Hamoun Sabri

A Commentary on: Wei H, Shu Z, Tian M, Ge Y, Li D . The Accuracy of Autonomous Robotic Surgery vs. Dynamic Navigation in Implant Placement: An Open-Label, Double-Arm, Randomized Controlled Clinical Trial. Clin Oral Implants Res. 2025;36:1486 –97 Design: Double-arm, randomized controlled clinical trial comparing the accuracy and early clinical outcomes of autonomous robotic surgery and dynamic navigation for single-tooth implant placement. Both systems used the same optical tracking technology, allowing a more standardized comparison between the two computer-assisted surgical approaches. Case selection: Forty healthy adult patients requiring single implant-supported restoration were included and randomly allocated to either the autonomous robotic surgery group or the dynamic navigation group. Eligible patients presented with adequate soft tissue dimensions, sufficient bone volume, good oral hygiene, and no limitation in mouth opening. Patients with systemic contraindications to implant surgery, conditions or treatments affecting osseointegration, pregnancy or nursing status, recent head and neck radiotherapy, or inability to comply with follow-up were excluded. Data analysis: Implant placement accuracy was assessed by superimposing preoperative and postoperative CBCT scans. The primary outcomes were coronal, apical, and angular deviations between planned and actual implant positions. Secondary outcomes included surgical time, postoperative pain, edema, complications, and early implant success. Between-group comparisons were performed using parametric or non-parametric tests according to data distribution, with additional regression analysis to adjust for baseline variables. Results: Autonomous robotic surgery showed significantly lower angular deviation than dynamic navigation. No statistically significant differences were observed for coronal or apical deviations. Robotic procedures required significantly longer surgical time than dynamic navigation. Postoperative pain, edema, complications, and early implant success were comparable between groups, with all implants meeting success criteria after 3 months of healing. Conclusions: Autonomous robotic surgery may provide superior angular accuracy compared with dynamic navigation when both systems use the same optical tracking technology. However, this advantage was not accompanied by significant improvements in linear accuracy or early clinical outcomes, and robotic surgery required longer operative time. These findings support the potential of autonomous robotic systems for precise implant placement, while emphasizing the need for larger clinical trials, longer follow-up, and evaluation in more complex scenarios before broad clinical superiority can be established.

Background: Regenerative therapies have become central to periodontics and implant dentistry and are becoming more widely applied to reconstruct supporting bone and associated soft tissues. With increased recognition of the benefits of using biomimetic materials as scaffolds in contemporary regenerative technologies, the field is seeking to develop and optimize predictable, personalized regenerative strategies for hard and soft tissue reconstruction. This review aims to: (1) evaluate the current evidence on these approaches in the context of hard and soft tissue deficiencies around teeth and implants, (2) assess the clinical utility of these approaches, and (3) propose a framework for integrating these regenerative technologies into daily clinical practice. Methods: Applicable research on the treatment of hard and /or soft tissue deficiencies around teeth and dental implants were conducted. For soft tissue regeneration, data from eligible randomized clinical trials (RCTs) reporting the outcomes of gingival (for teeth, as gingival thickness [GT]) and mucosal thickness (implants, MT) with a bilaminar approach were analyzed using a mixed models network meta‐analysis. A meta‐analysis could not be performed to evaluate personalized, emerging technologies for bone regeneration given the lack of comparable clinical studies and as such, an alternative evaluative approach was undertaken and involved a qualitative assessment of the relevant literature highlighting innovations in these emerging modalities. Results: A total of 78 RCTs were included for a quantitative analysis on soft tissue regeneration. Fifty‐four reported the outcomes of GT with a bilaminar approach (a total of 2952 teeth), and 24 assessed MT around implants (851 implants). The analysis of GT for natural dentition showed that bilaminar approaches with any of the explored soft tissue grafts (connective tissue graft (CTG), human acellular dermal matrix (hADM), first generation collagen matrix (CMX), “volume stable” collagen matrix (VCMX) yield a statistically significant increase in GT (compared with untreated sites), with the highest estimate for CTG, followed by VCMX, hADM, pADM, and CMX. Similarly, the analysis of MT around implants also showed a significant increase for all the investigated treatment groups, compared with untreated sites. No other significant differences were noted among the other treatment groups of (VCMX, hADM, and pADM). For the qualitative assessment of emerging technologies for bone regeneration, early investigational studies have been conducted evaluating the use of computer aided personalized scaffold design and manufacturing, stem cell transplantation, stem cell secretome delivery, and artificial intelligence. To date, there are limited controlled studies evaluating these approaches but the results of studies which have been conducted demonstrate safety, efficacy, and favorable patient‐reported outcomes. Clinical translation of these emerging, personalized technologies for hard tissue regeneration will largely depend upon feasibility and cost effectiveness. Conclusions: For the treatment of dento‐alveolar deficiencies within the hard or soft tissue structures around teeth and implants, we found that autogenous soft tissue grafts as well as soft tissue grafting substitutes are generally effective to yield a significant increase in the soft tissue thickness of the treated sites. In the regeneration of hard tissue, emerging, personalized strategies have demonstrated promising early outcomes, yet additional longitudinal, controlled studies are required before these modalities can be considered for widespread clinical adoption. Plain language summary: Dentists and researchers are looking to find new ways to help the gums and bone around teeth and dental implants heal and grow back. In this review, we looked at 78 studies that tested different methods for improving gum tissue thickness as well as rebuilding the bone that supports teeth and implants. We found that using a patient's own gum tissue is still the most effective way to thicken and strengthen the gums. However, newer materials made from collagen or donated tissue can work almost as well and are easier for patients because they do not require tissue to be taken from the mouth. Around dental implants, all of these options helped increase gum tissue thickness, which may lower the risk of future disease and improve the look and long‐term success of treatment. For rebuilding bone, early research on stem cells, 3D‐printed materials, and products that help the body to heal on its own looks very promising, but larger studies are needed to confirm the results. Overall, this research shows that regenerative dentistry is moving toward more comfortable, less invasive, and more personalized treatments that can improve healing, appearance, and long‐term stability.

