Aim: To answer the following PECO question: “In systemically healthy human subjects (P), which are the differences between peri‐implantitis (E) and peri‐implant health/mucositis (C) in terms of bacterial presence/count (O)?”Materials and Methods: Cross‐sectional studies fulfilling specific inclusion criteria established to answer the PECO question were included. Two review authors independently searched for studies, screened the titles and abstracts, did full‐text analysis, extracted the data from the included reports, and performed the risk of bias assessment through an adaptation of the Newcastle/Ottawa tool for cross‐sectional studies and of the JBI critical appraisal checklist. In case of disagreement, a third reviewer author took the final decision. Study results were summarized using random effects meta‐analyses.Results: A total of 12 studies were included, involving 1233 participants and 1513 implants. Peri‐implantitis was associated with the presence of S. epidermidis (Odds ratio, OR = 10.28 [95% Confidence interval, CI: 1.26–83.98]), F. nucleatum (OR = 7.83 [95% CI: 2.24–27.36]), T. denticola (OR = 6.11 [95% CI: 2.72–13.76]), T. forsythia (OR = 4.25 [95% CI: 1.71–10.57]), P. intermedia (OR = 3.79 [95% CI: 1.07–13.35]), and P. gingivalis (OR = 2.46 [95% CI: 1.21–5.00]). Conversely, the presence of A. actinomycetemcomitans (OR = 3.82 [95% CI: 0.59–24.68]), S. aureus (OR = 1.05 [95% CI: 0.06–17.08]), and C. rectus (OR = 1.48 [95% CI: 0.69–3.17]) was not associated with peri‐implantitis.Conclusions: Peri‐implantitis is associated with the presence of S. epidermidis and specific periodontopathogens (P. gingivalis, T. forsythia, T. denticola, F. nucleatum, and P. intermedia). (CRD42021254589)

Flapless and fully guided implant placement has the potential to maximize efficacy outcomes and at the same time to minimize surgical invasiveness. The aim of the current systematic review was to answer the following PICO question: “In adult human subjects undergoing dental implant placement (P), is minimally invasive flapless computer‐aided fully guided (either dynamic or static computer‐aided implant placement (sCAIP)) (I) superior to flapped conventional (free‐handed implant placement (FHIP) or cast‐based/drill partially guided implant placement (dPGIP)) surgery (C), in terms of efficacy, patient morbidity, long‐term prognosis, and costs (O)?” Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the PICO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, performed full‐text analysis, extracted the data from the published reports, and performed the risk of bias assessment. In cases of disagreement, a third review author took the final decision during ad hoc consensus meetings. The study results were summarized using random effects meta‐analyses, which were based (wherever possible) on individual patient data (IPD). A total of 10 manuscripts reporting on five RCTs, involving a total of 124 participants and 449 implants, and comparing flapless sCAIP with flapped FHIP/cast‐based partially guided implant placement (cPGIP), were included. There was no RCT analyzing flapless dynamic computer‐aided implant placement (dCAIP) or flapped dPGIP. Intergroup meta‐analyses indicated less depth deviation (difference in means (MD) = −0.28 mm; 95% confidence interval (CI): −0.59 to 0.03; moderate certainty), angular deviation (MD = −3.88 degrees; 95% CI: −7.00 to −0.77; high certainty), coronal (MD = −0.6 mm; 95% CI: −1.21 to 0.01; low certainty) and apical (MD = −0.75 mm; 95% CI: −1.43 to −0.07; moderate certainty) three‐dimensional bodily deviations, postoperative pain (MD = −17.09 mm on the visual analogue scale (VAS); 95% CI: −33.38 to −0.80; low certainty), postoperative swelling (MD = −6.59 mm on the VAS; 95% CI: −19.03 to 5.85; very low certainty), intraoperative discomfort (MD = −9.36 mm on the VAS; 95% CI: −17.10 to −1.61) and surgery duration (MD = −24.28 minutes; 95% CI: −28.62 to −19.95) in flapless sCAIP than in flapped FHIP/cPGIP. Despite being more accurate than flapped FHIP/cPGIP, flapless sCAIP still resulted in deviations with respect to the planned position (intragroup meta‐analytic means: 0.76 mm in depth, 2.57 degrees in angular, 1.43 mm in coronal, and 1.68 in apical three‐dimensional bodily position). Moreover, flapless sCAIP presented a 12% group‐specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases. Evidence regarding more clinically relevant outcomes of efficacy (implant survival and success, prosthetically and biologically correct positioning), long‐term prognosis, and costs, is currently scarce. When the objective is to guarantee minimal invasiveness at implant placement, clinicians could consider the use of flapless sCAIP. A proper case selection and consideration of a safety margin are, however, suggested.

