Use of a digitally guided triple technique for bone reduction, implant placement, and immediate interim prostheses in complete-arch implant surgery.

A digitally guided triple technique for bone reduction, implant placement, and immediate interim prostheses in complete-arch implant surgery is presented. This technique integrates bone reduction and implant placement information into a dual-function surgical template and introduces a digital approach to fabricating immediate interim implant-supported fixed dental prostheses with the same occlusal relationship as the one evaluated with diagnostic removable prostheses.

Immunomodulatory effects of berberine on the inflamed joint reveal new therapeutic targets for rheumatoid arthritis management.

Rheumatoid arthritis (RA) is a chronic inflammatory syndrome designated by synovial joint inflammation leading to cartilage degradation and bone damage as well as progressive disability. Synovial inflammation is promoted through the infiltration of mononuclear immune cells, dominated by CD4+ T cells, macrophages and dendritic cells (DCs), together with fibroblast-like synoviocytes (FLS), into the synovial compartment. Berberine is a bioactive isoquinoline alkaloid compound showing various pharmacological properties that are mainly attributed to immunomodulatory and anti-inflammatory effects. Several lines of experimental study have recently investigated the therapeutic potential of berberine and its underlying mechanisms in treating RA condition. The present review aimed to clarify determinant cellular and molecular targets of berberine in RA and found that berberine through modulating several signalling pathways involved in the joint inflammation, including PI3K/Akt, Wnt1/ß-catenin, AMPK/lipogenesis and LPA/LPA1 /ERK/p38 MAPK can inhibit inflammatory proliferation of FLS cells, suppress DC activation and modulate Th17/Treg balance and thus prevent cartilage and bone destruction. Importantly, these molecular targets may explore new therapeutic targets for RA treatment.

Collagen intrafibrillar mineralization as a result of the balance between osmotic equilibrium and electroneutrality.

Mineralization of fibrillar collagen with biomimetic process-directing agents has enabled scientists to gain insight into the potential mechanisms involved in intrafibrillar mineralization. Here, by using polycation- and polyanion-directed intrafibrillar mineralization, we challenge the popular paradigm that electrostatic attraction is solely responsible for polyelectrolyte-directed intrafibrillar mineralization. As there is no difference when a polycationic or a polyanionic electrolyte is used to direct collagen mineralization, we argue that additional types of long-range non-electrostatic interaction are responsible for intrafibrillar mineralization. Molecular dynamics simulations of collagen structures in the presence of extrafibrillar polyelectrolytes show that the outward movement of ions and intrafibrillar water through the collagen surface occurs irrespective of the charges of polyelectrolytes, resulting in the experimentally verifiable contraction of the collagen structures. The need to balance electroneutrality and osmotic equilibrium simultaneously to establish Gibbs-Donnan equilibrium in a polyelectrolyte-directed mineralization system establishes a new model for collagen intrafibrillar mineralization that supplements existing collagen mineralization mechanisms.

Quaternary ammonium-based biomedical materials: State-of-the-art, toxicological aspects and antimicrobial resistance.

Microbial infections affect humans worldwide. Many quaternary ammonium compounds have been synthesized that are not only antibacterial, but also possess antifungal, antiviral and anti-matrix metalloproteinase capabilities. Incorporation of quaternary ammonium moieties into polymers represents one of the most promising strategies for preparation of antimicrobial biomaterials. Various polymerization techniques have been employed to prepare antimicrobial surfaces with quaternary ammonium functionalities; in particular, syntheses involving controlled radical polymerization techniques enable precise control over macromolecular structure, order and functionality. Although recent publications report exciting advances in the biomedical field, some of these technological developments have also been accompanied by potential toxicological and antimicrobial resistance challenges. Recent evidenced-based data on the biomedical applications of antimicrobial quaternary ammonium-containing biomaterials that are based on randomized human clinical trials, the golden standard in contemporary medicinal science, are included in the present review. This should help increase visibility, stimulate debates and spur conversations within a wider scientific community on the implications and plausibility for future developments of quaternary ammonium-based antimicrobial biomaterials.

Adopting the principles of collagen biomineralization for intrafibrillar infiltration of yttria-stabilized zirconia into three-dimensional collagen scaffolds.

