Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 26 appraisals
International dental journal
Deep Learning Based on Swin-Transformer and 3D U-Net: Implant Three-Dimensional Position Planning
INTRODUCTION AND AIMS: This study aimed to devise a deep learning-based model for the automated identification of anatomical mandibular lingual concavities in the posterior mandible and the prediction of biologically guided three-dimensional implant positions. METHODS: Cone-beam computed tomography (CBCT) images with single-tooth posterior mandibular edentulism were included. A deep learning framework was constructed utilizing 3D U-Net and Swin-Transformer. This framework was designed to perform automated segmentation of teeth, mandible, and the mandibular nerve canal; to classify morphological types of lingual concavities; and to identify implant key points with coordinate prediction. Model performance was assessed via five-fold cross-validation. RESULTS: The proposed model achieved Dice similarity coefficients ranging from 0.87 to 0.91 for dental segmentation. In the classification of mandibular lingual concavities, an accuracy of 0.92 to 0.97 was attained. Regarding the prediction of three-dimensional implant positions, the automatically generated plans maintained a safety margin of 3.20 to 3.89 mm from the mandibular nerve canal. Furthermore, sufficient bone volume was preserved at both cervical and apical implant levels, with buccal/lingual cervical bone widths averaging 4.94 to 5.78 mm. CONCLUSION: The deep learning model in this experiment performed well across different views and learning tasks in a retrospective internal validation setting. Furthermore, it demonstrated the ability to accurately identify relevant anatomical structures, and the predicted three-dimensional implant positions showed clinically acceptable safety margins in the internal validation cohort. CLINICAL RELEVANCE: This model provides a preliminary AI-assisted framework for identifying critical mandibular anatomical structures and generating biologically guided preliminary implant position suggestions, thereby helping to mitigate intraoperative complications and reduce the risk of postoperative mechanical and biological complications in preclinical evaluation.
2 Aug 2026
Read appraisal →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 →BMC oral health
Accuracy of virtual facebow compared to conventional facebow: a systematic review
BACKGROUND: Digital technologies are rapidly evolving and have been introduced across many fields in dentistry, particularly prosthetic and restorative dentistry. In digital treatment planning, virtual articulators are helpful in simulating complex maxillomandibular movements and analyzing occlusion. Despite these advancements, evidence-based literature standardizing the transfer of clinical data to virtual environments remains limited. The aim of this review was to explore the accuracy of various methods in transferring maxillary digital models to virtual articulators compared with conventional facebow techniques. METHODS: The research (PICO) question focused on assessing the accuracy of virtual facebow transfer compared to that of conventional facebows. An electronic search was performed in 3 databases between January 2014 to December 2025: PubMed/MEDLINE, Scopus, and Web of Science. Eligibility criteria included in vitro studies, clinical trials, case reports, clinical reports, and clinical techniques that evaluated the accuracy of virtual articulation in fixed prosthodontics for dentate patients, published in English. Studies were excluded if they were not in English, involved orthognathic surgery, focused on edentulous patients, or were published before 2014. A comprehensive search was conducted in December 2025. Two reviewers (PE, HA) independently examined the identified papers in accordance with the predetermined qualifying criteria. For each included study, publication details, study characteristics, and methodological aspects were documented. RESULTS: The total number of articles retrieved was 1,916. Of these articles, 10 met the inclusion criteria and were used for qualitative synthesis. Several techniques were reported for transferring the maxillary model to virtual articulator, such as digital photographs, face scans with or without intraoral or extraoral scan body, smartphone applications, digital photographs using Kois glasses, CBCT, and stereophotogrammetry. Most studies showed comparable accuracy of different digital methods that transfer the maxillary cast to the articulator. However, one study showed that the photography-based method demonstrated superior trueness and precision compared to both facial scanning and the conventional facebow technique. Another study found that the accuracy of positioning a maxillary digital scan relative to a 3D facial scan using a virtual facebow technique is highly dependent on the facial scanning method employed. CONCLUSIONS: Virtual facebow transfer can be recorded using techniques such as digital photographs, face scans, virtual facebow software, and smartphone scanning. Virtual facebow systems demonstrate promising repeatability and clinically acceptable transfer accuracy in selected workflows; however, due to heterogeneity among available studies, definitive conclusions regarding any improvement over conventional techniques cannot yet be drawn. Further standardized in vitro and clinical studies with large sample sizes, standardized assessments, and comparison methods are needed to draw meaningful conclusions in order to prove precedence of one method over the other. However, the use of a device to facilitate the transfer of a virtual maxillary cast to a virtual articulator has been promising.
