Chinese Journal of Oral Implantology

Preface to the forum on zygomatic implant surgery and dental implant

Editorial Board of Chinese Journal of Oral Implantology

2025, 30(3): 201-202. DOI: 10.12337/zgkqzzxzz.2025.06.001

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A new classification of the edentulous atrophic maxillae based on zygomatic implant surgery and immediate loading protocols

Wu Yiqun, Wang Feng, Tao Baoxin

2025, 30(3): 203-208. DOI: 10.12337/zgkqzzxzz.2025.06.002

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Immediate loading in edentulous maxillae remains a clinical focus, particularly challenging in cases with moderate to severe atrophy. While the effectiveness of dental implants for immediate loading of the edentulous maxillae has been increasingly proven, accomplishing this in cases with inadequate bone volume is notably important and presents a significant challenge. Multiple methods have been proposed to achieve feasibility and safety for immediate loading of edentulous jaws, however, they can neither meet the complex situations of various clinical cases nor provide clear guidance for protocol selection in clinical practice. This article is based on the significant development of zygomatic implant surgery in recent years and proposes a new classification of the edentulous maxillae based on zygomatic implant surgery and corresponding immediate loading protocols. The classification and immediate loading protocols are as follows: 1. The bone volume in the bilateral second premolar area (5-5) is sufficient, and at least four conventional dental implants, including tilted implants, can be placed without bone augmentation to achieve immediate loading; 2. The bone volume in the first premolar area (4-4) on both sides is sufficient, and at least two conventional dental implants can be inserted without bone grafting. Immediate loading can be achieved by combining 2-4 conventional dental implants in the anterior area with zygomatic implants in both posterior regions; 3. There is insufficient bone volume in the second premolar area (5-5) on both sides, while the bone volume in the molar areas is sufficient, and at least one conventional dental implant can be placed on each molar side. Zygomatic implants are used in the anterior area on both sides, and conventional implants are used in the posterior areas to achieve immediate loading;4. Insufficient volume is observed in the full maxilla (7-7). Immediate loading can be achieved by quad zygomatic implant surgery. This classification and the corresponding immediate loading protocols aim to cover various complex clinical scenarios of edentulous maxillae, providing a reference and indication for the selection of immediate loading plans for these patients.

Application of short implants in the edentulous maxilla

Zhou Yanmin, Luo Jiaxin

2025, 30(3): 209-216. DOI: 10.12337/zgkqzzxzz.2025.06.003

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Patients with edentulous maxillae often face the challenge of insufficient bone height due to factors such as alveolar bone resorption and maxillary sinus pneumatization, making it difficult for traditional implants to achieve adequate primary stability. Short implants (typically less than 8 mm in length) have emerged as an innovative solution for addressing insufficient bone volume and have shown great potential in the field of maxillary implant rehabilitation for edentulous patients in recent years. This article reviews the clinical applications of short implants in edentulous maxillae, including primary stability requirements, influencing factors, and prosthetic superstructure design considerations.

Long-term outcomes of maxillary sinus health after zygomatic implant treatment:a 16-year follow-up study

Zhou Guohui

2025, 30(3): 217-223. DOI: 10.12337/zgkqzzxzz.2025.06.004

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Objective Maxillary sinusitis is the most common biological complication in zygomatic implant therapy, and the surgical technique and the pathway of zygomatic implants have long been considered closely associated with the occurrence of maxillary sinusitis. Although the exact pathogenic causes of maxillary sinusitis following zygomatic implant treatment remain unclear, clinicians continue to explore different surgical approaches to reduce the risk of maxillary sinusitis. The authors of this paper first introduced a zygomatic implant surgery combined with maxillary sinus floor elevation in 2010. Methods This study aims to investigate the long-term outcomes of maxillary sinus health in patients who underwent bilateral zygomatic implant treatment from 2007 to 2008, with a minimum follow-up period of 16 years. Results A total of 16 patients were included in the study, of whom 13 could be contacted. Only one patient presented with a history of recurrent maxillary sinusitis affecting the left side. Six patients agreed to undergo updated cone-beam computed tomography (CBCT) examinations. Another asymptomatic patient presented with sinus opacity, and two more patients presented with radiological signs of maxillary sinus membrane thickening. Conclusion Zygomatic implant combined with the sinus floor elevation without bone grafting does not necessarily cause maxillary sinusitis.

