Narrow-diameter versus regular-diameter dental implants for mandibular overdentures: A systematic review and meta-analysis.

PURPOSE: The aim of this systematic review was to compare treatment outcomes in terms of implant survival rate, marginal bone loss, and patient-reported outcome measures (PROMs) between narrow-diameter implants and regular-diameter implants (RDIs) for mandibular implant overdentures (MIOs). METHODS: This study was based on the methodology adapted as per Cochrane. Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched for pertinent studies published by July 22, 2022. Outcome parameters included in this meta-analysis were implant survival rate, marginal bone loss, visual analogue scale score for patient satisfaction, and value of oral health impact profile. RESULTS: A total of 782 non-duplicate articles and 83 clinical study registrations were identified from database and hand searches, of which 26 were eligible for full-text searches. Finally, 12 publications reporting on 8 independent studies were included in this review. In the meta-analysis, implant survival rate and marginal bone loss did not significantly differ between narrow-diameter implants and RDIs. Regarding RDIs, narrow-diameter implants were associated with significantly better outcomes in general patient satisfaction and oral health-related quality of life than RDIs for mandibular overdentures. CONCLUSIONS: Narrow-diameter implants have competitive treatment outcomes compared to RDIs in terms of implant survival rate, marginal bone loss, and PROMs. [Correction added on July 21, 2023, after first online publication: The abbreviation RDIs was changed to PROMs in the preceding sentence.] Thus, narrow-diameter implants might be an alternative treatment option for MIOs in situations with limited alveolar bone volume.

Mini-implant mandibular overdentures under a two-step immediate loading protocol: A 4-6-year retrospective study.

OBJECTIVES: This retrospective study to evaluate the treatment outcomes of mandibular mini-implant overdentures (MIODs) placed under a two-step immediate loading protocol. BACKGROUND: The mini-implant overdenture emphasises the advantages of simplicity using flapless surgery and immediate loading. However, some mini-implant have lowe initial stability. MATERIALS AND METHODS: A total of 30 participants who used mandibular MIODs and maxillary removable complete dentures (RCDs) over 4 years were included. Four one-piece mini-implants (<3 mm in diameter) were placed by a flapless surgical approach after fabrication of new RCDs, and the O-ring attachment was attached at least 8 weeks after implant placement. RESULTS: The average observation period was 58.9 ± 9.2 months after mini-implant loading. The survival rate of the implants was 100.0%, and the overall change in mean marginal bone level (ΔMBL) was -0.9 ± 1.1 mm. The implant success rate was 83.3% at the implant level, and 66.7% at the patient level. The mean initial Periotest value was 0.9 ± 3.1, and it was positively associated with ΔMBL and implant success (P < .05). Patient satisfaction improved after conversion from RCDs to MIODs (P < .05), and mastication and pain showed greater satisfaction with longer loading time (P < .05). CONCLUSIONS: The mandibular MIODs could be chosen as an alternative treatment under a two-step immediate-loading protocol in edentulous patients with limited alveolar bone volume. To ensure superior treatment outcomes of MIODs, initial stability of implant must be obtained using as wide a diameter as possible within the anatomically allowable limits.

Color stability of provisional restorative materials with different fabrication methods.

PURPOSE: The aim of this study was to investigate and compare the color stability of provisional restorative materials fabricated by 3D printing, dental milling, and conventional materials. MATERIALS AND METHODS: For the experimental groups, two commercially available 3D-printing provisional resins (E-Dent 100; EnvisionTEC GmbH, Germany & VeroGlaze™; Stratasys®, USA), two dental milling blocks (PMMA Disk; Yamahachi Dental Co., Japan & Telio®CAD; Ivoclar Vivadent AG, Liechtenstein), and two conventional materials (Alike™; GC Co., Japan & Luxatemp automix plus; DMG, Germany) were used. The water sorption and solubility test were (n=10, respectively) carried out according to ISO4049:2000 (International Standards Organization, Geneva, Switzerland). For the color stability test (n=10), coffee and black tea were used as staining solutions, and the specimens were stored for 12 weeks. Data were analyzed by one-way ANOVA and Tukey's HSD using SPSS version 22.0 (SPSS Inc. Chicago, IL, USA) (P<.05). RESULTS: Alike and Veroglaze showed the highest values and Luxatemp showed the lowest water sorption. In the color stability test, the ΔE of conventional materials varied depending on the staining solution. PMMA milling blocks showed a relatively low ΔE up to 4 weeks, and then significantly increased after 8 weeks (P<.05). 3D-printed materials exhibited a high ΔE or a significant increase over time (P<.05). CONCLUSION: The degree of discoloration increased with time, and a visually perceptible color difference value (ΔE) was shown regardless of the materials and solutions. PMMA milled and 3 D-printed materials showed more rapid change in discoloration after 8 weeks.