In this paper, we report a process for generating collagen-yttria-stabilized amorphous zirconia hybrid scaffolds by introducing acetylacetone-inhibited zirconia precursor nanodroplets into a poly(allylamine)-coated collagen matrix. This polyelectrolyte coating triggers intrafibrillar condensation of the precursors into amorphous zirconia, which is subsequently transformed into tetragonal yttria-stabilized zirconia after calcination. Our findings represent a new paradigm in the synthesis of non-naturally occurring collagen-based hybrid scaffolds under alcoholic mineralizing conditions.

A feasible method to eliminate nanoleakage in dentin hybrid layers.

PURPOSE: To determine whether high-pressure air blowing during adhesive application affects the infiltration of resin comonomers and nanoleakage manifestation in the resin/dentin interface under simulated pulpal pressure. MATERIALS AND METHODS: Thirty mid-coronal dentin surfaces were bonded with an etch-and-rinse adhesive (Adper Single Bond 2) under simulated pulpal pressure. In the control group, the adhesive was thinned by ordinary air blowing with a pressure of 0.2 MPa, while in the experimental group, a high-pressure air blowing technique (pressure: 0.4 MPa) was used. All other procedures followed the manufacturer's instructions. Resin tag formation and nanoleakage in the bonding interface were evaluated with scanning electron microscopy (SEM) and transmission electron microscopy (TEM). RESULTS: When adhesive was thinned with high pressure air blowing, longer and more homogeneous resin tags were formed. The bonding interface demonstrated good overall morphology and integrity. Almost perfect infiltration of resin and no obvious nanoleakage were observed. CONCLUSION: Thinning of adhesive with high-pressure air blowing provides a clinically feasible adjunctive procedure for better resin infiltration.

Intrafibrillar silicification of collagen scaffolds for sustained release of stem cell homing chemokine in hard tissue regeneration.

Traditional bone regeneration strategies relied on supplementation of biomaterials constructs with stem or progenitor cells or growth factors. By contrast, cell homing strategies employ chemokines to mobilize stem or progenitor cells from host bone marrow and tissue niches to injured sites. Although silica-based biomaterials exhibit osteogenic and angiogenic potentials, they lack cell homing capability. Stromal cell-derived factor-1 (SDF-1) plays a pivotal role in mobilization and homing of stem cells to injured tissues. In this work, we demonstrated that 3-dimensional collagen scaffolds infiltrated with intrafibrillar silica are biodegradable and highly biocompatible. They exhibit improved compressive stress-strain responses and toughness over nonsilicified collagen scaffolds. They are osteoconductive and up-regulate expressions of osteogenesis- and angiogenesis-related genes more significantly than nonsilicified collagen scaffolds. In addition, these scaffolds reversibly bind SDF-1α for sustained release of this chemokine, which exhibits in vitro cell homing characteristics. When implanted subcutaneously in an in vivo mouse model, SDF-1α-loaded silicified collagen scaffolds stimulate the formation of ectopic bone and blood capillaries within the scaffold and abrogate the need for cell seeding or supplementation of osteogenic and angiogenic growth factors. Intrafibrillar-silicified collagen scaffolds with sustained SDF-1α release represent a less costly and complex alternative to contemporary cell seeding approaches and provide new therapeutic options for in situ hard tissue regeneration.

Biomimetic silicification of demineralized hierarchical collagenous tissues.

Unlike man-made composite materials, natural biominerals containing composites usually demonstrate different levels of sophisticated hierarchical structures which are responsible for their mechanical properties and other metabolic functions. However, the complex spatial organizations of the organic-inorganic phases are far beyond what they achieved by contemporary engineering techniques. Here, we demonstrate that carbonated apatite present in collagen matrices derived from fish scale and bovine bone may be replaced by amorphous silica, using an approach that simulates what is utilized by phylogenetically ancient glass sponges. The structural hierarchy of these collagen-based biomaterials is replicated by the infiltration and condensation of fluidic polymer-stabilized silicic acid precursors within the intrafibrillar milieu of type I collagen fibrils. This facile biomimetic silicification strategy may be used for fabricating silica-based, three-dimensional functional materials with specific morphological and hierarchical requirements.

A new fixation method for stick-shaped specimens in microtensile tests: laboratory tests and FEA.

