Fernanda Faot

Background: Conventional envelope flap techniques for implant placement in edentulous mandibles are associated with greater postoperative morbidity, especially in elderly patients or those with anatomical limitations. Minimally invasive alternatives aim to preserve soft tissues and reduce complications, enhancing clinical predictability. Methods: A clinical study was conducted with ten fully edentulous patients, in whom 20 regular implants were placed in the interforaminal region without surgical guides. A modified Neumann incision with a mesial relaxing cut and partial‐thickness “L”‐shaped flap was used. Digital planning was performed using free software. Surgical time, number of anesthetic tubes, adverse events, flap healing, peri‐implant inflammation (PI), gingival bleeding index (GBI), and probing depth (PD) were evaluated at 14, 30, 60, and 90 days postoperatively. Results: No surgical complications, such as dehiscence, infection, paresthesia, or early implant loss, were observed. All patients achieved primary wound healing. The mean surgical time was 44 min (range: 25–61 min), with an average of four anesthetic tubes per patient. GBI and PD remained low throughout follow‐up, with few sites showing PD ≥ 4 mm. Healing scores and inflammatory parameters progressively improved over time. Conclusions: The modified Neumann incision with mesial relaxing cut, guided by digital planning, proved to be a safe, predictable, and minimally invasive approach for implant placement in edentulous mandibles. This technique demonstrated favorable healing, reduced surgical time, and effective PI control, making it suitable for patients with systemic fragility or anatomical challenges. Key points: The modified Neumann incision with mesial relaxing cut allows for safe and direct visualization of the mental foramen with limited flap elevation, reducing surgical trauma and preserving soft tissue integrity. This technique demonstrated favorable healing outcomes and low postoperative morbidity, even in elderly patients and anatomically challenging mandibles, without the need for physical surgical guides. Digital preoperative planning using free software enhances precision and predictability, making the approach reproducible and applicable in daily clinical practice. Plain language summary: This study describes a new, less invasive surgical technique for placing dental implants in the lower jaw of patients who have lost all their teeth. The method, called the modified Neumann incision with a mesial relaxing cut, was tested in 10 patients who received 2 implants to support a mandibular overdenture. The technique allows the surgeon to see important anatomical structures, such as nerves, while reducing the amount of tissue that needs to be cut or lifted. Patients were followed for 3 months after surgery, and the healing process, inflammation, and peri‐implant health were monitored. The results showed that all patients healed well, with no significant complications or pain, and the soft tissues around the implants remained healthy. The approach proved to be safe, efficient, and well tolerated, particularly for older adults and individuals with health conditions that increase surgical risks. This technique may help make implant treatments more comfortable and predictable for edentulous patients, although larger studies are still needed to confirm these findings.

This study reported preliminary clinical outcomes of a randomized clinical trial comparing immediate and conventional loading protocols for mandibular overdentures supported by two narrow-diameter implants with a regular platform manufactured by additive technology. The focus was on primary implant stability, assessed using insertion torque and the implant stability quotient (ISQ). Sixteen completely edentulous participants (11 men, 5 women; mean age: 67.7 ± 7.6 years) received new complete dentures prior to surgery and were followed for up to 180 days, depending on the outcome assessed. Insertion torque was recorded at implant placement (motor and manual wrench), implant stability was measured at baseline and 90 days, and peri-implant healing and health parameters were evaluated at 7, 14, 30, 60, 90, and 180 days. A significance level of 5% was adopted for all statistical analyses. Immediate loading was performed on the day of implant placement, while conventional loading occurred after a 12-week healing period. The immediate loading group showed higher insertion torque (motor: 58.13 ± 5.18 Ncm, p=0.001; wrench: 58.44 ± 4.37 Ncm, p=0.004). ISQ increased significantly from baseline to 90 days in both groups (Immediate: 68.05 ± 6.08 to 72.44 ± 3.38; Conventional: 65.58 ± 5.47 to 70.72 ± 4.63; p<0.001), with no significant between-group differences (p=0.117). Peri-implant healing was more stable in the conventional group, with 100% of bone beds healed at 30 days (p=0.01). Significant between-group differences were observed at selected time points for peri-implant outcomes (p<0.05). Within the limitations of this preliminary short-term evaluation, both protocols appeared clinically feasible.

