Implant dentistry has been solidifying its academic foundation. It has gained worldwide trust as the primary option for dental treatment in general clinical practice for missing teeth. However, patients who desire implant treatment may encounter difficulties due to insufficient bone volume. Particularly in the posterior maxilla, the proximity of the tooth roots to the sinus floor and the dynamic bone remodeling after tooth extraction often lead to vertical and horizontal bone height reduction, making implant treatment challenging. The anatomical complexity of the maxillary sinus also poses a high hurdle for general clinicians, making it one of the difficult cases in implant treatment. On the other hand, sinus floor elevation procedures have made it possible to treat many cases that were previously impossible, providing predictability in treatment. Many cases involving the posterior maxilla require this procedure. There are various clinical options and treatment variations for sinus floor elevation, and achieving predictable treatment outcomes requires evidence-based treatment planning and execution. Historically, sinus floor elevation has accumulated the most documented evidence in implant dentistry, and what was once only possible under hospitalization can now be completed in most cases on an outpatient basis.

However, despite the significant clinical advantages of sinus floor elevation, complications can have a substantial impact, sometimes requiring solutions beyond the capabilities of dental practitioners alone. Detailed preoperative risk assessment, meticulous treatment strategy planning, and preparation for complications are essential. The ITI Treatment Guide Vol. 5：Sinus floor elevation procedures, co-authored with Prof. Simon Jensen from Denmark and published in 2011, has been translated into over ten languages and is globally recognized as a treatment guideline for sinus floor elevation. This article builds on that foundation, incorporating the latest updates and discussing the current consensus on treatment protocols and the outcomes achieved from long-term cases. It also addresses the management of difficult cases and potential complications in sinus floor elevation procedures.

Since the bone tissue around osseointegrated implants directly supports masticatory loads, it is extremely important to understand the response of bone tissue to loading, the so-called mechanobiology of implants.

Previously, our series of animal experiments revealed that repetitive loading on implants causes anabolic effects on not only bone volume but also bone quality, including collagen fiber, biological apatite orientation, and number of osteocytes. Furthermore, the specific thread design could control bone quality such as collagen fiber, biological apatite, and osteocyte network alignment according to the loading direction. It is well known that bone structure and volume can adapt to mechanical loading, known as Wolff’s Law and Mechanostat Theory. In other words, the mechanobiology of bone volume as a scalar quantity has been developed into the mechanobiology of bone quality as a vector quantity.

In the current article, we share some interesting results of research on peri-implant bone mechanobiology and also introduce the development of bone quality-controlled implant designs, the scientific evidence of early loading of the implant, and a novel approach to peri-implantitis based on the mechanobiology of bone quality.

This review introduces the relationships between the test results for oral hypofunction, subjective frailty symptoms and oral health-related quality of life of outpatients in dental clinics. The review also introduces the effects of various prosthetic methods for patients with partial edentulism on oral hypofunction, subjective frailty symptoms, and oral health-related quality of life.

In today’s super-aging society, it is essential to prevent oral frailty in order to extend healthy life expectancy and ensure that the older adult population remain both physically and mentally sound and independent. In particular, the decline in dietary diversity, which can lead to sarcopenia, appears to be related to reduced chewing function caused by tooth loss and issues with prosthetic devices. Implant treatment is a highly effective method for improving these issues. However, to truly enhance health, simply providing prosthetic treatment is insufficient；managing oral function is vital. Our department is investigating changes in oral function before and after implant surgery in patients, and based on our research findings, it is evident that maintaining and enhancing oral function through implant treatment is crucial during the early stages of old age, particularly for those transitioning from middle to later life.

Moreover, even if healthy life expectancy increases, everyone eventually faces the final stage of life. In a super-aging society, expectations for implant treatments that take into account the possibility of patients becoming dependent are growing. For instance, due to decreased independence, we often encounter situations where implant care that could be performed on an outpatient basis is not feasible in nursing homes or at home. Therefore, as a second stage in old age, it is considered useful to modify prosthetic devices to minimize the decline in chewing function and quality of life (QOL), making oral care easier for family members and caregivers when patients reach a certain age and outpatient visits become challenging.

Objective:Dental implant treatment is considered to induce high levels of psychological and physiological stress. This study aimed to clarify stress responses to prosthetic treatments for missing teeth, including implant-related procedures, by evaluating both psychological and physiological indicators and comparing the responses between two patient groups:general patients and those with dental phobia.

Method:A total of 130 patients who had received treatment at Kanagawa Dental University Hospital between 2019 and 2024 were included in the study (75 general patients and 55 patients with dental phobia). Following explanations of each treatment procedure, psychological stress was assessed using a recall-based visual analog scale (VAS), and physiological stress was simultaneously evaluated by measuring salivary a-amylase (sAA) activity.

Results:Among patients with dental phobia, the median VAS score for implant placement was 93.0, significantly higher than that of general patients (60.5). The median sAA activity was also significantly higher in patients with dental phobia (83.0 kIU/L) compared to general patients (33.5 kIU/L). Additionally, implant treatment was associated with greater stress responses than bridge treatment across both groups.

Conclusion:Implant treatment elicited higher stress responses than other prosthetic treatments for missing teeth, with the effect being particularly pronounced in patients with dental phobia.

Dental procedures under local anesthesia often leave many patients feeling anxious and fearful about the treatment. The same is true for implant surgery, which adds significant stress to patients. Recently, we have reported that fear and anxiety during oral surgical procedures performed under local anesthesia can be reduced by the use of VR. In this study, we investigated whether VR viewing during implant placement surgery can reduce anxiety.

