Purpose: To evaluate the influence of denture cleansers on the surface roughness, Candida albicans adhesion, and biofilm formation on denture base acrylic resins.

Study selection: Electronic databases and gray literature were searched using an individual search strategy. In vitro studies that evaluated the effects of immersion in denture cleansers on the surface roughness (µm) and antimicrobial activity (CFU/mL) on samples of heat-polymerized denture base acrylic resins were included.

Results: After screening, 17 studies were included, and a qualitative synthesis was performed. After assessing the risk of bias, only nine studies were included in the meta-analysis. The meta-analysis results showed that the evaluated solutions (0.5% sodium hypochlorite, 1% sodium hypochlorite, alkaline peroxide, and natural substances) did not influence the roughness of the acrylic resin. However, in the qualitative analysis, it was not possible to confirm an association between roughness and C. albicans adhesion and biofilm formation on the acrylic resin samples.

Conclusion: Denture cleansers did not affect the surface roughness of denture base acrylic resins.

Purpose: Implant-supported fixed complete dentures (IFCD) experience failures and complications related to biological and technical risk factors. This study investigated the effect of biomechanical variables of IFCD on 1-year peri-implant bone loss at the buccal, palatal/lingual, mesial, and distal implant sides. A new method was used to measure the geometric biomechanical variables of IFCD using cone beam computed tomography (CBCT).

Methods: The study sample consisted of 246 external hexagon implants supporting 48 hybrid IFCD in 44 patients. CBCT images obtained immediately (T0) and 1 year (T1) after prosthesis installation were used to measure the support polygon area, clinical crown/implant (C/I) ratio (vertical lever), anteroposterior power and resistance arms, anterior and posterior cantilevers (horizontal levers), and peri-implant bone remodeling (T1-T0). Data were analyzed using multilevel multivariable models.

Results: The average total bone loss in the mandible and maxilla were 0.88 mm, with a loss of 0.62 mm in the mandible and 1.08 mm in the maxilla. The C/I ratio had a significant effect on bone loss on the mesial, distal, and palatal/lingual sides (P <.05). The anterior cantilever had a protective effect on the lingual side of the anterior implant. No effect on bone loss was found for the support polygon area, posterior cantilever, resistance arm, or power arm (P >.05).

Conclusions: The results suggest that the C/I ratio and anterior cantilever in IFCD affect peri-implant bone loss according to the implant side and position in the arch.

Purpose Existing options for attaching facial and somato prostheses, such as skin adhesives, are problematic because of microbial colonization and skin irritation. This study aims to evaluate the suitability of adhesive polyurethane gel sheets containing cetylpyridinium chloride (CPC)-montmorillonite (Mont) for prosthesis fastening.

Methods Adhesive gel sheets were fabricated as mixtures of base resin (99.6 wt% polyol) and hardening agent at a ratio of 3:1 with 0 (control), 2, 5, 10, or 15 wt% CPC-Mont. The controlled release of CPC, antimicrobial activity, in vitro skin irritation, and adhesive force against silicone and human skin at different blending ratios were determined. Statistical analyses of the data were performed using one-way analysis of variance (ANOVA), analysis of covariance (ANCOVA), Tukey’s test, or single regression analysis, as appropriate.

Results The amount of CPC released increased with the CPC-Mont blending ratio and was linearly proportional to the surface occupation area ratio of CPC-Mont. The samples with >5 wt% CPC-Mont exhibited antimicrobial activity against Staphylococcus aureus at an exposure time of 0 d, and samples with >2 wt% CPC-Mont exhibited antimicrobial activity against Candida albicans at an exposure time of 1 d. All samples were classified as non-irritant based on an in vitro skin irritation test. The adhesive force on the silicone material and human skin decreased with increasing CPC-Mont blending ratio.

Conclusions Samples with 5 wt% CPC-Mont are potential candidates as antimicrobial adhesive polyurethane gel sheets for fastening facial and somato prostheses.

Purpose: To investigate the effect of prosthodontic treatment on the ingestible food profile in adult Japanese outpatients, and to identify the related risk factors that can deteriorate the profile.

Methods: The participants were 277 outpatients who visited university-based specialty clinics in Japan for prosthodontic treatment. The demographic data, number of present teeth assessed via intraoral examination, and oral health-related quality of life assessed by the total Oral Health Impact Profile (OHIP-J54) scores of all participants were recorded before treatment. Ingestible food profile score (IFS) was recorded using a validated food intake questionnaire. Eligible participants who answered the questionnaire before and after treatment were categorized into five groups based on the prosthodontic treatments they received (i.e., crowns, bridges, removable partial dentures, removable complete dentures, and removable complete and partial dentures).

