Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 11 appraisals
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 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 →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 →Medical science monitor : international medical journal of experimental and clinical research
Systematic Review of Case Reports and Case Series Published Between 2015 and 2025 on the Use of Biomaterials for Closure of Oroantral Fistula
Oroantral fistulas (OAFs) challenge the clinical decision-making of oral surgeons, requiring selection of an effective biomaterial for successful closure. This systematic review aims to evaluate recent biomaterials and techniques for closing oroantral fistulas, as reported in case reports and series. The goal of this review was to assess how different biomaterials affect the clinical closure of OAFs and oroantral communication. This systematic review followed PRISMA guidelines. Multiple scientific databases (Scopus, Web of Science, Cochrane Library) were comprehensively searched using relevant MeSH terms and Boolean operators. Inclusion criteria were case series, reports, and presentations using biomaterials for OAF closure published between 2015 and 2025, with visibly defined outcomes. Reviews, animal studies, and case series and reports without biomaterial use were excluded. Two independent reviewers performed title/abstract and full-text screening. Data extraction included patient demographics, OAF characteristics, biomaterials used, and outcomes. Narrative synthesis was performed after assessing quality using the Joanna Briggs Institute tool. The final assessment of 189 records yielded 18 eligible studies, having patients (age range 20-77 years) with varied etiologies, such as infections and extraction, OAF dimensions, and follow-up periods (9 days to 13 months). Commonly used biomaterials included platelet-rich fibrin (PRF), advanced PRF, collagen membranes, and other grafts. Patient outcomes showed consistent OAF closure, symptom relief, and uneventful healing. Studies represented 12 countries. Variability in reporting OAF characteristics was noted. Diverse biomaterials are effective for OAF closure, with frequent use of PRF and advanced PRF. Consistent reporting of OAF characteristics is essential for future research and improved comparability.
17 Apr 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 →Quintessence international (Berlin, Germany : 1985)
Photobiomodulation-assisted surgical wound healing at palatal donor site area: a systematic review
OBJECTIVE: The aim was to critically analyze the effects of photobiomodulation on recovery of the donor area after free gingival graft (FGG) surgery. DATA SOURCES: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science with date of access up to 7 April 2025, structured according to the PICO strategy: patients ≥ 18 years undergoing removal of FGGs from the palatal region (P), intervention with photobiomodulation at the donor site (I), compared with natural healing (C), evaluating wound healing as the primary and pain as the secondary outcome (O). A total of 668 records were identified and 8 randomized clinical trials, in which 284 participants were included. In outcomes, clinical healing parameters and patient-reported pain were analyzed, in which the majority of studies demonstrated that photobiomodulation positively influenced epithelialization, reduction in wound area, and tissue color during the first two postoperative weeks. However, the effect on pain control was inconsistent among studies, with only two showing statistically significant reductions. The studies included demonstrated clinical and methodologic heterogeneity due to different laser parameters, and their designs made statistical pooling of data unfeasible for a meta-analysis. CONCLUSION: Photobiomodulation appears to be a promising adjunctive therapy to accelerate palatal wound healing after FGG, particularly in the early postoperative period. Nevertheless, the clinical benefit in pain management remains uncertain. Future well-designed studies with standardized protocols are needed to strengthen contemporary evidence. (Quintessence Int 2026;57:230-241; doi: 10.3290/j.qi.b6762754).
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
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
Read appraisal →Dental clinics of North America
Artificial Intelligence in Diagnostic Oral and Maxillofacial Imaging, Surgical Applications, and Teledentistry
The article deals with the utilization of artificial intelligence (AI) and related technologies for the diagnosis of oral and maxillofacial anatomic variants and pathologic entities. The diagnosis of dental caries and periodontal disease is the most common aspect of dental diagnosis in a general dental setting and so, there was a subsection for this topic. There are dedicated portions within this article on applications of AI for oral and maxillofacial surgery.
4 Apr 2026
Read appraisal →