Peri-implant diseases are an emerging public health problem, and it’s considered that limitations of standard diagnostics play the role herein. The study objective was the estimation of pathological bone resorption at clinical and biological level in patients with peri-implant mucositis (PIM) and peri-implantitis (PI) before and 6 months after standard treatment and to compare them with healthy controls (HC). The split-mouth interventional study included 60 patients affected with PIM or PI. Patients that also presented at least one more HC were enrolled in the study and underwent standard non-surgical and surgical treatment, respectively. Standard clinical parameters and soluble levels of RANKL were measured in peri-implant crevicular fluid baseline and 6 months following treatment. Clinical parameters and RANKL significantly decreased following treatment in PIM and PI. However, bleeding on probing and probing depth remained significantly increased when compared to HC. RANKL answered requests for biomarker of peri-implant diseases, its baseline levels were significantly increased in PIM and PI, they decreased following treatment and reached HC in peri-implantitis, while in PIM RANKL remained significantly increased. Presence of pathological bone resorption in patients lacked its clinical signs, and respective persistence following treatment suggest the need for biomarker-supported diagnosis for timely diagnosis of peri-implantitis and appropriate orientation of respective management strategies.

Background: The aim of this ex vivo study was to compare the resistance to lateral wall failure during sequential implant site preparation using osseodensification (OD) burs and conventional rotary drills in a standardized narrow ridge model. The primary outcome was the drill diameter at first lateral wall perforation. Secondary outcomes included paired perforation occurrence at a clinically relevant diameter (4.0 mm) and perforation morphology (length and width). Methods: Twenty standardized trabecular bone blocks were prepared in a paired within-specimen design, with each block receiving two osteotomies: one prepared using conventional rotary drills and the other using OD burs. Osteotomy diameter was sequentially increased according to the manufacturers’ protocols until lateral wall perforation occurred. The drill diameter at first perforation was recorded. Perforation morphology (length and width) was quantified using high-resolution extraoral digital scanning and software-based measurements. Statistical analysis was performed using paired non-parametric tests (α = 0.05). Results: OD burs significantly delayed lateral wall perforation compared with conventional drills (median 4.30 vs. 4.00 mm; p = 0.0000171). At the 4.0 mm drill step, perforation occurred in 16/20 (80%) conventional versus 2/20 (10%) OD preparations (p = 0.0013). Perforation length was significantly greater with conventional drilling (p = 0.000681), while no significant difference was observed for perforation width (p = 0.073). Conclusions: Within the limits of this decorticated trabecular ex vivo model, OD increased resistance to lateral wall failure, delayed perforation onset, and reduced perforation length compared with conventional drilling.