The International Journal of Oral & Maxillofacial Implants

Purpose: To compare the influence of immediate loading (IL) and non-immediate loading (NIL) protocols on overdentures retained by reduced-diameter implants (≤ 3.5 mm). Materials and Methods: Electronic databases including MEDLINE (via PubMed), Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) comparing clinical outcomes of immediately loaded and non-immediately loaded reduced-diameter implants supporting overdentures. The risk of bias within and across the studies and the certainty of evidence were assessed by RoB 2.0 and GRADE, respectively. A sensitivity analysis was performed by eliminating studies at high risk of bias and repeating the data synthesis employing the random effects model. Subgroup analyses were conducted based on the implant diameter and the length of follow-up. Results: Overall, six RCTs with 255 patients were included in this systematic review. The meta-analyses found similar implant survival rates between immediately loaded and non-immediately loaded implants in the mini-implant (RR = 0.98; 95% CI = 0.95, 1.01; P = .12) and narrow-diameter implant subgroups (RR = 0.99; 95% CI = 0.94, 1.03; P = .56) as well as in short-term (RR = 0.98; 95% CI = 0.97, 1.00; P = .11) and long-term (RR = 0.97; 95% CI = 0.93, 1.01; P = .09) follow-up subgroups. Additionally, marginal bone loss (MBL) showed no statistically significant difference between the loading protocols in the subgroup of long-term follow-up (MD = 0.03; 95% CI = –0.16, 0.23; P = .74). Three RCTs investigating peri-implant parameters found relatively higher modified plaque index (PI) and probing depth (PD) in reduced-diameter implants under IL. Conclusions: Compared with NIL, the IL protocol can achieve comparable survival rates and MBL in reduced-diameter implants supporting overdentures. Keywords: conventional loading, immediate loading, implant-retained overdenture, loading protocol, reduced-diameter implant

Purpose: To analyze the risk of dental implant failure for patients with a history of antidepressant use through a systematic review and meta-analysis. Materials and Methods: An electronic search was performed up to June 2023 in three databases including PubMed/MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials; data on the comparison of implant failure rate for patients with and without the use of antidepressants were included. Meta-analyses for the risk ratio of implant failure rate at patient level and implant level were performed. Results: Overall, 11 clinical studies were selected for inclusion in this review. The meta-analyses showed a risk ratio of 2.44 (95% CI = 1.75 to 3.39; P < .0001) and 2.44 (95% CI = 1.73 to 3.46; P < .0001) for the implant failure at patient level and implant level, respectively. The comparisons presented a low heterogeneity for the patient-level analysis and a moderate heterogeneity for the implant-level analysis among the pooled studies. Subgroup analyses also revealed that patients who received only selective serotonin reuptake inhibitors (SSRIs) or SSRIs with other types of antidepressants had a higher risk of implant failure than those who were not on any antidepressants. Conclusions: The current review demonstrates that the use of antidepressants such as SSRIs may increase the risk of dental implant failure at both patient level and implant level. Although limited evidence suggests that a certain type of SSRI (sertraline) may have more influence on implant failure than other SSRIs, future studies are needed to confirm this finding. Keywords: antidepressants, dental implants, selective serotonin reuptake inhibitors, systematic review

Purpose: To describe the emerging evidence concerning etiologic factors and pathophysiologic mechanisms involved in peri-implant inflammatory diseases. Materials and Methods: An electronic search for articles published until November 2022 was conducted in MEDLINE by three independent reviewers to identify the manuscripts’ reporting data on etiologic factors and pathophysiologic mechanisms associated with peri-implant diseases. Results: Current evidence suggests that peri-implant mucositis and peri-implantitis are inflammatory conditions linked to a microbial challenge. However, in recent years there has been increasing evidence indicating that certain peri-implant inflammatory conditions may not be primarily related to biofilm-mediated infectious processes but rather to other biologic mechanisms, such as a foreign body response. Conclusions: Current evidence in the dental and medical literature opens new avenues for a more complex interpretation of the etiopathogenetic factors involved in peri-implant diseases. A better understanding of various factors related to the host response, including dysbiosis mechanisms associated with changes in microbiota composition, is necessary for a more precise physiopathologic characterization of these diseases. Keywords: dental implant, foreign body response, microbial biofilm, peri-implant diseases, peri-implant infection