Objectives: Computer Assisted Implant Surgery (CAIS) with different technologies and modalities is becoming increasingly utilized in clinical practice. The aim of this White Paper was to synthesize evidence, reported experience, and best practices with regard to clinically relevant outcomes of static, dynamic, and robotic CAIS.Materials and Methods: A review of the literature compiled existing evidence from clinical studies up to November 2024, which was later discussed and synthesized into clinically relevant questions with a panel of international experts.Results: There is overwhelming evidence for the superiority of static, dynamic, and robotic CAIS with regard to the accuracy of implant placement and some limited evidence of superior esthetic outcomes. At the same time, outcomes related to implant primary stability, survival rates, intra‐ and postoperative complications, marginal bone loss, and peri‐implant tissue health appear similar between guided and non‐guided implant surgery, while efficiency is poorly defined and studied. The importance of accuracy in the execution of a comprehensive, prosthetically driven treatment plan is not reflected in most studies, which focus mainly on the assessment of procedures rather than entire treatment workflows. Such inherent limitations of available research might conceal some of the potential of guided CAIS.Conclusions: Guided CAIS can achieve at least as good clinical outcomes as non‐guided implant surgery. Studies that can assess the benefits of CAIS as part of a treatment workflow, rather than isolated procedures, could improve our understanding of the potential of these technologies.

The objective of the study was to assess the effect of soft‐tissue volume augmentation during early, delayed, and late dental implant therapy in terms of professionally determined esthetics and self‐reported patient satisfaction on esthetics. For this, a comprehensive electronic literature search was performed to identify randomized clinical trials (RCTs) and controlled clinical trials (CCTs) reporting professionally determined esthetic outcomes and self‐reported patient satisfaction on esthetics (primary outcomes) during early, delayed, and late dental implant placement comparing soft‐tissue volume augmentation to the absence of soft‐tissue grafting (control) (PICO 1) or comparing various soft‐tissue augmentation techniques, procedures, and materials (PICO 2). Secondary outcomes were mucosal thickness (MT), intra‐ and postoperative complications, marginal soft‐tissue‐level changes, keratinized tissue width, radiographic marginal bone levels, and clinical parameters for the diagnosis of peri‐implant tissue health. The standard mean differences (SMD)/weighted mean differences (WMD) were estimated for the Pink Esthetic Score (PES), self‐reported patient satisfaction assessed by Visual Analog Scale (VAS) and MT gain for PICO 1 and PICO 2 by employing a random effect model. Five RCTs were included for PICO 1, whereas 7 RCTs and 1 CCT addressed PICO 2. PICO 1: The SMD for the PES between autogenous soft‐tissue grafting (SCTG) and the absence of grafting (control group) was 0.47; 95% CI [−0.15, 1.09; p = 0.14] based on 5 RCTs. The SMD for the VAS values for patient‐reported satisfaction on esthetics in the SCTG and control group was 0.46; 95% CI [−0.12, 1.03; p = 0.12] (2 RCTs). The WMD for gain of MT amounted to 1.06 mm; 95% CI [0.81, 1.31; p = 0.00] in favor of the SCTG group (3 RCTs). PICO 2: The SMD for the PES comparing collagen‐based matrices (CM group) to the SCTG group was −0.32; 95% CI: (−0.57, −0.07; p = 0.01), in favor of the SCTG group (5 RCTs and 1 CCT). The SMD for the VAS for patient‐reported satisfaction on soft‐tissue esthetics was 0.24; 95% CI: (−0.31, 0.78; p = 0.40) (2 RCTs comparing CM vs. SCTG). The WMD for gain of MT was −0.27 mm; 95% CI: (−0.36, −0.17; p = 0.00), significantly favoring the SCTG group (4 RCTs). Professionally and patient‐assessed outcomes showed no substantial differences between autogenous soft‐tissue grafting and the absence of grafting for early, delayed, and late implant placement. However, autogenous soft‐tissue grafts led to significantly improved esthetic outcomes as assessed by professionals compared to soft‐tissue substitutes. Patient‐assessed outcomes, nevertheless, were similar regardless of the grafting material (i.e., SCTG or soft‐tissue substitute). Therefore, autogenous soft‐tissue grafting, though, resulted in a considerably higher gain in mucosal thickness compared to both the absence of soft‐tissue grafting and the use of soft‐tissue substitutes. Complications and adverse events were rarely reported by the included studies, thus suggesting that many trials underreport harms (e.g., complications).

