Estrogen deficiency is one of several contributing factors to catabolic changes in bone surrounding dental implants, impairing bone repair in defects requiring bone regeneration. Functionalizing bone substitutes is an alternative approach among various strategies to address this challenge. In this study, the aim was to evaluate the effect of functionalizing deproteinized bovine bone (Bio-Oss^®, BO) with genistein via sonication on peri-implant bone defects in ovariectomized rats. The animals were randomly distributed according to the treatment into the following four groups (n = 10): BO sonicated with genistein (BOS + GEN), BO sonicated alone (BOS), untreated BO (BO), and blood clot only (CLOT). After twenty-eight days, implant removal torque was determined, and the peri-implant bone parameters were calculated based on computed microtomography. Additionally, the gene expression of bone turnover markers was evaluated. As a main result, the functionalization with genistein increased implant removal torque and the peri-implant bone volume in the BOS + GEN group compared to both BOS and BO groups (both p < 0.05). These findings suggest that the sonification of deproteinized bovine bone functionalized with genistein improves bone repair in peri-implant bone defects in ovariectomized rats.

Background: Estrogen deficiency, a key factor in osteoporosis, may influence peri-implant healing, which requires cautious and individualized planning for dental implant placement. Functionalizing biomaterials with bioactive molecules, such as soy-derived isoflavone, could enhance their osteoconductive potential. Objective: Investigate the performance of genistein in the functionalization of bioactive glass and deproteinized bovine bone by sonochemistry on peri-implant bone repair in ovariectomized rats. Methods: In total, 50 female rats were divided into five groups ( n = 10): blood clot (CLOT); bioactive glass (BG); bioactive glass functionalized with genistein (BG + GEN); deproteinized bovine bone (BO); and deproteinized bovine bone functionalized with genistein (BO + GEN). Thirty days after ovariectomy, implants were placed in the tibia of the rats. Calcein and alizarin were administered at 14 and 24 days post-surgery, respectively. The rats were euthanized 28 days after implant placement for analysis. Results: BO + GEN showed the highest removal torque (5.4 Ncm), significantly higher than BO (2.3 Ncm; p < 0.05), followed by BG + GEN (4.2 Ncm), BG (3.3 Ncm), and CLOT (2.1 Ncm). BG + GEN and BO + GEN upregulated the bone markers (RANKL, OPG, OCN, IBSP) ( p < 0.05). Micro-CT revealed higher bone volume percentage (BV/TV) in BO + GEN (11.67%) and BG + GEN (10.51%) versus their controls ( p < 0.05). Trabecular separation (Tb.Sp) was significantly reduced in BO + GEN compared to BG ( p < 0.05). Conclusion: These findings suggest that genistein can potentiate the osteoconductive properties of clinically used biomaterials, enhancing peri-implant bone repair in ovariectomized rats.

Estrogen deficiency is a primary cause of osteoporosis, compromising bone mineral density that may impair peri-implant healing. Given the compromised bone environment associated with estrogen deficiency, strategies such as particle reduction via sonochemistry are promising approaches to enhance regenerative outcomes. However, its effects in promoting bone formation remain insufficiently explored. Therefore, this study evaluated the potential of two sonicated biomaterials to improve peri-implant repair in ovariectomized rats. Fifty female rats were allocated into five groups: blood clot (CLOT), Biogran^® (BGN), sonicated Biogran^® (BGS), Bio-Oss^® (BON), and sonicated Bio-Oss^® (BOS). Tibial peri-implant defects were created 30 days after ovariectomy and analyzed 28 days later by removal torque, microcomputed tomography, and confocal microscopy. BGS exhibited the highest removal torque (6.28 Ncm), followed by BON (5.37 Ncm), BOS (3.92 Ncm), BGN (3.15 Ncm), and CLOT (2.58 Ncm). Micro-CT revealed bone volume fraction (BV/TV) values of 8.07% (CLOT), 6.47% (BOS), 6.02% (BGS), 5.55% (BGN), and 2.84% (BON). For the trabecular number (Tb.N), BGS (1.11 mm⁻¹) showed a significant increase compared with BGN (0.69 mm⁻¹), p < 0.05. These findings show that sonochemically modified bioactive glass improves mechanical stability and trabecular microarchitecture under estrogen-deficient conditions. However, further studies are needed to standardize sonication parameters for different biomaterials and expand their translational applicability.

This overview aimed to critically synthesize existing findings, evaluate the consistency of evidence across systematic reviews with meta-analysis, and guide clinical decision-making regarding the relationship between abutment height and peri-implant marginal bone loss. This study was registered in PROSPERO (CRD420261340476) and conducted following the recommendations of the Cochrane Handbook and PRISMA guidelines. The research question was: “What is the influence of abutment height on peri-implant marginal bone loss, and what is the level of confidence in the available evidence considering methodological quality, risk of bias, and overlap among systematic reviews with meta-analysis?” The search was performed in March 2026 across PubMed, Scopus, Embase, Cochrane Library, Web of Science, gray literature via ProQuest Dissertations and Theses, and major journals in the field. The methodological quality of the included reviews was assessed using the AMSTAR-2 tool, and the risk of bias was evaluated with the ROBIS tool. Overlap of primary studies across the systematic reviews was analyzed using an evidence matrix, the Corrected Covered Area (CCA), and the GROOVE tool. The databases found 836 records, and five systematic reviews with meta-analysis published between 2019 and 2025 were included. AMSTAR-2 indicated that two reviews were of low quality and three were critically low quality. According to ROBIS, three reviews were at high risk of bias, while two were at unclear risk. Overlap analysis revealed a covered area of 45.83% and a CCA of 32.29%, indicating very high overlap. A trend suggesting that abutments ≥ 2 mm are associated with lower peri-implant marginal bone loss was observed. However, due to the predominance of critically low methodological quality and risk of bias among the included reviews, these findings should be interpreted cautiously.