Search Results (502)

Background: Custom-made subperiosteal implants have re-emerged as a valuable option for the rehabilitation of patients with severe maxillofacial atrophy and post-oncological defects. Despite advances in digital workflows and implant design, their unique anatomical, biological, and prosthetic characteristics pose specific challenges for long-term maintenance, and no dedicated standardized guidelines are currently available. Methods: This narrative review critically appraises the available literature on implant maintenance and related fields. A comprehensive search was conducted across PubMed, Scopus, and Web of Science, including studies on peri-implant maintenance, supportive periodontal therapy, full-arch and zygomatic implant rehabilitations, and subperiosteal implants. Due to the lack of direct evidence, a qualitative narrative synthesis was adopted to develop preliminary clinical considerations for maintenance of custom-made subperiosteal implants. These considerations should be interpreted as an expert-informed perspective rather than validated clinical guidelines. Results: Conventional maintenance protocols developed for endosseous implants are not directly transferable to subperiosteal implants due to differences in the implant–tissue interface, biomechanics, diagnostic parameters, and hygiene accessibility. Key challenges include the absence of a conventional peri-implant sulcus, possible implant exposure, complex prosthetic geometries, and potential susceptibility to biofilm accumulation in areas with limited access. Evidence from related fields highlights the importance of structured maintenance, individualized risk-based follow-up, effective biofilm control, and patient-specific home-care strategies. Conclusions: Preliminary evidence-informed clinical considerations for the maintenance of subperiosteal implants are proposed, with emphasis on plaque control, individualized follow-up, descriptive clinical monitoring, and hygiene-oriented prosthetic and surgical planning. These considerations are not intended as validated guidelines, but as a practical starting point for clinical reasoning in an area where dedicated evidence remains limited. Full article

Background/Objectives: The aim of the study was to determine the prevalence of molar absence and the need for limited preprosthetic orthodontic treatment in the situation of lateral molar edentulism in adult patients. Methods: The need for orthodontic treatment was studied retrospectively in a cohort of adult patients of both genders who presented for dental treatment at the Oral Rehabilitation Clinic of the University of Medicine and Pharmacy of Craiova. After applying the inclusion/exclusion criteria, the final study group consisted of 478 patients. The collected data were centralized in Microsoft Excel and statistical analyses were performed using SPSS software version 26. Results: The results of the study showed that more than 50% of adult patients need orthodontic treatment. The patients with the greatest need for orthodontic treatment also had a higher DMFT (p < 0.0005), indicating a higher need for dental caries treatment, as well as prosthetics of edentulous areas. The prevalence of molar edentulism was 57.31%. The acceptance of the treatment plan was inversely proportional to the need for orthodontic treatment. Tooth wear (p < 0.0005) and maxillary edentulism (p = 0.002) significantly contributed to a higher DAI. Conclusions: The need for orthodontic treatment increases with age, but the acceptance of oral rehabilitation plans that include orthodontic treatment is low. Better interdisciplinary collaboration is needed to ensure that adult patients benefit from the best treatment options. Full article

Occupational safety and health (OSH) is increasingly relying on wearable technologies, yet research on such bodycentric antenna systems remains fragmented across diverse disciplines. This review introduces bodycentric antenna systems for occupational safety and health (BASOSH) as a novel unified framework that explicitly links electromagnetic performance, human–body interaction, and OSH objectives within a single conceptual model. Based on a preliminary scientometric analysis, the existing literature is categorized into four application pillars: (i) monitoring workers’ health and safety, (ii) supporting occupational activity, (iii) preventing accidents and mitigating risks, and (iv) rehabilitation and prosthetics. The analysis highlights a lack of integrated design approaches, as most studies address only a subset of the BASOSH framework. To overcome this fragmentation, a parametric design function is proposed, jointly weighting wireless performance, human–body effects, and OSH outcomes, to enable the unified design and comparison of BASOSH. By systematizing a previously scattered research area and establishing a common design language, this work defines BASOSH as a distinct research domain and provides a foundation for the development of personalized and context-aware OSH solutions. Full article

