigate and compare peri-implant soft-tissue responses to tooth-colored abutment materials frequently used in implant dentistry. STUDY SELECTION: A comprehensive electronic search was performed in three databases (MEDLINE via PubMed, Google Scholar, and Scopus) to identify relevant literature. The study-selection criteria included original research articles written in English that investigated the effects of various tooth-colored abutment materials on peri-implant soft-tissue responses. RESULTS: In total, 136 articles were included in this systematic review. Tooth-colored abutment materials, particularly zirconia and polyetheretherketone (PEEK), facilitated favorable soft-tissue adaptation, enhanced esthetics, and contributed to long-term implant success. Zirconia demonstrated excellent biocompatibility, enhanced cell viability and attachment, and lower inflammatory responses compared to titanium, suggesting improved soft-tissue integration and reduced biofilm-related risks. PEEK exhibited favorable mechanical properties and biocompatibility but limited cell attachment due to its hydrophobicity, indicating the need for surface modification. Titanium remains the clinical standard for integration but is associated with greater inflammation and biofilm formation than tooth-colored materials. CONCLUSIONS: This review highlights the effects of tooth-colored abutment materials on peri-implant soft-tissue responses and emphasizes the importance of selecting appropriate materials for successful dental implants. Zirconia represents a promising biological alternative to titanium, promoting a stable soft-tissue barrier that contributes to minimizing inflammation and maintaining long-term tissue health. Conversely, while PEEK offers strong mechanical properties, it faces challenges regarding cell proliferation and matrix production, limiting its optimal biological performance. Further research will provide deeper insights into the best options for enhancing patient and esthetic outcomes.
14 July 2026
Read appraisal →The Journal of prosthetic dentistry
Deep learning-based object detection of dental implant systems in panoramic and periapical radiographs
STATEMENT OF PROBLEM: The manual identification of dental implant systems on radiographs is time-consuming, operator-dependent, and prone to diagnostic inaccuracies, particularly for patients where clinical documentation is lacking. The increasing variety of implant designs further complicates identification in prosthetic and surgical practice. PURPOSE: The purpose of this study was to develop and evaluate a deep learning-based model for the automated identification of 7 implant systems (Adin, Dentium, Dionavi, Make It Simple (MIS), Nobel, Noris, and Osstem) using panoramic radiographs and periapical radiographs in an effort to enhance diagnostic efficiency and support clinical decision-making in prosthodontic care. MATERIAL AND METHODS: A total of 4677 anonymized radiographic images with 8189 implants were curated and annotated using Roboflow with bounding boxes outlining fixture components. The preprocessing involved normalization, resizing to 640×640 pixels, and geometric augmentation (rotation, cropping, and blurring) to handle class imbalances. You Only Look Once (YOLO) v10 architecture, implemented with PyTorch, using CSPDarknet and PANet for multiscale feature fusion, was used to optimize real-time detection. Transfer learning used pretrained weights, with training for over 500 epochs (batch size: 32) on NVIDIA T4 GPUs. Data partitioning involved an 80:10:10 ratio (training: validation: testing), with performance evaluated using precision, recall, F1-score, and mean average precision (mAP). RESULTS: The model achieved a mAP of 98.3%, with mean precision, recall, and F1-score values of 93%, 86%, and 89%, respectively. Osstem implants demonstrated maximum discriminability (99% precision, 95% recall). In contrast, Nobel implants exhibited low recall (72.7%), attributed to the sparsity of the dataset (564 samples for Nobel compared with 2320 for Osstem) and similar radiopacity patterns. CONCLUSIONS: The YOLOv10 model demonstrated good performance in identifying dental implants, showing clinical promise for minimizing prosthetic mismatches. Subject to ethics and regulatory approvals, additional improvements involving 3-dimensional imaging and heterogeneous datasets may add precision and validate artificial intelligence as an evidence-based advance in implant dentistry.
2 July 2026
Read appraisal →The International journal of oral & maxillofacial implants
The Effect of Sinus Elevation and Onlay Grafts on Biologic and Technical Complications of Implants Placed in the Resorbed Posterior Maxilla: A Systematic Review and Analysis of Studies
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.