13 July 2026
Read appraisal →Clinical oral investigations
Predicting occlusal force distribution from intraoral scans using deep learning: a pilot study
OBJECTIVES: This pilot study investigated whether occlusal force distribution measured by T-Scan can be predicted from intraoral scan images using deep learning. METHODS: Paired intraoral scan and T-Scan images from 26 subjects were analyzed. Following quality control, data were randomly partitioned at the subject level into training (n = 18), validation (n = 4), and independent test (n = 4; 8 image pairs) sets. Five deep learning architectures (U-Net, ResNet-UNet, Vision Transformer, CNN-Attention, and Pix2Pix) were trained to predict T-Scan force maps from occlusal scan images. Structural Similarity Index (SSIM) was predefined as the primary endpoint. Nonparametric statistical comparisons (Friedman test with Holm-corrected Wilcoxon post hoc analysis) and bootstrap confidence intervals were used. RESULTS: A significant difference in SSIM was observed among models (χ² = 19.3, p = 0.00069). CNN-Attention achieved the highest structural similarity (mean SSIM 0.501 ± 0.030), significantly outperforming U-Net, Vision Transformer, and ResNet-UNet (adjusted p < 0.05), while not differing significantly from Pix2Pix. Pix2Pix demonstrated the lowest mean absolute error (0.237 ± 0.018), indicating superior pixel-level intensity approximation. Validation curves revealed distinct optimization behaviors, with adversarial training showing late-stage improvements in SSIM. CONCLUSIONS: Deep learning models approximated T-Scan occlusal force maps from intraoral scan images in this pilot dataset. These findings suggest that artificial intelligence may help estimate functional occlusal force distribution from morphological intraoral scan data. Further studies with larger datasets are required to validate clinical applicability. CLINICAL SIGNIFICANCE: Computational prediction of functional occlusal force maps from intraoral scans may represent a future step toward integrating morphological and functional data within digital dentistry workflows; however, larger validation studies are required before clinical application.
7 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 Journal of prosthetic dentistry
Performance of large language models conducting systematic review tasks in prosthodontics.
STATEMENT OF PROBLEM: Systematic reviews (SRs) are time-consuming and resource-intensive processes. Whether large language models (LLMs) can improve the process is unclear. PURPOSE: The purpose of this study was to evaluate the accuracy and reliability of 4 LLMs (GPT-4, Gemini, Claude, and Elicit) in performing SR tasks (full-text screening, data extraction, and risk of bias assessment) at 3 different sequential periods of time (0, 15, and 30 days). MATERIAL AND METHODS: A comprehensive systematic search was conducted across 5 databases in December 2024, with 59 articles evaluated for screening (2 used for pilot) and 31 for data extraction (2 used for pilot). A 3-pronged prompting strategy was used, including persona-based initialization, few-shot learning, and structured population, intervention, control, outcome (PICO) criteria. Performance was assessed through 3 repeated evaluations at 2-week intervals by measuring accuracy and reliability using standard metrics (accuracy, precision, F1-score, sensitivity, and specificity) against expert assessments, data extraction quality on a 0 to 5 scale, and risk of bias agreement via the Cohen kappa, with statistical analysis using Kruskal-Wallis and Dunn post hoc tests (α=.05). RESULTS: In full-text screening, Claude achieved the highest sensitivity at 97%, while Claude and Elicit both showed strong overall performance with 86% accuracy and 87% F1-scores. All models maintained sensitivity above 90%. For data extraction, GPT-4 consistently performed best with median scores of 5.0, while Claude and Gemini showed similar capabilities. Significant differences only appeared in labeling and modeling tasks during Week 1 (P=.04). Risk of bias assessment agreement with experts varied from 55% to 90% across different criteria. CONCLUSIONS: LLMs show potential for SR efficiency (especially for data extraction) but require human oversight because of variable performance across models and tasks.