Immediate loading with zygomatic implants for edentulous maxilla with giant maxillary sinus: a case report

Kang Shibo, Ma Yina, Guo Aixia, Gao Peng, Ma Weiping, Cheng Xinghan, Yu Qiong, Zhang Dayong

2025, 30(3): 224-233. DOI: 10.12337/zgkqzzxzz.2025.06.005

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In this paper, a patient with severe alveolar bone atrophy in the maxillary posterior region, a giant pneumatized maxillary sinus, and insufficient restoration space underwent zygomatic implantation with immediate loading. Following extraction of the remaining maxillary teeth and occlusal space elevation by 6 mm using a temporary denture, bilateral maxillary zygomatic and inclined implants were placed. Immediate loading was completed 3 days after implant placement, and final restoration was achieved after 6 months. Based on a comprehensive analysis of the patient’s preoperative clinical data, the authors eliminated several alternative surgical approaches and ultimately selected the bilateral zygomatic implantation protocol, which successfully restored the patient's maxillary edentulism. By analyzing this case, the authors synthesized treatment principles and clinical experiences for the diagnosis and management of similar cases, providing valuable insights for addressing comparable implant scenarios.

Application of tilted implants in rehabilitation of the edentulous maxilla

Guo Houzuo, Di Ping

2025, 30(3): 234-242. DOI: 10.12337/zgkqzzxzz.2025.06.006

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Edentulous maxillary patients often face the clinical challenge of insufficient residual bone volume during implant rehabilitation. By optimizing the three-dimensional positioning of implants, the tilted implantation technique maximizes the utilization of existing anatomical bone structures while avoiding the risks associated with bone augmentation procedures, thereby achieving favorable primary stability. Compared to traditional bone grafting protocols, this approach significantly reduces surgical trauma and supports immediate loading, effectively shortening the overall treatment duration. With advancements in oral implantology, tilted implantation has demonstrated significant clinical advantages in the rehabilitation of the edentulous maxilla. This article systematically reviewed the application progress of the tilted implantation technique in maxillary edentulous rehabilitation from the perspectives of clinical indications, surgical protocols, and clinical prognosis.

Navigation-assisted digital surgical workflow for zygomatic implant-supported reconstruction of maxillary defects

Su Guanyu, Wang Feng

2025, 30(3): 243-249. DOI: 10.12337/zgkqzzxzz.2025.06.007

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Maxillary bone defects severely compromise patients’ abilities to chew, speak, and swallow, and also significantly affect facial aesthetics. Traditional prosthetic rehabilitation and free flap reconstruction present inherent limitations in clinical practice. Zygomatic implant technology, by anchoring implants to the zygomatic bone, offers a novel approach for the functional and structural rehabilitation of maxillary defects. However, this technique involves complex craniofacial anatomical structures and demands high surgical precision and intraoperative stability. The clinical success of zygomatic implants largely depends on accurate preoperative planning and precise surgical execution. In recent years, the integration of digital technologies has greatly enhanced the accuracy and predictability of zygomatic implant surgery. This article systematically reviews the digital surgical workflow for managing maxillary defects with zygomatic implants, including multimodal imaging data acquisition and registration, prosthesis-driven implant planning, and the application of dynamic navigation systems and augmented reality technologies. Additionally, representative clinical cases are presented to illustrate the practical value of these digital technologies in zygomatic implant surgery for maxillary reconstruction. Looking ahead, with the continuous advancement of artificial intelligence and robotic-assisted surgical technologies, the degree of automation and intelligence in zygomatic implant procedures is expected to improve further, thereby promoting more personalized and precise solutions for maxillary defect rehabilitation.

Current status of zygomatic implantation: technological evolution and clinical application

Chen Jingxia, Zhou Yanmin

2025, 30(3): 250-254. DOI: 10.12337/zgkqzzxzz.2025.06.008

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Zygomatic implantation, a clinical solution for patients with severe maxillary atrophy, overcomes the limitations of traditional implant procedures and enables the combined retention of maxilla-zygomatic implants. This paper systematically reviews the development of zygomatic implant technology, focusing on its application in the restoration of complex maxillary bone defects, the evolution of indications, and innovative treatment strategies. The purpose is to provide a theoretical basis and clinical support for precision treatment in the field of oral and maxillofacial repair.