Comparison of 3D-Printed Dental Implants with Threaded Implants for Osseointegration: An Experimental Pilot Study.

This study aimed to compare bone healing and implant stability for three types of dental implants: a threaded implant, a three-dimensional (3D)-printed implant without spikes, and a 3D-printed implant with spikes. In four beagle dogs, left and right mandibular premolars (2nd, 3rd, and 4th) and 1st molars were removed. Twelve weeks later, three types of titanium implants (threaded implant, 3D-printed implant without spikes, and 3D-printed implant with spikes) were randomly inserted into the edentulous ridges of each dog. Implant stability measurements and radiographic recordings were taken every two weeks following implant placement. Twelve weeks after implant surgery, the dogs were sacrificed and bone-to-implant contact (BIC) and bone area fraction occupied (BAFO) were compared between groups. At implant surgery, the primary stability was lower for the 3D-printed implant with spikes (74.05 ± 5.61) than for the threaded implant (83.71 ± 2.90) (p = 0.005). Afterwards, no significant difference in implants' stability was observed between groups up to post-surgery week 12. Histomorphometrical analysis did not reveal a significant difference between the three implants for BIC (p = 0.101) or BAFO (p = 0.288). Within the limits of this study, 3D-printed implants without spikes and threaded implants showed comparable implant stability measurements, BIC, and BAFO.

The reliability of Anycheck device related to healing abutment diameter.

PURPOSE: The purpose of this in vitro study was to examine the reliability of the Anycheck device and the effect of the healing abutment diameter on the Anycheck values (implant stability test, IST). MATERIALS AND METHODS: Thirty implants were placed into three artificial bone blocks with 10 Ncm, 15 Ncm, and 35 Ncm insertion torque value (ITV), respectively (n = 10). (1) The implant stability was measured with three different kinds of devices (Periotest M, Osstell ISQ Mentor, and Anycheck). (2) Five different diameters (4.0, 4.5, 4.8, 5.5, and 6.0 mm) of healing abutments of the same height were connected to the implants and the implant stability was measured four times in different directions with Anycheck. The measured mean values were statistically analyzed. RESULTS: The correlation coefficient between the mean implant stability quotient (ISQ) and IST value was 0.981 (P<.01) and the correlation coefficient between the meant periotest value (PTV) and IST value was -0.931 (P<.01). There were no statistically significant differences among the IST values with different healing abutment diameters. CONCLUSION: There was a strong correlation between the Periotest M and Anycheck values and between the ISQ and IST. The diameter of the healing abutment had no effect on the Anycheck values.

Effects of type of magnet attachment and implant angulation in two implant overdenture models.

PURPOSE: The purpose of this study is to evaluate the effects of type of magnet attachment and implant angulation in two implant overdenture models. MATERIALS AND METHODS: Magnet attachments used in this study were flat and dome types (MGT5515, MGT5520D, Dentium Co., Seoul, Korea). Two implants with keepers were inserted in the resin blocks at a distance of 24 mm. For the first model, the implants were parallel to the vertical and perpendicular to the horizontal; for the second model, both were angulated 5 degrees to the mesial; for the third model, both were angulated 10 degrees toward the mesial. The retentive force was measured in both vertical and lateral directions. Statistical analyses were performed using SPSS software version 22.0 (α=.05). RESULTS: The flat type magnet attachment showed the highest lateral retentive force in the 20° divergent group (P<.05) and the dome type magnet attachment showed the highest lateral retentive force in the parallel group (P<.05). The vertical and lateral retentive force of the dome type magnet attachment was greater than that of the flat type magnet attachment in every direction (P<.05). CONCLUSION: Within the limitations of this study, the dome shape magnet attachment can resist vertical and lateral retentive force more superiorly than the flat type magnet attachment, regardless of angle, in the mandibular two implant model.