Purpose: To explore the effect of adding an allogeneic soft tissue graft at the time of single implant placement using a fully digital workflow for implant placement and restoration without making either analog or digital impressions. Materials and Methods: A prospective randomized clinical study was performed enrolling 39 participants requiring single-tooth implants. The patients were randomized into one of two groups: (1) the graft group, which received an allogeneic dermal graft at the time of implant placement (n = 19), or (2) the nongraft group (n = 20). A fully digital surgical and restorative protocol was implemented for both groups. Intraoral scans were taken before implant placement (T0), at the time of final crown delivery (T1), and 1 year after placement (T2). Intraoral scans were aligned using Geomagic Control X 2020 software, and linear and volumetric changes in buccal tissues were measured at T0, T1, and T2. Implant survival, probing depths (PDs), and complications were recorded. Participants were asked to complete an Oral Health Impact Profile (OHIP)- 14 survey at T0 and T2. Marginal bone levels were measured at T0 and T2 on periapical radiographs. Results: Overall, 39 participants completed surgery and restoration in the incisor, canine, premolar, and molar sites. Two early failures were recorded in central incisor positions (95% survival). Crown delivery without complication from the digital workflow (impressionless) was achieved for 36 out of 39 cases (92%), and implant depth control was the main challenge. At 1 year, 37 participants attended the follow-up appointment. Both groups showed gain in buccal tissue thickness without significant differences between the two groups for both linear and volumetric measurements (P > .05). Soft tissue grafting was associated with minimal added morbidity. The interproximal marginal bone changes were recorded as follows: –0.16 mm mesial and –0.12 mm distal for the graft group and –0.01 mm mesial and –0.11 mm distal for the nongraft group (P = .07 for mesial and .83 for distal). The OHIP score was significantly reduced at T2 compared to T0 (P = .003) for the entire cohort. Conclusions: Augmentation of the alveolar mucosa on the buccal aspect of single-tooth implants is associated with clinically favorable outcomes. A fully digital workflow has been validated to permit crown delivery on CAD/CAM abutments without implant impressions. Keywords: allograft, digital, marginal bone loss, single implant, soft tissue graft

Purpose: To evaluate the influence of immediate loading on the osseointegration and bone density of implants placed in a healed alveolar bone crest and supporting single crowns. Materials and Methods: Two solid titanium transmucosal miniimplants were placed in the distal regions of the mandible in 14 patients. One mini-implant was immediately functionally loaded, whereas the other was left unloaded. After 2 months of healing, biopsy samples were retrieved and the levels of new bone, old bone, and total bone (new + old) were assessed. Results: Histologic examination was performed on biopsies from 12 patients (n = 12). The new bone-to-implant contact percentage (BIC%) was 40.3% ± 16.8% and 55.1% ± 19.1% (P = .043) at the unloaded and loaded sites, respectively; in addition, the total BIC% was 44.9% ± 17.0% and 59.5% ± 18.8%, respectively (P = .034). The new bone density was 45.9% ± 11.6% for the unloaded implants and 45.9% ± 16.7% for the loaded implants (P = .622). Conclusions: Immediate loading had a positive effect on bone apposition at the implant surface, but no effect on bone density was observed after 2 months of healing. Keywords: biopsy, clinical trial, immediate dental implant loading, implant-supported prosthesis, osseointegration

