Search Results (150)

Focused-ion-beam scanning electron microscopy (FIB-SEM) provides site-specific access to buried interfaces, particle interiors, porous electrode architectures, and localized degradation regions in energy materials. This capability is particularly valuable for rechargeable batteries, solid-state ion conductors, alkali-metal electrodes, and reactive solid–liquid interfaces, where the structures governing transport and failure are rarely exposed at a free surface. However, the preparation and imaging steps that reveal these regions may also alter them. Ion milling, environmental transfer, vacuum exposure, scanning electron microscopy (SEM), cryogenic handling, transmission electron microscopy (TEM), scanning transmission electron microscopy (STEM), energy-dispersive X-ray spectroscopy (EDS), electron energy-loss spectroscopy (EELS), and atom probe tomography (APT) can each modify local morphology, chemistry, or phase state. These effects are especially important when the intended evidence involves light elements, metastable phases, nanoscale coatings, reactive interphases, volatile species, or ion-conducting materials. This perspective develops a claim-specific framework for evaluating such results. Preparation- and imaging-induced changes are related to the material feature being interpreted and to the minimum control needed to distinguish the two origins. For porous electrodes, the relevant outputs include pore volume, connectivity, tortuosity, crack geometry, phase fraction, and active surface area. For reactive interfaces and solid electrolytes, the critical questions concern alkali-metal redistribution, surface amorphization, light-element contrast, implanted-species chemistry, and beam-induced phase formation. The discussion further compares conventional Ga-FIB, cryogenic FIB, Xe plasma FIB, low-energy Ar+ polishing, broad-ion-beam preparation, ultramicrotomy, and repeated particle-oriented FIB workflows. Reliable interpretation requires the preparation route, transfer conditions, imaging dose, analytical acquisition, and claim-specific controls to be reported together with the final microscopy result. Full article

Background: Er:YAG laser (λ = 2940 nm) biomodification of the implant osteotomy site removes the smear layer after rotary preparation and may enhance bone-implant contact. This randomized controlled clinical study evaluated implant stability dynamics following Er:YAG laser biomodification using resonance frequency analysis (RFA). Methods: Ninety patients were randomized 1:1 into a case group (n = 45; rotary osteotomy + Er:YAG biomodification; 400 mJ, 17 Hz) and a control group (n = 45; rotary osteotomy alone). Implant stability quotient (ISQ) was measured by RFA in vestibulo-oral (VO) and mesiodistal (MD) directions at placement, days 10, 20, 30, and month 3. Results: The case group showed significantly higher ISQ values at all time points in both directions (t-test, p < 0.05). Repeated measures ANOVA revealed a significant time × group interaction in the MD direction (F = 14.461, p < 0.001, partial η² = 0.341). Primary VO ISQ: 75.04 ± 4.27 (cases) vs. 72.29 ± 3.38 (controls); primary MD ISQ: 76.49 ± 4.29 vs. 72.89 ± 2.29. The proportion achieving ISQ ≥ 70 was consistently higher in the case group. Conclusions: Er:YAG laser biomodification combined with rotary osteotomy yields higher, more stable ISQ values throughout early healing in mandibular D2/D3 bone, potentially supporting shorter healing intervals and early loading in selected clinical situations. Full article

