Prevalence of early and late oral implant loss among smokers: a nationwide survey in Japan

A cross-sectional, nationwide survey was conducted in Japan to examine the relationship between tobacco smoking and oral diseases including implant failure. A questionnaire survey was sent to designated facilities by post, and 158 answered questions regarding implant loss. Smoking status, number of implant failures, and other related variables were collected from the participating dentists as secondary data. A total of 1966 patients who were treated with dental implants by participating dentists during the survey period were analysed. Among the total sample, 90 (5%) had early implant loss (≤12 months) and 153 (8%) had late implant loss (>12 months and ≤120 months). The number of pack-years was significantly higher in the total (early and late) implant loss group (31.2 ± 15.9) than in the group with no implant loss (26.1 ± 18.1) (P = 0.026). In the multivariate analysis, the number of implants installed, smoking, and pack-years were significant factors for total implant loss. The adjusted odds ratio for implant failure for current smokers compared with never smokers was 2.07 (95% CI 1.19–3.62) for early implant loss and 1.48 (95% CI 0.92–2.37) for late implant loss. This study reaffirms that current smoking is associated with an increased risk of early implant loss, irrespective of the duration of smoking exposure.     

Comparison between computer-guided and freehand dental implant placement surgery: A systematic review and meta-analysis

The purpose of this systematic review was to compare computer-guided (fully guided) and freehand implant placement surgery in terms of marginal bone loss, complications, and implant survival. This review followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42019135893). Two independent investigators performed the search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published up to April 2020 and identified 1508 references. After a detailed review, only four studies were considered eligible. These studies involved a total of 154 patients with 597 dental implants and a mean follow-up period of 2.25 years. There was no difference between computer-guided surgery and freehand surgery in terms of the marginal bone loss (mean difference ?0.11 mm, 95% confidence interval (CI) ?0.27 to 0.04 mm; P = 0.16), mechanical complications (risk ratio (RR) 0.85, 95% CI 0.36–2.04; P = 0.72), biological complications (RR 1.56, 95% CI 0.42–5.74; P = 0.51), and implant survival rate (RR 0.53, 95% CI 0.11–2.43; P = 0.41). This meta-analysis demonstrated that both computer-guided and freehand surgeries yielded similar results for marginal bone loss, mechanical and biological complications, and implant survival rate.     

Narrow-diameter implants versus regular-diameter implants for rehabilitation of the anterior region: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate studies comparing implant survival rates, marginal bone loss (MBL), and mechanical and biological complication rates between narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) used for oral rehabilitation in the anterior region. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases for studies published until May 2020. A total of 843 implants (484 NDIs and 359 RDIs) were included. No significant difference in implant survival rate (risk difference (RD) 0.01, 95% confidence interval (CI) ?0.01 to 0.03; P = 0.34), MBL (standardised mean difference ?0.51 mm, 95% CI ?1.29 to 0.26 mm; P = 0.19), mechanical complications (RD 0.01, 95% CI ?0.02 to 0.04; P = 0.40), or biological complications (RD 0.01, 95% CI ?0.09 to 0.11; P = 0.85) was found between the implant groups. Within the limitations of this study, it is concluded that NDIs are an effective alternative to RDIs due to similar survival rates, MBL, and mechanical and biological complication rates. However, future studies are highly encouraged due to the small number of interventional studies on this topic.     

Dental implants in patients with osteoporosis: a systematic review with meta-analysis

There is currently no consensus regarding the survival rate of osseointegrated implants in patients with osteoporosis. A systematic review with meta-analysis was performed to evaluate the survival rate of implants in such patients. The PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases were used to identify articles published up to September 2016. The systematic review was performed in accordance with PRISMA/PICO requirements and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk (RR) of implant failure and mean marginal bone loss were analyzed within a 95% confidence interval (CI). Fifteen studies involving 8859 patients and 29,798 implants were included. The main outcome of the meta-analysis indicated that there was no difference in implant survival rate between patients with and without osteoporosis, either at the implant level (RR 1.39, 95% CI 0.93–2.08; P = 0.11) or at the patient level (RR 0.98, 95% CI 0.50–1.89; P = 0.94). However, the meta-analysis for the secondary outcome revealed a significant difference in marginal bone loss around implants between patients with and without osteoporosis (0.18 mm, 95% CI 0.05–0.30, P = 0.005). Data heterogeneity was low. An increase in peri-implant bone loss was observed in the osteoporosis group. Randomized and controlled clinical studies should be conducted to analyze possible biases.     

Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis

No consensus has been reached regarding the influence of the flapless and open-flap surgical techniques on the placement of dental implants. This systematic review compared the effects of flapless implant placement and implant placement with elevation of the mucoperiosteal flap in terms of marginal bone loss, implant survival rate and complications rates. This review followed PRISMA guidelines and was registered in PROSPERO with the registration number CRD42017071475. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until December 2017. The search identified 559 references. After a detailed review, 24 studies were assessed for eligibility. A total of 1025 patients who had received a total of 1873 dental implants were included. There were no significant differences between the flapless and open-flap surgical techniques in terms of implant survival rates (P = 0.34; risk ratio (RR): 1.36; confidence interval (CI): 0.72–2.56), marginal bone loss (P = 0.23; MD: −0.20; CI: −0.52–0.13), or complication rates (P = 0.67; RR: 1.10; CI: 0.70–1.73). The current meta-analysis showed that the implant survival rate, marginal bone levels, and complications of flapless surgery were similar to those of open-flap surgery over a mean follow-up period of 21.62 months.     

Clinical viability of single implant-retained mandibular overdentures: a systematic review and meta-analysis

The aim of this meta-analysis was to verify the clinical viability of single implant-retained mandibular overdentures (SIMO). An electronic search of the PubMed and Cochrane databases was performed (end date July 2017); this was supplemented by a manual search of the literature. Only prospective clinical trials and randomized controlled trials (RCTs) that evaluated SIMO with a minimum follow-up of 12 months were included. The meta-analysis was based on the Mantel–Haenszel method. Dental implant and prosthetic failure were the dichotomous outcome measures; these were evaluated through the risk ratio (RR) and odds ratio (OR), with corresponding 95% confidence intervals (CI). Of 499 articles identified, nine fulfilled the inclusion criteria. A total of 205 implants were placed in patients with a mean age of 64.1 years; the cumulative survival rate was 96.6% over a mean follow-up period of 37.3 months. The procedure used (SIMO vs. two implant-retained mandibular overdenture) did not affect dental implant failure (P = 0.45) or prosthetic failure (P = 0.65): RR 1.06 (95% CI 0.91–1.23) and RR 0.88 (95% CI 0.51–1.51), respectively; OR 2.56 (95% CI 0.27–24.39; P = 0.41) and OR 0.44 (95% CI 0.15–1.26; P = 0.13), respectively. Within the limitations of this systematic review and meta-analysis, SIMO with a complete denture as the opposing arch may be considered an alternative treatment for completely edentulous patients. However, this study also confirmed the need for more RCTs on this topic.     

Osseointegration of fiber-reinforced composite implants: Histological and ultrastructural observations

ObjectivesThe aim of this study was to evaluate the bone tissue response to fiber-reinforced composite (FRC) in comparison with titanium (Ti) implants after 12 weeks of implantation in cancellous bone using histomorphometric and ultrastructural analysis.Materials and methodsThirty grit-blasted cylindrical FRC implants with BisGMA–TEGDMA polymer matrix were fabricated and divided into three groups: (1) 60 s light-cured FRC (FRC-L group), (2) 24 h polymerized FRC (FRC group), and (3) bioactive glass FRC (FRC–BAG group). Titanium implants were used as a control group. The surface analyses were performed with scanning electron microscopy and 3D SEM. The bone–implant contact (BIC) and bone area (BA) were determined using histomorphometry and SEM. Transmission electron microscopy (TEM) was performed on Focused Ion Beam prepared samples of the intact bone–implant interface.ResultsThe FRC, FRC–BAG and Ti implants were integrated into host bone. In contrast, FRC-L implants had a consistent fibrous capsule around the circumference of the entire implant separating the implant from direct bone contact. The highest values of BIC were obtained with FRC–BAG (58 ± 11%) and Ti implants (54 ± 13%), followed by FRC implants (48 ± 10%), but no significant differences in BIC or BA were observed (p = 0.07, p = 0.06, respectively). TEM images showed a direct contact between nanocrystalline hydroxyapatite of bone and both FRC and FRC–BAG surfaces.ConclusionFiber-reinforced composite implants are capable of establishing a close bone contact comparable with the osseointegration of titanium implants having similar surface roughness.     

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75–33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97–7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: ?4.33–9.90; p = 0.44), surgical site infection (95% CI: ?0.88–2.60; p = 0.33) and fistula formation (95% CI: ?3.81–3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I² = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.     