PURPOSE: To introduce a new fixation method for stick-shaped specimens for use in microtensile tests and to evaluate the effect of this new method on microtensile bond strength, failure modes, and stress distribution. MATERIALS AND METHODS: Flat mid-coronal dentin surfaces were prepared on 12 caries-free human third molars and randomly divided into two groups for testing with two dental adhesives (Adper Single Bond 2 [SB2] and Clearfil SE Bond [SEB]). Following adhesive application and composite buildups, the bonded teeth were sectioned into beams. Sticks from each tooth were then equally divided into two subgroups for microtensile bond testing according to the utilized gripping devices (a flat Ciucchi's jig and the experimental setup). Failure modes were examined with a field-emission scanning electron microscope (FESEM). Three-dimensional models of each gripping device and specimen were developed, and stress distributions were analyzed by finite element analysis (FEA). Statistical significance was set at α = 0.05 RESULTS: Compared to those fixed using a flat Ciucchi's jig, sticks fixed with the experimental setup yielded lower bond strength values (p = 0.021 for SB2 and p = 0.007 for SEB) and more mixed failure patterns (p = 0.036 for both SB2 and SEB). In addition, the experimental setup guaranteed a uniaxial tensile force that was perpendicular to the bonding interface and produced a more uniform stress distribution at the bonding interface. CONCLUSION: An experimental setup for fixing microtensile sticks was proposed that was designed to provide a uniform stress distribution at the adhesive interface. FEA and failure mode analysis confirmed such uniform distribution, thus supporting the validity of the bond strength results obtained with this new fixture design.

The integration of peri-implant soft tissues around zirconia abutments: Challenges and strategies.

Stable soft tissue integration around the implant abutment attenuates pathogen penetration, protects underlying bone tissue, prevents peri-implantitis and is essential in maintaining long-term implant stability. The desire for "metal free" and "aesthetic restoration" has favored zirconia over titanium abutments, especially for implant restorations in the anterior region and for patients with thin gingival biotype. Soft tissue attachment to the zirconia abutment surface remains a challenge. A comprehensive review of advances in zirconia surface treatment (micro-design) and structural design (macro-design) affecting soft tissue attachment is presented and strategies and research directions are discussed. Soft tissue models for abutment research are described. Guidelines for development of zirconia abutment surfaces that promote soft tissue integration and evidence-based references to inform clinical choice of abutment structure and postoperative maintenance are presented.

Evaluation of a novel primer containing isocyanate group on dentin bonding durability.

OBJECTIVES: To evaluate the benefits of a novel dentin-bonding primer, namely, isocyanate-terminated urethane methacrylate precursor (UMP), which can form covalent bonds with demineralized dentin collagen. METHODS: The synthesized and purified UMP monomer was characterized and tested its effects on the degree of conversion (DC) and wettability of an acetone-based dental adhesive. Then UMP primers of different concentrations were formulated and used to prepare adhesive specimens, which were compared with solvent-treated groups. Primer-treated specimens with and without aging were also compared. To evaluate the bonding interface, microtensile strength tests, nano-indentation tests and nanoleakage- eavaluation were performed using a field-emission scanning electron microscope and nano-indenter. Data were analyzed using SPSS 20.0 software with significance set at α = 0.05 using one-way analysis of variance (ANOVA) and two-way ANOVA to characterize the effects of the primer. RESULTS: Treatment with the UMP primer promoted the DC and wettability of the adhesive on the demineralized dentin surface (P < 0.05); it also increased the bond strength of the aged dentin bonding interface (P < 0.05). Nanoleakage was reduced; the bonding interface became more stable, and the continuity and strength of the hybrid layer improved (P < 0.05) following UMP treatment. The application of 5 mM UMP as a primer for dentin bonding could lead to a stable bonding interface and long-lasting bonding effects. SIGNIFICANCE: The use of 5 mM UMP primer developed in this study could improve dentin bonding durability and has excellent clinical application prospects.

Ethanol-wet bonding technique may enhance the bonding performance of contemporary etch-and-rinse dental adhesives.