Articular cartilage, a highly specialised and avascular tissue, exhibits limited regenerative potential following trauma or degenerative conditions such as osteoarthritis (OA). Conventional surgical interventions, including microfracture and autologous chondrocyte implantation (ACI), have shown limited long-term efficacy due to donor site morbidity and restricted cell proliferation. In this context, mesenchymal stromal cells (MSCs) have emerged as a promising alternative owing to their multipotency, self-renewal capacity, and low immunogenicity. While bone marrow (BM) remains the traditional source of MSCs, recent studies have reported that peripheral blood-derived mesenchymal stromal cells (PB-MSCs) may possess chondrogenic, osteogenic, and adipogenic potential comparable to that of BM-derived MSCs. PB-MSCs can be harvested through minimally invasive methods, thereby avoiding the complications associated with BM aspiration. Experimental evidence indicates that PB-MSCs exhibit strong cell viability, proliferative potential, and the ability to synthesise cartilage-specific extracellular matrix proteins, such as type II collagen and sulphated glycosaminoglycans, within three-dimensional scaffolds. Immunophenotypically, PB-MSCs express mesenchymal markers including CD29, CD44, CD90, and CD105 while lacking hematopoietic markers CD34 and CD45. Flow cytometry analyses reveal that CD105⁺ populations increase following cryopreservation, highlighting their clinical utility. In contrast to these experimentally defined PB-MSCs, the term peripheral blood stem cells (PBSCs) is used in clinical studies to describe heterogeneous, non-cultured peripheral blood-derived cell preparations, typically enriched in hematopoietic stem and progenitor cells following granulocyte colony-stimulating factor (G-CSF) mobilisation, without full mesenchymal characterisation. In vitro studies confirm successful tri-lineage differentiation, whereas in vivo investigations have demonstrated effective cartilage regeneration using PB-based clinical approaches, including postoperative intra-articular administration of hyaluronic acid (HA) combined with PBSCs, as well as implantation of PBSCs covered with a collagen membrane. Furthermore, advancements in biomaterial engineering, such as poly(ethylene glycol)–cysteine–arginine–glycine–aspartic acid (PEG-CRGD) hydrogels, have enhanced PB-MSC adhesion, proliferation, and chondrogenic differentiation while promoting immunomodulation through M2 macrophage polarisation. Despite these promising outcomes, the available evidence remains limited and heterogeneous, with substantial variability in cell definitions, experimental models, and clinical study designs, which currently constrains definitive conclusions regarding clinical efficacy. Future research should focus on optimising isolation protocols, understanding molecular pathways governing PB-MSC chondrogenesis, and standardising clinical applications. Overall, PB-MSCs represent a viable, less invasive, and translationally relevant cell source for cartilage regeneration and regenerative orthopaedic therapies Full article

Background: Post-extraction alveolar ridge is an important factor affecting dental implant restoration. Among myriads of bone grafting materials, dentinal grafts are gaining faster popularity among clinicians. Unlike conventional xenografts derived from animal sources, these autogenous materials may offer advantages in terms of biocompatibility and cost. Objective: This article aims to compare their performance with other commonly used materials, like xenografts, or natural blood clots and to examine whether they could maintain bone quality and quantity during socket healing with better properties than the rest of the graft materials in terms of implants success rate. Methods: This search was conducted in multiple medical databases (PubMed/MEDLINE, Scopus, Cochrane Library, Embase, and Google Scholar) for studies published between 2015 and 2025. This search focused exclusively on randomized controlled trials. The study quality was assigned by using the Cochrane Risk of Bias 2 tool, performing statistical pooling of results using random-effects meta-analysis when appropriate. Results: Eight randomized controlled trials involving 249 patients and 281 bone graft sites were selected according to inclusion and exclusion criteria. Dentinal grafts produced significant increase in formation of new bone compared to xenografts (12.4% greater, 95% CI: 6.8–18.0%, p < 0.001). The grafts also resorbed more completely, leaving less foreign material behind (8.6% less residual material, p < 0.001). Importantly, implants placed in bone preserved with dentinal grafts showed comparable stability and success rates to those in bone treated with xenografts. When compared to allowing sockets to heal naturally, dentinal grafts dramatically reduced bone loss by 60–70% horizontally and 65–75% vertically. Remarkably only minor complications were observed (2.2%), with no serious adverse events across all studies. Conclusions: Our analysis indicates that dentinal grafts represent a viable and potentially superior alternative to conventional xenografts for not only preserving alveolar bone after tooth extraction but also in any existing bone defects. The evidence particularly supports using partially demineralized preparations. These materials demonstrate excellent biocompatibility, produce good bone quality, and offer cost advantages. Full article

Purpose: The aim of this in vitro study was to evaluate the degree of surface wear in implant drills from four commercial systems subjected to standardized osteotomy cycles. Materials: Four implant systems (Osstem, Megagen, Straumann, and Bego) were evaluated using sets of three drills of increasing diameters. A total of 120 osteotomies were performed in standardized porcine rib specimens under controlled drilling conditions (1200 rpm, continuous 4 °C saline irrigation, 32:1 reduction handpiece). After each drilling series, drills were cleaned, sterilized, and analyzed using SEM in three orientations. Wear was assessed using a seven-parameter scoring system. Multifactorial ANOVA, Pearson correlation, and hierarchical clustering were employed to evaluate the effects of drill brand, diameter, and wear patterns. Results: Both drill brand and diameter significantly influenced total wear scores (p < 0.001). Small-diameter pilot drills exhibited the highest wear, while large-diameter drills showed minimal degradation. Among the systems tested, Bego drills demonstrated the greatest overall wear, whereas Osstem drills—particularly the 2.0 mm drill—displayed unusually low wear for their size. A strong negative correlation between drill diameter and wear score was observed. Cluster analysis identified distinct wear patterns associated with specific drill sizes, with small drills showing prominent guide-face nicks and accumulation formation, medium drills exhibiting chipping and rake angle cleavage, and large drills presenting minimal wear. SEM imaging confirmed progressive surface deterioration, including edge rounding, microchipping, and irregular surface defects. Conclusions: Implant drill wear is strongly dependent on drill diameter, and cutting geometry. Small-diameter drills are most susceptible to surface degradation, which may increase friction and thermal load during osteotomy. Systems with enhanced material properties or optimized geometries demonstrated superior wear resistance. These findings highlight the importance of monitoring drill condition, adhering to recommended reuse limits, and considering advanced drill coatings or materials to ensure safe and predictable implant site preparation. Further research incorporating real-time thermal measurements and extended drilling cycles is needed to establish evidence-based guidelines for drill longevity and clinical performance. Full article

