In Vitro Effect of Modified Polyetheretherketone (PEEK) Implant Abutments on Human Gingival Epithelial Keratinocytes Migration and Proliferation

Multifunctional type lll recombinant human collagen incorporated sodium alginate hydrogel with sustained release of extra cellular vehicles for wound healing multimodal therapy in diabetic mice

The effective promotion of wound healing poses a substantial challenge for clinical treatment. Despite evidence supporting the role of extracellular vesicles (EVs) in this process, their therapeutic potential is currently restrict by challenges in targeting and maintaining them. The manufacturing process for rhCol III, or recombinant human collagen III, is stable, and the rejection rate is low. We used a cross-linking method to prepare a rhCol III incorporated sodium alginate (SA) hydrogel, which enabled to accomplish an EV sustained release that was site-specific. Cell viability through MTT assay, proliferation and ROS generation were performed with MC3T3-E1cell lines. In addition, diabetic wounds are characterised by an environment of hyper-inflammation and elevated oxidative stress. The rhCol III/SA-EVs hydrogel, which is a delivery vehicle with anti-inflammatory and antioxidant characteristics, promotes wound healing in this setting. The In vivo effectiveness of the created wound dressing on a diabetic wound model was examined in this study. After 21 days of treatment, the wound dressing significantly (p < 0.05) expedited wound healing compared to the control group, and wound closure was approximately 95% without any negative systemic reactions.

METTL3 promotes the progression of osteosarcoma through the N6-methyladenosine modification of MCAM via IGF2BP1

BACKGROUND

The molecular mechanisms of osteosarcoma (OS) are complex. In this study, we focused on the functions of melanoma cell adhesion molecule (MCAM), methyltransferase 3 (METTL3) and insulin like growth factor 2 mRNA binding protein 1 (IGF2BP1) in OS development.

METHODS

qRT-PCR assay and western blot assay were performed to determine mRNA and protein expression of MCAM, METTL3, IGF2BP1 and YY1. MTT assay and colony formation assay were conducted to assess cell proliferation. Cell apoptosis, invasion and migration were evaluated by flow cytometry analysis, transwell assay and wound-healing assay, respectively. Methylated RNA Immunoprecipitation (MeRIP), dual-luciferase reporter, Co-IP, RIP and ChIP assays were performed to analyze the relationships of MCAM, METTL3, IGF2BP1 and YY1. The functions of METTL3 and MCAM in tumor growth were explored through in vivo experiments.

RESULTS

MCAM was upregulated in OS, and MCAM overexpression promoted OS cell growth, invasion and migration and inhibited apoptosis. METTL3 and IGF2BP1 were demonstrated to mediate the m6A methylation of MCAM. Functionally, METTL3 or IGF2BP1 silencing inhibited OS cell progression, while MCAM overexpression ameliorated the effects. Transcription factor YY1 promoted the transcription level of METTL3 and regulated METTL3 expression in OS cells. Additionally, METTL3 deficiency suppressed tumor growth in vivo, while MCAM overexpression abated the effect.

CONCLUSION

YY1/METTL3/IGF2BP1/MCAM axis aggravated OS development, which might provide novel therapy targets for OS.

Fabrication of bFGF/polydopamine-loaded PEEK implants for improving soft tissue integration by upregulating Wnt/β-catenin signaling

The difficulties associated with polyetheretherketone (PEEK) implants and soft tissue integration for craniomaxillofacial bone repair have led to a series of complications that limit the clinical benefits. In this study, 3D printed multi-stage microporous PEEK implants coated with bFGF via polydopamine were fabricated to enhance PEEK implant-soft tissue integration. Multistage microporous PEEK scaffolds prepared by sulfonation of concentrated sulfuric acid were coated with polydopamine, and then used as templates for electrophoretic deposition of bFGF bioactive factors. Achieving polydopamine and bFGF sustained release, the composite PEEK scaffolds possessed good mechanical properties, hydrophilicity, protein adhesion properties. The in vitro results indicated that bFGF/polydopamine-loaded PEEK exhibited good biocompatibility to rabbit embryonic fibroblasts (REF) by promoting cell proliferation, adhesion, and migration. Ribonucleic acid sequencing (RNA-seq) revealed that bFGF/polydopamine-loaded PEEK implants significantly upregulated the expression of genes and proteins associated with soft tissue integration and activated Wnt/β-catenin signaling in biological processes, but related expression of genes and proteins was significantly downregulated when the Wnt/β-catenin signaling was inhibited. Furthermore, in vivo bFGF/polydopamine-loaded PEEK implants exhibited excellent performance in improving the growth and adhesion of the surrounding soft tissue. In summary, bFGF/polydopamine-loaded PEEK implants possess soft tissue integration properties by activating the Wnt/β-catenin signaling, which have a potential translational clinical application in the future.