Results: Multivariate analysis of covariance revealed a statistically significant main effect of prosthodontic intervention (time course: before and after treatment) on mean IFS (P=0.035, F=4.526), even after adjusting for covariates (age, number of present teeth, and treatment modality). Multiple linear regression analysis revealed that the low number of present teeth (r=0.427, P<0.001) and a high OHIP-J54 total score (r=-0.519, P<0.001) of the patients at the baseline were significantly associated with their baseline IFSs, even after adjusting for confounding variables.

Conclusions: The findings of this multicenter follow-up study indicate the importance of prosthodontic rehabilitation in improving patients’ ingestible food profiles.

Purpose We aimed to assess removable partial denture occlusal rests composed of polyether-ether-ketone (PEEK) and zirconia, using finite element analysis.

Methods Three-dimensional PEEK and zirconia rest models, including the occlusal rest (1.5 mm thickness at the basal portion, 3.0 mm width) and minor connector (1.5 mm thickness, 6.0 mm height), and rest seat models with mechanical properties of enamel were constructed. The radius of transitional curvature between the rest and minor connector was 0.1-0.5 mm. The rest and rest seat model interfaces were set as frictional contacts (μ = 0.1), and the base of the rest seat model was restrained in all the directions. A 100 N downward load was applied perpendicular to the bottom surface of the minor connector. The maximum value of the first principal stress (Max-S1) was compared to the flexural and fatigue strengths of each material. Occlusal rests with 1.0-2.0 mm thickness, 2.0-3.5 mm width, and 0.5 mm radius of transitional curvature were analyzed.

Results Max-S1 was observed at the transitional part and decreased with increasing radius of the transitional curvature, rest width, and thickness. PEEK rests with at least 1.5 mm thicknesses and 3.0 mm widths showed lower Max-S1 than the flexural strength. Max-S1 of all PEEK rests exceeded the PEEK fatigue strength, whereas Max-S1 of the zirconia rests was lower than the zirconia fatigue strength.

Conclusions Zirconia occlusal rests with conventional metal rest designs have sufficient fatigue strength. PEEK occlusal rests have insufficient fatigue strength and may not withstand repeated mastication.

Purpose This retrospective study aimed to evaluate the survival and success rates of ceramic partial laminate veneers. Scanning electron microscopy was used to evaluate fractures and marginal defects.

Methods In total, 31 patients received 79 partial laminate veneers on the maxillary anterior teeth. After adhesive luting, restorations were evaluated by calibrated clinicians for up to eight years using modified United States Public Health Service (USPHS) criteria. In addition, epoxy resin replicas were fabricated from silicone impressions and analyzed using scanning electron microscopy. Survival analyses were performed using the Kaplan-Meier and log-rank tests (α = 0.05). Success was analyzed in percentages by comparing the baseline and last follow-up.

Results The cumulative survival rates were 100% after 1 year; 95.9% (SE 2.8%) after 5 years; and 61.4% (SE 25.3%) after 8 years. No significant differences (P > 0.05) were observed between functional and non-functional restorations. Changes in the USPHS criteria evaluation were only observed for adaptation: 12.5% (SE 4.7%), marginal discoloration: 4.2% (SE 3.0%), color match: 4.2% (SE 3.0%), and fractures: 16.7% (SE 5.3%). Scanning electron microscopy evaluations revealed undetected initial cracks and deficiencies in the restorations.

Conclusions Partial laminate veneers displayed good survival rates during the long-term follow-up. The main problems observed were related to the quality of the margins, color mismatch, and restoration integrity. However, in most cases, restoration replacement was not required.

Purpose: To determine the effect of a dynamic impression lining material (DIL) on the retention and stability of mandibular complete dentures (LCD), masticatory performance, and the oral health-related quality of life (OHRQoL) of the patients wearing complete denture (CD) compared with those wearing a denture with conventional hard denture liner (HL).

Methods: Twenty-five patients who wore CD with an ill-fitting LCD were randomly assigned to two groups: LCD relined with DIL (Dynamic impression lining material) or HL (Tokuyama® Rebase II (fast)). Three objective measures (denture retention, stability, and masticatory performance) were measured. The OHRQoL was also measured using the Thai version of oral impacts on daily performance. Outcomes were measured at six time points: baseline, 3 days, 1 week, 1 month, 3 months, and 6 months after relining. Outcome changes were analyzed using a generalized estimating equation, and all models were adjusted for age, mandibular ridge form, and CD age at a 5% significance level.