Objective: The purpose of this study was to assess the outcome of sinus grafting with a beta-tricalcium phosphate/hydroxyapatite (ß-TCP/HA) alloplast particulate biofunctionalized with cross-linked hyaluronic acid (xHya), comparing two surgical access techniques. Clinical, histological, histochemical, immunohistochemical and histomorphometrical parameters were used to characterize the tissue samples, which were retrieved at the second surgery for implant placement five months after sinus floor elevation (SFE). Materials and Methods: Twenty patients with a residual bone height ≤ 4 mm, estimated by a Cone Beam Computed Tomography (CBCT), were randomly allocated either to an innovative transcrestal sinus floor elevation (tSFE = tests) approach or a conventional lateral window approach (lSFE = controls) using piezoelectric preparation. The tSFE was carried out using the hydraulic Jeder^®-System. Grafting in both groups was performed using a ß-TCP–HA combination, which was biofunctionalized with a cross-linked hyaluronic acid. For both access techniques, a cross-linked collagen membrane covered either the bone window or transcrestal osteotomy. For second-stage surgery, a second CBCT was used to assess the bone volume and possible implant positioning to compare it with the baseline CBCT. Bone cores were harvested at implant placement and evaluated histomorphometrically. Patients were followed for 1-year post-op for survival rate estimation. Non-superiority was hypothesized for both surgical methods; thus, the primary outcome measure assessed different discomfort levels using patient-reported outcome measures (PROMs) for each therapeutic approach. Secondary outcomes were the volume change in subantral bone after sinus floor elevation, the chance of placing a 10 mm long implant with no need for additional augmentation, histological evaluation of the newly gained tissue, and implant integration and one-year survival. Results: Eighteen patients (n = 18/20) qualified for implant placement at five months, and ten donated tissue biopsies for microscopic analysis. Primary outcome reporting using PROMs was discarded due to truncated patient enrollment. The secondary parameter, placement of a ≥10 mm long implant without additional augmentation, was achieved for nine sites/patients from the lSFE control group. All patients from the tSFE test group received an implant that was positioned alongside additional augmentation. In both groups, all implants integrated and were functionally loaded. A total of 10 core samples (3 from the tSFE group and 7 from the lSFE group) were obtained and analyzed. Microscopically, new bone formation appeared consistent in all obtained samples. Specimens revealed advanced and ongoing osteogenesis, with most histological markers reacting positively in the immunohistochemical (IHC) staining. The histomorphometric calculation revealed that a mean of 61.17 ± 16.55% of the total area was occupied by newly formed bone, 30.43 ± 10.09% by connective tissue and 8.92 ± 15.29% by residual graft substitute. One-year follow-up of the loaded implants showed a 100% implant survival rate. Conclusions: Biofunctionalizing ß-TCP + HA particulate with cross-linked hyaluronic acid in sinus floor elevation procedures appears to be a safe and beneficial approach, resulting in satisfactory clinical, radiographic and histological parameters. In our study population, which presented with very atrophic residual subantral bone conditions, the hydrodynamic transcrestal sinus floor elevation method required a back-up treatment by the conventional lateral approach. Full article