2 July 2026
Read appraisal →The Journal of prosthetic dentistry
A simulation-based study of 3D printing angle optimization by integrating deep learning and NSGA-III for prosthesis and retainer manufacturing
STATEMENT OF PROBLEM: Current dental 3-dimensional (3D) printing workflows lack automated tools for optimizing build orientations that preserve critical clinical surfaces. Existing slicing software programs often require manual adjustment and may place supports in functional areas. PURPOSE: The purpose of this simulation-based study was to develop and evaluate a computational framework by integrating deep learning and Non-dominated Sorting Genetic Algorithm III (NSGA-III) to optimize build orientations for dental crowns and retainers by minimizing the support area (SA) and printing height (PH). A secondary objective was to assess the effects of angular resolution and mesh simplification on optimization outcomes. MATERIAL AND METHODS: A 3-stage framework was developed using PointNet++ for cast classification, MeshSegNet for feature recognition, and NSGA-III for dual-objective optimization. Mesh simplification was applied to enhance computational efficiency. Twenty-four dental casts were tested in a repeated-measures design at 1, 5, and 10 degrees angular resolutions. Nonparametric statistical analyses were performed using the Friedman test (α=.05) with post hoc Wilcoxon signed-rank tests and Bonferroni correction. RESULTS: Mesh simplified reduced computation time by 87.0% without altering optimal orientation distributions. Reduced angular resolution significantly affected PH and SA outcomes under most conditions (P<.001), except for SA in the PH-optimized group (P=.004). Post hoc analysis confirmed the largest degradation in accuracy between 1 and 10 degrees. Compared with commercially available software programs, the proposed framework consistently avoided the placement of supports on critical surfaces. CONCLUSIONS: The proposed framework provides an automated and efficient approach to optimizing build orientations in dental 3D printing. Although simulation results demonstrated improved optimization performance, further experimental validation is required before clinical application.
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 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 →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 →The International journal of prosthodontics
A Systematic Review and Meta-analysis Evaluating the Survival, Failure, and Complication Rates of Metal-Ceramic, Veneered, and Monolithic All-Ceramic Tooth-Supported Single Crowns-Part 1
PURPOSE: To evaluate five-year survival rates of metal-ceramic, veneered all-ceramic, and monolithic all-ceramic tooth-supported single crowns (SCs) and assess biological and technical complications. MATERIALS AND METHODS: A systematic search of Medline (PubMed), Embase, and CENTRAL (2014-2024) identified clinical studies on tooth-supported fixed dental prostheses (≥3 years mean follow-up). Manual screening and 30 studies from previous reviews were added. Sixty-four studies met inclusion, reporting on 3,509 metal-ceramic and 8,051 all-ceramic SCs. Robust Poisson regression models were used to estimate pooled five-year survival rates. RESULTS: Twelve studies investigated metal-ceramic crowns, 49 all-ceramic crowns, and three both. Five-year survival rates were: 98.5% for monolithic lithium-disilicate reinforced glass-ceramic, 97.3% for veneered densely-sintered zirconia, 97.1% for metal-ceramic, 96.8% for monolithic densely-sintered zirconia, 95.7% for veneered leucite/lithium-disilicate reinforced glass-ceramic, 94.5% for densely-sintered alumina, 94.3% for glass-infiltrated alumina, 90.4% for feldspathic/silica-based ceramic. Survival rates of feldspathic/silica-based ceramic (P<0.0001), glass-infiltrated alumina (P=0.019), densely sintered alumina (P=0.002), and veneered leucite/lithium-disilicate reinforced glass-ceramic (P=0.021) were significantly lower than monolithic lithium-disilicate SCs. Except for feldspathic/silica-based ceramic and metal-ceramic crowns, material/design types performed similarly in anterior and posterior regions. Monolithic lithium-disilicate and monolithic zirconia crowns showed significantly fewer ceramic fractures and chipping compared to veneered alternatives. CONCLUSIONS: Lithium-disilicate and zirconia-based all-ceramic SCs achieve five-year survival rates comparable to metal-ceramic crowns. Monolithic designs reduce fracture and chipping risk, improving long-term clinical outcomes.