Background: Engineered scaffolds hold promise for personalizing surgical therapy and are being increasingly applied in clinical practice. Therefore, a comprehensive synthesis of existing data on ridge augmentation is warranted. Methods: A systematic review and meta‐analysis were conducted following PRISMA guidelines (PROSPERO: CRD42024611887). Four databases (MEDLINE, EMBASE, Cochrane Central, Scopus) and the grey literature were searched. Eligible studies included randomized clinical trials and prospective case series. The primary outcomes were horizontal, vertical, and volumetric bone gains. A meta‐analysis was performed to obtain pooled estimates for vertical bone gain (mm), horizontal bone gain (mm), volumetric bone gain (mm ³ ), and early and late complication rates (%). The certainty of evidence was evaluated using the GRADE approach. Results: Thirteen studies ( n = 241 patients, mean age 47.1 years) and 202 defects (12.4% horizontal, 27.2% vertical, and 60.4% combined) were included. Risk of bias was significant, with three of six randomized clinical trials showing low risk and all non‐randomized studies showing moderate‐to‐serious risk of bias. Nine studies used customized computer‐aided design and manufacturing (CAD/CAM) titanium mesh devices, while the remaining studies used materials like polyether ether‐ketone scaffolds (two studies), three‐dimensional hydroxyapatite blocks (one study), or customized allogeneic bone blocks (one study). Pooled horizontal bone gain was 4.96 mm (95% CI: 4.48–5.44 mm), vertical gain 5.64 mm (95% CI: 5.26–6.02 mm), and volumetric gain 1307 mm ³ (95% CI: 1000–1700 mm ³ ) over a 6 to 9‐month follow‐up period. The overall complication rate, irrespective of timing and resorbable membrane use, was 21.7% [16.4–27.0]. The pooled early and late (<4 or ≥4 weeks) complication rates were 24.3% and 16.5%, respectively. Based on six studies, the early complications were 25.6% without versus 21.4% with resorbable membranes. Meta‐regression identified smoking status, surgical experience of the operator, and the defect type as significant factors influencing bone gain. Conclusions: Engineered scaffolds show promise in managing complex alveolar defects, achieving significant bone gains in all dimensions. However, a high complication rate makes the outcomes unpredictable and limits their use to selective cases. Plain language summary: This review investigated the usefulness of patient‐specific scaffolds in improving our ability to rebuild lost jawbone. Researchers included 13 studies using different scaffolds, such as custom‐made titanium meshes, polyether ether‐ketone scaffolds, three‐dimensionally printed bone‐like blocks, or customized donated bone blocks. On average, patients gained about 5 mm of new bone in both width and height, and a significant increase in overall bone volume after 6 to 9 months. However, complications were common, affecting about one in five patients. Using a resorbable membrane helped reduce early problems. Key factors such as the surgeon's experience, the type of bone defect (combined horizontal and vertical defects vs. purely vertical), and whether the patient smoked had a strong impact on both bone gain and complications. These findings demonstrated that engineered scaffolds can successfully rebuild missing jawbone, but because complications are relatively frequent, they should be used only in carefully selected patients by highly experienced surgeons.