Purpose: To estimate the effect of simvastatin gel in the osseointegration of dental implants using bone scintigraphy. Materials and Methods: A total of 20 participants with missing mandibular first molars and D2 type bone were assigned equally to two groups. Group A received 1.2% simvastatin and group B received placebo gels during the placement of implants. The participants were subjected to bone scintigraphy to determine the osteoblastic activity at baseline, 30 days, and 90 days after implant placement. Results: Group A had a significant increase in osteoblastic activity between baseline, day 30, and day 90 (P < .05), with a higher mean of 100.06% ± 21.644% on day 30. Group B had a significant increase in osteoblastic activity only between baseline and day 30 and between baseline and day 90 (P < .05). There was no difference between days 30 and 90 (P > .05), with a higher mean of 79.20% ± 18.255% on day 30. A bivariate analysis performed at different time periods revealed a significant difference between groups A and B on day 30. Conclusions: Implants placed with 1.2% simvastatin gel showed enhanced osteoblastic activity in the 4th week after implant placement, indicating that there was a faster rate of osseointegration at an early stage. Keywords: osseointegration, osteoblastic activity, simvastatin

Purpose: To evaluate the dimensional changes in the alveolar crest after buccal overbuilding was performed prior to tooth extraction in a dog model. Materials and Methods: At the test sites, alveolar crest overbuilding was performed on the buccal aspect of the distal root of the third premolar using xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both third premolars were extracted and implants were immediately placed into the alveolus, allowing nonsubmerged healing. After 3 months, biopsy samples were collected. Results: Upon histologic analysis, no statistically significant differences in hard tissue dimensions were found. The buccal bone plate at the test sites presented a tendency for higher resorption compared to the control sites. However, if the contribution of the residue of biomaterial is considered, a higher volumetric gain was registered at the test than at the control sites. Conclusions: The buccal overbuilding performed prior to tooth extraction did not contribute to the preservation of the alveolar crest dimensions after extraction. This could be due to failure to incorporate the graft into the newly formed bone. Keywords: biomaterials, bone graft, bone substitute, bone regeneration, histology, immediate placement, surgical procedure, tooth extraction

Purpose: To evaluate a new cultivated coral graft (CCG) in an in vivo experimental guided bone regeneration (GBR) procedure. Materials and Methods: The calvarias of eight rabbits were surgically exposed, and circular defects 8 mm in diameter were prepared. One defect was filled with CCG particles (experimental group); the contralateral defect (control group) was spontaneously filled by blood clot. All defects were covered with a collagen membrane. Subjects were euthanized after 8 weeks. Results: Histologic observations of the defects showed similar bone growth patterns in both experimental and control osteotomies. In the experimental defects, no traces of coral particles were observed. Histometric analysis showed denser bone in the pristine zone (65%–66%) than in the peripheral zone for both the control (50%) and experimental defects (31%) (P = not significant). The new bone percentage was reduced from the peripheral zone toward the middle and the center of the defect (31%, 32%, and 27%, respectively) as the distance from the peripheral pristine bone borders increased. Conclusions: The existing data supports the complete degradation of CCG as a spacemaintaining scaffold for GBR procedures. Keywords: animal study, bone, coral graft, GBR, rabbit

The following technique describes the virtual planning of a single implant by combining an intraoral digital scan, an open-source computer-aided design software program, bone sounding, and 2D radiographic imaging. The surgical implant guide is fabricated using additive manufacturing technologies. Further, the surgical implant guide positioned in the patient’s mouth is used to radiographically verify the estimated mesiodistal implant angulation before proceeding with the surgical intervention and can be modified if necessary. When a CBCT scan is not available, this technique eases implant planning procedures and minimizes possible surgical complications. Keywords: 3D printing, additive manufacturing, computer-aided design, computer-aided implant planning, surgical implant guide

Purpose: To assess the accuracy and precision of prosthetically driven implant placement achieved through static computer-aided implant surgery by analyzing the linear and angular deviations of implants. Materials and Methods: A total of 53 implants were included in the study. The implants were positioned using either tooth-supported templates or tooth-and-tissue-supported templates with fixation pins. Two distinct guided surgery approaches were used: pilot drill guided and fully guided. 3D data from the implant planning phase was superimposed with the 3D data from the final implant positions using the “Treatment Evaluation” tool within coDiagnostiX implant planning software (Straumann). This enabled the automatic calculation of deviations in implant placement accuracy. Results: The average angular deviation observed was 3.90 degrees. For linear deviations, the mean 3D deviation was 1.04 mm at the most coronal point of the implants and 1.56 mm at the implant apex. Conclusions: This research demonstrates the feasibility of a digital workflow for guided implant surgery, offering a promising treatment option. Nonetheless, it is important to note that deviations do occur, particularly in the apical region of the implant. Care should be taken, particularly in cases of limited bone availability. Keywords: computer-aided surgery, dental implants, dental informatics, prosthodontics