Background: Autogenous tooth-derived grafts have been proposed as an alternative to xenografts for alveolar ridge preservation, offering biological similarity to bone and potentially more favorable remodeling. This study compared the healing outcomes of a collagenated xenograft, and a tooth-derived graft prepared with an automated processing device. Methods: Six Beagle dogs underwent bilateral extraction of the third and fourth mandibular premolars. Each animal contributed two sockets grafted with root-derived particulate prepared using an automated device for tooth cleaning, grinding, and demineralization, and two sockets grafted with a collagenated xenograft, all covered by a collagen membrane. After 3 months, histological sections were analyzed to assess crestal dimensions and the relative proportions of mature (lamellar) and immature bone (woven/parallel fibered), residual graft material, and soft tissues. Results: Lingual crest height did not differ between groups, whereas the buccal crest was slightly higher at xenograft sites compared with the tooth-graft sites. The tooth-graft group exhibited significantly fewer residual particles (0.5 ± 1.1%) and a higher proportion of total bone (65.6 ± 9.1%) compared with the xenograft group, which showed 19.7 ± 16.0% graft remnants (p = 0.032). Corticalization at the socket entrance was observed predominantly in the tooth-graft sites. No inflammatory infiltrates were detected in the examined section. Conclusions: Tooth-derived grafts promoted an almost complete replacement by vital bone with minimal residual material, whereas xenografts provided slightly better buccal contour preservation but resulted in regenerated tissues containing persistent graft particles. The biological differences observed may have implications for subsequent implant placement. Full article

Background: Previous reports suggest that patient age at the time of implant placement is not a factor in implant survival. However, analysis of data compiled for a previously published study on the effect of enamel matrix derivative (EMD), a frequently used biomaterial to aid bone regeneration, on peri-implantitis indicated that age and use of EMD may be a factor in implant survival. The current study further evaluated the existing database to determine the effect of age and EMD use on long term survival of implants. Methods: An existing database from a private periodontal specialty practice was evaluated for the effect of age at the time of implant placement on implant survival. In addition, all available clinical factors were evaluated, including the use of EMD at any point during site preparation or implant placement to determine any effect on implant survival. Results: Patient age at the time of implant placement had a negligible effect on implant survival for younger individuals. However, starting at 58 years of age, an increase in relative risk for implant loss was noted. When the patient age was divided into groups, it was determined that patients ≥ 58 and ≤68 years had a statistically significantly increased relative risk of implant loss (2.75), which was sharply reduced if EMD had been used (1.24). This trend was also noted to a lesser extent in patients older than 68 years. Conclusions: The risk of implant loss was elevated when implants were placed in older patients. This risk was reduced if EMD had been used at any point during implant site preparation or placement. Full article

Traditional surgical techniques are based on the manual application of force using mallets and osteotomes, which often result in uncontrolled impact forces, procedural inconsistencies, and patient discomfort. Magnetic mallets (MMs), magnetodynamic devices, provide a controlled application of force using electromagnetism, aiming to achieve greater precision, reduced operating time, and improved surgical outcomes. The aim of the present systematic review was to evaluate the effectiveness of MMs compared to conventional surgical techniques in oral and implant surgery. The focused question was as follows: “Do magnetic mallets improve clinical outcomes in oral and implant surgery compared to traditional instruments?” Only clinical studies comparing the use of MMs with traditional techniques in oral surgery were included. The following databases were searched up to 27 November 2025: Pubmed, Scopus, Web of Science. For quality assessment, the Cochrane Risk of Bias 2 (RoB 2) tool was applied for randomized controlled trials (RCTs), while the Newcastle–Ottawa Scale (NOS) was used for non-randomized studies. Data were screened and synthesized by two reviewers. The systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. In total, 347 studies were initially found and 6 matched the inclusion criteria and were included in the review, for a total of 282 patients. Five RCTs were included, as well as one retrospective study. The studies investigated were as follows: implant site preparation (two studies with a total of 86 patients), sinus lift and contextual implant insertion (three studies, total: 102 patients), dental extraction (two studies, total: 70 patients), and split-crest (one study with 46 patients). The outcomes suggest that MMs may serve as a potential alternative to traditional techniques, exhibiting promising although preliminary outcomes. The studies included reported a lower incidence of benign paroxysmal positional vertigo with the use of MMs compared to hand osteotomes. Regarding quality assessment, RCTs raised some concerns, while the retrospective study had a moderate risk of bias. Despite the promising results, the paucity of high-quality controlled trials limits definitive conclusions on the superiority of MM over conventional techniques. Further well-designed comparative trials are needed to confirm the clinical benefits, optimize protocols across different indications, and evaluate MMs’ potential role in the management of critical bone conditions and complex surgery. Full article