Aim: To evaluate outcome measures in clinical studies on alveolar ridge augmentation (ARA) and map them to the Implant Dentistry Core Outcome Set and Measurement (ID‐COSM) framework and the Food and Drug Administration (FDA) terminology. Methods: A systematic search was carried out across four databases through June 2025. Randomised and non‐randomised clinical trials, prospective clinical studies, cohort studies and pilot clinical studies evaluating ARA performed before or simultaneously with implant placement were included. Extracted outcomes were mapped to ID‐COSM domains, subdomains and specific outcomes, and all were classified into FDA‐style outcome types. Risk of bias (RoB) was assessed using Domain 4 of RoB 2.0/ROBINS‐I, and associations between RoB and completeness of outcome reporting were analysed with Spearman's rank correlation and Kruskal–Wallis tests (α = 0.05). Results: Four hundred and twenty‐nine studies were included, predominantly randomised controlled trials (56.4%). Less than half of the studies fulfilled the mandatory ID‐COSM domains (47.6%), and none reported all nine subdomains. For mandatory outcomes, surgical complications (52.7%) and implant placement feasibility (48.3%) were more frequently reported than bone dimensional changes (33.8%), and peri‐implant bone stability was reported in only 11.0% of studies. For FDA categorisation, clinician‐reported outcomes (86.3%) and biomarkers (87.7%) predominated, while patient‐reported outcomes were reported in 31.9% of studies. Observer‐reported or performance outcomes were completely absent. Lower risk of bias was associated with more complete reporting of outcomes across domains, subdomains and specific outcomes ( p = 0.032, 0.017 and 0.009, respectively). Conclusion: Outcome reporting for ARA trials is highly heterogeneous and poorly aligned with the standardised minimum outcomes recommended by ID‐COSM and FDA categorisation.

Background: Peri‐implant soft tissue dehiscence deficiencies (PSTDs) are common esthetic complications in the anterior maxilla, yet the parameters that protect the peri‐implant soft tissue margin (STM) over time remain unclear. Previous studies have identified several risk indicators, but longitudinal thresholds capable of predicting stable STM have not been established. This study aimed to evaluate 5‐year STM behavior and identify clinically meaningful predictors of long‐term stability. Methods: This prospective longitudinal study included patients with anterior single implants with or without PSTD. Clinical and ultrasonographic examinations were performed at baseline ( T ₀ ) and 5 years ( T ₅ ), and included STM stability (primary outcome), PSTD incidence, mucosal thickness at 1 and 3 mm from the STM (MT1 and MT3), keratinized mucosa (KM) width, buccal bone thickness (BBT), and buccal bone dehiscence (BBD). Logistic regression, receiver operating characteristic curve (ROC) analysis, stratified subgroup analysis, and correlation testing were performed. Results: A total of 133 implants in 124 patients were evaluated. PSTD prevalence increased from 51.1% at T ₀ to 74.4% at T ₅ , (incidence 47.7%). MT3 was the dominant predictor of STM stability (AUC = 0.998). The optimal statistical threshold was 2.01 mm, while a clinical stability threshold of 2.23 mm yielded 100% stability in this dataset. Other predictors (MT1, KM, BBT) were significant only in univariate models. In implants without PSTD at T ₀ , MT3 alone predicted stability, whereas in implants with PSTD at T ₀ , multiple variables influenced STM outcomes. Conclusions: MT3 is the critical determinant of 5‐year STM stability at anterior implants. In our cohort, achieving a MT3 ≥ 2.23 mm was found to be associated with a long‐term stable peri‐implant soft tissue.

