Background: Macro- and micro-geometry are among the factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to test a protocol for early loading by controlling implant stability with the selection of fixtures with different thread depth according to the bone density of the implant site. Materials and Methods: Patients needing implant therapy for fixed prosthetic rehabilitation were treated by inserting fixtures with four different thread diameters, selected based on clinical assessment of bone quality at placement (D1, D2, D3, and D4, according to Misch classification). Final insertion torque (IT) and implant stability quotient (ISQ) were recorded at baseline and ISQ measurements repeated after one, two, three, and four weeks. At the three-week measurement (four weeks after implant replacement), implants with ISQ > 70 Ncm were functionally loaded with provisional restorations. Marginal bone level was radiographically measured 12 months after implant insertion. Results: Fourteen patients were treated with the insertion of forty implants: Among them, 39 implants showing ISQ > 70 after 3 weeks of healing were loaded with provisional restoration. Mean IT value was 82.3 ± 33.2 Ncm and varied between the four different types of bone (107.2 ± 35.6 Ncm, 74.7 ± 14.0 Ncm, 76.5 ± 31.1 Ncm, and 55.2 ± 22.6 Ncm in D1, D2, D3, and D4 bone, respectively). Results showed significant differences except between D2 and D3 bone types. Mean ISQ at baseline was 79.3 ± 4.3 and values in D1, D2, D3, and D4 bone were 81.9 ± 2.0, 81.1 ± 1.0, 78.3 ± 3.7, and 73.2 ± 4.9, respectively. Results showed significant differences except between D1 and D2 bone types. IT and ISQ showed a significant positive correlation when analyzing the entire sample (p = 0.0002) and D4 bone type (p = 0.0008). The correlation between IT and ISQ was not significant when considering D1, D2, and D3 types (p = 0.28; p = 0.31; p = 0.16, respectively). ISQ values showed a slight drop at three weeks for D1, D2, and D3 bone while remaining almost unchanged in D4 bone. At 12-month follow-up, all implants (39 early loading, 1 conventional loading) had satisfactory function, showing an average marginal bone loss of 0.12 ± 0.12 mm, when compared to baseline levels. Conclusion: Matching implant macro-geometry to bone density can lead to adequate implant stability both in hard and soft bone. High primary stability and limited implant stability loss during the first month of healing could allow the application of early loading protocols with predictable clinical outcomes.

Titanium implants undergo an aging process through surface hydrocarbon deposition, resulting in decreased wettability and bioactivity. Plasma treatment was shown to significantly reduce surface hydrocarbons, thus improving implant hydrophilicity and enhancing the osseointegration process. This study investigates the effect of plasma surface treatment on bone-to-implant contact (BIC) of implants presenting a nanostructured calcium-incorporated surface (XPEED^®). Following a Randomized Controlled Trial (RCT) design, patients undergoing implant surgery in the posterior maxilla received additional plasma-treated (n = 7) or -untreated (n = 5) 3.5 × 8 mm implants that were retrieved after a 4-week healing period for histological examination. Histomorphometric analysis showed that plasma-treated implants exhibited a 38.7% BIC rate compared to 22.4% of untreated implants (p = 0.002), indicating enhanced osseointegration potential. Histological images also revealed increased bone formation and active osteoblastic activity around plasma-treated implants when compared to untreated specimens. The findings suggest that plasma treatment improves surface hydrophilicity and biological response, facilitating early bone formation around titanium implants. This study underscores the importance of surface modifications in optimizing implant integration and supports the use of plasma treatment to enhance osseointegration, thereby improving clinical outcomes in implant dentistry and offering benefits for immediate and early loading protocols, particularly in soft bone conditions.

This study aimed to histologically evaluate the effects of XPEED^® and SLA surface on the mineral apposition rate (MAR) at 3 and 5 weeks in titanium dental implants placed in human bone. In total, 17 titanium dental implants with XPEED^® surface (n = 9) used as test and SLA surface (n = 8) used as control were included in this study. Each patient received four doses of tetracycline 500 mg at 12 h intervals 2 weeks prior to biopsy retrieval. Implant retrieval was performed, and retrieved biopsies were carefully treated for histomorphometric evaluation under epifluorescence microscopy. At 3 and 5 weeks, newly formed bone appeared in direct contact with both types of tested surfaces. At 3 weeks, the MAR value was, respectively, 2.0 (±0.18) μm/day for XPEED^® implants and 1.5 (±0.10) μm/day for SLA implants (p = 0.017). At 5 weeks, lower MAR values for both XPEED^® and SLA implants were noted, with 1.2 (±0.10) μm/day and 1.1 (±0.10) μm/day, respectively (p = 0.046). The overall evaluation by linear regression analysis for both time and implant surfaces showed a decreased osteoblast activity at 5 weeks compared to 3 weeks (p < 0.005). The results of the present study show that the bone apposition rate occurs faster around implants with XPEED^® surface at 3 weeks and 5 weeks of healing. MAR values may support the use of implants with XPEED^® surfaces in early loading protocols.