Objective: This study compared magnetodynamic surgery, traditional drill-based surgery, and piezoelectric surgery for the preparation of the implant site, focusing on operative time and intra/postoperative discomfort. Methods: A total of 86 patients (69.8% female, 30.2% male) treated at the Oral Surgery Clinic, University of Trieste, were included: 43 underwent implant placement with the Magnetic Mallet (MM); the remaining 43 received preparations with the Piezodevice (IP) on one side and drills (Ds) on the other. All surgeries were performed by the same operator. Data included bone quality, operative time, and postoperative questionnaire responses for pain (VAS) and analgesic use. A statistical analysis was conducted using Mann–Whitney U and Kruskal–Wallis tests. Results: Significant differences emerged in operative times and pain perception, influenced by bone quality. The MM and D had comparable times in D1–D2 and D3–D4 bone, but the D produced higher VAS scores. The MM vs. IP showed significant differences in absolute times (p = 0.00018) and relative times for both D1–D2 (p = 0.01875) and D3–D4 (p = 0.00584), with qualitative VAS differences. The IP vs. D also showed significant absolute (p = 0.000005) and relative time differences for D1–D2 (p = 0.00718) and D3–D4 (p = 0.000145), with VAS variations. In the MM group, higher bone density significantly prolonged times (p = 0.04136). Conclusions: Within the limits of this study, the traditional drill-based technique remains valid and widely used, but the Magnetic Mallet can offer advantages in terms of patient comfort and postoperative recovery. The Piezodevice, while excelling in tissue preservation, is limited by longer operative times. Full article

Background/Objectives: To determine the optimal site preparation and placement protocols for immediate implant positioning in robot-assisted surgeries. Methods: In vitro models of immediate and healed extraction sockets were created using 3D printing. A robotic system was used for implant site preparation and implant placement. The implant surgeries were allocated into eight experimental groups using 12 printed models in total. Each model incorporated two implant sites, an immediate site (tooth 21) and a healed site (tooth 26), resulting in 24 implants overall. With 3 implants assigned to each group, the 24 implant placements were evenly distributed across the 8 groups. For each group, the lateral force experienced during surgery was recorded by the haptic sensor on the robotic arm, and implant positional deviations were assessed by superimposing post-surgical CBCT images with the virtual implant planning. Results: Healed sites showed significantly higher accuracy than immediate sites, with reduced platform and apical deviations (p < 0.001) and markedly lower lateral force experienced by drills. In fully guided procedures, thread tapping greatly improved accuracy in immediate sites but had limited benefit in healed sites. Compared with partially guided workflows, fully guided rCAIS markedly enhanced accuracy in immediate sites (≈0.8 mm reduction in platform/apical deviation, p < 0.001), while no meaningful differences were observed in healed sites. Fully guided protocols also reduced insertion force in healed sites. Conclusions: Immediate sites showed lower implant positional accuracy and experienced higher lateral forces during surgery than healed sites. In immediate sites, thread tapping and fully guided rCAIS improved placement accuracy. Full article

Background: Primary stability of dental implants depends on bone quality, bone quantity, and implant design. In cases of large defects, such as periapical lesions, the selection of an appropriate alveolar ridge preservation (ARP) material is crucial for bone regeneration and preparation for implant placement. Objective: The aim of this study was to evaluate clinical and histological outcomes of a novel ARP material hydroxyapatite and sugar cross-linked collagen (HSCC) combined with a knife-edge thread implant (KTI) design. Methods: Thirty patients were divided into two groups: a control group treated with KTI after spontaneous alveolar ridge healing, and an experimental group that underwent ARP using HSCC, and six months later, KTIs were placed in newly formed bone. Clinical parameters including insertion torque value (ITV), resonance frequency analysis (RFA), implant stability quotient (ISQ), and horizontal bone dimension were evaluated. Histological analysis was also performed. Results: No significant differences were observed between groups in ITV, ISQ, or horizontal bone dimension (p > 0.05). However, histological analysis demonstrated a significantly higher number of active osteoblasts in the ARP group compared to the control (p < 0.001), whereas collagen deposition was significantly greater in the control group (p < 0.001). Conclusions: ARP using HSCC, combined with KTI, provides favorable conditions for primary stability and successful graft integration, supporting reliable implant placement in sites with bone defects. Full article