Evaluation of Transfer Learning with Deep Convolutional Neural Networks for Screening Osteoporosis in Dental Panoramic Radiographs.

: Dental panoramic radiographs (DPRs) provide information required to potentially evaluate bone density changes through a textural and morphological feature analysis on a mandible. This study aims to evaluate the discriminating performance of deep convolutional neural networks (CNNs), employed with various transfer learning strategies, on the classification of specific features of osteoporosis in DPRs. For objective labeling, we collected a dataset containing 680 images from different patients who underwent both skeletal bone mineral density and digital panoramic radiographic examinations at the Korea University Ansan Hospital between 2009 and 2018. Four study groups were used to evaluate the impact of various transfer learning strategies on deep CNN models as follows: a basic CNN model with three convolutional layers (CNN3), visual geometry group deep CNN model (VGG-16), transfer learning model from VGG-16 (VGG-16_TF), and fine-tuning with the transfer learning model (VGG-16_TF_FT). The best performing model achieved an overall area under the receiver operating characteristic of 0.858. In this study, transfer learning and fine-tuning improved the performance of a deep CNN for screening osteoporosis in DPR images. In addition, using the gradient-weighted class activation mapping technique, a visual interpretation of the best performing deep CNN model indicated that the model relied on image features in the lower left and right border of the mandibular. This result suggests that deep learning-based assessment of DPR images could be useful and reliable in the automated screening of osteoporosis patients.

Effect of conversion to implant-assisted removable partial denture in patients with mandibular Kennedy classification â : A systematic review and meta-analysis.

OBJECTIVE: This review evaluated the change in treatment outcomes after conversion from conventional removable partial denture (RPD) to implant-assisted removable partial denture (IARPD). The patient-reported outcome measures (PROMs), objective parameters for evaluation of functional performance, and biological and mechanical complication were evaluated. MATERIALS AND METHODS: This systematic review was based on the Cochrane review methodology and followed the criteria of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus up to April 3, 2019. After the initial search, additional electronic and hand searches were performed to identify further studies, ongoing studies, and gray literature, without restrictions on language, year of publication, or publication type. RESULTS: In total, 6,544 non-duplicate articles were identified, and 31 were eligible for full-text search. Finally, 19 publications based on 13 independent studies were selected. In the meta-analysis, general patient satisfaction was significantly increased (p < .05), and the improved mastication was remarkable oral function. In oral health-related quality of life, the oral health impact profile score was significantly improved, and improvements of physical pain and psychological disability were prominent (p < .05). Masticatory performance was improved in terms of maximum bite force, active occlusal contact area, and mandibular jaw movement (p < .05). The weighted mean survival rate of implants was 96.60%. CONCLUSIONS: After conversion from conventional RPD to IARPD, the PROMs and masticatory performance significantly improved in partially edentulous patients under mandibular Kennedy classification I.

Bar versus ball attachments for maxillary four-implant retained overdentures: A randomized controlled trial.

OBJECTIVES: To compare the clinical treatment outcomes of maxillary four-implant retained overdentures with either splinted (bar) attachments or non-splinted (ball) attachments. MATERIAL AND METHODS: Forty participants who were dissatisfied with their existing conventional maxillary complete dentures were included in this randomized controlled trial. Six months after implant placement, a definitive prosthesis was inserted. Implant success, condition of peri-implant tissue, prosthodontic maintenance and complications, and patient satisfaction were assessed. Outcomes were recorded at baseline, prosthesis delivery, and at 3 and 12 months following prosthesis delivery, and a statistical analysis was performed. RESULTS: Thirty-two of the forty patients completed the 1-year follow-up and had their treatment outcomes evaluated. The mean marginal bone loss after 1 year of loading was 0.34 ± 0.88 mm, and there were no significant differences between the two groups. Plaque index, gingival index and bleeding on probing were significantly higher in the bar group (p<.001), and the implant success rate of the bar group was significantly lower than that of the ball group (p=.028). The most frequent prosthodontic maintenance and complication issue was the need to change the bar clip or O-ring as a result of retention loss. Patient satisfaction did not differ between the two groups except for aesthetics at 3 months. CONCLUSIONS: Within the limitations of this study, the maxillary 4-implant retained overdenture exhibited predictable results regardless of the attachment systems (ball or bar) in the 1-year follow-up period. The bar group was more vulnerable than the ball group with respect to maintaining peri-implant tissue health.