14 June 2026
Read appraisal →The International journal of prosthodontics
Accuracy of Stereophotogrammetry in Implant Scanning Compared to Intraoral Scanning in Completely Edentulous Patients-A Systematic Review and Meta-analysis
PURPOSE: To evaluate the accuracy of full-arch implant impressions by comparing photogrammetry and intraoral scanning (IOS) techniques through a systematic review and meta-analysis following the Cochrane protocol. MATERIALS AND METHODS: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science up to May 2024. Keywords based on the PICO question were used without time or language restrictions. In vitro studies assessing full-arch implant rehabilitations that compared photogrammetry to IOS were included. The risk of bias was assessed using the Quin Tool Method. Data were analyzed through metaanalysis in RevMan (Cochrane), grouping the results into three subgroups: angle deviation, precision (μm), and trueness (μm). RESULTS: The search yielded 6,348 studies: 11 met the eligibility criteria, and 7 provided sufficient data for quantitative meta-analysis. Photogrammetry demonstrated superior precision, with a mean difference (MD) of -0.03 (95% CI: -0.04, -0.02) and a high weight of 94.2%, indicating consistent evidence. The results for angle deviation were MD = -0.12 (95% CI: -0.16, -0.08, P < .00001), and for trueness the results were MD = -0.16 (95% CI: -0.19, -0.13, P < .00001). The photogrammetry group also showed favorable results. Although trueness exhibited expressive MD values, it had a lower overall weight (5.8%). CONCLUSIONS: Within the limitations of this study, photogrammetry significantly improves the accuracy of fullarch implant rehabilitations compared to IOS. These findings support the adoption of photogrammetry for more accurate and consistent outcomes in dental implant procedures.
28 May 2026
Read appraisal →International journal of implant dentistry
A randomized controlled pilot trial comparing peri-implant tissue health beneath CAD/CAM-milled PEEK versus cobalt-chromium telescopic crowns for mandibular overdentures
PURPOSE: This pilot randomized clinical trial compared peri-implant tissue health around milled cobalt-chromium (CoCr) versus polyether ether ketone (PEEK) secondary telescopic crowns in implant-retained mandibular overdentures over 12 months. METHODS: Twelve completely edentulous patients received two implants each. After randomization, secondary crowns were fabricated from milled CoCr (n = 6 patients) or PEEK (n = 6 patients). Assessor-blinded outcome assessments such as marginal bone loss (MBL), probing depth (PD), and plaque index (PI) were performed at baseline, 6, 9, and 12 months post-loading. Statistical analysis used the patient as the unit of analysis. RESULTS: No statistically significant inter-group differences were found at any time point. At 12 months, mean MBL was 0.48 ± 0.15 mm for CoCr and 0.45 ± 0.16 mm for PEEK (p = 0.735). PD increased over time within groups but remained comparable between groups (CoCr: 2.58 ± 0.58 mm, PEEK: 2.33 ± 0.41 mm at 12 months; p = 0.411). PI scores also showed no significant inter-group differences (p > 0.05). CONCLUSIONS: Over 12 months, milled PEEK and CoCr secondary telescopic crowns demonstrated comparable peri-implant tissue health. PEEK presents a viable metal-free alternative for this application. These preliminary findings warrant confirmation in larger, long-term studies.
14 May 2026
Read appraisal →The Journal of oral implantology
Particulate Bone Grafts vs Split Bone Cortical Plates: Resorbable and Nonresorbable Membranes in Vertical Augmentation
This study aimed to evaluate vertical bone gain in the anterior edentulous mandible using the split cortical bone plate technique with 2 different graft and membrane combinations: autogenous particulate grafts with titanium-reinforced polytetrafluoroethylene membrane (T1) and a mixture of autogenous and xenograft particulate grafts with a collagen membrane (Bio-Gide) (T2). Twenty-two patients presenting with severe vertical alveolar ridge atrophy were randomly allocated into 2 equal groups with 11 participants in each group. Cone beam computerized tomography was used to assess vertical bone gain and crestal bone loss at 6 months, 1 year, and 5 years postgrafting. Keratinized tissue width and peri-implant probing depth were also measured at the same intervals to evaluate long-term soft tissue stability and peri-implant health. Whereas both groups demonstrated comparable vertical bone gain, the T1 group exhibited better maintenance of keratinized gingiva. It reduced crestal bone loss over time, suggesting the clinical utility of nonresorbable membranes in enhancing soft and hard tissue outcomes in complex augmentation cases.
