Purpose: To assess the body of evidence of short versus regular implants after bone augmentation (BA) in the atrophic posterior mandible in the context of implant treatment success outcomes.Methods: Seven databases, two registries, and reference lists were searched for systematic reviews and meta-analysis (SR/MA), randomized controlled trials (RCTs) and longitudinal studies published in English, Spanish or German since 2012. Confidence in the SR/MA methodology was evaluated using AMSTAR-2 and the risk of bias of primary studies using Cochrane’s RoB 2.0 and ROBINS-I. A random-effects meta-analysis and a meta-regression were performed for continuous and dichotomous outcomes. GRADE approach was used to assess the certainty of the evidence.Results: Eighteen SRs/MAs, most of them “critically low” and “low” confidence with substantial overlap, included 14 relevant RCTs with a high risk of bias. A cohort study with moderate risk of bias was added. Quantitative synthesis of 595 implants and 281 hemiarches/patients indicates that the use of short implants (< 10 mm) compared to regular implants and BA may reduce implant failure at 1-year follow-up, and marginal bone loss (MBL) at 3-, 5-, and 8-year follow-up; is likely to reduce the risk of biological complications at 1-, 3-, 5-, and 8-year follow-up; and may be the patient's preferred alternative. There is a correlation between bone height, MBL and biological complications.Conclusions: The available evidence partially suggests that the use of short implants could decrease implant failure, MBL, and biological complications, and increase patient satisfaction. However, given the need for further RCTs and real-world evidence to fully evaluate short- and long-term outcomes, it would be prudent for clinicians to carefully consider the individual needs and circumstances of the patients before deciding whether to use short implants.Trial registrationPROSPERO CRD42022333526Graphical

Purpose: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. Methods: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. Results: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34–2.29) at the entry point and 2.95 mm (95% CI: 1.66–4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04–4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83–1.54) at the entry point and 1.80 mm (95% CI: 1.10–2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43–2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69–2.39) at the entry point and 3.23 mm (95% CI: 2.34–4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86–5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. Conclusion: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.

Introduction: The objective of the study was to provide long‐term clinical outcomes and complications in the severely atrophic edentulous maxillae treated by means of the quad zygoma protocol (QZP) using the Anatomy‐Guided Approach (AGA).Methods: This was a retrospective cohort study of all consecutive patients with severely atrophic edentulous maxilla and insufficient bone height and width in the anterior and posterior regions bilaterally, who underwent rehabilitation with the QZP between May 2006 and December 2021. All patients were followed for at least 1 year. All zygomatic implants (ZIs) were placed by the same surgeon. The primary endpoint of the study was the implant survival rate. Secondary endpoints were implant success rate, prosthesis success rate, complications, and Oral Health‐Related Quality of Life using the OHIP‐14 questionnaire.Results: A total of 56 patients (men 16, women 40) with 224 ZIs (Nobel Biocare, n = 204; Straumann, n = 16; Southern Implant, n = 4) placement were included with a mean follow‐up period 8.8 ± 3.9 years (range, 1.2–17.0). The survival (success) rate was 97.7%. Five ZIs in four patients failed. The mean time between implant placement and failure was 8.6 years (range, 0.5–13.3). All patients received immediate loading with acrylic prosthesis. The successful rates for the definitive prosthesis were 98.2%. Forty‐two patients received posterior cantilever for rehabilitation of fixed definitive prosthesis. Local orofacial inflammation (35.7%) and Sinusitis (12.5%) were the most common complications, occurring at a mean follow‐up of 10.0 (range, 4.2–14.9) and 10.3 (range, 4.3–16.2) years, respectively. In 48 patients, the mean score of the OHIP‐14 questionnaire was 1.7 ± 2.6 with the follow‐up period of 9.0 ± 4.1 years.Conclusions: The rehabilitation of severely atrophic edentulous maxilla using the QZP has shown a predictable and high survival rate in the long term. The implementation of an immediate loading protocol offers potential benefits in stabilizing ZIs with cross‐arch stabilization. Moreover, the use of a posterior cantilever in reconstruction can effectively establish functional occlusion through well‐distributed ZIs, eliminating the need for additional implant placement.