Purpose: To investigate the influence of a single infrapositioned ankylosed tooth or implant-supported restoration on smile esthetics. Materials and Methods: A series of 48 digitally modified images that simulated varying degrees of infraposition (from 0.25 to 2.0 mm, with a step of 0.25 mm) were created for each maxillary anterior tooth by altering the full-portrait image of a smiling man, adjusted to show medium and high smile lines. For the model with the high smile line, a series of 24 digitally modified images were created that simulated the infraposition of a single anterior tooth with a restored incisal edge. Smile esthetics for each of the images were evaluated by 160 participants (80 dentists and 80 laypersons), and a visual analog scale (VAS) was implemented. Results: For the images with the high smile line, an infraposition of ≥ 0.25 mm in the central incisor region and ≥ 0.5 mm in the region of the lateral incisor or the canine had a negative effect on the perceived smile esthetics for both the dentists and the laypersons. Regarding the medium smile line, an infraposition of ≥ 0.5 mm in the central and lateral incisor region had a negative effect on the perceived smile esthetics for both groups of observers. In the canine area, an infraposition of ≥ 0.5 mm for the dentists and ≥ 0.75 mm for the laypersons also had a negative impact on the smile esthetics. Conclusions: Even a minor infraposition of a single maxillary anterior ankylosed tooth or implant-supported restoration can reduce the perceived attractiveness of the smile. Infraposition in the canine site can be better tolerated in a medium smile line compared to a high smile line. In patients with a high smile line, prosthetic intervention is needed to restore the incisal edge of an infrapositioned tooth without harmonizing the gingival contour; this can be beneficial for the lateral incisor but ineffective for the central incisor and unfavorable for the canine. Keywords: ankylosed tooth, craniofacial growth, implant submersion, infraocclusion, smile esthetics

Purpose: Marginal bone resorption (MBR) around dental implants may sometimes be a self-limiting condition due to balancing immunologic reactions against utilized materials rather than a progressive bacterial infection. Contrary to previous assumptions from ligature-induced experimental peri-implantitis studies, a recent 8-week experiment by the present authors showed that marginal ligatures trigger an inflammatory immune response, resulting in bone resorption around implants in the absence of plaque. The present study aimed to investigate whether this inflammatory/immunologic reaction attenuates or progresses toward implant failure after a longer healing time (12 weeks). Materials and Methods: Sterile silk ligatures were placed around the top of titanium (Ti) implants and compressed against the femoral cortical bone plate of six rabbits. A nonligated implant was used as a control. After 12 weeks of submerged healing, ground sections of implants and surrounding tissues were investigated with light microscopy. The marginal soft tissues were also analyzed using selected quantitative polymerase chain reaction (qPCR) markers. Results: Histologically, the ligatures were outlined by immune cells, including multinucleated giant cells (MNGCs), with adjacent fibrous encapsulation and resorbed peripheral bone that contrasted from the osseointegrated nonligated control implants. The difference in expression of qPCR markers was not significant, but > two-fold upregulation of markers CD11b, IL1β, ARG1, NCF1, and CD4 and > twofold downregulation of CD8 indicated a mild, focal inflammatory/immune response against the ligatures compared to controls, with upregulation of M1 and M2 macrophages, neutrophils, and helper T-cells as well as downregulation of killer T cells. Further, the bone formation markers OC and ALPL were > two-fold downregulated (consistent with the lack of osseointegration of the ligatures) compared to control implants. Conclusions: Marginal silk ligatures trigger an inflammatory/immune response and aseptic bone resorption around implants. Compared to the previous 8-week study, the inflammatory reaction against the silk appears to attenuate with time, with only a mild persisting inflammation that may block osseointegration; instead, a fibrous tissue encapsulation–type reaction is maintained. This may explain why traditional ligature experiments have required regular exchange of ligatures for the bone resorption to progress. Keywords: bone loss, dental implant, immunology, ligature, osseointegration