PURPOSE: To determine whether bonds of contemporary etch-and-rinse adhesives made with ethanol-wet bonding are stronger and more durable than those made with water-wet bonding, and to explore the possible reasons for the bonding results. MATERIALS AND METHODS: Flat surfaces of midcoronal dentin were made in extracted human third molars. The dentin surfaces were randomized into 6 groups according to bonding techniques (water- vs ethanol-wet bonding) and dental adhesives [Single Bond 2 (SB), Prime Bond NT (PB), and Gluma Comfort Bond (GB)]. After etching and rinsing, dentin surfaces were either left water-moist or immersed in ethanol. Following adhesive application and composite buildups, the bonded teeth were sectioned into beams for microtensile bond strength evaluation with or without NaOCl challenge. The morphology of the hybrid layer was analyzed with SEM. The wettability of water- vs. ethanol-saturated dentin was evaluated. The concentrations of non-volatile ingredients in the adhesives were compared. RESULTS: Compared to water-wet bonding, ethanol-wet bonding yielded similar (p > 0.05 for PB and GB) or higher (p < 0.05 for SB) 24-h bond strength, displayed significantly higher bond strength after chemical challenge (p < 0.05, for all three adhesives), and produced more even hybrid layers. Moreover, ethanol-saturated dentin exhibited a lower contact angle than water-saturated specimens, and the concentrations of non-volatile ingredients of the adhesives decreased in the order of SB > GB > PB. CONCLUSION: Ethanol-wet bonding could improve the bonding efficacy of contemporary etch-and-rinse adhesives, probably due to the good wettability of ethanol-saturated dentin and the structure of the hybrid layer. Moreover, this positive effect of ethanol-wet bonding might be influenced by the composition of adhesives.

In vitro and in vivo evaluations of three computer-aided shade matching instruments.

This study evaluated the accuracy and reliability of three computer-aided shade matching instruments (Shadepilot, VITA Easyshade, and ShadeEye NCC) using both in vitro and in vivo models. The in vitro model included the measurement of five VITA Classical shade guides. The in vivo model utilized three instruments to measure the central region of the labial surface of maxillary right central incisors of 85 people. The accuracy and reliability of the three instruments in these two evaluating models were calculated. Significant differences were observed in the accuracy of instruments both in vitro and in vivo. No significant differences were found in the reliability of instruments between and within the in vitro and the in vivo groups. VITA Easyshade was significantly different in accuracy between in vitro and in vivo models, while no significant difference was found for the other two instruments. Shadepilot was the only instrument tested in the present study that showed high accuracy and reliability both in vitro and in vivo. Significant differences were observed in the L*a*b* values of the 85 natural teeth measured using three instruments in the in vivo assessment. The pair-agreement rates of shade matching among the three instruments ranged from 37.7% to 48.2%, and the incidence of identical shade results shared by all three instruments was 25.9%. As different L*a*b* values and shade matching results were reported for the same tooth, a combination of the evaluated shade matching instruments and visual shade confirmation is recommended for clinical use.

Effect of different grit sizes of diamond rotary instruments for tooth preparation on the retention and adaptation of complete coverage restorations.

STATEMENT OF PROBLEM: Internal adaptation and retention are important factors for the longevity of crown restorations. However, how tooth surface roughness associated with diamond rotary cutting instruments affects the retention and internal adaptation of complete coverage restorations remains unknown. PURPOSE: This study evaluated the relationship between the surface roughness of prepared teeth and the internal adaptation and retention of complete coverage restorations after preparation with diamond rotary cutting instruments of different grit sizes. MATERIAL AND METHODS: Ninety-two extracted human teeth were divided into 4 groups and assigned to different final grit sizes of the diamond rotary instruments used for preparation following a grit decreasing sequence from coarse (125 to 150 µm), to medium (106 to 125 µm), to fine (53 to 63 µm), to extra fine (20 to 30 µm). After preparation, the surface roughness of 32 teeth was measured with a profilometer. The other 60 teeth were prepared as abutments, with 28 of these teeth used to measure microleakage and cement thickness. The remaining 32 teeth were used to test the retention between teeth and nickel-chromium alloy crowns with a universal testing machine. The data were analyzed with a 1-way ANOVA and Fisher's LSD post hoc multiple comparison tests to determine significant intergroup differences in surface roughness and retention force (α=.05). Microleakage scores and cement thickness were analyzed with the Kruskal-Wallis rank sum test; these were also conducted as multiple comparison tests (α=.05). RESULTS: The teeth prepared with the coarsest diamond rotary cutting instruments showed the highest mean surface roughness (SD) (4.8 (0.4) µm), and those prepared with the finest diamond rotary instruments had the lowest mean cement thickness (0.5 (1.2) µm; P<.001 when compared to teeth in the coarse group). The finer surfaces showed less microleakage (P =.03). However, no significant differences in retention were found (P=.19) across the groups. CONCLUSIONS: Teeth prepared with the finer grit rotary instruments have smoother tooth surfaces and crown restorations with better internal adaptation. The grit size of the diamond rotary cutting instruments does not affect the removal force between the complete coverage crown and the prepared tooth.