(1) Background: In the lateral area of the maxilla, the alveolar bone can lose significant volume due to maxillary sinus pneumatization following teeth extractions. This preliminary study evaluated the effectiveness of a novel technique for one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm residual alveolar bone. The subsequent survival rate at 1-year post-occlusal loading was assessed. (2) Methods: 15 patients were selected, the main inclusion criteria were the partially edentulous area in the posterior maxilla with alveolar bone height of less than 1.5 mm below the sinus. All of the patients underwent one-stage sinus lifting, along with simultaneous implant placement using a “butterfly” anchorage device to optimize the primary stability and xenograft bone as graft material. At 6 to 9 months after surgery, the anchorage device was removed and implants were loaded. Panoramic x-ray images were used to assess the new bone formation, while the biological stability was measured using resonance frequency analysis. (3) Results: 15 implants were inserted. The mean implant stability quotient (ISQ) value was 71.3 (SD = ±2.51) and the mean healing period was 7.3 (SD = ±1.23) months. The mean bone height after the healing period was 14.4 (SD = ±2.05). A statistically significant correlation was found between the healing period and the ISQ value (Spearman rho = 0.684, sig. = 0.005). No statistically significant correlation was found between the ISQ value and the new regenerated bone height (Person r = 0.389, sig. = 0.152). Smoking was identified as a risk factor involved in postoperative complications. (4) Conclusions: The results of the present preliminary study demonstrated that the proposed “butterfly” technique was effective when performing one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm of residual alveolar bone. The survival rate was 100% at 1-year post occlusal loading.

Background/Objectives: The rehabilitation of severely resorbed anterior alveolar ridges presents significant clinical challenges due to esthetic demands and the limited bone volume in this region. Basal cortical implants, which are designed to engage dense basal bone, could offer an alternative by providing stable anchorage in compromised sites. Methods: This report evaluates the ARi^® Implant System, which features cortical anchorage and a calcium-incorporated nanostructured surface (XPEED^®) in two anterior ridge defect cases. Soft tissue augmentation using a vascularized interpositional periosteal (VIP) flap was applied in one case, and biphasic calcium phosphate (BCP) grafting and collagen membranes were employed for ridge contouring in both cases. Results: At a two-year follow-up, both cases showed stable peri-implant tissues and satisfactory esthetic results. Conclusions: Although basal cortical implants provide good primary stability, their use does not eliminate the need for bone augmentation, especially in the anterior esthetic region. Future clinical studies are required to substantiate long-term outcomes and broader applicability.

Rehabilitation of severely resorbed anterior alveolar ridges presents considerable challenges due to compromised esthetics and insufficient bone volume. Conventional implant placement often necessitates extensive bone augmentation procedures, increasing patient morbidity, treatment duration, and overall complexity. Therefore, basal cortical implants have been developed to use basal cortical bone anchorage, offering enhanced initial stability and reducing the need for additional bone grafting. The ARi® Implant System, a novel basal cortical implant, combines a uniquely optimized thread design with a nanostructured, calcium-incorporated XPEED® surface treatment to promote early osteoblastic activity, rapid bone-to-implant integration, and improved biomechanical stability. This report describes two clinical cases involving patients with significant anterior alveolar ridge defects. The ARi® Implant System was used with vascularized interpositional periosteal (VIP) flap techniques, synthetic bone grafting, and collagen membrane coverage to optimize ridge augmentation and soft tissue stability. Both patients showed successful outcomes with stable osseointegration, minimal marginal bone loss, and excellent esthetic integration at 2-year follow-ups. The treatment approach reduced surgical complexity and healing time while enhancing patient satisfaction. The ARi® Implant System demonstrates promising clinical efficacy in anterior ridge augmentation, providing stable, esthetically pleasing outcomes without extensive bone grafting. Further biomechanical and long-term studies are necessary to confirm these findings.