Results: After LCD relining, the frequency and severity of adverse oral impacts significantly decreased. In the DIL group, denture pain occurred on and off over six months, and an ill-fitting denture impacted at one month. In the HL group, denture pain continuously decreased over time. At 3 months, changes in the clinical properties of DIL were observed, including perceived odor. The material also peel-off from the denture base, and plaque accumulation was observed. In contrast, the HL properties remained stable for over 6 months.

Conclusions: Although DIL improves denture retention and stability, masticatory performance, and the OHRQoL of the patients who wear CD, oral adverse effects were not eliminated. The clinical properties of DILs changed at 3 months, while the HL remained relatively stable for up to 6 months.

(The clinical trial registration number: Thai Clinical Trials Registry (TCTR) number TCTR20210625005.)

Purpose: Handheld-type scanners are widely used in clinical practice. This study examined the accuracy of handheld-type scanners using plaster statues to assess their performance in facial recognition.

Methods: Twelve 4-mm zirconia balls as measuring points were attached to the facial portions of three types of plaster statue. Six digital facial images of each plaster statue were obtained using one of the following five handheld-type scanners: Artec Eva, Artec Spider, Bellus 3D FaceApp, SNAP, and Vectra H1. Four-millimeter spherical objects were manually placed at the measurement points on the scanned data generated using computer-aided design software and coordinate positions were measured using a contact-type high-resolution three-dimensional measurement device. Consequently, the discrepancy between the distance measured using the contact-type device and that measured using the handheld-type scanner was calculated. The scanning time, processing time, and deviation of the distance between the measuring points were analyzed using two-way analysis of variance and t-test with Bonferroni correction.

Results: The scanning and processing times ranged from 15.2 to 42.2 s and 20.7 to 234.2 s, respectively. Overall, 97% of all measured distances by Spider were within ±1.00% deviation; 79%, Vectra; 73%, Eva; 70%, Bellus; and 42%, SNAP.

Conclusions: The performance of handheld-type scanners using plaster statues varied among the different scanners. The scanning time of Eva and the processing time of Bellus were significantly shorter than those of other scanners. Furthermore, Spider exhibited the best accuracy, followed by Eva, Vectra, Bellus, and SNAP.

Purpose: This study aimed to investigate the relationship between tongue factors (tongue strength and tongue volume), systemic factors (grip strength and walking speed), and the extracellular water/total body water ratio.

Methods: This cross-sectional study included community-dwelling adults. Body water composition and skeletal muscle mass index were measured using bioelectrical impedance analysis. Moreover, tongue grip strength, tongue volume, occlusal support condition (Eichner classification), and walking speed were measured. Multiple linear regression analysis was performed to investigate the relationship between the tongue and systemic factors as dependent variables and body water composition.

Results: We included 171 community-dwelling adults (62 men and 109 women) aged 70.0 years (interquartile range: 8). Tongue strength (r=-0.22, P=0.004) and grip strength (r=-0.39, P<0.001) were correlated with the extracellular water/total body water ratio. In multiple linear regression analysis, tongue strength was associated with the extracellular water/total body water ratio (β=-0.20, P=0.034), and grip strength was associated with the extracellular water/total body water ratio (β=-0.12, P=0.047), sex, body mass index, skeletal muscle mass index, and occlusal support condition.

Conclusions: A higher extracellular water/total body water ratio indicates lower tongue and grip strength. Dentists and dental hygienists should be aware of systemic factors present in patients with lower tongue and grip strength. These findings may lead to further medical investigations and diagnosis of other systemic diseases.

Purpose: To assess the influence of several factors on the survival of tooth-supported fixed partial dentures (FPDs) with vital and non-vital abutments.

Methods: The present retrospective cohort study was based on the records of patients treated with 3-to-7-unit tooth-supported FPDs with a minimum follow-up time of 6 months after prosthesis delivery. Cumulative survival rate (CSR) was calculated over the maximum follow-up period. Cox regression models were used to evaluate the association between the clinical covariates and prosthesis failure.