In vivo experiment of repairing mandibular first molar with different thread implants under immediate load in Beagle dogs

Li Xinru, Cao Zepeng, Liu Yibo, Han Zekui, Zhou Libo

2025, 30(3): 255-261. DOI: 10.12337/zgkqzzxzz.2025.06.009

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Objective To investigate the effect of two kinds of implants with different thread designs on the biological distribution of the implant and the bone interface surrounding the mandibular molar area under immediate load. Methods Beagle dogs were employed for the immediate implantation and immediate loading model. The accuracy, implant stability quotient (ISQ), and osseointegration of the two implants were evaluated by histological analysis, and the stability and osseointegration of the two implants were evaluated in vivo. Results There were no significant differences in total error of implant point, total error of apical point, and angle error between conical cylindrical implants and double-threaded conical cylindrical implants (P>0.05). There was no significant difference in ISQ values of the two types of implants in all directions 3 months after operation (P>0.05). Histological observation at 3 months after surgery showed that conical cylindrical implants' BIC and BV/TV values were significantly lower than those of double-threaded conical cylindrical implants (P<0.05). Conclusion The double-threaded cone-column design of double-threaded conical cylindrical implants has higher initial stability and bone binding rate during immediate implantation and immediate loading, suggesting that double-threaded conical cylindrical implants should be given priority when immediate implantation and immediate loading in the molar area.

Effect of a KABP-based systematic oral health education program on postoperative care of dental implants in patients with periodontal disease

Chen Shanshan, Wang Xue, Yuan Miao

2025, 30(3): 262-268. DOI: 10.12337/zgkqzzxzz.2025.06.010

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Objective To evaluate the effect of a KABP-based nursing model combined with systematic oral health education on postoperative care of dental implants in patients with periodontal disease. Methods A total of 96 patients who underwent oral implant restoration at the Affiliated Stomatological Hospital of Nanjing Medical University from January to June 2022 were enrolled in this prospective study. Patients were randomly assigned to a control group (n=48) and an intervention group (n=48) using a random number table. The control group received systematic oral health education, while the intervention group received a KABP-based educational intervention. Outcome measures included peri-implan indices, cytokine levels (IL-8, IL-1β, TNF-α), disease knowledge awareness, compliance with professional oral maintenance, incidence of peri-implant mucositis and peri-implantitis, and patient satisfaction. Results Before the intervention, there were no statistically significant differences in peri-implant indices (BI, PLI, PD), cytokine levels (IL-8, IL-1β, TNF-α), or disease knowledge awareness between the two groups (P>0.05). After the intervention, the peri-implant indices and cytokine levels were significantly lower in the intervention group compared to the control group (P<0.05), while disease knowledge awareness and compliance with professional oral maintenance were significantly higher (P<0.05). Additionally, the incidence of peri-implant mucositis and peri-implantitis in the intervention group was lower than in the control group (P<0.05), and patient satisfaction with the restoration was higher in the intervention group (P<0.05). Conclusion The application of a KABP-based nursing model combined with systematic oral health education can effectively improve peri-implant indices, reduce inflammatory cytokine levels, enhance disease knowledge awareness, improve compliance with professional oral maintenance, and increase patient satisfaction following dental implant therapy in patients with periodontal disease. Furthermore, it can decrease the incidence of peri-implant mucositis and peri-implantitis.