Objectives: This study aimed to identify the oral health conditions of homeless individuals in Rome, the most frequently required dental treatments, and to describe a standardized, replicable clinical protocol tailored to the specific needs and access barriers of this vulnerable population. Methods: Five hundred homeless individuals received comprehensive dental examinations at the Primary Care Services of the Dicastery for the Charity Services (Vatican City) between September 2023 and January 2026. Clinical assessments included oral hygiene status, periodontal health, caries prevalence, and degree of edentulism. Treatment interventions were programmed by scheduling subsequent appointments. For patients requiring prosthetic rehabilitation, treatment was sequenced into distinct steps: preparatory treatments (hygiene, extractions, conservative procedures), impression taking, prosthesis try-in, and delivery. Results: Oral health assessment revealed poor or absent hygiene (85.4%), high DMFT scores (63.0%), and root residues (22.4%). Periodontal disease affected 94.0% of participants (gingivitis 73.0%, periodontitis 21.0%). Tooth loss patterns included partial edentulism (12.0%) and complete edentulism (24.0%). A total of 440 appointments were scheduled, with an attendance rate of 78.4%. Prosthetic rehabilitation was completed in 150 patients: 50 received partial dentures (33.3%) and 100 complete dentures (66.7%). Conclusions: The examined homeless individuals experienced severe oral health deterioration characterized by extensive tooth loss and advanced periodontal disease. A substantial prosthetic rehabilitation was needed in this sample. The proposed sequential treatment protocol demonstrated high feasibility and patient adherence in this vulnerable population. Comprehensive dental services that address both immediate emergency needs and long-term rehabilitative care are crucial for improving oral health-related quality of life and facilitating social reintegration. Patient-reported outcomes indicated meaningful improvements in digestive function, aesthetic satisfaction, and employment opportunities following prosthetic rehabilitation. Full article

Background/Objectives: Implant explantation is often considered the standard treatment for severe peri-implant inflammatory lesions, including cases with apical involvement. However, this approach is relatively invasive and aggressive, which can lead to significant loss of bone and soft tissues, potentially compromising future prosthetic rehabilitation, particularly in the esthetic zone. This study aimed to present implant apicoectomy as a conservative alternative that would allow preservation of implant stability while effectively treating localized inflammation. Methods: This case report presents a female patient who was diagnosed with retrograde peri-implant inflammation, and an implant apicoectomy was performed as a conservative approach to implant explantation. The procedure was carried out using a minimally invasive microsurgical technique. Results: The treatment resulted in complete clinical and radiographic healing, maintenance of implant osseointegration and stability, and resolution of clinical symptoms, including fistula closure. No recurrence of periapical infection was observed during the twelve-month clinical and radiological follow-up visit. Conclusions: Implant apicoectomy may be considered a minimally invasive and effective alternative to explantation in selected cases of retrograde peri-implantitis, preserving hard and soft-tissue architecture while maintaining implant functionality. This approach may be particularly beneficial in esthetic regions where preservation of tissue architecture is critical for optimal clinical outcomes. Full article

A clinically unresolved question in full-arch implant rehabilitation is whether early peri-implant bone adaptation is primarily a local (implant-level) phenomenon, a shared within-arch response, or a patient-level characteristic—information is unavailable from conventional mean-based outcome reporting. This prospective secondary analysis quantified the hierarchical distribution of peri-implant marginal bone level change (ΔMBL) in monolithic zirconia full-arch prostheses directly connected to multi-unit abutments during the first year of function. Unlike mean-based endpoints, this approach identifies whether early bone adaptation variability originates primarily at the implant, prosthetic-arch, or patient level. Of 308 implants placed in 40 completely edentulous patients rehabilitated with 49 prostheses, 2 implants failed before delivery of the definitive prosthesis and were excluded from radiographic analysis, leaving 306 implants available for multilevel analysis. Implant-level ΔMBL was analyzed using an unconditional three-level linear mixed-effects model. Implant survival was 99.2%, prosthetic survival was 100%, and mean ΔMBL at 12 months was 0.38 ± 0.27 mm. Variance partitioning showed that 60.8% of total variability occurred at the implant level, 28.4% occurred at the patient level, and 10.8% occurred at the prosthetic-arch level, providing a framework for identifying at which level of the restorative system future clinical interventions may have the greatest impact. Findings should be interpreted within the context of a secondary analysis with a 12-month follow-up and no explanatory covariates; longer-term comparative studies with explanatory multilevel designs are required to confirm and extend these observations. Full article