Risk factors associated with post-loading implant loss of removable and fixed implant-supported prostheses in edentulous jaws

Purpose

This study analyzed risk factors for post-loading implant loss in cases of implant-supported prostheses applied to edentulous jaws of Japanese patients.

Marginal bone loss one year after implantation: a systematic review of different loading protocols

The aim of this study was to analyse the influence of different loading protocols on marginal bone loss (MBL). The outcomes of different implant loading protocols were assessed at 1 year after implantation, with focus on MBL; protocols included immediate, immediate non-occlusal, early, and conventional loading. The search strategy resulted in 889 studies. Twenty-two of these studies fulfilled the inclusion criteria. Among the included studies, the lowest MBL was for immediately loaded implants (0.05 ± 0.67 mm) and the highest for immediate non-occlusally loaded implants (1.37 ± 0.5 mm). The results of the meta-analysis showed an estimated mean MBL of 0.457 mm (95% confidence interval (CI) 0.133–0.781) for immediate loading, 0.390 mm (95% CI 0.240–0.540) for immediate non-occlusal loading, 0.488 mm (95% CI 0.289–0.687) for early loading (>2 days to <3 months), and 0.852 mm (95% CI 0.429–1.275) for conventional loading (>3 months) implant protocols. The lowest decrease in 1-year implant survival per millimetre increase in MBL was observed for immediate loading and the highest for conventional loading. Conventional loading showed a significantly higher MBL than the other three loading protocols. This systematic review and meta-analysis indicates that the immediate loading protocol is a reasonable alternative to the conventional loading protocol.     

Long-term outcomes of craniofacial implants for the restoration of facial defects

The aim of this study was to evaluate the long-term survival of craniofacial implants and prostheses and to identify factors associated with failure in a cohort of patients. A 25-year retrospective analysis was conducted at Royal Melbourne Hospital. Data included demographic characteristics, age, site and cause of the deformity, and number and survival of implants. Odds ratios were calculated and event-to-time Kaplan–Meier analyses performed. One hundred and ten patients were included (341 implants); their mean age was 46.2 years. The overall implant survival rate was 79.5% (mean follow-up 10.6 years). Temporal implants had the highest success rate (97.0%), followed by nasal implants (87.5%) and orbital implants (63.3%); differences were statistically significant (P < 0.0001 and P = 0.033, respectively). Kaplan–Meier analyses to determine long-term implant and prosthesis survival found temporal implants had the highest prosthetic (P < 0.0001) and implant survival (P < 0.0001). Patients with congenital deformities demonstrated the highest success rate. Radiotherapy was found to increase the risk of implant failure (P = 0.02). Craniofacial implant-retained prostheses are a reliable and effective option for the restoration of facial defects, with good long-term success rates. Orbital implants and those placed post oncological surgery have a higher failure rate.     

Is there an association between the use of antidepressants and complications involving dental implants? A systematic review and meta-analysis

The aim of this systematic review was to evaluate published evidence on the association between the use of antidepressants and complications involving dental implants. Two reviewers independently performed electronic searches of the MEDLINE/PubMed, Cochrane Library, and Scopus databases for relevant articles published up to May 30, 2019. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Newcastle–Ottawa Scale was used for the appraisal of the methodological quality of the studies included. A meta-analysis was performed to determine the risk of dental implant failure in individuals taking antidepressants. Five comparative observational studies were selected for this review; these included a total of 2056 participants with 5302 implants. The results suggest a risk ratio of 3.73 (95% confidence interval 1.85–7.52, P = 0.0002) for implant failure in antidepressant users submitted to oral rehabilitation when compared to non-users. However, these studies did not present methodological rigour or standardize the drugs used. Thus, there is insufficient evidence for an association between antidepressant use and dental implant complications.     

Is buccolingual angulation of maxillary anterior implants associated with the crestal labial soft tissue thickness?