This study aimed to evaluate and compare clinical parameters, subgingival microbiota composition, and matrix metalloproteinase-8 (MMP-8) expression between dental implants and homologous teeth under healthy conditions, across distinct implant platform designs. A total of 47 patients contributed 79 implants and 79 homologous teeth. Clinical parameters, including probing depth (PD) and dimensions of keratinized mucosa (HKM, TKM, and WKM), were assessed. Subgingival biofilm samples underwent analysis by checkerboard DNA-DNA hybridization. Peri-implant and gingival crevicular fluid were collected for MMP-8 quantification. Results: Implants showed significantly increased PD and reduced keratinized mucosa dimensions compared with teeth. While overall microbial loads were comparable, the microbiological profiles differed: Actinomyces naeslundii I, Actinomyces oris, Prevotella intermedia, and Treponema denticola were detected at higher levels in teeth. Conversely, Prevotella nigrescens, Aggregatibacter actinomycetemcomitans A + B, and Selenomonas noxia were more prevalent in implants. High levels of Aggregatibacter actinomycetemcomitans A + B and Selenomonas noxia were observed in the External Hexagon (EH) group. Importantly, MMP-8 expression was approximately 29% higher in implants than in teeth (p<0.05), regardless of the implant platform design. MMP-8 levels correlated exclusively with crevicular fluid volume, but not with other clinical parameters. Dental implants differ from homologous teeth, presenting increased PD, reduced keratinized mucosa height (HKM), and distinct microbial compositions. Although total bacterial levels were similar, implants showed elevated MMP-8 levels compared with teeth, independent of implant platform, suggesting distinct biochemical activity even in clinically healthy sites.

Background: The long‐term influence of mandibular atrophy on masticatory function, patient‐reported outcomes, and prosthetic maintenance in users of implant‐retained overdentures remains unclear. Objective: To assess the impact of mandibular bone atrophy on masticatory function, quality of life, patient satisfaction, and prosthetic maintenance over a five‐year period. Methods: Twenty‐four fully edentulous patients were rehabilitated with mandibular overdentures retained by two narrow‐diameter implants and divided into two groups according to mandibular bone height: atrophic mandible ( AM ) and non‐atrophic mandible ( NAM ). Masticatory performance ( MP ) and swallowing threshold ( ST ) were assessed, while quality of life and satisfaction were evaluated using the Dental Impact on Daily Living ( DIDL ) questionnaire. Prosthetic maintenance events were recorded over 5 years. Multilevel mixed‐effects regression evaluated temporal trends and group differences, and chi‐square tests were used for prosthetic events. Results: Four participants were lost to follow‐up, resulting in 10 individuals per group at 5 years. The AM group showed significant reductions in MP_X50 (–9.66%; p = 0.00) and ST_X50 (–1.9%; p = 0.01); and increase in ST_ME5.6 (+43.32%; p = 0.01). The eating/chewing domain of the DIDL was significantly lower in the AM group (0.35 ± 0.72) compared to the NAM group (0.73 ± 0.47). Although overall prosthetic maintenance did not differ significantly, the AM group exhibited a higher frequency of Equator dislodgement (9.24%; p = 0.00) and attachment replacement (6.02%; p = 0.00). Conclusion: Mandibular atrophy adversely affected masticatory function, patient‐reported chewing satisfaction, and the frequency of specific prosthetic complications over 5 years.

Objectives: This prospective longitudinal case series investigated changes in functional, radiographic, and patient‐centered outcomes in users of two narrow‐diameter implant‐retained mandibular overdentures (IMO) over a 5‐year follow‐up.Materials and Methods: Twenty‐four patients from a previous 3‐year study (8 man, 16 women, 71.58 ± 7.03 years, mean mandibular edentulism duration 23.9 ± 14.4 years) were invited for a 5‐year follow‐up evaluation of radiographic and functional parameters. Masticatory function (MF) was assessed using the Swallowing Threshold Test (ST), with X50 and B cut‐off values indicating satisfactory performance. Oral health‐related quality of life (OHRQoL) was evaluated using the OHIP‐Edent questionnaire. The Posterior Mandibular Area Index (PAI) was analyzed using digital panoramic radiographs. Data was analyzed using multilevel mixed‐effects linear regression.Results: Twenty participants completed the 5‐year follow‐up evaluation. ST_X50 (4.00–3.70; p ≤ 0.01; 95% CI: 0.47–1.82) reached a significant reduction along with an increased number of masticatory cycles (59.33–65.60; p ≤ 0.01; 95% CI: 0.32–1.11) between years. The number of IMO wearers presenting satisfactory mastication increased but persisted as unsatisfactory in nine participants by year 5. Declines in the Functional Limitation and Physical Disability domains of OHRQoL were noted, with unsatisfactory mastication correlating with higher pain (coef: 2.5; p: 0.03; 95% CI: 0.25–4.74) and psychological disability scores (coef: 0.94; p ≤ 0.01; 95% CI: 0.19–1.68). PAI increased significantly (1.13–1.68; p ≤ 0.01; 95% CI: 0.24–0.56), indicating ongoing bone remodeling.Conclusions: Although MF and bone parameters improved over 5 years, persistent unsatisfactory mastication continued to negatively affect quality of life. These findings underscore the interdependence between functional and patient‐centered outcomes in IMO users.Trial Registration: The Brazilian Registry of Clinical Trials (ReBEC), Trial identification: UTN code: U1111‐1259‐4127