CBCT evaluation of maxillary sinus exostoses in dental implant patients

Wang Yibo, Ding Chao, Zhuang Jiatong

2025, 30(3): 269-274. DOI: 10.12337/zgkqzzxzz.2025.06.011

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Objective To retrospectively investigate the parameters of maxillary sinus exostoses (MSEs) in a dental implant potients using cone-beam computed tomography (CBCT) and evaluate its association with age and sex. Methods This study reviewed CBCT scans of the maxillary sinuses from 533 patients who underwent preoperative imaging for implant treatment at our hospital between July 2023 and April 2025. Data on MSE location, size, morphology, symmetry, presence of concurrent mucoperiosteal abnormalities, sinus septa, and demographic variables were collected. Statistical analyses included chi-square test, Fisher’s exact test, and one-way ANOVA. Results Among 1,066 maxillary sinuses in 533 patients, MSE was identified in 74 sinuses of 59 patients, with bilateral occurrence in 15 patients (25.4%). Morphologically, 54.1% (40/74) were pearl-shaped, 35.1% (26/74) flat-shaped, and 10.8% (8/74) irregular-shaped. MSEs were predominantly located on the lateral wall (51.4%, 38/74) and sinus floor (43.2%, 32/74), with 5.4% (4/74) on the medial wall. Concurrent mucoperiosteal abnormalities were observed in 54.1% (49/74) of sinuses, sinus septa in 8 sinuses (10.8%), and multiple independent MSEs in 16.2% (12/74) of affected sinuses. The mean MSE size was (7.67±4.86) mm. No significant differences were found in MSE prevalence or location across sex or age groups (P>0.05). Conclusion Most MSEs were solitary, unilateral, and located on the lateral wall or floor of the maxillary sinus without sinus septa. Approximately half were small, pearl-shaped lesions, and mucoperiosteal abnormalities coexisted in nearly half of the affected sinuses. No demographic correlations were observed, but significant variations existed in MSE morphology and size.

Influence of different implant collar designs on marginal bone resorption: a Meta-analysis

Wan Ke, Hao Junjiang, Su Hanqi, Su Yucheng

2025, 30(3): 275-280. DOI: 10.12337/zgkqzzxzz.2025.06.012

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Objective To systematically evaluate the effect of smooth and rough implant collars on marginal bone resorption. Methods A systematic search was conducted in Embase, PubMed, CNKI, and Wanfang databases from inception to June 2024. Two independent reviewers screened, analyzed, and assessed the relevant literature. Meta-analysis was performed using RevMan 5.4 and Stata 15.0. Results Seven studies, involving 702 implants, were included. The meta-analysis showed that marginal bone resorption in the rough collar group was significantly lower than in the smooth collar group [MD=0.34,95% CI (0.08,0.61),P<0.05]. Subgroup analysis showed that the advantage of the rough collar in preserving marginal bone was more significant when the implant placement duration was less than 12 months. Conclusion Based on the available data, the rough implant collar is more favorable for marginal bone preservation compared to the smooth collar.

Research progress in the construction of murine experimental model of peri-implantitis

Sun Yuxin, Shi Bin, Wu Tao

2025, 30(3): 281-287. DOI: 10.12337/zgkqzzxzz.2025.06.013

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Peri-implantitis is one of the most intractable complications in dental implant treatment, which is also the key factor for implant failure. The construction of relevant animal experimental models that can accurately simulate the pathological features of peri-implantitis is crucial for in-depth exploration of its pathogenesis. This review systematically collates the research progress in recent years on the establishment of murine experimental models of peri-implantitis. The content encompasses the scientific selection of experimental animals, the application of innovative modeling methods, modeling time, the accurate evaluation of modeling outcome indicators, and an in-depth analysis of key factors such as success rate. The aim is to provide more comprehensive and accurate references for researchers in this field.

Advances in barrier membranes for guided bone regeneration in oral applications

Li Guangda, Ding Mingchao, Chang Xin, Jing Boya, Wang Jingfu, Wang Weiqi

2025, 30(3): 288-295. DOI: 10.12337/zgkqzzxzz.2025.06.014

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Guided bone regeneration (GBR) has become a standard clinical approach for the treatment of localized jawbone defects. In this process, barrier membranes play an important role by preventing the migration of soft tissue from the mucosal side into the bone defect area, thereby maintaining a secluded space for bone regeneration. The biological properties and clinical performance of different membranes vary depending on their origin, fabrication methods, and structural characteristics. This paper summarizes the biological functions and mechanisms of commonly used barrier membranes in GBR, with a particular focus on the properties of different membrane types. The advantages and limitations of these biomaterials are discussed, along with their clinical applications and potential directions for future material development.

