{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:48:11Z","timestamp":1782902891778,"version":"3.54.5"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: To evaluate the clinical feasibility and short-term radiographic outcomes of adapting a prosthesis-based guide system originally developed for single-implant placement for multi-implant placement in the edentulous maxilla, and to compare implant-level marginal bone change from prosthetic loading to one year between full-rough (IBT\/IBNT\/IBR) and hybrid-surface (MSC-IBT\/MSC-IBNT) implants in a split-mouth design. Patient-reported outcomes were assessed with the OHIP-14 questionnaire. Methods: Fifteen patients with an edentulous maxilla received four or five maxillary implants placed flaplessly using a 3D-printed prosthesis-based guide incorporating polyether-ether-ketone (PEEK) rails and interchangeable angulation-correction sleeves (0\u00b0, 12\u00b0, 24\u00b0). Implants had either a fully roughened or a hybrid (rough apical and middle third with a machined coronal collar) surface. Side allocation was non-randomized: the hybrid side was assigned by alternating sequence and three patients received only full-rough implants for prosthetic reasons. All patients followed a delayed loading protocol and received a screw-retained zirconia fixed bridge. Standardized periapical radiographs were obtained at definitive prosthetic loading (baseline) and at the 12-month follow-up. Implant-level marginal bone loss was calculated as the mean of mesial and distal measurements per implant. All radiographic measurements were performed by two independent examiners (M.T. and T.M.); intra-rater reliability (M.T., remeasurement of 10 radiographs) and inter-rater reliability (M.T. versus T.M., full dataset) were quantified by intraclass correlation coefficient (ICC; two-way mixed effects, absolute-agreement, single-measurement). The primary split-mouth surface comparison was performed at the patient level by averaging implant-level change scores within each surface for each patient and comparing the paired patient-level means with a Wilcoxon signed-rank test. No a priori sample-size calculation was performed; the study was designed as a feasibility pilot. Results: Sixty-one implants were placed in 15 patients (seven male, eight female; mean age 62.5 \u00b1 8.9 years; three current smokers). Four implants in three patients required removal and replacement during the observation period (three early failures, one late failure; per-implant early-failure rate of 3\/61, 4.9%); one patient (P7) withdrew from clinical follow-up. Paired baseline and 12-month radiographs were available for 53 implants from 14 patients. Median implant-level marginal bone level increased from 0.38 mm (IQR 0.20\u20130.54) at baseline to 0.78 mm (IQR 0.47\u20131.32) at 12 months (paired Wilcoxon signed-rank, p &lt; 0.001); two implants exceeded 4 mm of bone change at 12 months. In the patient-level paired surface comparison (n = 8 patients contributing at least one full-rough and one hybrid implant with paired data), full-rough implants showed less 12-month marginal bone change than hybrid implants in every paired patient (median paired difference full-rough hybrid of \u22120.49 mm; Hodges\u2013Lehmann pseudo-median of 0.55 mm; paired Wilcoxon p = 0.012). OHIP-14 scores at one year (n = 14) showed a pronounced floor effect, with most patients scoring zero across most domains. Both intra-rater (M.T.) and inter-rater (M.T. versus T.M.) reliability showed good agreement (ICC = 0.85). Conclusions: A prosthesis-based guide system originally validated for single-implant placement can be feasibly adapted for flapless multi-implant rehabilitation of the edentulous maxilla, with early clinical and radiographic outcomes broadly consistent with comparable published series. Contrary to the design rationale that a machined coronal collar would limit early crestal remodeling, full-rough implants showed less 12-month within-patient bone change than hybrid implants in the eight paired patients; this finding is preliminary and hypothesis generating given the small, unbalanced paired sample and the contrast with larger published series. The approach is best characterized as a reduced infrastructure alternative to proprietary guided-surgery platforms, remains operator dependent, and requires confirmation in formally powered, balanced split-mouth trials with concealed allocation, placement anchored bone level measurement, postoperative CBCT for deviation quantification, and longer follow-up.<\/jats:p>","DOI":"10.3390\/dj14070395","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:19:02Z","timestamp":1782893942000},"page":"395","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prosthesis-Based 3D Guide System for Maxillary Implant Placement: A Feasibility Study Using a Split-Mouth Evaluation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1843-1839","authenticated-orcid":false,"given":"Marco","family":"Tudts","sequence":"first","affiliation":[{"name":"Department of Periodontology, Dental School, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tashia","family":"Moodley","sequence":"additional","affiliation":[{"name":"Cosmident, Private Practice, 2500 Lier, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6194-0931","authenticated-orcid":false,"given":"Rani","family":"D\u2019haese","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Dentistry, Dental School, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Vandeweghe","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Dentistry, Dental School, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/jre.13337","article-title":"Burden of Severe Periodontitis and Edentulism in 2021, with Projections up to 2050: The Global Burden of Disease 2021 Study","volume":"59","author":"Nascimento","year":"2024","journal-title":"J. Periodontal Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/j.1365-2842.2009.02039.x","article-title":"The Future of Complete Dentures in Oral Rehabilitation. A Critical Review","volume":"37","author":"Carlsson","year":"2010","journal-title":"J. Oral Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"498305","DOI":"10.1155\/2013\/498305","article-title":"The Impact of Edentulism on Oral and General Health","volume":"2013","author":"Emami","year":"2013","journal-title":"Int. J. Dent."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/jopr.12350","article-title":"Complete Edentulism and Comorbid Diseases: An Update","volume":"25","author":"Felton","year":"2016","journal-title":"J. Prosthodont."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1902\/jop.1991.62.1.2","article-title":"The Excessive Loss of Branemark Fixtures in Type IV Bone: A 5-Year Analysis","volume":"62","author":"Jaffin","year":"1991","journal-title":"J. Periodontol."},{"key":"ref_6","first-page":"108","article-title":"Management of the Edentulous Maxilla with Implant-Supported Prostheses","volume":"11","author":"Taylor","year":"2000","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Gonzalez-Gonzalez, I., Dellanos-Lanchares, H., Brizuela-Velasco, A., Alvarez-Riesgo, J.A., Llorente-Pendas, S., Herrero-Climent, M., and Alvarez-Arenal, A. (2020). Complications of Fixed Full-Arch Implant-Supported Metal-Ceramic Prostheses. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124250"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"66","DOI":"10.14219\/jada.archive.1996.0032","article-title":"The Edentulous Predicament. II: The Longitudinal Effectiveness of Implant-Supported Overdentures","volume":"127","author":"Zarb","year":"1996","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1600-051X.2009.01493.x","article-title":"A Systematic Review of Implant-Supported Maxillary Overdentures after a Mean Observation Period of at Least 1 Year","volume":"37","author":"Slot","year":"2010","journal-title":"J. Clin. Periodontol."},{"key":"ref_10","first-page":"265","article-title":"Patient Satisfaction with Turned Titanium Implants Placed in the Edentulous Mandible","volume":"8","author":"Collaert","year":"1997","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_11","first-page":"470","article-title":"The Effects of Age, Jaw Site, and Bone Condition on Oral Implant Outcomes","volume":"11","author":"Bryant","year":"1998","journal-title":"Int. J. Prosthodont."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/clr.12638","article-title":"Computer-Supported Implant Planning and Guided Surgery: A Narrative Review","volume":"26","author":"Vercruyssen","year":"2015","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"55","DOI":"10.11607\/jomi.2014suppl.g1.4","article-title":"Cone Beam Computed Tomography in Implant Dentistry: A Systematic Review","volume":"29","author":"Bornstein","year":"2014","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/j.1600-0501.2009.01788.x","article-title":"A Systematic Review on the Accuracy and the Clinical Outcome of Computer-Guided Template-Based Implant Dentistry","volume":"20","author":"Schneider","year":"2009","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/prd.12175","article-title":"Current State of the Art of Computer-Guided Implant Surgery","volume":"73","author":"Ackhurst","year":"2017","journal-title":"Periodontol. 2000"},{"key":"ref_16","first-page":"234","article-title":"Accuracy of Computer-Aided Oral Implant Surgery","volume":"24","author":"Valente","year":"2009","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/j.ijom.2011.09.009","article-title":"Depth Deviation and Occurrence of Early Surgical Complications Using a Single Stereolithographic Guide","volume":"40","author":"Cassetta","year":"2011","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_18","first-page":"127","article-title":"Proof of Concept of a New 3D-Guided System for a Single Implant Overdenture in the Mandible: An In Vitro Study","volume":"39","author":"Tudts","year":"2024","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1708-8208.2009.00255.x","article-title":"A Prospective Study on the Accuracy of Mucosally Supported Stereolithographic Surgical Guides in Fully Edentulous Maxillae","volume":"14","author":"Elaut","year":"2012","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_20","first-page":"116","article-title":"The Accuracy of Computer-Guided Implant Surgery with Mucosa-Supported Surgical Templates in the Edentulous Maxilla: A Systematic Review","volume":"25","author":"Tahmaseb","year":"2014","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_21","first-page":"53","article-title":"Consensus Statements and Recommended Clinical Procedures Regarding Computer-Assisted Implant Dentistry","volume":"24","author":"Jokstad","year":"2009","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S286","DOI":"10.1111\/jcpe.12957","article-title":"Peri-Implant Diseases and Conditions: Consensus Report of Workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions","volume":"45","author":"Berglundh","year":"2018","journal-title":"J. Clin. Periodontol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S246","DOI":"10.1111\/jcpe.12954","article-title":"Peri-Implantitis","volume":"45","author":"Schwarz","year":"2018","journal-title":"J. Clin. Periodontol."