[Enhancing effects of perlecan or vascular endothelial growth factor-165 on angiogenesis in mice].

OBJECTIVE: To explore the angiogenesis-promoting effects of perlecan or vascular endothelial growth factor (VEGF) at different time points through quantitative analysis of microvessel density (MVD). METHODS: Four kinds of scaffolds: open-cell polylactic acid (OPLA) (control), OPLA + VEGF-165, OPLA + perlecan and OPLA + VEGF-165 + perlecan were implanted into mice. At Weeks 1, 2, 3, 4, 6 and 8, OPLA was harvested and then HE and immunocytochemistry were employed to detect the angiogenesis-promoting effects of scaffold. MVD of each group was appraised by the Tukey test. RESULTS: The scaffolds exhibited excellent biocompatibility with tissue. Numerous vessels were spotted obviously around the implants, especially at Week 8. And the OPLA scaffold degraded with the elapsing of time and its inner part was divided into many sections along with the ingrowth of vessels. Compared with the other three groups, the MVD of the OPLA + VEGF-165 + perlecan group was the highest at all time points. There were statistical differences between the OPLA + VEGF-165 + perlecan and OPLA groups at Week 1 (3.30 ± 0.42 vs 1.80 ± 0.29); MVD of the OPLA + VEGF-165 + perlecan group was thrice as much as the OPLA group at Week 3 (11.70 ± 0.87 vs 4.50 ± 0.34); at Week 8, MVD of the OPLA + VEGF-165 + perlecan group was more than thrice as much as the OPLA group (31.40 ± 1.35 vs 9.90 ± 0.67). CONCLUSION: Angiogenesis is synergistically enhanced by the combined application of VEGF-165 and perlecan in mice.

Polyetheretherketone Framework for Implant-supported Full-arch Fixed Dental Prostheses in a Periodontitis Patient with a 6-year Follow-up: a Case Report.

Dental implants are widely used in the rehabilitation of patients with edentulous jaws caused by periodontitis. The success of implants is closely related to their framework material and patients' periodontal health. Polyetheretherketone (PEEK) is a kind of high polymer material that has broad prospects as the framework for full-arch dental prostheses, but long-term follow-up data are lacking. The present clinical report demonstrates the use of a PEEK framework for the construction of an implant-supported full-arch fixed dental prosthesis for a patient diagnosed with periodontitis. With the guidance of biological width, a provisional retained restoration was achieved to create the emergence profile, resulting in a 3D printed PEEK framework with good aesthetics and biological functions.

Sesamol counteracts on metabolic disorders of middle-aged alimentary obese mice through regulating skeletal muscle glucose and lipid metabolism.

Background: Globally, obesity is a significant public problem, especially when aging. Sesamol, a phenolic lignan present in sesame seeds, might have a positive effect on high-fat diet (HFD)-induced obesity associated with aging. Objective: The purpose of current research study was to explore salutary effects and mechanisms of sesamol in treating alimentary obesity and associated metabolic syndrome in middle-aged mice. Methods: C57BL/6J mice aged 4-6 weeks and 6-8 months were assigned to the young normal diet group, middle-aged normal diet group, middle-aged HFD group, and middle-aged HFD + sesamol group. At the end of experiment, glucose tolerance test and insulin tolerance test were performed; the levels of lipids and oxidative stress-related factors in the serum and skeletal muscle were detected using chemistry reagent kits; lipid accumulation in skeletal muscle was observed by oil red O staining; the expressions of muscular glucose and lipid metabolism associated proteins were measured by Western blotting. Results: Sesamol decreased the body weight and alleviated obesity-associated metabolism syndrome in middle-aged mice, such as glucose intolerance, insulin resistance, dyslipidemia, and oxidative stress. Moreover, muscular metabolic disorders were attenuated after treatment with sesamol. It increased the expression of glucose transporter type-4 and down-regulated the protein levels of pyruvate dehydrogenase kinase isozyme 4, implying the increase of glucose uptake and oxidation. Meanwhile, sesamol decreased the expression of sterol regulatory element binding protein 1c and up-regulated the phosphorylation of hormone-sensitive lipase and the level of carnitine palmityl transferase 1α, which led to the declined lipogenesis and the increased lipolysis and lipid oxidation. In addition, the SIRT1/AMPK signaling pathway was triggered by sesamol, from which it is understood how sesamol enhances glucose and lipid metabolism. Conclusions: Sesamol counteracts on metabolic disorders of middle-aged alimentary obese mice through regulating skeletal muscle glucose and lipid metabolism, which might be associated with the stimulation of the SIRT1/AMPK pathway.