Context: Prosthetic rehabilitation of acquired maxillary defects with Maxillary Resection Prostheses (MRPs) remains biomechanically challenging, particularly in partially edentulous patients, where conventional clasp-retained designs often yield suboptimal retention, stability, and functional outcomes. Research Gap: The integration of telescopic crown systems with semi-precision attachments incorporating a rotational latching mechanism has not been previously described as a unified approach to optimise load distribution and prosthesis stability in maxillary defect rehabilitation. Objective: To describe and clinically evaluate a novel prosthetic design combining telescopic crowns and a semi-precision rotational latching attachment to enhance retention, stability, and functional performance of MRPs. Methodology: A 31-year-old patient with a unilateral maxillary defect following partial maxillectomy presented with an unstable interim prosthesis and impaired speech and mastication. A definitive MRP was designed using telescopic crowns on the remaining dentition to establish a controlled path of insertion and improved axial load transfer. A semi-precision attachment with a key–keyway rotational latching mechanism was incorporated into the secondary framework to engage specific undercuts while minimising lateral forces on abutment teeth. A provisional prosthesis was used for 3 months to evaluate base extension, phonetics, and functional parameters before fabrication of the definitive prosthesis. Results: Serial follow-up at 1, 3, and 6 months demonstrate consistent prosthesis stability, precise seating, and favourable retention. Marked improvements were observed in speech intelligibility, masticatory efficiency, and patient-reported comfort. Conclusions: This combined prosthetic strategy represents a novel and biomechanically optimised approach for the rehabilitation of partially edentulous maxillary defects, with promising clinical and functional outcomes. Full article

Dental implant placement has evolved from conventional freehand techniques toward digitally guided workflows integrating cone-beam computed tomography (CBCT), computer-aided design/computer-aided manufacturing (CAD/CAM), and dynamic navigation systems. Although guided surgery improves positional accuracy, its clinical relevance compared with freehand placement remains debated. This narrative review, based on a systematic and structured literature search following predefined selection criteria, analyzes studies published between 2000 and 2025 comparing guided and freehand implant placement regarding accuracy, survival, complications, biological outcomes, and workflow efficiency. Searches of PubMed/MEDLINE, Embase, and Web of Science identified 40 eligible human clinical studies for qualitative synthesis. Guided placement consistently demonstrated greater positional accuracy, with angular deviations of approximately 2–4° versus 5–9° for freehand placement and linear deviations reduced by about 1 mm. Nevertheless, implant survival rates were high and comparable for both techniques, generally exceeding 95% across short- and medium-term follow-up. Overall complication rates were low; guided approaches reduced anatomical risk and improved prosthetic predictability in complex or multi-implant cases, while freehand placement allowed greater intraoperative flexibility and tactile feedback, potentially optimizing primary stability in variable bone conditions. Marginal bone loss and peri-implant tissue outcomes were similar between approaches. Guided workflows required additional planning time and costs but enhanced reproducibility in complex rehabilitations. Guided and freehand implant placement should therefore be considered complementary strategies, with optimal outcomes depending on case selection, surgical expertise, and the balanced integration of digital technologies into contemporary implant practice. Full article