We aimed to examine the relationship between crestal labial soft tissue thickness (CLSTT, measured with a digital calliper at the crestal level of casts) and implant buccolingual angulation (IBLA). The records of 22 females and 10 males treated with two bone-level implants (3.3–4.6 mm) between the maxillary canines were evaluated. IBLA was recorded as cingulum, incisal, or labial based on the screw access hole position on provisional restorations. Postoperative implant labial bone thickness (ILBT) at the crestal (2 mm from crest) and mid-implant levels were measured on sectional cone beam computed tomography scans. The mean (SD) ridge width at the crestal level was 6.81 (0.98) mm. Mean (SD) CLSTT for implants with cingulum, incisal, and labial angulations were 2.98 (0.84), 2.24 (0.51), and 1.71 (0.72) mm, respectively. Significant differences were detected between CLSTT of implants with cingulum and incisal, as well as cingulum and labial angulations (P < 0.01). Of implants with cingulum, incisal, and labial angulations, 3.4%, 20%, and 53.3%, respectively, had a CLSTT < 2 mm. Overall, 74.2% of CLSTT variance could be predicted by IBLA and ILBT at the crestal and mid-implant levels. A significant association between CLSTT and IBLA was noted when ILBT (crestal level) was <2 mm (P < 0.01). Implants with labial angulations carry a higher risk of soft tissue complications when the crestal implant labial bone thickness is <2 mm.     

Texture analysis of cone beam computed tomography images reveals dental implant stability

The aim of this study was to characterize the alveolar bone of edentulous maxillary sites using texture analysis (TA) of cone beam computed tomography (CBCT) images and to correlate the results to the insertion torque, thus verifying whether TA is a predictive tool of final implant treatment. This study was conducted on patients who had received single implants in the maxilla (46 implants) 1 year earlier and whose torque values were properly recorded. Three cross-sections of the sites were selected on CBCT scans. Two regions of interest (ROIs) corresponding to the implant bone site and peri-implant bone were also outlined, according to virtual planning. The CBCT scans were exported to MaZda software, where the two ROIs were delimited following the previously demarcated contours. Values for the co-occurrence matrix were calculated for TA. With regard to the insertion torque value, there was a direct correlation with the contrast of the peri-implant bone (P < 0.001) and an inverse correlation with the entropy of the implant bone site (P = 0.006). A greater contrast indicates a greater torque value for insertion of the implants, and there is a possible association with a lower entropy value of the implant–bone interface.     

Clinical outcome and bone healing of implants placed with high insertion torque: 12-month results from a multicenter controlled cohort study

This study evaluated the clinical outcome and the crestal bone resorption of implants placed with high insertion torque (up to 80 N cm). 102 patients were treated with 156 tapered implants. 42 implants (control group) presented insertion torque between 30 and 45 N cm (mean = 37.4 SD 8.2). 114 implants (experimental group) were placed with insertion torque between 50 and 80 N cm (mean = 74.8 SD 7.9). All implants were early loaded after 2 months. Peri-implant marginal bone levels were assessed immediately after surgery, and at 6- and 12-month follow up examinations. At the 12-month follow up all implants were clinically stable. After 12 months, patients in the experimental group lost an average of 0.41 mm (CI 95% 0.522; 0.263) of crestal bone compared with 0.45 mm (CI 95% 0.561; 0.286) for those in the control group. There were no significant differences between the two groups. No direct or inverse relationship was observed between the insertion torque values and crestal bone resorption. The results show that the use of high insertion torque (up to 80 N cm) did not prevent osseointegration and did not increase bone resorption around tapered implants early loaded up to 1 year after implant placement.     

Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies

The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short dental implants (≤7 mm) versus vertical bone augmentation followed by regular dental implants (>7 mm) in the deficient posterior mandible. In total, eight RCTs (six using interpositional sandwich grafting and two using a guided bone regeneration technique) were reported in 17 articles at different time points. In the meta-analysis of the sandwich group, the relative risk (RR) for implant loss at 1 year was in favour of short implants (RR 0.41, P = 0.02), while no significant difference was found at 3 years (RR 0.65, P = 0.43), 5 years (RR 1.08, P = 0.86), or 8 years (RR 1.53, P = 0.52). The risk of complications was in favour of short implants (RR 0.34, P = 0.0002), as was the mean difference in marginal bone resorption after 1 year (−0.09 mm, P = 0.17), 3 years (−0.32 mm, P < 0.00001), 5 years (−0.65 mm, P < 0.00001), and 8 years (−0.88, P < 0.00001). The mean residual osseointegration length of the implants was between 2.94 mm and 4.44 mm in the short implants group and between 7.97 mm and 8.62 mm in the regular implants group after 5 years. In conclusion, in the deficient atrophic posterior mandible, short implants and regular implants demonstrate comparable outcomes within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.     