Physical properties and color stability of injection-molded thermoplastic denture base resins.

PURPOSE: The purpose of this study was to compare mechanical and physical properties of injection-molded thermoplastic denture base resins. MATERIALS AND METHODS: In this study, six commercially available products (VA; Valplast, LC; Lucitone, ST; Smiltone, ES; Estheshot-Bright, AC; Acrytone, WE; Weldenz) were selected from four types of thermoplastic denture base materials (Polyamide, Polyester, Acrylic resin and Polypropylene). The flexural properties and shore D hardness have been investigated and water sorption and solubility, and color stability have evaluated. RESULTS: For the flexural modulus value, ES showed the highest value and WE showed significantly lower value than all other groups (P<.05). Most of experimental groups showed weak color stability beyond the clinically acceptable range. CONCLUSION: Within the limits of this study, thermoplastic denture base resin did not show sufficient modulus to function as a denture base. In addition, all resins showed discoloration with clinical significance, and especially polyamides showed the lowest color stability.

Effect of non-thermal plasma on the shear bond strength of resin cements to Polyetherketoneketone (PEKK).

PURPOSE: This study aimed to assess the effect of non-thermal plasma on the shear bond strength of resin cements to polyetherketoneketone (PEKK) in comparison to other surface treatment methods. MATERIALS AND METHODS: Eighty PEKK discs were subjected to different surface treatments: (1) Untreated (UT); (2) Non-thermal plasma (NTP); (3) Sandblasting with 50 µm Al2O3 particles (SB); and (4) Sandblasting + Non-thermal plasma (SB+NTP). After each surface treatment, the contact angle was measured. Surface conditioning with Visio.Link was applied in all groups after pre-treatment. RelyX Unicem resin cement was bonded onto the PEKK specimens. After fabrication of the specimens, half of each group (n=10) was initially tested, while the other half was subjected to thermocycling (5℃ to 55℃ at 10,000 cycles). Shear bond strength (SBS) testing was performed using a universal testing machine, and failure modes were assessed using stereomicroscopy. The SBS results were analyzed statistically using one-way ANOVA followed by Tukey's post hoc test. Independent t-test was used to examine the effect of thermocycling (P<.05). RESULTS: The highest SBS values with or without thermocycling were observed with PEKK specimens that were treated with SB+NTP followed by the SB group. The lowest SBS results were observed in the UT groups. CONCLUSION: The shear bond strength between PEKK and resin cements was improved using non-thermal plasma treatment in combination with sandblasting.

Two-Step Immediate Loading of Mandibular Overdentures Retained by Mini-implants: A Prospective Clinical Study.

PURPOSE: This study aimed to evaluate treatment outcomes of mandibular overdentures retained by two different mini-implant systems with ball attachments under a two-step immediate loading protocol. MATERIALS AND METHODS: This clinical trial investigated treatment outcomes of mandibular mini-implant overdentures in 45 edentulous patients. MDI implants (3M ESPE) and SlimLine implants (Dentium) were randomly selected for placement in the anterior mandible in each group (MDI = 21; SlimLine = 24) with a flapless surgical approach. The side of the tissue in the region of the complete mandibular denture where mini-implants were placed was immediately relined with soft reliner (COE-SOFT). The female components were attached on the dentures 2 months after implant placement. Clinical and radiographic data were collected during follow-up. Statistical analyses were performed using SPSS software version 22.0 (α = .05). RESULTS: A total of 177 mini-implants were inserted in the anterior mandibles of 45 totally edentulous patients. There were five implant failures (97.2% success rate) and no significant differences between the two implant groups. Most mini-implants showed stable initial Periotest values (a mean ± standard deviation of 1.03 ± 3.65 mm) and a mean marginal bone loss of 0.50 ± 0.75 mm at 12 months. Multiple regression analysis revealed that implants ≤ 2.4 mm in diameter had higher Periotest values than those ≥ 2.8 mm. Intial Periotest values significantly influenced implant failure (P < .05). CONCLUSION: There were no significant differences in treatment outcomes between patients treated with MDI or SlimLine implants. Mini-implants with wider diameters showed higher initial stability than those with narrow diameters, which may influence implant survival.