Cytomorphometric and Clinical Changes in Gingival Tissue after Subgingival Tooth Preparation-A Pilot Study

Tooth preparation for a metal-ceramic crown with a subgingival finish line can lead to inflammatory changes in the gingival tissue, often accompanied by cell damage. This study aimed to evaluate the clinical signs of inflammation and the cytomorphological status of the gingival tissue before and after tooth preparation. The research included a homogeneous group of 19 patients with an indication for upper canine preparation. Before and after treatment, the gingival and the gingival bleeding indexes were determined, gingival swabs were taken, and direct smears prepared on slides for cytomorphometric analysis. The values of the measured gingival indexes were statistically significantly higher (p < 0.001) after tooth preparation. They decreased over time, which indicated the reversibility of the resulting changes. Cytological examination showed no statistically significant difference between the values of nuclear area, perimeter, Feret diameter, Feret angle, integrated optical density, MinFeret, and roundness, before and after the treatment. Significantly higher values of circularity, integrated optical density, MinFeret (p < 0.05), as well as roundness (p < 0.001) were found after 72 h, compared to those taken 15 min after tooth crown preparation. This study is a pioneering attempt to show gingival changes during fixed prosthodontic treatment and may shed new light on pathogenetic events in prosthodontic patients.

Influence of fabrication method on the biological properties of modified PEEK

To investigate the influence of fabrication method on the biological properties of modified PEEK. Two materials were tested in this study: press and CAD/CAM milled ceramic-reinforced PEEK (BioHPP, Bredent, Germany). The residual diphenyl sulfone in these two materials was detected and their biological effects on human gingival fibroblasts (HGFs) were evaluated by assaying cell viability, apoptosis, and inflammation. Diphenyl sulfone was not detected in press and milled BioHPP. The cell viability of them complied with ISO standards. The mRNA expression levels of Bax and Caspase-3 were up-regulated and that of Bcl-2 was downregulated when HGFs were cultured with the eluates of these two materials. There was no difference in cell viability, apoptosis, and inflammation between them. Hence, the fabrication method did not affect the biological properties of modified PEEK, the press and CAD/CAM milled modified PEEK all presented favorable cytocompatibility despite the expression of apoptosis-associated genes at the mRNA level.

A novel injectable hydrogel containing polyetheretherketone for bone regeneration in the craniofacial region

Polyetheretherketone (PEEK) is an organic material introduced as an alternative for titanium implants. Injectable hydrogels are the most promising approach for bone regeneration in the oral cavity to fill the defects with irregular shapes and contours conservatively. In the current study, injectable Aldehyde-cellulose nanocrystalline/silk fibroin (ADCNCs/SF) hydrogels containing PEEK were synthesized, and their bone regeneration capacity was evaluated. Structure, intermolecular interaction, and the reaction between the components were assessed in hydrogel structure. The cytocompatibility of the fabricated scaffolds was evaluated on human dental pulp stem cells (hDPSCs). Moreover, the osteoinduction capacity of ADCNCs/SF/PEEK hydrogels on hDPSCs was evaluated using Real-time PCR, Western blot, Alizarin red staining and ALP activity. Bone formation in critical-size defects in rats' cranial was assessed histologically and radiographically. The results confirmed the successful fabrication of the hydrogel and its osteogenic induction ability on hDPSCs. Furthermore, in in vivo phase, bone formation was significantly higher in ADCNCs/SF/PEEK group. Hence, the enhanced bone regeneration in response to PEEK-loaded hydrogels suggested its potential for regenerating bone loss in the craniofacial region, explicitly surrounding the dental implants.