Peri-implant diseases based on microdysbiosis and intervention strategies

Chen Gang, Zhao Xin, Zhong Fei, Gu Hongzheng

2025, 30(3): 296-304. DOI: 10.12337/zgkqzzxzz.2025.06.015

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Peri-implant disease is a chronic inflammation condition affecting the soft and hard tissues surrounding dental implants, primarily caused by bacterial infection. It is categorized into peri-implant mucositis and peri-implantitis. Oral microbial dysbiosis plays an important role that is characterized by alterations in microbial composition and function. In linking the pathogenesis of peri-implant diseases to microdysbiosis, current microbiome research faces several challenges: elucidating the molecular mechanisms driving the initiation and persistence of dysregulated microbiome structure, discerning causal host-microbiome relationships, and expounding secondary microbial changes during disease progression. In this review, we systematically classify dysbiosis from a conceptual perspective, outlining its immunological associations across category. We further elaborate on the causes of bacterial dysbiosis and analyze its potential impact on clinical treatment strategies. At the molecular level, understanding the origins, intrinsic regulatory mechanisms, environmental regulatory factors, and downstream effects of oral microdysbiosis may facilitate the development of microbiome-targeted therapies against peri-implant diseases. This research direction holds significant importance for promoting precision medicine in the context of peri-implant diseases.

Research progress on the role and mechanism of the Wnt/Ca²⁺/CaMKⅡsignaling pathway in osteogenic regulation and diabetic bone metabolism disorders

Ding Jiaqi, Zhou Wenjuan

2025, 30(3): 305-311. DOI: 10.12337/zgkqzzxzz.2025.06.016

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Diabetes mellitus (DM), a prevalent chronic metabolic disorder, is closely associated with disrupted bone metabolic homeostasis, which can impair osteoblast function through various molecular pathways, ultimately leading to abnormal bone metabolism. Additionally, diabetic oxidative stress can severely impair the process of new bone formation, leading to compromised osseointegration of the implant and even implant failure. Among these pathways, the Wnt/Ca²⁺/CaMKⅡ signaling axis plays a pivotal role in regulating osteoblast differentiation, bone matrix synthesis, and bone remodeling, all of which are essential processes in bone formation. This review systematically examines the impact of the Wnt/Ca²⁺/CaMKⅡ pathway on bone metabolic homeostasis in diabetic conditions, with a focus on the molecular mechanisms underlying diabetic bone metabolism disorders. Furthermore, the review discusses the potential of the Wnt/Ca²⁺/CaMKⅡpathway as a promising therapeutic target for managing diabetes-related bone lesions, providing novel insights into the intervention strategies for metabolic bone diseases and impaired osseointegration of dental implants in diabetic patients.

Application of the PBL-CBL teaching method in a maxillary sinus floor elevation course involving aspiration-assisted management of maxillary sinus cysts

Wang Jing, Jiang Yuhuan, Zhou Weikai, Man Yi

2025, 30(3): 312-316. DOI: 10.12337/zgkqzzxzz.2025.06.017

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Objective This study aimed to investigate the effectiveness of an integrated teaching method combining problem-based learning (PBL) and case-based learning (CBL) in a maxillary sinus floor elevation course involving aspiration-assisted management of maxillary sinus cysts. Methods Master's degree candidates in dental implantology (Class of 2023) at the West China School of Stomatology, Sichuan University, 40 in total, were randomly assigned to an experimental group and a control group, 20 in each group. The course content focused on the use of aspiration techniques for managing maxillary sinus cysts during sinus floor elevation procedures, and included both theoretical instruction and surgical demonstrations. The experimental group received instruction via the integrated PBL-CBL approach, while the control group followed traditional teaching methods. Effectiveness was evaluated by comparing classroom performance (participation, quality of questions and responses, teamwork, clinical reasoning, and communication skills), theoretical knowledge and clinical skill assessments, and student satisfaction (including feedback on course content, teaching methods, instructional media, and teaching quality). Results The experimental group demonstrated significantly higher scores across all evaluated aspects, including classroom performance, theoretical knowledge, clinical competencies, and satisfaction levels (P<0.05). Conclusion The integrated PBL-CBL teaching method effectively enhances students' theoretical knowledge and clinical practical skills, improves teaching outcomes, and increases overall course satisfaction. This approach supports innovation in dental education and is worthy of wider application.

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