Short implants (≤6 mm) as an alternative treatment option to maxillary sinus lift

The aim of this systematic review was to evaluate survival rate of short dental implants placed in the posterior area of the maxilla. The electronic literature search of studies published between January 1, 2010 and February 29, 2020 was performed using specific word combinations. The outcome was to meta-analyse the implant survival rate (ISR). The search generated 238 potential studies. After screening procedures, only nine randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. ISR of short implants ranged from 91.9% to 100%, while standard-length implants ISR ranged from 82.9% to 100% with a follow-up from 1 to 5 years in function. The risk ratio difference was 1.24 (95% confidence interval: 0.63–2.45, P = 0.52) for short dental implants failure when compared with standard dental implants, and was not statistically significant. Based on the evidence of the included studies, short implants (≤6 mm) reported high survival rates over short to medium follow-up in posterior maxilla, but the long-term success is as yet not demonstrated.     

Three-dimensional measurement of radiographic bone–implant contact lengths of zygomatic implants in zygomatic bone: a retrospective study of 66 implants in 28 patients

Zygomatic implant treatment is widely applied for severe maxillary atrophy to help rehabilitate the maxillary dentition. This retrospective study was performed to evaluate the actual radiographic bone–implant contact (rBIC) lengths of zygomatic implants. The records of 28 patients who underwent zygomatic implant surgery and subsequent follow-up examinations between August 2013 and September 2018 in the Department of Oral and Maxillofacial Surgery, Taipei Tzu Chi Hospital were reviewed. The surgeries were performed by a single surgeon using the same treatment protocol. All patients had a computed tomography scan at 1 year after the surgery. Using three-dimensional imaging software, an investigator measured the rBIC lengths of 66 implants and documented their clinical status. The implant survival rate was 100%. The mean rBIC length was significantly longer in male patients than in female patients (20.80 ± 5.88 mm versus 17.79 ± 6.34 mm; P = 0.028). The mean rBIC length of double zygomatic implants was significantly longer when compared to that of single implants (21.11 ± 6.23 mm versus 17.75 ± 5.85 mm; P = 0.027). This article is novel in reporting the exact rBIC lengths of zygomatic implants in a clinical setting. The results showed that zygomatic implants are a viable treatment modality for full-mouth rehabilitation.     

Superficial versus deep system single venous anastomosis in the radial forearm free flap: a meta-analysis

The selection of the superficial or deep drainage system for use with the radial forearm free flap (RFFF) remains controversial. The aim of this study was to identify the optimal drainage system for single venous anastomosis. A systematic review and cumulative meta-analysis was performed to assess superficial and deep system single venous anastomosis for use with the RFFF in postoperative reconstruction of the head and neck. This study included 1073 flaps (495 superficial system-based flaps, 578 deep system-based flaps) reported in six studies. The outcomes assessed in the studies selected for this meta-analysis included venous compromise, flap failure, and the salvage success rate. Venous compromise was more common in the superficial system group (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.36–3.86, P = 0.002). The rate of successful salvage was higher with the superficial system (OR 8.19, 95% CI 1.75–38.3, P = 0.008). The rate of flap failure was lower in the superficial system group (OR 0.30, 95% CI 0.04–2.48, P = 0.27). Although the deep system showed a lower risk of venous compromise, the evidence provided by the meta-analysis was insufficient to determine which type of drainage system is more suitable for single venous anastomosis in RFFF. All included studies were cohort studies; therefore, findings must be interpreted with caution.     

Effects of anodized implants coated with Escherichia coli-derived rhBMP-2 in beagle dogs

This study evaluated the effects of Escherichia coli-derived rhBMP-2 (ErhBMP-2) coated onto anodized implants to stimulate bone formation, osseointegration and vertical bone growth in a vertical bone defect model. Six young adult beagle dogs were used. After a 2-month bone healing period, anodized titanium implants (8 mm in length) were placed 5.5 mm into the mandibular alveolar ridge. Eighteen implants coated with ErhBMP-2 (BMP group) and another 18 uncoated implants (control group) were installed using a randomized split-mouth design. The implant stability quotient (ISQ) values were measured. Specimens were fabricated for histometric analysis to evaluate osseointegration and bone formation. The ISQ values at 8 weeks after implant placement were significantly higher in the BMP group than in the control group (p < 0.05). Histological observations showed that the changes in bucco-lingual alveolar bone levels were higher in the BMP group than in the control group (p < 0.05). The ErhBMP-2 coated anodized implants can stimulate bone formation and increase implant stability significantly on completely healed alveolar ridges in dogs. Further studies evaluating the effects of ErhBMP-2 on osseointegration in the bone–implant interface are warranted.