The subjects were 47 patients who underwent implant placement surgery under local anesthesia and were randomly divided into two groups:the non-VR group (24 patients) and the VR group (23 patients). A questionnaire survey including a visual analog scale (VAS) was used to compare whether fear and anxiety were reduced during the procedure before and after surgery.

The VAS score of the VR group decreased significantly to －23.3±24.2 mm, while that of the non-VR group was －6.25±25.0 mm before and during surgery. Additionally, 87.0％ of the patients in the VR group were satisfied with the results of the 5-point postoperative questionnaire, and 78.2％ reported a reduction in anxiety. On the other hand, none of the patients experienced symptoms of cybersickness.

These findings indicate that the VR group had reduced fear and anxiety associated with the procedure than the non-VR group. We conclude that VR is a valuable tool for reducing anxiety and fear during implant placement procedures.

Purpose:This study aimed to investigate the potential of generative AI as an educational tool to support students’ knowledge acquisition and clinical judgment skills in specialized education. To achieve this, we compared and evaluated the answer capabilities of three types of generative AI (GPT-4o, GPT-o1, and Claude 3.5 Sonnet) in response to questions related to oral implantology from the National Dental Licensing Examination.

Materials and Methods:A total of 92 questions (36 text-based and 56 image-based) related to implantology from the 99th to 117th National Dental Licensing Examinations were selected and presented to each model three times. Correct answer rates were recorded. All questions were also translated into English to examine the impact of language differences. Statistical analyses included one-way ANOVA, Holm’s post-hoc test, and the t-test.

Results:All models demonstrated high accuracy on text-based questions (83.3-96.3%), whereas their accuracy on image-based questions was lower (62.5-73.2%). Overall, GPT-o1 achieved the highest average accuracy (82.2%), followed by Claude 3.5 Sonnet and GPT-4o. Holm’s test revealed significant differences in performance between GPT-o1 and GPT-4o for both text-based questions and the overall score. No significant differences were found between the Japanese and English versions of the questions.

Conclusion:This study indicates that generative AI, especially GPT-o1, shows strong potential as an educational support tool in dental implantology, particularly for knowledge-based content. With further enhancement through prompt engineering and fine-tuning, these models could evolve into interactive systems that foster students’ clinical reasoning and decision-making skills

Significant vertical bone resorption following the removal of blade implants often complicates implant retreatment, particularly in the posterior mandible where bone loss is more pronounced. This report details a case where functional and aesthetic recovery was achieved through staged implant placement in the interforaminal region after removing blade implants from the mandibular molar regions.

The patient was an 80-year-old male who presented with occlusal pain in the bilateral mandibular molar regions. Clinical examination revealed the presence of blade implants in both areas, which exhibited significant mobility due to peri-implantitis and surrounding bone loss. After removing the blade implants, a provisional prosthesis was fabricated and supported by the remaining mandibular anterior teeth. Subsequently, tilted implants were placed in the bilateral mandibular premolar regions to maximize the use of available bone.

Following a four-month healing period without loading, the remaining mandibular anterior teeth were extracted, and three additional implants were placed in the interforaminal region. These implants were connected with those in the premolar regions, and a provisional prosthesis with anterior guidance was delivered to stabilize occlusion and restore function.

Simultaneously, treatment was conducted for the maxilla, where sapphire implants in the left molar region showed mobility. The implants were removed, and new implants were placed with careful consideration of occlusal reconstruction to ensure long-term stability. After confirming satisfactory recovery of stomatognathic function with the provisional prostheses, definitive restorations were fabricated and delivered.

This comprehensive treatment plan, which involved phased implant placement and occlusal reconstruction, successfully addressed the challenges associated with severe bone loss and peri-implantitis caused by the failed blade and sapphire implants.

The patient has been followed for eight years postoperatively, with no signs of complications or recurrence of peri-implantitis. Both functional and aesthetic outcomes have remained stable, demonstrating the efficacy of this staged approach for complex cases involving significant bone resorption and compromised implant sites.

This study aimed to evaluate visiting nurses’ oral assessment and healthcare performances, their knowledge and perceptions on oral implants, and factors associated with their performances to determine problems and obtain materials that promote dental and nursing collaboration in home healthcare. A web-based questionnaire survey was conducted among visiting nurses working at 312 home-visit nursing stations in Fukuoka Prefecture. A total of 66 (21.2%) visiting nurses responded to the questionnaire. The percentages of oral assessments and healthcare performances to their patients at home were 56.1% and 54.5%, respectively；>50% of them reported to have no knowledge of peri-implantitis/peri-mucositis and the need for post-treatment maintenance. About >60% of them answered that they could not assess oral implant superstructure abnormality or a loosened oral implant body. Their higher oral assessments and healthcare performances were significantly associated with higher knowledge and recognition levels of oral implants and higher awareness levels of collaboration with oral health professionals. Since >40% of home-care nurses did not perform oral assessments and healthcare procedures on their patients at home, their oral assessments and healthcare performances for the prevention and early detection of oral diseases and aspiration pneumonia among elderly people at home are expected to be further promoted. In addition, their low knowledge of oral implants and recognizing abnormalities suggested the need to provide visiting nurses information regarding oral implants. Information provision regarding oral implants by oral health professionals to visiting nurses and collaboration between them may further promote oral assessments and healthcare performances of visiting nurses, improve their ability to assess oral implant abnormalities, and promote their dental referrals.