Results: A total of 331 FPDs in 229 patients were included. The CSRs were 90.1% and 77.6% after 5 and 10 years and 67.9% and 52.1% after 15 and 20 years, respectively. Tooth-supported FPD failure was more prevalent within the first years of prosthesis delivery. Loss of one or more abutment teeth and loss of prosthesis retention were the main reasons for failure. Smoking and type of prosthesis material significantly influenced the survival of FPDs. Abutment vitality, position of the non-vital abutment, or prosthesis length did not show any significant influence on the occurrence of prosthesis failure.

Conclusions: Smoking and the type of prosthesis material are suggested to contribute to an increased rate of FPD failure irrespective of abutment vitality.

Purpose This study investigated the usefulness of a newly proposed intraoral scanning method, using markers that can be used directly in the oral cavity, in order to improve the accuracy of impression taking of the residual ridge for fabrication of removable partial dentures.

Methods An intraoral scanner was used to scan a dental model of a partially edentulous mandibular arch (Kennedy Class I). As markers, pieces of dried pasta were used. The scanning operation was performed under three conditions. In Condition 1, scanning was performed on the remaining teeth and the residual ridge without markers. In Condition 2, scanning of the remaining teeth and residual ridge was performed with markers. In Condition 3, the markers were removed from the model used in Condition 2, and the residual ridge was scanned again. The scanning data of each condition was superimposed on the control data, and the shape error was calculated and compared among the conditions.

Results There was a significant difference in trueness of the residual ridge before and after marker application. The application of markers improved the trueness, while maintaining precision. Re-scanning after removing the marker did not affect trueness between before and after re-scanning and the re-scanned region showed shape continuity with the surrounding region.

Conclusions The present method using markers that can be used in the oral cavity was effective in improving the accuracy of impression taking at the residual ridge.

Purpose: This study aimed to assess patients’ expected burdens before treatment and their perceived burdens after the surgical and prosthodontic procedures of mandibular overdenture treatment and to evaluate factors influencing patients’ perceptions.

Methods: Data were collected from 47 participants enrolled in a randomized clinical trial comparing mandibular overdentures retained by one or two implants. A 20-item questionnaire measured on a four-point Likert scale covering the surgical and prosthetic treatment procedures was used to assess the patients’ perception of the procedural burdens before (expected burdens) and immediately after (experienced burdens) each procedure. Operators’ perceptions of intercurrences associated with the procedures were also assessed as an independent variable.

Results: Low levels of perceived burdens were observed both before and after treatment. The mean overall scores of 1.65 ± 0.46 and 1.53 ± 0.33 for expected and experienced burdens, respectively, indicated that most items ranged between “not burdensome at all” and “somewhat burdensome.” Significant differences between expected and experienced burdens were found for eight items (P < 0.001). Considering the treatment stages, expected burdens scored higher in the pre-surgical, surgical, and prosthetic stages and lower in the post-surgical phase than experienced burdens. Overall, the experienced burdens were significantly affected by the expected burdens (P < 0.001) and operator’s perceived burdens(P = 0.045).

Conclusions: Treatments were associated with low levels of perceived burdens related to surgical and prosthodontic procedures and were highly correlated with the expected burdens before treatment. However, patients tend to overestimate the expected burdens before treatment, especially for surgical procedures.

Purpose Denture adhesives improve the stability of incompatible dentures; however, complete removal of adhesives after use is difficult. Only a few studies have focused on the removal of denture adhesives. Hence, this study aimed to assess the efficacy of surfactants in removing cream denture adhesives from acrylic resin materials.

Methods Solutions of twelve surfactants with various hydrophilic-lipophilic balance (HLB) values were prepared. Two cream denture adhesives, colored for visualization, were spread onto transparent acrylic resin plates. After immersion into surfactant solutions, the effects of the surfactants on residual adhesives were evaluated. We also investigated the effect of denture cleaners (with or without the surfactants) on the removability of adhesives and artificial oily dirt, and their effects on the surface properties of denture materials. The obtained data were analyzed using appropriate statistical methods.

Results Five surfactants [BT-5, BL-4.2, BT-7, BT-9, and Triton X-100 (TX)] with HLB values in the 10.5-13.5 range effectively removed adhesives. Addition of BT-9 and TX (HLB=13.5) to denture cleaners improved the adhesives’ removal. Furthermore, the addition of TX to the cleaners did not interfere with the removal of artificial oily dirt and did not damage the denture materials’ surface.