Two Gingival Cell Lines Response to Different Dental Implant Abutment Materials: An In Vitro Study

Objectives: This study aimed to investigate the response of human gingival fibroblasts (HGFB) and human gingival keratinocytes (HGKC) towards different dental implant abutment materials. Methods: Five materials were investigated: (1) titanium (Ti), (2) titanium nitride (TiN), (3) cobalt-chromium (CoCr), (4) zirconia (ZrO2), and (5) modified polyether ether ketone (m-PEEK). Both cell lines were cultured, expanded, and seeded in accordance with the protocol of their supplier. Cell proliferation and cytotoxicity were evaluated at days 1, 3, 5, and 10 using colourimetric viability and cytotoxicity assays. Data were analysed via two-way ANOVA, one-way ANOVA, and Tukey’s post hoc test (p < 0.05 for all tests). Results: There was a statistically significant difference in cell proliferation of HGKC and HGFB cells in contact with different abutment materials at different time points, with no significant interaction between different materials. There was a significant effect on cell proliferation and cytotoxicity with different exposure times (p < 0.0001) for each material. Cell proliferation rates were comparable for both cell lines at the beginning of the study, however, HGFB showed higher proliferation rates for all materials at day 10 with better proliferation activities with ZrO and m-PEEK (40.27%) and (48.38%) respectively. HGKC showed significant interactions (p < 0.0001) in cytotoxicity between different materials. Conclusion: The present in vitro assessment investigated the biocompatibility of different abutment materials with soft tissue cells (HGFB and HGKC). The findings suggest that m-PEEK and TiN are biologically compatible materials with human cells that represent the soft tissue and can be considered as alternative implant abutment materials to Ti and ZrO2, especially when the aesthetic is of concern.

Strategically designed SPEEK nanofibrous scaffold with tailored delivery ofresveratrolfor skin wound regeneration

Electro-spinnable polymeric materials can easily form two-dimensional (2D) nanofibrous scaffolds improving biochemical functionalities specially in the area of skin wound healing and nanomedicine, but it has been hard to achieve this on a highly mechanically stable biopolymer, Poly ether ether ketone (PEEK), due to its intrinsic hydrophobicity and chemical inertness. Herein, we demonstrated a novel nanomedicine healing system consisting of sulphonated poly ether ether ketone combined withresveratrol(SPEEK+RSV), which could act as an effective 2D nano bio-materialin vitroandin vivo, without observable cytotoxicity. The fabricated nanocomposites exhibited enriched skin cell proliferation and adhesion as confirmed from the results of MTT, cell adhesion and live-dead assay. Results of SEM analysis showed a uniform nano-sized distribution with adequate pore size and porosity % facilitating a desired breathable environment at the wound site. The results of FT-IR, tensile studies and TGA analyses confirmed the presence of appropriate bonds and improved mechanical stability of theRSVincorporated nanofibrous scaffold. Results of anti-microbial analysis portrayed good potentiality of the fabricated nanofibers in treating wounds colonized with bacterial infections. Controlled drug release of resveratrol established the bio-compatibility of the nanofibers in skin wound regeneration.In vivoanalysis assessed in female Wistar rats enabled complete wound closure with 100 % wound contraction within 16 days. Results of histopathology analysis through H-E and MT staining presented the re-surfing of the wound environment with regeneration of epithelium, granulation tissue and collagen. Thus, the fabricated 2D nanofibrous scaffold incorporated with pharmaceutical RSV bio-medicine perceptively mimicked skin ECM convincingly aiding the progression of skin wound regeneration mechanism.

Efficacy of contemporary agents on disinfection and surface roughness of polyetheretherketone implant abutments

AIM

The present study was designed to estimate the disinfection and surface roughness (Ra) of colonized (E. coli, C. albicans, S.aureus, and S. mutans) PEEK implant abutment disinfected with PDT, chemical, and herbal agents.