28 May 2026
Read appraisal →Clinical oral investigations
Three-dimensional stability during orthodontic retention: A comparative analysis of conventional, CAD/CAM-fabricated, and robotically bent fixed retainers versus removable appliances
OBJECTIVES: To evaluate three-dimensional anterior tooth position changes during orthodontic retention and to compare the effectiveness of three distinct fixed retainer fabrication designs including robotically bent retainers alongside with removable retainers. MATERIALS AND METHODS: This retrospective cohort study included 113 patients (226 dental arches; mean retention period 1.3 ± 0.6 years). Combined fixed lingual plus removable retention (group 1, n = 148 arches) comprised CAD/CAM Memotain, conventional multistranded stainless-steel (Twistflex), and robotically bent retainers; group 2 (n = 78 arches) received removable retention only. Digital model superimposition using a three-dimensional tooth-specific coordinate system quantified rotational and translational tooth movements, Little's Irregularity Index (LII), transverse arch widths, and bonding failures. RESULTS: Combined fixed and removable retention showed higher stability than removable-only retention (55% vs. 33% stable arches). Removable retention increased the odds of moderate-to-severe instability (maxilla OR 4.37, 95% CI 1.74-10.98; mandible OR 14.35, 95% CI 3.24-63.56), whereas fixed lingual retention was protective (maxilla OR 0.23, 95% CI 0.09-0.58; mandible OR 0.07, 95% CI 0.02-0.31). Instability mainly involved canine rotations and vertical translations. Robotically bent and CAD/CAM Memotain retainers showed the lowest movement magnitudes and variability, with minimal LII increases. Intercanine and intermolar widths remained stable across fixed retainers. Bonding failures (25%) strongly predicted severe instability. CONCLUSIONS: Three-dimensional tooth movements during retention mainly involve canine rotations and vertical translations. All fixed retainer designs (Twistflex, CAD/CAM-fabricated, and robotically bent) provided greater stability than removable-only retention. CLINICAL RELEVANCE: All fixed retainer designs require regular monitoring of bonding integrity; digitally fabricated and robotically bent retainers demonstrated marginally lower dimensional variability, which may be clinically relevant over longer observation periods.
25 May 2026
Read appraisal →Scientific reports
3D‑printed training model for periodontal splinting: a randomized preclinical study
Preclinical simulation is essential for students to practice before clinical treatment. A low-cost 3D-printed model was developed with repositionable mobile maxillary anterior teeth to train periodontal splinting and evaluate learner perception and repositioning accuracy. In a two-period randomized cross-over course 43 students in their fourth year completed two palatal slot splints from the right to the left maxillary canine (FDI 13-23) in randomized material order. They used a polyethylene ribbon and a pre-impregnated unidirectional glass-fibre bundle. Outcomes included an electronic questionnaire using an anchored 6‑point ordinal scale from 1 for "Excellent" to 6 for "Unsatisfactory" following the German school grading system and geometric deviation of each tooth to an ideal position. The course was rated overall as good (Md 2.0, IQR 1.0) and highly clinically relevant (Md 1.0, IQR 1.0). Self-reported preparedness for splinting improved from poor (Md 5.0, IQR 1.0) before the course to good (Md 2.0, IQR 1.0; p < 0.001) after the course. In this pilot study, no statistically detectable positional deviations between materials or between the first and second session in this cohort were observed. This inexpensive, reproducible 3D-printed model enables realistic periodontal splinting training under simulated mobility conditions and may support structured preparation for clinical teaching.