Aim: To provide updated and comprehensive estimates of the changes in prevalence of periodontitis in Africa, based on epidemiological data up to 2025. Methods: A systematic literature search was conducted through MEDLINE, Embase, Scopus, Web of Science and Google Scholar. Meta‐analyses were performed to estimate the prevalence of periodontitis across population subgroups and diagnostic criteria. Results: Twenty‐three studies met the inclusion criteria. Among children (< 10 years), prevalence was 1.9% (95% CI: 0.9%–3.9%; I ² = 77.7%) and among adolescents (10–19 years), it was 11.2% (95% CI: 4.7%–24.3%; I ² = 98.1%). In young adults (20–25 years), prevalence was 12.8% (95% CI: 2.8%–42.8%; I ² = 98.9%), in adults (25–49 years), 20.0% (95% CI: 11.9%–31.7%; I ² = 99.1%) and in older adults (≥ 50 years) 23.1% (95% CI: 12.2%–39.3%). Substantial variation was observed across diagnostic definitions and thresholds. Geographic region and urban versus rural origin emerged as significant modifiers of prevalence. Conclusion: Epidemiological studies on periodontitis in Africa often overrepresent younger populations and rely on non‐confident diagnostic criteria, likely underestimating true prevalence. Nevertheless, updated estimates suggest a concerning burden among younger age groups. More comprehensive research is needed to enhance the accuracy of prevalence estimates of periodontitis in Africa.

Aims: To quantify immediate graft displacement following tension‐free flap closure in non‐contained alveolar ridge defects regenerated using three membrane fixation strategies in an ex vivo human model. Methods: Eighteen sites from six fresh cadaveric heads with non‐contained defects underwent horizontal guided bone regeneration using deproteinized bovine bone mineral and a collagen membrane stabilized by no fixation (NF), periosteal sutures (PS), or titanium fixation pins (FP). Techniques were applied sequentially. Cone‐beam CT scans were obtained at baseline, post‐grafting, and after passive closure. Linear ridge width was measured at 12 standardized positions, and graft volumes were segmented from STL reconstructions. Mixed‐effects multilevel linear regression assessed width changes, while Friedman and paired Wilcoxon tests evaluated volumetric outcomes, with Tukey‐adjusted contrasts for intergroup comparisons. Results: Fixation pins virtually eliminated graft displacement (−6.7 ± 87 mm ³ ) and achieved the highest stability (81.2% ± 8.2%), significantly outperforming periosteal sutures (−96 ± 165 mm ³ ; 70.1% ± 4.5%) and no fixation (−247 ± 150 mm ³ ; 44.4% ± 17.9%) (loss p = 0.030; stability p = 0.002). Ridge collapse was greatest with no fixation (−1.37 ± 0.85 mm) compared with PS (−0.40 ± 0.62 mm) and FP (−0.28 ± 0.61 mm). After adjustment, PS and FP reduced collapse by 0.96 mm ( p = 0.012) and 1.11 mm ( p = 0.004), respectively. Conclusion: Even after passive flap release and tension‐free closure, membrane fixation, particularly with titanium pins, provides superior resistance to graft displacement in non‐contained defects, while unfixed membranes allow substantial graft loss and are therefore not recommended in non‐contained defects.

Objectives: To quantify long‐term (≥ 5 years) implant survival after lateral sinus floor elevation (LSFE) and to identify clinical predictors of long‐term survival using conventional and machine‐learning meta‐analytic techniques. Methods: A systematic search was conducted through MEDLINE, Embase and Scopus. Randomized trials, prospective or retrospective studies with ≥ 10 patients and ≥ 5‐year follow‐up were eligible. Risk of bias was assessed with RoB‐2 (RCTs) and the Newcastle–Ottawa Scale (observational studies); certainty of evidence was graded with GRADE approach. A multilevel random‐effects meta‐analysis (logit‐transformed proportions) estimated pooled survival while accounting for clustering of multiple implants per patient. Moderator effects were explored by mixed‐effects meta‐regression. A MetaForest machine‐learning model examined non‐linear interactions among predictive factors. Results: Thirty‐two studies (48 cohorts) involving 7,902 implants and ≈ 2,800 patients met the criteria (3 RCTs, 7 prospective non‐randomized, and 22 retrospective studies; follow‐up 5–13 years). Pooled long‐term survival was 95.8 % (95 % CI: 94.5–96.8 %); Heterogeneity was substantial (I² = 82.8 %) but fell to 53.2 % in MetaForest residuals. Meta‐regression identified lower survival with Graftless procedures versus allografts(β = 1.11, p = 0.016), autografts(β =2.40, p = 0.005), Xenografts(β =1.53, p = 0.04), Xenografts+Allografts(β =1.55, p = 0.04) and Xenografts+Autografts(β =1.82, p = 0.03) with no significant difference versus Alloplasts. Residual bone height (RBH) < 4 mm (β = –0.53, p = 0.039) as well as smoking prevalence (1.96 % per 10 % increase, p = 0.009) reduced survival. MetaForest ranked smoking, age, RBH, follow‐up duration and membrane use as the principal predictors; barrier membranes mitigated the negative effect in smokers and in low‐RBH sites. Time‐to‐failure analysis of 205 failed implants showed 59 % of losses within the first year and 96 % by year 5. Overall certainty of evidence was low. Conclusions: Implants placed after LSFE exhibit high 5–13‐year survival (96 %). Use of bone graft materials and their mixtures yield more favorable outcomes compared to Graftless protocol, whereas RBH < 4 mm and smoking significantly impair implant survival. Barrier‐membrane coverage is advisable for smokers and short‐RBH sites. Despite the long‐term nature of this review (≥5 years of follow‐up), most failures occur within the first three years of function, underscoring the need for intensified monitoring during this early phase.