Background/Objective: Soft-tissue volume augmentation with gingival grafts enhances implant-prosthodontic esthetics by maintaining or reconstructing a convex contour of the vestibular mucosa. However, it presents disadvantages related to donor site, surgical complexity, and post-procedural discomfort. This study evaluated clinical performance of a native porcine-derived collagen–elastin matrix with uniquely oriented porous structure for soft-tissue volume augmentation at single implant sites. Method and Materials: Soft-tissue augmentation was performed at sites of a single implant, which underwent immediate, early, or late loading protocols. Implant success, its survival, and mucosal health status including change in tissue thickness acquired through 3D scans of casts prepared from impressions before and after tissue augmentation were evaluated. Biocompatibility of the collagen matrix (CM) was assessed through histological analyses. Results: Forty-five patients received 50 implants with simultaneous augmentation using CM. At the last follow-up (mean 22.1 ± 15.0 months), the peri-implant soft tissue was healthy and stable, and all implants were surviving and successful. Tissue thickness change at augmented sites did not vary with time interval between pre- and post-treatment, indicating stability of augmentation. Soft-tissue biopsies (n = 3) showed healthy peri-implant soft tissue with good vascularization and no inflammation. Conclusions: This retrospective analysis demonstrated good clinical performance and high biocompatibility of CM for soft-tissue volume augmentation around dental implants. Full article

Alveolar ridge preservation (ARP) is crucial for maintaining bone and soft-tissue integrity after tooth extraction, thereby facilitating future implant placement. Among various biomaterials, platelet-rich fibrin (PRF) and freeze-dried bone allograft (FDBA) are commonly used; however, their comparative effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate and compare the outcomes of PRF, FDBA, and spontaneous healing with blood clot in ARP, incorporating recent randomized controlled trials and comparative studies published up to June 2025. Electronic searches were conducted across multiple databases following the PRISMA 2020 guidelines, and the risk of bias was assessed using RoB-2 and ROBINS-I tools. Primary outcomes included changes in alveolar ridge height and width, while secondary outcomes encompassed histological, radiographic, implant-related, and patient-centered measures. Twenty studies were included for qualitative synthesis and sixteen for quantitative analysis. Meta-analyses showed no significant difference between PRF and FDBA in ridge height (SMD = −0.24; 95% CI: −0.56 to 0.08; p = 0.145) or width preservation (SMD = −0.16; 95% CI: −0.73 to 0.42; p = 0.597). PRF significantly reduced ridge height loss compared to spontaneous healing (SMD = −0.79; 95% CI: −1.33 to −0.25; p = 0.004) and enhanced histologic new bone formation (SMD = 1.43; 95% CI: 0.39 to 2.47; p = 0.007), while FDBA showed a non-significant trend toward benefit (SMD = −0.37; 95% CI: −0.86 to 0.11; p = 0.129). Moderate risk-of-bias and heterogeneity were observed among included studies. In conclusion, PRF and FDBA are both effective for alveolar ridge preservation, outperforming spontaneous healing. PRF offers biologically driven benefits in bone quality and soft-tissue healing, whereas FDBA provides greater structural stability. These findings suggest a promising clinical potential for PRF in improving bone quality at the implant site. Moreover, considering cost, preparation complexity, and site-specific needs, PRF may serve as a cost-effective, clinically favorable option for ARP. Future multi-center randomized trials with standardized PRF protocols and long-term follow-up are recommended. Full article

Background and Clinical Significance: Maxillary sinus augmentation is a well-established surgical procedure for dental implant placement in the posterior maxilla when the residual alveolar bone height is insufficient. Traditionally, the lateral approach has been preferred in cases with less than 4 mm of bone; however, the crestal approach has emerged as a less invasive alternative, particularly with the advent of advanced techniques and tools such as hydraulic pressure systems and dedicated osteotomy kits. Case Presentation: This case report presents the clinical management of a 68-year-old female patient requiring rehabilitation of the right maxillary molars, where the residual bone height measured only 3.6 mm (in position 1.6) and 2.5 mm (in position 1.7). Using the CAS kit system with rounded drills and hydraulic pressure, a controlled crestal sinus elevation was performed, followed by simultaneous implant placement. Despite the extremely limited bone height, a final insertion torque of 30 Ncm was achieved for both implants, likely due to favorable sinus floor anatomy, under-preparation of the implant sites, and the use of tapered, macro-textured implants. Postoperative follow-up over three years showed stable bone levels and successful prosthetic rehabilitation with single crowns. Conclusions: This case report highlights the potential of the crestal approach in anatomically challenging scenarios. Proper planning, technique, and implant selection are mandatory to achieve predictable and long-lasting outcomes, even in cases previously considered contraindicated for this method. Further randomized controlled trials are needed to confirm this preliminary result. Full article