25 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
Preliminary Evaluation of Large Language Models in Kennedy Classification and Removable Partial Denture Planning: An In Silico Study
BACKGROUND This study evaluated text-based large language models for Kennedy classification and removable partial denture planning in partially edentulous cases, where comparative evidence on accuracy remains limited. MATERIAL AND METHODS Twenty-six partially edentulous cases, defined according to the Federation Dentaire Internationale tooth numbering system and classified as Kennedy Classes I to IV, were included. Case scenarios were constructed by an experienced prosthodontist. Questions were independently submitted to 4 large language models without prior training or prompting: ChatGPT-5.2, Claude Sonnet 4.6, Gemini 3 Flash, and Perplexity. Responses were evaluated by 2 independent prosthodontists (different from the case developer) - blinded to the identity of each model - using predefined criteria for Kennedy classification accuracy and prosthetic planning consistency. Statistical analyses included intergroup comparisons and effect size estimation. RESULTS Statistically significant differences were identified among the models in both tasks (P<0.001). For Kennedy classification, the effect size was moderate (Kendall's W=0.402). Gemini 3 Flash achieved the highest mean score, followed by ChatGPT-5.2, Perplexity, and Claude Sonnet 4.6. Similarly, significant differences were observed in removable partial denture planning performance (Kendall's W=0.424); Gemini 3 Flash scored significantly higher than the other models (P≤0.001). CONCLUSIONS Large language models showed variable performance under zero-shot conditions. Although Gemini 3 Flash achieved higher scores, the moderate effect sizes warrant cautious interpretation. These models may serve as adjunctive decision-support tools in prosthodontics but cannot replace clinical judgment.
12 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Impact of novel systemic cancer therapies on osseointegration and dental implant outcomes: a systematic review
PURPOSE: Advances in systemic cancer therapies such as immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors (TKIs), and anti-angiogenic agents have markedly improved survival in patients with solid and hematologic malignancies. As survivorship increases, oral rehabilitation with dental implants is increasingly sought to restore quality of life. However, these therapies may adversely affect bone healing, angiogenesis, and immune regulation, raising concerns regarding implant-related complications. This systematic review aimed to evaluate reported dental implant outcomes and complications in patients receiving novel systemic cancer therapies, emphasizing the implications for supportive oncology. METHODS: This review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251142681). PubMed/MEDLINE, Scopus, ScienceDirect, and the Cochrane Library were searched for English-language clinical reports describing dental implant outcomes in patients treated with ICIs, TKIs, or anti-angiogenic agents. Study selection, data extraction, and quality appraisal using the Joanna Briggs Institute checklist for case reports were performed independently by two reviewers. RESULTS: Seven case reports (2017-2024) were included, representing Level IV evidence. Two cases involving TKIs reported successful osseointegration and long-term survival. In contrast, five cases described adverse outcomes including early failure and MRONJ predominantly associated with anti-angiogenic agents, either alone or in combination with ICIs and antiresorptive agents. These complications often resulted in significant functional morbidity and the need for invasive surgical intervention. CONCLUSION: Based on limited case report evidence, anti-angiogenic therapies were more frequently observed in cases with adverse outcomes, including implant-related MRONJ and failure, while TKIs were associated with favorable outcomes in limited cases. The role of ICIs remains unclear due to sparse data, particularly regarding monotherapy effects. Given the preliminary nature of current evidence derived from case reports, prospective studies with appropriate control groups are urgently needed to establish evidence-based guidelines. PROSPERO NUMBER AND DATE OF REGISTRATION: CRD420251142681; 08/09/2025.