Background: Periodontitis, a chronic inflammatory disease, is linked to systemic conditions such as cardiovascular and kidney disease. Serum α‐Klotho, an anti‐aging protein with anti‐inflammatory properties, has been associated with systemic diseases, but its role in periodontitis is unclear. This study evaluated the relationship between serum α‐Klotho levels and periodontitis severity while accounting for confounders. Methods: In this cross‐sectional study, data from 961 participants in the National Health and Nutrition Examination Survey (NHANES) database were analyzed. Periodontitis was classified into stages (I–IV) and grades (A–C) using the ACES (Application of the 2018 periodontal status Classification to Epidemiological Survey data) guidelines. Serum α‐Klotho levels were measured via enzyme‐linked immunosorbent assay (ELISA). Ordinal logistic regression assessed associations between α‐Klotho levels and periodontitis, adjusting for confounders such as age, smoking, comorbidities, and oral hygiene. The number of lost teeth was analyzed as a secondary outcome. Results: In both adjusted and unadjusted regression models, no significant association was found between α‐Klotho levels and periodontitis. Particularly, adjusted models revealed no significant association between α‐Klotho levels and periodontitis stage (OR = 1.0001, p = 0.547, 95% CI: 0.9997–1.0006) or grade (OR = 0.9996, p = 0.144, 95% CI: 0.9991–1.0001). Age, smoking, and comorbidities significantly predicted severity. Despite a weak negative correlation between α‐Klotho and tooth loss ( r = –0.07, p = 0.023), this association was no longer significant after adjustment. Conclusion: No significant association was found between serum α‐Klotho levels and periodontitis severity. Age, smoking, and comorbidities were key predictors, highlighting the multifactorial nature of periodontitis. Further longitudinal and mechanistic studies are needed to clarify whether α‐Klotho has a value as a biomarker of periodontal inflammation or disease progression.

Objectives: To evaluate the current patient‐reported outcome measures (PROMs) and clinician‐reported outcomes (ClinROs) following sinus floor elevation (SFE) for implant‐based rehabilitation in the fully edentulous maxilla. Methods: A systematic search was conducted across PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials, covering publications from 2013 to 2024. We included prospective studies assessing PROMs and ClinROs. The COSMIN checklist was used to evaluate PROMs quality. Results: Eighteen studies met the inclusion criteria, comprising randomized controlled trials, controlled clinical trials, and case series. Fourteen distinct ClinROs were identified, predominantly implant survival (61.11%) and peri‐implant bone‐level changes (50%). Conversely, ClinROs directly associated with SFE procedures—such as maxillary sinus bone height/volume changes (27.7%) and sinus membrane perforation (10.5%)—were underreported. Prosthetic outcomes were addressed in 11.11% of studies, and PROMs in 50% of the studies. Seven different PROMs were identified, with a focus on masticatory function and overall satisfaction. COSMIN analysis revealed that OHIP‐49 and the denture satisfaction questionnaire (DSQ) were the most robust PROMs, scoring “very good” across multiple domains. Patients' overall satisfaction and complaint‐based PROMs lacked validation. Conclusions: Current reporting of ClinROs emphasizes implant‐related metrics, while outcomes directly related to SFE are inconsistently reported. Validated PROMs are needed to ensure consistency and reliability in outcome assessment. OHIP‐49 and DSQ demonstrated strong psychometric properties and are recommended as core PROMs. Future studies should incorporate early and long‐term PROMs and adopt a standardized approach to outcome reporting.