Conclusions Surfactants with HLB values in the 10.5-13.5 range are suitable for removal of cream denture adhesives from acrylic resin materials. In particular, TX (HLB=13.5) efficiently removes adhesives without damaging denture materials or impairing original detergency.

Purpose: To evaluate the fracture behavior of inlay-retained fixed partial dentures (IRFPDs) made of experimental short fiber-reinforced composite (SFRC) computer-aided design/computer-aided manufacturing (CAD/CAM) block before and after cyclic fatigue aging.

Methods: Five groups (n=20/group) of three-unit posterior IRFPDs were fabricated. The first and second groups were CAD/CAM fabricated from experimental SFRC blocks or lithium-disilicate (IPS e.max CAD, IVOCLAR) materials, the third group comprised a three-dimensional-printed composite (Temp PRINT, GC), and the fourth and fifth groups comprised conventional laboratory flowable composite (Gradia Plus, GC) and commercial flowable SFRC (everX Flow, GC), respectively. All IRFPDs were luted into a metal jig with adhesive dual-cure resin cement (RelyX Ultimate, 3M ESPE). Half the IRFPDs per group (n=10) were subjected to fatigue aging for 10,000 cycles. The remaining half were statically loaded until fracture without fatigue aging. The load was applied vertically between triangular ridges of the buccal and lingual cusps. The fracture mode was visually examined using optical and scanning electron microscopy (SEM). Data were statistically analyzed using a two-way analysis of variance (ANOVA) followed by Tukey’s HSD test.

Results: ANOVA revealed that IRFPDs made of experimental SFRC CAD/CAM had the highest (P<0.05) load-bearing capacity before (2624±463 N) and after (2775±297 N) aging among all groups. Cyclic fatigue aging decreased the load-bearing capacity (P>0.05) of all tested prostheses, except for the experimental SFRC CAD/CAM and conventional laboratory composite IRFPDs (P>0.05). SEM images showed the ability of discontinuous short fibers in the experimental SFRC CAD/CAM composite to redirect and hinder crack propagation.

Conclusions: CAD/CAM-fabricated IRFPDs made of experimental SFRC blocks showed promising performance in clinical testing in terms of fracture behavior.

Purpose: This study aimed to evaluate the influence of subcrestal implant placement depth on bone remodeling using time-dependent finite element analysis (FEA) with a bone-remodeling algorithm over 12 months.

Methods: Seven models of different subcrestal implant placement depths (0, 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mm) were analyzed using FEA to evaluate the biomechanical responses in the bone and implant, including von Mises equivalent stress, strain energy density (SED), and overloading elements. SED was used as a mechanical stimulus to simulate cortical and cancellous bone remodeling over the first 12 months after final prosthesis delivery.

Results: The highest increase in cortical bone density was observed at Depth 1.5, whereas the lowest increase was observed at Depth 3.0. In contrast, the highest increase in bone density was observed at Depth 3.0 in the cancellous bone, whereas the lowest increase was observed at Depth 0. The highest peak von Mises stress in the cortical bone occurred at Depth 2.5 (107.24 MPa), while that in the cancellous bone was at Depth 2.5 (34.55 MPa). Notably, the maximum von Mises stress values in the cancellous bone exceeded the natural limit of the bony material, as indicated by the overloading elements observed at the depths of 2.0, 2.5, and 3.0 mm.

Conclusions: Greater bone density apposition is observed with deeper implant placement. An implant depth of more than 1.5 mm exhibited a higher maximum von Mises stress and greater overloading elements.

Purpose: A novel implant model consisting of meso-scale cactus-inspired spikes and nano-scale bone-inspired trabeculae was recently developed to optimize meso-scale roughness on zirconia. In this model, the meso-spike dimension had a significant impact on osteoblast function. To explore how different nano-textures impact this model, here we examined the effect of different nano-trabecula sizes on osteoblast function while maintaining the same meso-spike conformation.

Methods: Zirconia disks with meso-nano hybrid surfaces were created by laser etching. The meso-spikes were fixed to 40 μm high, whereas the nano-texture was etched as large and small trabeculae of average Feret diameter 237.0 and 134.1 nm, respectively. A polished surface was also prepared. Rat bone marrow-derived and human mesenchymal stromal cell-induced osteoblasts were cultured on these disks.