Purpose: To investigate the esthetic outcomes based on the color differences in zirconia (Zr) of varying thickness, resin cement color, and types of titanium (Ti) implant surface treatments. Materials and Methods: Overall, 28 high-translucency monolithic zirconia (HTMZ) specimens were arranged into four groups based on Zr thickness: 1.0, 1.5, 2.0, and 2.5 mm (n = 7 per thickness). Each group was tested using two resin cement colors (clear and opaque) in combination with six surface-treated Ti groups (n = 7), including untreated titanium (UT), anodization (AN), 50-μm alumina airborne-particle abrasion followed by AN (SBAN), AN followed by 50-μm alumina airborne-particle abrasion (ANSB), 9.5% hydrofluoric acid followed by AN (HFAN), and AN followed by 9.5% hydrofluoric acid (ANHF). This created a total of 48 experimental groups, including the use of composite resin (n = 7, shade A2D) for four control groups. All specimens were measured using a spectrophotometer and subsequently compared with composite resin (control) with the corresponding Zr thickness to establish color differences. A color difference of < 2.7 was considered clinically acceptable. The data obtained were statistically analyzed using ANOVA and post hoc test (P = .05). Results: Zr thickness, resin cement color, and type of Ti implant surface treatment significantly affected the observed color differences (P < .05). When using 2.5-mm HTMZ with clear resin cement on AN, UT, SBAN, HFAN, and ANSB, the mean color differences were below the clinically acceptable values, and the 95% CIs of color differences were below the clinically acceptable values for AN, UT, and SBAN groups. Conclusions: HTMZ with a minimum thickness of 2.5 mm and clear resin cement on AN, UT, and SBAN groups potentially result in acceptable color matching with 95% CIs. Keywords: anodize, cement, ceramic, color, spectrophotometer, zirconia

Purpose: To evaluate and compare patient satisfaction levels in edentulous patients treated with different configurations of implant-supported prostheses as well as previous prosthesis experiences before implant treatment. Materials and Methods: A study population of 142 patients was identified and separated into four treatment groups: group 1 comprised 43 patients treated with an implant-supported overdenture in the mandible and conventional complete denture in the maxilla; group 2 comprised 32 patients treated with implant-supported overdentures in the maxilla and mandible; group 3 comprised 26 patients treated with an implant-supported overdenture in the mandible and a fixed prosthesis in the maxilla; and group 4 comprised 41 patients treated with implant-supported maxillomandibular fixed restorations. Questionnaires asking about masticatory performance, pronunciation, comfort, and social ability were used to evaluate treatment outcomes. Results: The patients in group 4 were significantly more satisfied regarding masticatory performance than other treatment modalities. Visual analog scale (VAS) scores for comfort and social ability were similar in groups 3 and 4 and significantly higher than those in groups 1 and 2. The patients who used a conventional removable prosthesis before implant treatment were more satisfied with their implant-supported prosthesis regarding social ability (P = .03). Conclusions: The treatment design of an implant-supported fixed prosthesis in the maxilla and implant overdenture in the mandible provided a comparable level of satisfaction with maxillomandibular fixed prosthesis for edentulous patients. This combination served as a practical solution especially for patients with mandibular atrophy who would require extensive surgeries to support maxillomandibular fixed prostheses. In the maxilla, patient satisfaction with an implantsupported overdenture was not superior to that with a conventional prosthesis. Note that previous removable prosthesis experience may influence social comfort for patients. Keywords: omplete denture, implant-supported fixed prosthesis, implant-supported overdenture, patient satisfaction