},{"key":"ref_24","first-page":"536","article-title":"Oral Implant Surfaces: Part 1\u2014Review Focusing on Topographic and Chemical Properties of Different Surfaces and In Vivo Responses to Them","volume":"17","author":"Albrektsson","year":"2004","journal-title":"Int. J. Prosthodont."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"De Bruyn, H., Pivovarova, M., Rondas, A., Scheldeman, M., Op de Laak, H., and Vandeweghe, S. (2025). Survival and Bone Remodeling in Hybrid Surface Dental Implants Placed with 3 Surgical Protocols up to 5 Years: A Retrospective Practice-Based Cohort Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217699"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4987526","DOI":"10.1155\/2016\/4987526","article-title":"Evaluation of Implant Collar Surfaces for Marginal Bone Loss: A Systematic Review and Meta-Analysis","volume":"2016","author":"Koodaryan","year":"2016","journal-title":"BioMed Res. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1111\/jcpe.14153","article-title":"Three-Year Outcomes of Dental Implants with a Hybrid Surface Macro-Design Placed in Patients with History of Periodontitis: A Randomised Clinical Trial","volume":"52","author":"Serrano","year":"2025","journal-title":"J. Clin. Periodontol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e70069","DOI":"10.1111\/cid.70069","article-title":"A 6-Year Randomized Controlled Trial on Different Implant Designs in Maxillary Overdenture Patients","volume":"27","author":"Matthijs","year":"2025","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_29","unstructured":"Offord, D., Kingsford, N., Glibert, M., Pitman, J., and Christiaens, V. (2025). Four-Year Outcomes of Immediately Loaded Full-Arch Maxillary Dental Implants with Hybrid Versus Roughened Surfaces: A Split-Mouth Randomized Controlled Trial. J. Clin. Med., 14."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"113","DOI":"10.11607\/prd.6264","article-title":"A Split-Mouth Study to Assess the Effect of Implant Surface Roughness on Implant Treatment Outcome After 5 Years","volume":"43","author":"Glibert","year":"2023","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Glibert, M., Matthys, C., Van Lancker, A., Segers, A., and De Bruyn, H. (2024). A Long-Term Split-Mouth Randomized Controlled Trial to Assess Implant Treatment Outcome Using Implants with a Different Surface Roughness. Appl. Sci., 14.","DOI":"10.3390\/app14041658"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1111\/j.1600-051X.2007.01118.x","article-title":"Reported Methodological Quality of Split-Mouth Studies","volume":"34","author":"Lesaffre","year":"2007","journal-title":"J. Clin. Periodontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1590\/1807-3107bor-2025.vol39.014","article-title":"Principles of Radiological Protection and Application of ALARA, ALADA, and ALADAIP: A Critical Review","volume":"39","author":"Estrela","year":"2025","journal-title":"Braz. Oral Res."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"van der Meulen, M.J., John, M.T., Naeije, M., and Lobbezoo, F. (2008). The Dutch Version of the Oral Health Impact Profile (OHIP-NL): Translation, Reliability and Construct Validity. BMC Oral Health, 8.","DOI":"10.1186\/1472-6831-8-11"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.tripleo.2006.11.034","article-title":"Flapless Implant Surgery: An Experimental Study","volume":"104","author":"Jeong","year":"2007","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_36","first-page":"271","article-title":"Flapless Implant Surgery: A 10-Year Clinical Retrospective Analysis","volume":"17","author":"Campelo","year":"2002","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_37","first-page":"601","article-title":"Flapless Dental Implant Surgery and Use of Cone Beam Computer Tomography Guided Surgery","volume":"224","author":"Comyn","year":"2018","journal-title":"Br. Dent. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.jdent.2015.03.003","article-title":"Smoking and Dental Implants: A Systematic Review and Meta-Analysis","volume":"43","author":"Chrcanovic","year":"2015","journal-title":"J. Dent."},{"key":"ref_39","first-page":"CD003878","article-title":"Interventions for Replacing Missing Teeth: Different Times for Loading Dental Implants","volume":"2013","author":"Esposito","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_40","first-page":"139","article-title":"\u201cAll-on-4\u201d Immediate-Function Concept for Completely Edentulous Maxillae: A Clinical Report on the Medium (3 Years) and Long-Term (5 Years) Outcomes","volume":"14","author":"Lopes","year":"2012","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_41","first-page":"S121","article-title":"Immediate\/Early Function of Br\u00e5nemark System TiUnite Implants in Fresh Extraction Sockets","volume":"7","author":"Rangert","year":"2005","journal-title":"Clin. Implant. Dent. Relat. Res."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/395\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:21:36Z","timestamp":1782901296000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":41,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["dj14070395"],"URL":"https:\/\/doi.org\/10.3390\/dj14070395","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}