Background/Objectives: Reconstruction of complex soft-tissue defects of the arm and elbow remains challenging because of exposed neurovascular structures, wide joint mobility, and the need to preserve function. The pedicled latissimus dorsi (LD) flap remains a valuable option, particularly when recipient vessels are compromised or functional restoration is required. Given the heterogeneity of these injuries, treatment must be individualized according to each patient’s defect characteristics, functional demands, and rehabilitation goals, reflecting personalized medicine principles. This study evaluated the indications and outcomes of pedicled LD flap transfer in arm and elbow defects. Methods: All consecutive patients who underwent pedicled LD flap reconstruction for upper extremity soft-tissue defects at our institution (January 2015–January 2025) were retrospectively reviewed. Demographic data, defect etiology, flap type, reconstructive goals, complications, and functional outcomes were analyzed. Results: Twenty-six patients were included (mean age 28.5 ± 7.6 years; 84.6% male). Electrical burns were the predominant etiology (92.3%). A musculocutaneous flap was used in 22 patients (84.6%) and a muscle-only flap in 4 (15.4%); supplementary split-thickness skin grafting was required in 17 (65.4%). Reconstructive goals included elbow flexion restoration (±neurovascular repair and soft-tissue coverage) in 12 patients (46.2%) and humeral stump preservation for prosthetic use in 14 (53.8%). No total flap loss occurred. Complications included partial necrosis in 1 patient (3.8%), donor-site seroma in 3 (11.5%), wound dehiscence in 2 (7.7%), and recipient-site hematoma in 1 (3.8%). No patient required amputation or shoulder disarticulation. Conclusions: The pedicled LD flap is a reliable option for complex arm and elbow defects. By tailoring flap design, nerve management, and rehabilitation to individual patient needs, this approach exemplifies personalized reconstructive planning in upper extremity trauma. Full article

Full-arch implant-supported rehabilitations are widely recognized as an effective treatment option for edentulous patients. Nevertheless, clinical decision-making regarding patient selection, surgical planning, prosthetic material choice, and long-term maintenance protocols remains heterogeneous and requires structured evidence-based guidance. A modified Delphi consensus process was conducted involving 29 experts during the Italian Consensus Conference. A systematic literature review covering the period 2015–2024 was performed, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Consensus was predefined as ≥90% agreement. Seven evidence-based consensus statements were developed addressing: (1) periodontal risk assessment using validated tools; (2) guided bone regeneration outcomes with technique-specific indications; (3) comparative survival of four versus six implants in mandibular full-arch rehabilitations; (4) equivalence of tilted and axial implant configurations; (5) prosthetic material selection, with monolithic zirconia showing high survival; (6) risk-stratified supportive maintenance protocols associated with a reduction in peri-implantitis incidence; and (7) systemic risk stratification, including absolute and relative contraindications, medication-related osteonecrosis of the jaw (MRONJ) risk management, and perioperative antibiotic prophylaxis. Full article

In this study, a fully digital workflow enabling the alignment of pre- and postoperative mandibular intraoral scans in complete-arch implant rehabilitation using intraosseous fiducial reference markers is presented. A prosthetically driven digital workflow was implemented for mandibular complete-arch rehabilitation in which two cylindrical intraosseous pins were placed in a median or paramedian mandibular region and used as fiducial reference markers to align pre- and postoperative intraoral scans. Pin osteotomies were prepared using a calibrated drilling protocol and preserved throughout surgery to allow for the exact repositioning of the pins. Implant positions were recorded using photogrammetry, while postoperative intraoral scans were acquired after suturing with the pins reinserted. Scan alignment was performed using a best-fit algorithm based exclusively on the fiducial pin geometry. Standardized convergent scanbodies without undercuts were used for intraoral scanning. The proposed workflow allowed for the alignment of pre- and postoperative mandibular scans without additional radiographic acquisitions and was compatible with both guided and free-hand implant placement, regardless of the degree of mandibular atrophy. Within the limitations of a proof-of-concept report, the use of intraosseous fiducial reference markers represents a minimally invasive and clinically applicable solution to a critical limitation of fully digital mandibular rehabilitation workflows, without the quantitative validation of accuracy, trueness, or reproducibility. Full article