Objectives: To identify patient‐reported outcomes (PROs), clinician‐reported outcomes (ClinROs) and patient‐reported outcome measures (PROMs) in studies evaluating the rehabilitation of the edentulous maxilla with implant‐supported fixed prosthesis using short and/or standard‐length and/or zygomatic implants. Materials and Methods: A systematic search was conducted in MEDLINE/PubMed, EMBASE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and National Clinical Trial Register for articles published between January 1, 2014, and March 24, 2024. Studies reporting both PROMs and ClinROs related to implant therapy in patients with fully edentulous maxillae were eligible for inclusion. Study characteristics, PROMs, and ClinROs were extracted from each article. Study quality was appraised using Cochrane's Risk of Bias 2 tool, Newcastle‐Ottawa Scale, or the Joanna Briggs Institute Critical Appraisal Tool according to the study design. Results: The electronic search identified 1981 titles after removing duplicates. Fourteen publications, reporting both ClinROs and PROMs based on 12 studies (14 publications). These studies evaluated a total of 575 participants and 3367 implants. Eight publications focused exclusively on one type of implant design: seven evaluated standard‐length implants and one examined zygomatic implants. The remaining six publications assessed two implant types: four compared zygomatic and standard‐length implants, while two compared short and standard‐length implants. The most frequently used PROMs among the publications ( n = 14) were Oral Health‐Related Quality‐of‐Life using OHIP questionnaires (7/14) and patient satisfaction using unstandardized questionnaires (7/14). The most frequently reported objective ClinROs were complication (14/14), marginal bone loss (10/14) assessed using standardized periapical radiographs, implant mobility/stability/failure (7/14), and implant survival (4/14). Subjective ClinROs related to the clinician's perception were reported in only one study (1/14) and focused on swelling after treatment. Conclusions: PROMs and objective ClinROs are often reported together in clinical trials involving short, standard‐length or zygomatic implants for implant‐supported fixed prostheses in edentulous maxillae. However, the frequent use of unstandardized questionnaires for PROMs hinders sound comparisons across studies. Subjective ClinROs based on clinician perception are rarely reported.

Objectives: This systematic review aimed to determine whether patient‐reported outcomes (PROs) are associated with clinician‐reported outcomes (ClinROs) in terms of esthetics in patients with single implant‐supported crowns in the esthetic region. Methods: A systematic electronic search was conducted following a pre‐established protocol to identify randomized controlled trials (RCT) involving patients with single implant‐supported crowns in the esthetic region. Studies had to assess both patient‐ and clinician‐reported outcomes. A two‐stage individual participant data (IPD) meta‐analysis was conducted. First, each study was analyzed separately to obtain correlation coefficients. Second, these estimates were pooled using a random‐effects restricted maximum likelihood (REML) model. Results: A total of 29 RCTs evaluating 1414 implant‐supported crowns were included, with IPD available for 14 trials evaluating 675 patients. At crown insertion, IPD meta‐analysis from 171 patients across four RCTs showed no significant correlations ( r = 0.11, 95% CI [−0.04; 0.27], p = 0.16) between pink esthetic score (PES) and patient satisfaction with esthetics assessed with visual analogue scale (VAS). At the 1‐year follow‐up, IPD from 502 patients in 11 studies showed a negligible positive correlation ( r = 0.09, 95% CI [−0.00; 0.18], p = 0.06) between PES or modified PES and VAS esthetic satisfaction. At 10‐year follow‐up, data from 80 patients in two studies showed no correlation between modified PES and VAS patient satisfaction ( r = −0.05, 95% CI [−0.37; 0.27], p = 0.75). Regarding white esthetic score (WES) and VAS satisfaction, data from 376 patients in seven studies showed no significant correlations at the 1‐year follow‐up ( r = 0.03, 95% CI [−0.08; 0.13], p = 0.60). Conclusion: Clinician‐reported outcomes, using PES and WES, showed no correlation with patient‐reported esthetic satisfaction, regardless of the follow‐up duration. Trial Registration: PROSPERO number CRD42023394920