Purpose: To assess the impact of implant placement at different time intervals on the esthetic and clinical outcomes in the esthetic zone. Materials and Methods: A literature screening was conducted in PubMed (MEDLINE), ScienceDirect, and Cochrane databases. Relevant articles were included according to selection criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was collected from studies published from 2017 to 2022 in English. Results: Nine articles were included, in which a total of 495 implants were placed; 250 of the implants were immediate, 109 were early, and 136 were delayed. Immediate implant placement (IIP) showed no statistically significant difference in Pink Esthetic Score (PES) compared with delayed implant placement (DIP). IIP showed significantly higher PES in comparison with early implant placement (EIP) (mean difference [MD] = –0.76; 95% CI = –1.50 to –0.02; P = .04). The probing depth (PD) was considerably greater for immediate implants than for delayed implants (MD = –0.62; 95% CI = –1.05 to –0.18; P = .005), and the Plaque Index (PI) was statistically greater for early implants compared with immediate implants (MD = 0.15; 95% CI = 0.11 to 0.19; P < .00001). All other soft tissue outcomes showed equal results. The marginal bone loss (MBL) was statistically higher in early implants compared with immediate implants (MD = 0.09; 95% CI = 0.02 to 0.16; P = .02). Conclusions: IIP had significantly superior PES, MBL, and PI results when compared with EIP. The PD was significantly higher for immediate implants compared with delayed implants. All other outcomes showed no significant difference between the three implant groups. It is important to highlight the limitations of this review such as the small number of studies included and the few reports on esthetic indices. Keywords: dental, dental implant, dental implantation, endosseous dental implant therapy, endosseous, esthetics

Purpose: This study assessed the accuracy of linear measurements and dental implant selection performed in a smartphone application compared to a computer software. Materials and Methods: Forty-four DICOM files from the posterior mandible in partially edentulous patients were evaluated by three trained and calibrated examiners. Images were analyzed using three visualization methods: cross-sectional view (CScr) and coronal (CSco) plane using the CS 3D Imaging software, and coronal (DRco) plane using the DroidRender smartphone application. For standardization, bone width and height measurements were taken in the edentulous posterior mandible, 10 mm posterior to the mental foramen. Implants were selected according to the 2022/2023Straumann Standard implant catalog. Linear measurements were compared using repeated-measures ANOVA, and implant selection was compared using Friedman test. Statistical analysis was performed using SPSS software, with a significance level of 5%. Results: Linear measurements showed a statistically significant difference for bone width (P = .030), but not for height (P = .685). The choice of implant was not influenced by the visualization method (P = .614). Conclusions: It is possible to suggest the use of smartphone applications as an additional diagnostic tool for DICOM evaluation and implant planning in the posterior mandible. Smartphone applications allow an assessment not limited to 2D images or to static environments. Therefore, information exchange and diagnostic opinion in emergency situations may be facilitated.  Keywords: clinical decision-making, cone beam computed tomography, dental implants, smartphone

Purpose: To determine the change in the sagittal and vertical position of mini-implants placed in the maxilla during distal movement of the entire maxillary dentition. Materials and Methods: Overall, 28 mini-implants (1 placed on each side in 14 patients) were evaluated in healthy patients aged 15 to 25 years old. CBCTs were taken immediately after leveling and aligning prior to distalization (T1) and after 6 months (T2) to evaluate the distal movement of the maxillary teeth and position of the mini-implants. The vertical and sagittal angulation of each mini-implant was measured at T1 and T2. The linear distance between the mini-implant and the alveolar crest, the maxillary sinus, the maxillary second premolar, and the maxillary first permanent molar were measured. The change in angulation and the linear displacement of the miniimplant were evaluated in the vertical and sagittal plane. Wilcoxon signed rank test was performed to determine if there was a statistically significant change in the position of the mini-implant. Results: Vertically, there was a significant change in the linear distance between the mini-implant and the alveolar crest on the right side (P ≤ .006) as well as the miniimplant and the maxillary sinus on the left side (P ≤ .003). Sagittally, there was a statistically significant rotation of the miniimplant occlusally (left side P ≤ .004 and right side P ≤ .002). The head and tip of the mini-implant were displaced toward the maxillary second premolar and away from the maxillary first permanent molar, respectively. There was a significant relative displacement of the mini-implant anteriorly away from the maxillary first permanent molar (left side P ≤ .026 and right side P ≤ .041) and closer to the maxillary second premolar (left side: P ≤ .011 and right side: P ≤ .002). Conclusions: There was a statistically and clinically significant rotation of the mini-implant in the vertical and sagittal direction during distal movement of the entire maxillary arch. The linear displacement of the mini-implant was more pronounced in the sagittal direction than the vertical direction. Keywords: cohort study, distal movement, displacement, mini-implant, sagittal, vertical