Purpose: The study aims to use cone beam computed tomography (CBCT) to (1) define the virtual valid length of pterygoid implants in maxillary atrophic patients from the prosthetic prioritized driven position and (2) measure the implant length engaged in the pterygoid process according to the HU difference of the pterygoid maxillary junction. Materials and methods: Virtual pterygoid implants were planned with CBCT of maxillary atrophic patients in the software. The entry and angulation of the implant were planned according to the prosthetic prioritized driven position in the 3D reconstruction image. The planned implant length and the valid length defined as the implant between the pterygoid maxillary junction and pterygoid fossa were recorded. The relationship between the implant and sinus cavity was also evaluated. Results: A total of 120 CBCT samples were enrolled and virtually planned. The mean age of the patients was 56.2 ± 13.2 years. One hundred and sixteen samples could successfully place virtual implants according to the criterion. The mean implant length and mean implant length beyond the pterygoid maxillary junction were 16.3 ± 4.2 mm (range, 11.5–18 mm) and 7.1 ± 3.3 mm (range, 1.5–11.4 mm), respectively. Ninety percent of virtually planned implants had a close relationship with the sinus cavity, and implants exhibited longer lengths when they had no relation with the sinus. Conclusion: From a prosthetic prioritized driven position with fixed entry and angulation, pterygoid implants achieve adequate bone anchorage length beyond the pterygoid maxillary junction. Due to the individual anatomy and the volume of the maxillary sinus, the implants presented a different positional relationship with the maxillary sinus. Graphical

Objectives: This experimental study compared the accuracy of implant insertion using the free‐hand (FH) technique, static computer‐aided surgery (S‐CAIS), or dynamic computer‐assisted surgery (D‐CAIS) and to evaluate the correlation of learning curves between surgeons' experience and surgical time.Materials and Methods: Thirty‐six models were randomly assigned to three groups (FH, n = 12; S‐CAIS, n = 12; D‐CAIS, n = 12). Each model was planned to receive four implants in the maxillary anterior and posterior regions. Twelve participants, six experienced surgeons, and six dental students were included in this study. The primary outcome was the deviation between the planned and final implant placement from each group. Secondary outcomes were each technique's learning curve regarding surgical time.Results: The average deviation at implant platform, apex and gradual deviation with FH technique were 1.31 ± 0.88 mm, 1.75 ± 0.9 mm and 6.67° ± 3.70°, respectively. The average deviation of implant platform, apex and angular in S‐CAIS were 0.67 ± 0.32 mm, 1.00 ± 0.39 and 2.66° ± 1.77°, respectively. The average deviation of implant platform, apex and angular in D‐CAIS were 1.14 ± 0.70 mm, 1.23 ± 0.58 and 3.20° ± 2.16°, respectively. Significant discrepancies at the implant platform, implant apex, and angular deviation were found between all surgical methods (p < 0.016). Learning curves were evident after multiple implant insertions using both freehand and S‐CAIS.Conclusion: The findings indicate that computer‐assisted implant insertion leads to a more precise implant alignment than implants inserted freehand in an experimental set‐up.

Objectives: This study aimed to investigate implant outcomes in patients with head and neck cancer undergoing radiotherapy or chemotherapy by incorporating the latest research findings.Methods: The present review was conducted to update the focused question: What is the survival rate of implants placed in patients with head and neck cancer receiving radiotherapy or chemotherapy compared to non‐irradiated patients? It built upon two previous systematic reviews (2014 and 2022) and provided an updated synthesis of the literature, focusing on clinical studies published between 2021 and 2024. The earlier reviews were included in the quantitative synthesis only to offer a broader longitudinal perspective.Results: Nine studies were identified, with seven included in the quantitative synthesis and meta‐analysis. The implant survival rate was significantly lower in irradiated patients (85.6%) compared to non‐irradiated patients (90.0%) (RR = 1.62, 95% CI: 1.33–1.98, p < 0.0001, I² = 0.2%). Additionally, implant failure risk was higher in grafted bone (RR = 2.03, 95% CI: 1.39–2.96, p = 0.0018, I² = 21.9%) than in native bone. Among irradiated patients, those receiving radiochemotherapy exhibited an even greater risk of implant failure (RR = 1.97, 95% CI: 1.09–3.56, p = 0.0331, I² = 0%) compared to non‐irradiated patients.Conclusions: Current evidence indicates that radiotherapy/chemotherapy significantly increases the risk of implant loss in patients with head and neck cancer, with higher radiation doses possibly being associated with increased peri‐implant bone loss, while implants placed in native bone exhibit a lower risk of failure compared to those placed in grafted bone.