Corrigendum to "Effects of rhBMP-2 Loaded Titanium Reinforced Collagen Membranes on Horizontal Bone Augmentation in Dogs".

[This corrects the article DOI: 10.1155/2017/7141296.].

Corrigendum to "Biomechanical Evaluation of a Tooth Restored with High Performance Polymer PEKK Post-Core System: A 3D Finite Element Analysis".

[This corrects the article DOI: 10.1155/2017/1373127.].

Shear bond strength of composite resin to high performance polymer PEKK according to surface treatments and bonding materials.

PURPOSE: The object of the present study was to evaluate the shear bonding strength of composite to PEKK by applying several methods of surface treatment associated with various bonding materials. MATERIALS AND METHODS: One hundred and fifty PEKK specimens were assigned randomly to fifteen groups (n = 10) with the combination of three different surface treatments (95% sulfuric acid etching, airborne abrasion with 50 µm alumina, and airborne abrasion with 110 µm silica-coating alumina) and five different bonding materials (Luxatemp Glaze & Bond, Visio.link, All-Bond Universal, Single Bond Universal, and Monobond Plus with Heliobond). After surface treatment, surface roughness and contact angles were examined. Topography modifications after surface treatment were assessed with scanning electron microscopy. Resin composite was mounted on each specimen and then subjected to shear bond strength (SBS) test. SBS data were analyzed statistically using two-way ANOVA, and post-hoc Tukey's test (P<.05). RESULTS: Regardless of bonding materials, mechanical surface treatment groups yielded significantly higher shear bonding strength values than chemical surface treatment groups. Unlike other adhesives, MDP and silane containing self-etching universal adhesive (Single Bond Universal) showed an effective shear bonding strength regardless of surface treatment method. CONCLUSION: Mechanical surface treatment behaves better in terms of PEKK bonding. In addition, self-etching universal adhesive (Single Bond Universal) can be an alternative bonding material to PEKK irrespective of surface treatment method.

Comparative Evaluation of a Four-Implant-Supported Polyetherketoneketone Framework Prosthesis: A Three-Dimensional Finite Element Analysis Based on Cone Beam Computed Tomography and Computer-Aided Design.

PURPOSE: The purpose of this pilot study was to evaluate and compare polyetherketoneketone (PEKK) with different framework materials for implant-supported prostheses by means of a three-dimensional finite element analysis (3D-FEA) based on cone beam computed tomography (CBCT) and computer-aided design (CAD) data. MATERIALS AND METHODS: A geometric model that consisted of four maxillary implants supporting a prosthesis framework was constructed from CBCT and CAD data of a treated patient. Three different materials (zirconia, titanium, and PEKK) were selected, and their material properties were simulated using FEA software in the generated geometric model. RESULTS: In the PEKK framework (ie, low elastic modulus) group, the stress transferred to the implant and simulated adjacent tissue was reduced when compressive stress was dominant, but increased when tensile stress was dominant. CONCLUSION: This study suggests that the shock-absorbing effects of a resilient implant-supported framework are limited in some areas and that rigid framework material shows a favorable stress distribution and safety of overall components of the prosthesis.

Effects of rhBMP-2 Loaded Titanium Reinforced Collagen Membranes on Horizontal Bone Augmentation in Dogs.

The aim of this study was to evaluate the efficacy of growth factor loaded collagen membranes on new bone formation during horizontal bone augmentation. Mandibular defects (4 × 4 × 4 mm) were surgically prepared in six male beagle dogs, which were then protected with one of three types of membranes: (1) titanium mesh, (2) titanium reinforced collagen, or (3) rhBMP-2 loaded titanium reinforced collagen. Animals were euthanized 8 and 16 weeks after surgery, and nondecalcified specimens were prepared and histomorphologically investigated to determine the degree of osteogenesis. Data were analyzed with Friedman test. With respect to the degree of osteogenesis at earlier stage (8 weeks after surgery), there was significantly higher new bone ratio in rhBMP-2 loaded membrane group (p > 0.05). However, with respect to the long-term results (16 weeks after surgery), there were no significant differences among the three membranes (p > 0.05). Based on histomorphometric analysis, there were no significant differences in horizontal bone gaining ratio (p > 0.05).