12 May 2026
Read appraisal →Journal of prosthodontic research
Flexural strength of translucent zirconia for single crowns and fixed dental prostheses-A systematic review
PURPOSE: The aim of this systematic review was to analyze the reported flexural strength values of commercially available translucent zirconia materials. Additionally, data were evaluated to assess the impact of different specimen preparations and test methods. STUDY SELECTION: This systematic review was conducted according to the PRISMA guidelines. Electronic searches were performed to identify in vitro studies published between January 1, 2013, and March 15, 2025, that reported flexural strength values of translucent zirconia and included the names of the tested materials and manufacturers. Flexural strength values were analyzed to assess the effects of yttria content, specimen processing, surface treatments, and test methods using Kruskal-Wallis analysis of variance (α = 0.05) and forest plots. RESULTS: A total of 78 laboratory studies met the inclusion criteria. The overall flexural strength values were significantly higher for 4Y-PSZ (803± 233 MPa) than for 5Y-PSZ materials (570 ± 116 MPa) (P = 0.005). Specimen processing, surface treatments, and test methods significantly affected the flexural strength values for 5Y-PSZ (P < 0.001) but not for 4Y-PSZ (P > 0.05). CONCLUSIONS: This systematic review highlights the challenges in comparing the flexural strength values of translucent zirconia owing to differences in processing parameters. Further standardization of test methods and adherence to ISO 6872 would improve comparability. Our findings support the clinical use of 4Y-PSZ for three-unit fixed dental prostheses (FDPs) and 5Y-PSZ for three-unit FDPs in the anterior region based on ISO 6872.
13 Apr 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 →Journal of prosthodontic research
Clinical performance, accuracy, and physical-mechanical properties of 3D-printed removable partial denture metal frameworks compared with conventionally and partially digitally produced frameworks: A systematic review.
PURPOSE: This systematic review evaluated the clinical performance, physical-mechanical properties, and accuracy of removable partial denture (RPD) frameworks fabricated using three-dimensional (3D) printing technologies-specifically, selective laser sintering (SLS), selective laser melting (SLM), and direct metal laser sintering (DMLS)-compared to those produced by conventional casting or methods using a partial digital workflow. STUDY SELECTION: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a literature search was conducted in the PubMed, Scopus, Web of Science, and Cochrane databases in October 2024. Studies were included if they compared the fit, accuracy, mechanical and physical properties, and clinical outcomes of metal RPD frameworks made using 3D printing technologies with those produced using conventional casting or partial digital methods. The risk of bias was assessed using appropriate tools (modified CONSORT, ROB2, and ROBINS-I) based on the study design and a qualitative analysis was conducted. This study received no funding and was registered with PROSPERO (#CRD42024597225). RESULTS: Thirty studies were included: 12 compared 3D printing technologies with conventional casting, eight with partial digital methods, and 10 with both. Clinically, 3D-printed frameworks could improve retention and patient satisfaction. The laboratory results showed higher density, better mechanical properties (yield strength, surface roughness, and microhardness), and varied accuracy by component and method, with SLM and DMLS often outperforming conventional casting. The evidence was limited by methodological variability, a moderate risk of bias in many studies, and inconsistencies across the study designs and parameters. CONCLUSIONS: 3D-printed RPD metal frameworks demonstrated clinical accuracy and mechanical-physical performance comparable or superior to those of conventional and partially digital methods for RPD frameworks, with ongoing advances expected to further enhance their precision and clinical applicability.
13 Apr 2026
Read appraisal →Journal of prosthodontic research
The clinical performance of CAD/CAM-fabricated hybrid ceramic restorations in cases with severe wear: A 3-year clinical trial
PURPOSE: To evaluate the clinical use of CAD/CAM hybrid ceramics in patients with severe tooth wear. METHODS: Forty-nine patients with severe tooth wear underwent prosthetic management with 116 hybrid ceramic restorations. The restorations were evaluated at 1 week and at 3, 6, 12, 18, 24, 30, and 36 months after placement. The amount of wear on the restorations, antagonist teeth, and opposite teeth was compared using digital superimposition analysis. A questionnaire was used to evaluate participants' satisfaction with the restorations. Complications were recorded, and survival rates were estimated using Kaplan-Meier analysis. RESULTS: The clinical performance of the restorations was stable for esthetic, functional, and biological parameters up to 3 years, except for greater changes in "surface and margin staining" and "fracture and retention." There was no significant difference in the amount of progressive wear among the restorations, antagonist teeth, and opposite side teeth until 18 months; however, the wear on the restorations increased gradually up to 36 months. Higher scores and identical satisfaction results were obtained for the chewing efficiency and cleanability during the observation period. The most common complications were restoration dislodgement (5.2%) and partial marginal chipping (4.3%), which were clinically repaired. Four restorations (3.4%) were extensively fractured and replaced. The estimated survival rate of the hybrid ceramic restorations at 3 years was 88.0%. CONCLUSIONS: The clinical use of hybrid ceramic restorations in patients with severe tooth wear improved chewing efficiency and esthetics, provided adequate resistance for load-bearing, and delivered a stable treatment outcome after functional use.
