Francisco G. F. Tresguerres

Objectives: To evaluate the clinical accuracy and patient-reported outcomes (PROMs) of robotic-assisted full-arch implant rehabilitation performed with an autonomous robotic implant system. Materials and Methods: Six consecutive edentulous patients requiring implant-supported full-arch rehabilitation were treated using the Yakebot task-autonomous robotic implant system following a fully digital workflow. A total of 36 Straumann Bone Level Tapered implants were placed using a flapless approach. Implant placement accuracy was assessed by comparing planned and postoperative CBCT datasets. Coronal, apical, depth, and angular deviations were automatically calculated using dedicated robotic planning software. Patient-reported outcomes were prospectively evaluated through a structured questionnaire assessing preoperative perceptions, postoperative morbidity, and overall treatment satisfaction. Results: All implants were successfully placed according to the robotic-assisted workflow without intraoperative complications or conversion to conventional surgery. Mean three-dimensional coronal and apical deviations were 0.45 ± 0.18 mm and 0.47 ± 0.19 mm, respectively, while mean total angular deviation was 1.30 ± 0.63°. Patients reported low preoperative anxiety (0.5 ± 0.8/10), limited postoperative pain (2.2 ± 3.5/10), swelling (1.3 ± 2.2/10), and interference with daily activities (1.3 ± 2.2/10). Overall surgical experience was highly rated (9.7 ± 0.8/10). Final satisfaction scores were exceptionally high, with all patients indicating they would undergo robotic-assisted surgery again and recommend the procedure to others. Conclusions: Robotic-assisted full-arch implant rehabilitation demonstrated a high level of clinical accuracy, with submillimetric coronal and apical deviations and low angular discrepancies. In addition, treatment was associated with low postoperative morbidity, excellent patient acceptance, and very high satisfaction. These findings support the potential of autonomous robotic implant surgery as a predictable and patient-centered approach for full-arch rehabilitation, although larger controlled studies are required to confirm these results.

Congenital third molar (3M) agenesis is a common dental anomaly associated with genetic, epigenetic, and craniofacial growth factors. Evidence regarding its prevalence across populations and its relationship with sagittal and vertical growth patterns remains limited. This study aimed to compare the prevalence of 3M agenesis in Spanish and Peruvian samples and analyze its association with craniofacial growth patterns. A multicenter cross-sectional study was conducted in 1191 patients aged 10–14 years (348 Spanish, 843 Peruvian). 3M agenesis was assessed on digital panoramic radiographs. Sagittal and vertical growth patterns were evaluated using Steiner’s cephalometric analysis (ANB and GoGn–SN angles). Overall, 3M agenesis prevalence was 25.1%, with no difference between the Spanish (25.0%) and Peruvian (25.15%) groups. A non-significant trend toward higher prevalence was observed in Spanish females. 3M agenesis was more frequent in maxillary than mandibular 3M (16.8% vs. 10.2%; p < 0.001). Growth patterns differed between populations, with Class I and normodivergent patterns predominating in Spanish subjects, and Class II and hyperdivergent patterns in Peruvians (p < 0.001). No significant associations were found between 3M agenesis and sagittal or vertical growth patterns (p > 0.05), although Class II patients exhibited a higher prevalence of mandibular 3M agenesis (14.8% vs. 10.8%; p = 0.04). 3M agenesis showed similar prevalence in both populations and was not associated with craniofacial growth patterns, except for mandibular 3M agenesis in Class II patients, suggesting a multifactorial etiology driven by genetic and developmental factors rather than demographic or skeletal variables. It should be noted, however, that the cross-sectional nature of the study, the recruitment of patients from university dental clinics, and the absence of multivariate regression analysis limit both the generalizability and the causal interpretation of the findings.

The present study describes a digitally guided workflow for the Split Bone Block Technique (SBBT) using standardized cortical and particulate allogeneic grafts in combination with custom-designed, 3D-printed surgical guides. The aim was to illustrate the feasibility of a donor-site-free alternative to the conventional autologous approach, which remains technically demanding and associated with increased morbidity. A narrative literature review and a single clinical case report were conducted to contextualize the proposed workflow. Digital planning was performed by merging DICOM and STL datasets to design cutting boxes for standardized allogeneic laminae and a transporter guide for intraoperative positioning. The technique was applied in a patient with severe horizontal ridge atrophy. Primary wound closure and uneventful healing were achieved. Six-month CBCT evaluation demonstrated an increase in horizontal ridge width from 2 mm to 8 mm. Within the limitations of a single illustrative case, this report suggests that a fully guided allogeneic SBBT workflow is feasible and may facilitate controlled graft adaptation while avoiding autologous bone harvesting. Further controlled clinical studies are required to evaluate accuracy, reproducibility, and long-term outcomes.

Aging induces changes in bone. Growth hormone (GH) is reduced by aging, and age-related changes observed in old bones might be due to a decrease in the GH/insulin-like growth factor-I (IGF-I) axis. GH administration on aged individuals is controversial. This study aimed to assess the effect of systemic GH treatment on bone properties, bone metabolism, and bone mineral density (BMD) in long bone of old rats. Aged Wistar rats were treated with GH at a dose of 2 mg/kg/day during 10 weeks. Plasma osteocalcin, IGF-I, and carboxy-terminal telopeptide of type I collagen levels were measured. Cross-sectional bone areas and BMD were measured by morphometric and densitometric analysis, respectively. Femora were analyzed by three point-bending testing. t -Test was used for statistical evaluation. p < 0.05 was considered to be significant. Significantly enhanced bone area, at the expense of the cortical area, was found in treated rats. The densitometric analysis showed 11% higher BMD in the experimental group. Significantly higher bone flexural modulus, stiffness, and ultimate load were observed in the treated rats. Plasma osteocalcin and IGF-I levels were significantly increased in the treated group, while the resorption marker concentration remained unchanged. Within the limitations of this experimental study, systemic GH administration has shown to enhance biomechanical properties, BMD, cortical mass, and plasma IGF-I and osteocalcin in old treated rats, compared to the control group; consequently, GH could be considered as an alternative therapy against age-related changes in the bone.