Results: Hybrid rough surfaces, regardless of nano-trabecula dimension, robustly promoted the osteoblastic differentiation of both rat and human osteoblasts compared to those on polished surfaces. Hybrid surfaces with small nano-trabeculae further enhanced osteoblastic differentiation compared with large nano-trabeculae. However, the difference in osteoblastic differentiation between small and large nano-trabeculae was much smaller than the difference between the polished and hybrid rough surfaces. The nano-trabecula size did not influence osteoblast attachment and proliferation, or protein adsorption. Both hybrid surfaces were hydro-repellent. The atomic percentage of surface carbon was lower on the hybrid surface with small nano-trabeculae.

Conclusions: Small nano-trabeculae promoted osteoblastic differentiation more than large nano-trabeculae when combined with meso-scale spikes. However, the biological impact of different nano-trabeculae was relatively small compared with that of different dimensions of meso-spikes.

Purpose: Manufacturing-related inaccuracies of surgical guides for static computer-aided implant surgery may contribute to the overall potential error in the obtained implant position. Measuring such inaccuracies before surgery may provide quality control assessment and improve the safety and outcomes of guided implant surgery. This technical report demonstrates a workflow to measure the accuracy of a surgical guide (at the intaglio surface and sleeve housing) using a freeware metrology software program.

Methods: The scan of a milled surgical guide was aligned to and compared with its reference computer-aided design model using a freeware metrology software program (GOM Inspect suite; GOM GmbH). The trueness of the internal surface of the surgical guide was measured as an indicator of adaptation to the supporting tissues. Additionally, some features were constructed to extract the plane at the sleeve entrance and sleeve axis and to set a local coordinate system on them. Linear and angular deviations between the planned and obtained sleeve axes were measured using this system. Such measurements, together with additional known data (sleeve offset and the planned implant length), allowed the estimation of linear errors in implant position at both the implant platform and apex by applying common geometric formulas, based on the assumption that all other sources of error in implant position could be effectively controlled during the surgical procedure.

Conclusions: The proposed digital technique is a cost-effective approach for quality control of the inaccuracies of a surgical guide and predicts the related potential error in implant position.

Patients: The patient was a 32-year-old man who underwent amalgam restoration of the mandibular right second molar. An amalgam restoration fracture was diagnosed by intraoral optical coherence tomography (OCT), and pulp exposure was examined during cavity preparation. Subsequently, a definitive ceramic restoration was fabricated, and the marginal fit in the oral cavity was evaluated using the OCT system.

Discussion: The existing OCT system cannot acquire images inside the oral cavity because of the large probe size. However, the proposed intraoral OCT system can access the prostheses in the mandibular right second molar. Therefore, dental diagnosis for restoration treatment with dental prosthesis fracture, marginal gap, and pulp exposure after tooth preparation is possible using the proposed intraoral OCT system.

Conclusions: The use of the intraoral OCT system improved dental diagnosis by allowing the dentist to confirm quantitative values through cross-sectional images, rather than that by determining a treatment plan after visual dental diagnosis.

Patients: A case series of 12 patients (mean age, 53.5 years) with horizontal ridge deficiencies had augmentations with customized 3D printed nanohydroxyapatite (3DHA) block grafts prior to implant placement. 3DHA graft materials were fabricated to fit the individual patient defects using DICOMs from CBCT images obtained from each patient. The CBCT images were then converted into the STL file format and 3DHA was reconstructed by 3D printing. Surgical bone augmentation consisted of 3DHA incorporating concentrated growth factors (CGFs) and platelet-rich fibrin (PRF) membrane. At 6 months, a bone biopsy and implantation were performed. The primary outcome was horizontal bone gain after 6 months. The secondary outcomes included information on the clinical outcomes, dimensions, and histomorphometric results.

Discussion: The 3DHA block graft was successful in 10 of 12 patients. Graft adjustment was not required. All 3DHA adapted and fit well at all defect sites. Maximum mean horizontal bone gains were 3.06 ± 1.02 and 3.56 ± 0.23 mm from the DICOMs and STL data sets, respectively. The volume gain was 229.8 ± 82.96 mm³. A low pain score after surgery was reported of 1.41 ± 0.51, while the healing index score increased with a maximum mean of 4.7 ± 0.67. Thirteen implants were placed with good primary stability (ISQ = 65 ± 4.08), without additional guided bone regeneration. Histomorphometric analysis revealed that new bone formation, bone tissue, residual grafts, and connective tissue were 28.6 ± 1.88, 30.48 ± 4.81, 19.82 ± 4.07, and 20.81 ± 4.41%, respectively.

Conclusions: A customized 3DHA block graft is a viable treatment option for primary implant-site augmentation.