8 Apr 2026
Read appraisal →The International journal of oral & maxillofacial implants
Bone Marrow Aspirate Concentrate and Xenograft Versus Autograft and Xenograft in the 3D Reconstruction of Atrophic Maxillary Ridges: A Split-Mouth Randomized Controlled Trial
PURPOSE: To evaluate bone quality and quantity after 3D augmentation of vertically and horizontally atrophied maxillary ridges and compare the use of bone marrow aspirate concentrate (BMAC) and xenograft versus autograft and xenograft, both using prebent titanium (Ti) mesh over a virtually augmented model. MATERIALS AND METHODS: Ten fully edentulous patients with severe maxillary vertical and horizontal bone loss were recruited. Virtual horizontal and vertical bone augmentation was performed for the deficient ridge to produce virtually augmented models for prebent Ti meshes preoperatively. Each patient was rehabilitated with BMAC and xenograft on one side of their mouth (test side) and with autograft and xenograft on the other (control side). For the test side, the mesh was loaded with a mix of xenograft and BMAC from the anterior iliac crest. For the control side, the mesh was loaded with a 1:1 ratio of xenograft to autograft mix. The meshes on both sides were fixed in place using miniscrews. RESULTS: CBCT scans were performed 6 months postoperatively for all patients. The test side showed a mean vertical bone gain of 3.47 ± 0.87 mm, which was comparable to that of the control side (4.10 ± 0.67 mm). The test side also showed a mean horizontal bone gain of 3.476 ± 0.59 mm, which was higher than that of the control side (2.918 ± 0.80 mm). While the mean resorption rate in the test side (106.2 ± 108.6 mm) was lower than the mean value in the control side (193.3 ± 107.9 mm), the differences in bone gain were not statistically significant. However, a statistically significant higher bone area percentage (47.9%) as well as a higher percentage of mature bone (67.7%) were detected in the test side compared to the control side (28.5% and 26.5%, respectively). CONCLUSIONS: 3D alveolar reconstruction using prebent Ti meshes loaded with xenograft mixed with BMAC could be a reliable and less complicated technique for vertically and horizontally atrophied maxillary ridges.
5 Apr 2026
Read appraisal →The International journal of oral & maxillofacial implants
Novel Double Expansion Technique (Khalifah's Technique) Versus Ridge Splitting in Immediate Implant Placement in Narrow Ridges: A Randomized Clinical Trial
PURPOSE: To present and compare the novel double expansion technique (DET) (Khalifah's technique) and the ridge splitting technique (RST) in cases of narrow ridges. MATERIALS AND METHODS: A total of 40 patients (57 dental implants [DIs]) with narrow ridges were randomly allocated to a control group, which employed the RST, and to a study group, which employed the DET. Secondary stability, marginal bone loss (MBL), keratinized mucosa width (KMW), Plaque Index (PI), bleeding index (BI), and probing depth (PD) were assessed at baseline (time of definitive abutment and temporary crown placement) and then at 3, 6, and 12 months. Pain and the number of analgesic tablets consumed were assessed daily during the first postoperative week. RESULTS: The study group had lower pain levels during the first 2 days postoperatively and presented with greater primary and secondary stability at baseline and at 3 months. Moreover, patients in that group had less MBL at all time points and greater KMW at 6 and 12 months postoperatively. Otherwise, both groups showed comparable results regarding PI, BI, and BD. CONCLUSIONS: The study group had superior performance, which may be attributed to the lower degree of trauma with the DET.