13 Apr 2026
Read appraisal →Journal of prosthodontic research
Cleaning methods of contaminated lithium disilicate ceramics: A systematic review and network meta-analysis
PURPOSE: To evaluate the effects of various cleaning methods on the bond strength between lithium disilicate (LS2) ceramics and resin cement under short- and long-term aging conditions using network meta-analysis (NMA) and pairwise meta-analysis (PMA). STUDY SELECTION: An electronic search of seven databases (PubMed, Scopus, Embase, Web of Science, Google Scholar, Defense Technical Information Center, and LILACS) with a manual search of the reference lists was conducted for articles published up to March 10, 2025. Eligible studies included those that assessed the bond strength of LS2, either uncontaminated or contaminated with human saliva, fit-checking materials, try-in paste, or their combinations, using different cleaning methods. Risk of bias was evaluated using the RoBDEMAT tool. A frequentist multivariable random-effects model was used to calculate the effect sizes. RESULTS: Fifteen studies met the inclusion criteria. Under short-term aging conditions, NMA showed higher bond strengths in the uncontaminated LS2 group and the contaminated groups cleaned with hydrofluoric acid etching, commercial ceramic cleaning agents, or phosphoric acid etching than those uncleaned or cleaned with water or alcohol. In long-term aging, PMA and NMA exhibited higher bond strengths in the uncontaminated LS2 group and contaminated group cleaned with phosphoric acid etching than those contaminated groups cleaned with water or alcohol. CONCLUSIONS: Phosphoric acid etching effectively eliminates contaminants, whereas the application of water or alcohol is ineffective. Although ceramic cleaning agents effectively decontaminate surfaces under short-term aging conditions, their performance deteriorates over time, potentially compromising long-term bond durability.
13 Apr 2026
Read appraisal →Journal of prosthodontic research
Short- and long-term effects of mandibular advancement device therapy for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis
PURPOSE: This systematic review and meta-analysis investigated the effects of mandibular advancement device (MAD) therapy on temporomandibular disorders (TMDs) in patients with obstructive sleep apnea (OSA). STUDY SELECTION: We included 14 clinical studies assessing the signs and symptoms of TMDs in patients with OSA treated with MAD therapy. The analysis was divided into short-term (<6 months) and long-term (≥1 year) follow-up phases. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for each study during follow-up. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology, and meta-analysis was conducted using Review Manager version 5.4. RESULTS: Across the 14 studies included, the average follow-up period was 18.4 months, and the overall certainty of the evidence was rated as very low. Four studies used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), six used the Helkimo Anamnestic Index, and four employed questionnaires. In short-term follow-up, a significant increase in pain-related TMDs was observed, including pain in the temporomandibular joint (TMJ) or masticatory muscles (pain-related TMDs: OR:4.49; 95%CI: 1.46 to 13.81, TMJ or masticatory muscles pain: OR:2.90; 95%CI: 1.26 to 6.71). Conversely, during long-term follow-up, the odds of pain in the TMJ or masticatory muscles were significantly reduced (OR:0.21; 95%CI, 0.05 0.89)Conclusions: MAD therapy for OSA did not cause long-term adverse effects on the TMJ or masticatory muscles. However, its short-term use may result in pain-related TMDs, highlighting the need to monitor and manage these symptoms during this period.
13 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 →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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