Purpose. The objective of this systematic review was to evaluate and compare the clinical efficacy of horizontal alveolar ridge augmentation techniques described by Khoury and Urban. Methods. A systematic electronic search in the MEDLINE databases, SCOPUS, WOS, and the Cochrane Central Register of Controlled Trials (CENTRAL) as well as a manual search, were conducted independently by two reviewers up to July 2021. Results. Six studies met the pre-established inclusion criteria and were included in the descriptive analysis. Due to the heterogeneity found across the included studies, meta-analysis could not be performed. Horizontal bone gain was between 3.93 ± 0.9 mm and 5.02 ± 0.8 mm with the Khoury technique and between 3.9 ± 0.9 mm and 5.68 ± 1.42 mm with the Urban technique. Similar complication rates were reported in both groups: infection (7%), in the Khoury technique, and membrane exposure (3.2–13.6%), in the Urban technique, being the most frequent events. Conclusions. Both techniques were found to be effective, in terms of clinical bone gain, for horizontal alveolar ridge gain. Nevertheless, available literature is limited, and there is a lack of comparative studies to better evaluate the results.

Background: The need of decortication on the recipient site remains unclear for bone regeneration. To our knowledge, there are no human clinical trials that studied the influence of decortication on cancellous allogeneic block grafting.Purpose: The aim of the present study is to evaluate the influence of perforating the cortex of the recipient site on cancellous allogeneic block graft integration and revascularization in the maxilla.Material and Methods: Twenty‐six patients referred for lateral bone augmentation were included in this clinical trial. Patients received freeze‐dried bone allograft cancellous blocks obtained from the iliac crest; cortical perforations of the recipient bed were performed in the test group while in the control group it was left intact. After a 4‐month healing period another surgery was performed to place dental implants, and a bone biopsy was collected using a trephine. All samples underwent micro‐CT scans, and were processed for histomorphometric and immunohistochemical analysis. Implant survival comparisons were made using a repeated measures analysis of variance (ANOVA) while all other variables were compared using the analysis of covariance (ANCOVA).Results: One hundred and nineteen implants were placed into 110 augmented sites. One hundred percent implant survival rate was reported during 24 months follow‐up period. No differences were reported in bleeding on probing at 1 (5.6 vs 9%) and 2 years (13.2 vs 12.1%), probing pocket depth at 1 (3.4 ± 0.95 vs 3.6 ± 1.12 mm) and 2 years (3.8 ± 1.02 vs 4.1 ± 1.46 mm), and marginal bone loss at 1 (0.2 ± 0.52 vs 0.3 ± 0.57 mm) and 2 years (0.6 ± 0.91 vs 0.5 ± 0.87 mm). No statistically significant differences were found in the micro‐CT and histomorphometric analysis in terms of newly formed bone (25.7 ± 11.2% vs 22.3 ± 9.7%), soft tissue (33.0 ± 14.7% vs 36.5 ± 15.7%), remnant allograft (39.3 ± 20.4% vs 41.2 ± 22.7%), and bone mineralization (57.2 ± 10.6% vs 53.8 ± 8.7%). Perforating the cortex of the recipient site had no significant effect on angiogenesis as shown by immunohistochemical analysis of CD34 positive blood vessels (39.21 ± 10.53/mm² vs 34.16 ± 12.67/mm²).Conclusion: Cancellous allogeneic bone block grafts are a clinically acceptable alternative for horizontal bone augmentation. Cortical perforations of the recipient site in the maxilla did not improve angiogenesis nor bone formation within the block graft.

Background A main drawback of bone block graft surgery is the resorption occurring in early stages of healing. To our knowledge, there are no studies comparing outcomes of freeze-dried bone allograft (FDBA) blocks with different architecture. Purpose The aim of this work was to investigate different factors that can affect graft resorption and to compare the resorption rates of two different types of allogeneic blocks, corticocancellous and cancellous. Materials and Methods A randomized clinical trial was designed. Twenty-eight patients referred for onlay bone augmentation prior to implant placement were included in the study. Preoperative computerized tomography (CT) was taken for all patients. Patients received FDBA blocks of either cancellous or corticocancellous bone obtained from the iliac crest. After a 4-month follow-up, postoperative CT was taken. Then, another surgery was performed, with the purpose to place dental implants. The aforementioned groups were compared for bone resorption and implant outcome using analysis of covariance (ANCOVA) and repeated ANOVA measures, respectively. Demographic data, trabecular bone density, and graft sites were also analyzed. Results A total of 93 implants were placed in the augmented bone sites over 28 patients. A 100% survival rate was achieved during a mean follow-up period of 24 months in both groups. Higher bone resorption rate was found with cancellous bone grafts (29.2% +/- 2.6) compared with corticocancellous grafts (19.3% +/- 2.3). Moreover, higher resorption rates in patients with lower bone density (185 Hounsfield Units) (16.8% +/- 2.1) and nonsmokers (22.1% +/- 2.3), respectively. Conclusion Within the limitations of this study, these findings indicate that both corticocancellous and cancellous FDBA grafts constitute a clinical acceptable alternative for bone reconstruction, although cancellous grafts present higher resorption rates. Moreover, host factors such as patient's low bone density and smoking habits may also increase graft resorption rates.