5 Apr 2026
Read appraisal →The International journal of oral & maxillofacial implants
Dimensional Changes of the Alveolar Ridge After Tooth Extraction Using the Socket Shield Technique Without Immediate Implant Placement: A Randomized Controlled Study
PURPOSE: To compare radiographic dimensional changes in postextraction sites treated with spontaneous healing versus the modified socket shield technique (mSST) without immediate placement using CBCT scans. MATERIALS AND METHODS: This randomized clinical study included 80 patients with a single maxillary anterior tooth that was not restorable. Patients were divided into two equal groups: (1) the test group, which used the mSST, and (2) the control group, which used the atraumatic extraction technique with spontaneous healing. CBCT scans were performed at baseline (before or immediately after extraction) and 6 months postsurgery. Measurements included alveolar ridge width at 1-mm, 3-mm, and 5-mm levels and buccal and palatal bone plate heights. Following this, implants were placed, and their primary stability was assessed. The main intervention was the use of the mSST compared to the atraumatic tooth extraction technique. The primary outcome was the change in buccal bone plate height over a 6-month follow-up period. In addition, covariates included patient age and sex. Paired t tests and independent t tests were used to evaluate intra- and intergroup differences, respectively. Statistical significance was set at P < .05. RESULTS: In the test group, a significant reduction in palatal wall height was observed (P < .001), while no significant changes were noted in other parameters (P ≥ .05). In the control group, significant decreases were observed in buccal and palatal plate heights as well as ridge width (P < .05). When comparing the groups, the test group demonstrated significantly less buccal wall height and ridge width resorption than the control group (P < .05). However, no significant difference was observed in palatal plate height resorption between the two groups (P = .507). The test group exhibited significantly higher primary stability rates compared to the control group (P = .001). CONCLUSIONS: The mSST with delayed implant placement demonstrated superior maintenance of buccal bone plate height and ridge width, along with significantly greater primary implant stability, compared to spontaneously healed sockets. This approach is beneficial for maintaining ridge integrity when immediate implant placement is not planned.
4 Apr 2026
Read appraisal →The International journal of oral & maxillofacial implants
Accuracy and Reliability of Artificial Intelligence Chatbots as Public Information Sources in Implant Dentistry
PURPOSE: To evaluate the accuracy, completeness, comprehensibility, and reliability of widely available artificial intelligence (AI) chatbots when addressing clinically significant queries pertaining to implant dentistry. MATERIALS AND METHODS: A total of 20 questions were devised based on a compiled list that were most frequently asked or encountered during patient consultations by three experienced prosthodontists. These questions were asked to ChatGPT-3.5, Gemini, and Copilot AI chatbots on three separate occasions in 12-day intervals. A three-point Likert scale (0 = incorrect; 1 = incomplete or partially correct; 2 = correct) and a two-point scale (true and false) were employed by the authors to grade the accuracy of the responses independently. Completeness and comprehensibility were also evaluated using a three-point Likert scale (scored 1, 2, or 3, with lower scores indicating a worse result). In addition to the questions generated by the specialists, AI chatbots were asked to provide five frequently asked questions and responses regarding dental implant prostheses. A comparison of total scores obtained from the chatbots was made with one-way analysis of variance (ANOVA). Twopoint scale data were analyzed via chi-square test. The reliability of the responses for each chatbot was analyzed by assessing the consistency of repeated responses via calculating Cronbach's alpha (α) coefficients. RESULTS: When the total accuracy scores of the chatbots were analyzed out of a 40-point total score (ChatGPT-3.5 = 28.78 ± 4.06; Gemini = 30.89 ± 4.08; Copilot = 29.11 ± 3.22), one-way ANOVA revealed no statistically significant differences (P = .461). For the evaluation of two-point accuracy scale data, which were analyzed via chi-square test, no statistical differences were revealed among the chatbots (P = .336). Gemini showed a higher completeness level than ChatGPT-3.5 (P = .011). There was no statistically significant difference among AI chatbots in terms of comprehensibility. Copilot demonstrated the greatest overall consistency among the three chatbots, with a Cronbach's α value of .863. This was followed by ChatGPT-3.5 with a Cronbach's α value of .779 and Gemini with a Cronbach's α value of .636. CONCLUSIONS: The accuracy of all three chatbots were found to be similar. All three chatbots demonstrated an acceptable level of consistency. However, given the low accuracy rate of chatbots in answering questions, it is clear that they should not be relied upon as a decision-maker, and the clinician's opinion must be given priority.
4 Apr 2026
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