Purpose: Dental implants are an established treatment option for varying edentulous conditions that has grown in popularity since the 1990s. This increased clinical application has shown a parallel increase in implant-related research. The objective of this paper was to perform a comprehensive bibliometric analysis of five dental implantology journals from 1991 to 2023. Materials and Methods: A search was done in the Web of Science database between 1991 and 2023 in five journals with a focus on dental implantology: Clinical Oral Implant Research, Clinical Implant Dentistry and Related Research, Implant Dentistry, The International Journal of Oral & Maxillofacial Implants, and International Journal of Oral Implantology. Results marked as a correction, retraction notice, retracted article, meeting abstract, or withdrawn publication were removed from the analysis. The time period analyzed was divided into four time periods, organized by decade: 1991 to 2000, 2001 to 2010, 2011 to 2020, and 2021 to 2023. Additionally, the top 100 cited papers were also exported separately. Authors and countries with most publications were tabulated from the Web of Science database. VOSviewer software was used to create network maps of keywords and title word occurrences for each of the time periods. HistCite software was used to analyze the number of publications and citation counts. Results: Network maps of keywords and title word occurrences suggested an early focus on osseointegration and titanium implants between 1991 and 2000. Publications between 2001 and 2010 saw a focus on in vivo studies, implant surface, and peri-implantitis. Publications from 2011 and later saw a focus on bone regeneration, complications, and zygomatic implants. The USA ranked highest in total number of publications in all analyzed time periods. Conclusions: Within the limitations of the present study, a comprehensive bibliometric analysis from 1990 to 2023 was reported. Trends in keywords and titles of implant publications were identified in these journals, which mirrored the trends seen in clinical practice.

Purpose: Patients may have high expectations regarding dental implants based on the source of their information, which can lead to challenges in clinical communication. This study aims to evaluate the quality of responses provided by Chat Generative Pretrained Transformer (ChatGPT, OpenAI), an artificial intelligence (AI) program, to patient questions in the field of dental implantology. Materials and Methods: This study was prospectively designed as a cross-sectional study. Frequently asked questions by patients about general information on dental implantology (Part 1) and dental implant brands (Part 2) were posed to the ChatGPT program. Responses were independently assessed by oral and maxillofacial surgeons (Group 1; n = 10), periodontologists (Group 2; n = 10), prosthodontists (Group 3; n = 10), and general dentists (Group 4; n = 10) using the Global Quality Scale (GQS, scored from 1 [low quality] to 5 [high quality]). Results: There was a total of 60 questions, with 30 questions in each part. Participants in the study were evenly distributed by gender (50% female, 50% male) with a mean age of 32.6 ± 4.07 years. The mean years of experience were 8.5 ± 3.12 years. There were no significant differences in mean age, gender, and years of experience among the groups (P > .05). The overall mean GQS score was 3.87 ± 0.29. Part 1 had a mean score of 3.9 ± 0.35, and Part 2 had a mean score of 3.85 ± 0.29, with no statistically significant difference (P > .05). Conclusions: The AI platform may contribute to the additional education of patients in the field of dental implantology and aid in understanding treatment procedures. However, it is concerning that ChatGPT may exhibit bias regarding dental implant brands, which could impact patient guidance.