Research Progress of Duodenal-Jejunal Bypass Liner in the Treatment of Obesity and Type 2 Diabetes Mellitus.

With the development of economy and improvement of people's living standards, the incidence of obesity and type 2 diabetes mellitus (T2DM) has increased significantly and obesity has also become one of the most important risk factors of T2DM. In light of these trends, there have been many ways to take effect in losing weight. However, they also have corresponding deficiencies including inapparent curative effect, complex and incomplete reversible procedures and severe complications. Duodenal-Jejunal Bypass Liner (DJBL), which mimics Roux-en-Y gastric bypass (RYGB), is proved to play a key role in weight loss and control of T2DM. DJBL is reversible, less invasive and is more suitable for the treatment of obesity and T2DM, which is associated with multiple mechanisms, including incretin effect, gastric emptying mechanism, bile acid regulation, intestinal microbiota, inflammatory reaction mechanism and neural mechanism. In our review, we aimed to elaborate DJBL's clinical efficacy, safety and mechanisms in detail.

Color change of glass ceramic restorations cemented by four types of dual-cured resin luting agents with different initiator systems.

This study aimed to comprehensively evaluate the effect of dual-cured resin luting agents with different initiator systems on the color stability of glass ceramic restorations by simulating various clinical glass ceramic restorations. Three commonly used shades from each of the two dual-cured resin luting agents with an amine-initiation system or without it were studied. The individual specimens had different translucency and thickness and were artificially aged using a xenon light aging machine. The color was measured before and after aging using a digital spectrophotometer with the difference calculated and analyzed statistically. As results, the amine-free dual-cured resin luting agents were more color stable than those using amine-initiation systems for both uncovered and bonding groups. The translucency and thickness of the ceramic, and shade and type of the resin luting agent significantly affected the color stability of glass ceramic restorations.

Polyetheretherketone versus titanium CAD-CAM framework for implant-supported fixed complete dentures: a retrospective study with up to 5-year follow-up.

PURPOSE: To evaluate the performance of polyetheretherketone (PEEK) versus titanium computer-aided designed and manufactured (CAD-CAM) framework for implant-supported fixed complete dentures (ISFCDs) with a follow-up for a duration of up to 5 years. METHODS: Consecutively edentulous patients who underwent ISFCDs with a PEEK framework or titanium framework at one dental specialist center were included in this retrospective study. Implant/prosthesis survival rates, mechanical/biological complications, and bone and soft tissue parameters were analyzed. Overall survival was analyzed using Kaplan-Meier survival curves and the log-rank test. RESULTS: Sixty ISFCDs (29 PEEK, 31 titanium) performed on 43 edentulous patients (331 implants) were included. An implant survival rate of 100% was obtained. There was no significant difference in the cumulative prosthesis survival rate between the PEEK (93.1%) and titanium groups (93.5%). The most common mechanical complications were fracture of the artificial veneer in both the PEEK (13.8%) and titanium (16.7%) groups. Bruxers had a higher prevalence of mechanical complications than non-bruxers (p<0.05). The biological complications included bleeding upon probing (13.8% for the PEEK group; 16.1% for the titanium group), soft tissue inflammation (3.4% for the PEEK group; 3.2% for the titanium group), and temporomandibular disorders (6.5% for the titanium group). The vertical bone loss was significantly lower in the PEEK group (0.70 mm) than in the titanium group (0.96 mm). Smokers had a significantly higher prevalence of biological complications than non-smokers. CONCLUSION: Within the limitations of this study, ISFCDs with PEEK frameworks can provide good prognosis for edentulous patients, still requiring longer-term validation.