Background/Objectives: The clinical decision between preserving periodontally compromised teeth and replacing them with dental implants represents a complex clinical dilemma influenced by biological, prosthetic, economic, and professional factors. The aim of this pilot study was to develop and preliminarily validate a questionnaire designed to assess dentists’ attitudes and therapeutic preferences regarding the use of periodontally compromised teeth as prosthetic abutments versus extraction and implant-supported rehabilitation. Methods: An observational cross-sectional study was conducted, among Romanian dentists, using a structured self-administered questionnaire consisting of 43 items organized into seven sections addressing clinical attitudes, decision-making factors, professional competence, prosthetic treatment preferences, and implant-related clinical practices. A total of 111 Romanian dentists completed the questionnaire. Responses were recorded using a five-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics software. Internal consistency was evaluated using Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC). Construct validity was assessed using exploratory factor analysis based on Principal Component Analysis with Varimax rotation. Results: The questionnaire demonstrated good internal consistency across most sections, with Cronbach’s alpha values ranging between 0.795 and 0.859 after scale optimization. Item–total correlations indicated adequate contribution of individual items to overall scale reliability. Intraclass correlation coefficients confirmed moderate reliability for individual items and good reliability for average section scores. Exploratory factor analysis showed satisfactory sampling adequacy (KMO = 0.709) and statistically significant Bartlett’s test of sphericity (p < 0.001), supporting the suitability of the data for factor analysis. The sample population was predominantly composed of early-career dentists with limited clinical experience, which should be considered when interpreting the findings. Conclusions: The developed questionnaire demonstrated satisfactory psychometric properties, including good internal consistency and acceptable construct validity, supporting its use as a research instrument for assessing Romanian dentists’ self-reported attitudes, therapeutic preferences, and perception-based decision patterns regarding the preservation of periodontally compromised teeth and implant-supported prosthetic rehabilitation. Full article

Background: COVID-19 is primarily a respiratory disease, but increasing evidence suggests possible oral and maxillofacial complications. This study presents a case series of post-COVID maxillary osteonecrosis (PC-RONJ) cases from western Romania and explores the possible association between SARS-CoV-2 infection, its treatment, and this complication. Methods: We conducted a multicenter retrospective case series of two patients with recent PCR-confirmed SARS-CoV-2 infection who subsequently developed maxillary osteonecrosis (ONC) between 2021 and 2023. Clinical examination, CT imaging (including 3D reconstructions), and ENT assessment were used to assess the severity of the disease. All medical records were reviewed to identify comorbidities, details of COVID-19 treatment, and the appearance of maxillofacial symptoms. Results: Both patients had been hospitalized for severe COVID-19 and treated according to the national protocol with systemic corticosteroids, oxygen therapy, anticoagulation, and antivirals. CT scans revealed marked osteolytic destruction of the maxilla and maxillary sinus walls, with extension toward adjacent facial bones. Microbiological analysis revealed a complex polymicrobial profile, including Gram-positive and Gram-negative bacteria as well as opportunistic fungal species, consistent with a chronic biofilm-associated infectious process. Patients received surgical treatment, followed by local care and, in both cases, prosthetic rehabilitation with maxillary obturators, which improved speech, chewing, and oral function. Conclusions: This case series suggests a possible association between severe COVID-19, its treatment, and subsequent maxillary osteonecrosis in susceptible patients; however, the small number of cases precludes causal inference. To our knowledge, this is the first Romanian report describing such cases in patients without prior antiresorptive therapy. These findings highlight the need for careful use of systemic corticosteroids and vigilant post-recovery monitoring of maxillofacial complications. Further studies are required to clarify the underlying mechanisms and risk factors. Full article

Objectives: The aim of this retrospective study was to evaluate the long-term clinical and radiographic performance of zirconia dental implants with one-piece and two-piece configurations supporting single-tooth restorations. The primary outcome was implant survival, while the secondary outcome was the assessment of interproximal marginal bone loss (MBL) over time. Materials and methods: A total of 67 implants placed in 55 patients were included, with a mean follow-up of 60.6 months. Forty-five implants were one-piece systems and twenty-two were two-piece systems. All surgical and prosthetic procedures were performed by the same operator, following the manufacturer’s recommendations. Final restorations were delivered three months after implant placement. Marginal bone levels were assessed radiographically at the time of definitive prosthesis delivery (T0) and at the last follow-up examination (T1). Statistical significance level was set at 5% (α = 0.05). Results: The overall implant survival rate was 100% in both groups. One-piece implants showed higher initial MBL values than two-piece implants; however, bone level changes over time were limited in both configurations, with no significant intra-group differences between T0 and T1. Conclusions: Both implant configurations showed excellent clinical and radiographic outcomes, with a 100% survival rate and limited marginal bone loss during long-term follow-up. Marginal bone levels appeared to be influenced more by implant neck design than by implant configuration, suggesting that zirconia implants with a smooth transmucosal design may represent a reliable metal-free option for single-tooth rehabilitation in properly selected patients. Full article