Effects of desensitizing agents for cervical dentin hypersensitivity: A randomized clinical trial.

PURPOSE: To evaluate the clinical efficacy of five commercially available desensitizing agents with different mechanisms applied to hypersensitive teeth. METHODS: A randomized clinical trial was conducted on subjects suffering dentin hypersensitivity in Korea University Guro Hospital from October 2013 to April 2015. A total of 64 subjects met the selection criteria and were randomly assigned to five commercially available desensitizing agents, and applied according to the manufacturers' instructions. Before and after application of desensitizing agents, subjects were evaluated with the Visual Analogue Scale (VAS) at baseline, 1 week, 1 month and 3 months. The difference between the degree of reduction of hypersensitivity in relation to time were evaluated with the repeated-measures ANOVA (P<0.05). RESULTS: Practitioner and subject-measured VAS values at 1 week, 1 month and 3 months showed a significant difference in all products compared with the first visit. On the other hand, no statistically significant differences between the products was shown. Desensitizing agents used in this clinical trial relieved dentin hypersensitivity up to 3 months. CLINICAL SIGNIFICANCE: The five tested desensitizing agents with different mechanisms were clinically effective in relieving dentin hypersensitivity up to 3 months and showed statistically significant pain reduction when compared to baseline scores.

Cumulative survival rate and associated risk factors of Implantium implants: A 10-year retrospective clinical study.

PURPOSE: The objective of this study was to determine the cumulative survival rate (CSR) and associated risk factors of Implantium implants by retrospective clinical study. MATERIALS AND METHODS: Patients who received Implantium implants (Dentium Co., Seoul, Korea) at Korea University Guro Hospital from 2004 to 2011 were included. The period between the first surgery and the last hospital visit until December 2015 was set as the observation period for this study. Clinical and radiographic data were collected from patient records, including all complications observed during the follow-up period. Kaplan-Meier analysis was performed to examine CSR. Multiple Cox proportional hazard model was employed to assess the associations between potential risk factors and CSR. RESULTS: A total of 370 implants were placed in 121 patients (mean age, 56.1 years; range, 19 to 75 years). Of the 370 implants, 13 failed, including 7 implants that were lost before loading. The 10-year cumulative survival rate of implants was 94.8%. The multiple Cox proportional hazard model revealed that significant risk factor of implant failure were smoking and maxillary implant (P<.05). CONCLUSION: The 10-year CSR of Implantium implants was 94.8%. Risk factors of implant failure were smoking and maxillary implant.

Epidemiology of Implant Mortality Disparity Among Intraoral Positions and Prosthesis Types.

PURPOSE: To examine the disparity of single-crown implant failure with a similar loss of the splinted prosthesis in differing anatomical locations while controlling for other demographic and clinical variables that may confound the relationship between prosthesis types and implant loss. MATERIALS AND METHODS: A multicenter retrospective cohort study was designed to include patients treated with dental implants from 2003 to 2014. The variables included age, sex, systemic disease, bone graft, implant placement date, position of dental implant, length of dental implant, diameter of dental implant, loading time, type of prosthesis, type of opposing occlusion, latest check date, and survival or loss of the dental implant. The demographic and clinical variables' influence on the survival of dental implants was estimated by the Kaplan-Meier method. The position and diameter were adjusted for the accurate estimation of the relationship between the prosthesis type and survival of the dental implant with the Cox proportional hazard method. RESULTS: A total of 1,151 dental implants from 403 patients were ascertained. After adjusting for the confounding effect of position and diameter, single-crown prostheses were 38.1 (95% CI: 15.1-118) times more likely to be lost than the connected-type prostheses. For single-crown implants, the waiting time for osseointegration before loading was the highest for the maxillary molar position and the lowest for the mandibular molar position (P < .0001), while the most frequent implant loss occurred in the maxillary anterior area, and the second frequent area was the maxillary molar position; the lowest occurrence of implant loss was for the mandibular molar position. This disparity was statistically significant (P = .0271). CONCLUSION: Despite the high survival rates of endosseous implants as a whole, since the variation of implant loss was observed among the different anatomical positions for single-crown implants, special attention has to be given to the maxillary anterior and maxillary molar positions. A longer healing time assuming compensation for disadvantageous bone quality was not directly effective in increasing implant longevity in the vulnerable positions.