MATERIAL AND METHODS

The American Type Culture Collection (ATCC) inoculated E.coli, C.albicans, S.mutans, and S.aureus in an in-vitro scenario using 60 PEEK implant abutment samples provided by the manufacturer. Following that, the samples were distributed in four disinfection methods categories - group 1: 5mM Rose Bengal PS (RB), group 2: ultrasonic disinfection (UD), group 3: 2% glutaraldehyde (GaH), and group 4: tea tree oil (TTO). To scrutinize the data and compare the means and standard deviations of CFU/mL (log10) for exposed E. coli, Candida albicans, S.aureus, and S.mutans, a two-way ANOVA and Tukey's multiple comparison test were performed.

RESULTS

Specimens treated with 2% GaH, UD, and TTO validated a significant reduction in E. coli, C. albicans, S aureus, and S. mutans CFU/mL (log10) colonies. Intragroup assessment designated that there is no reduction in CFU/mL (log10) of E.coli and C.albicans when PEEK implant abutment specimens are irradiated with 5Mm RB. A decline is seen in values of S. aureus, and S. mutans microbial strains on treatment with all four cleansers while the computation of C.albicans and E.coli colonies unveiled significant reduction with GaH, UD, and TTO except RB (p<0.05). The results of Ra showed that PEEK fabricated implant abutment specimens, when treated with UD (3.472±0.561μm), displayed a significantly higher Ra value as compared to other analyzed cleansing methods.

CONCLUSION

. Disinfection with 2% glutaraldehyde and Tea tree oil showed maximum antimicrobial efficacy and lower Ra values for PEEK implant abutments colonized with bacterial strains of E.coli, C.albicans, S.aureus, and S.mutans.

Evaluation of Zirconia and High Performance Polymer Abutment Surface Roughness and Stress Concentration for Implant-Supported Fixed Dental Prostheses

Background: The High Performance Polymer is a based polymer biomaterial that was introduced as dental material to manufacture dentures superstructure and dental implants abutments. However, its surface characteristics and stress state still need to be properly described. The aim of this study was to compare the surface characteristics of a High Performance Polymer (Bio-HPP, Bredent, Senden, Germany) for computer-aided design and computer-aided manufacturing (CAD/CAM) milling and a Zirconia (Zirkonzahn, Steger, Ahrntal, Italy). Methods: The abutments surface roughness (Ra) was evaluated for each abutment material (N = 12) using a confocal laser microscope. Data were evaluated using One-Way ANOVA and Tukey tests (p < 0.05). In addition, a finite element analysis software was used to present stress measurement data as stress maps with 100 N loading. Results were generated according to Von-mises stress criteria and stress peaks were recorded from each structure. Results: Results showed a mean Ra of 0.221 ± 0.09 μm for Bio-HPP and 1.075 ± 0.24 μm for Zirconia. Both surface profiles presented a smooth characteristic regardless the measurement axis. The stress peaks from implant fixture and screw were not affected by the abutment material, however the high performance polymer showed the highest stress magnitude for the abutment region. Conclusions: Comparing the present results with the literature it is suggested that the CAD/CAM High Performance Polymer abutments present an adequate surface roughness with acceptable values of stress.

Effect of anodized titanium abutment collars on peri-implant soft tissue: A split-mouth clinical study

STATEMENT OF PROBLEM

Anodic oxidation of titanium implant abutment collars has been used to mask their unesthetic grayish color. However, the effect of anodic oxidation on the health and appearance of peri-implant soft tissues is unclear.

PURPOSE

The purpose of this split-mouth clinical study was to investigate the effect of anodized titanium on the health and esthetics of peri-implant soft tissues.

MATERIAL AND METHODS

A total of 60 osseointegrated implants placed in 30 participants were included in the present study. Each participant received 2 randomly allocated abutments, one with a pink anodized collar and the other with an unanodized one to form 2 groups: unanodized group (control group) and anodized group (experimental group). All implants were restored with lithium disilicate restorations. Evaluations of the peri-implant soft tissues were performed at the time of definitive restoration insertion (baseline) and after 3, 6, 12, and 18 months: peri-implant probing depth, soft tissue recession, modified sulcus bleeding index, modified plaque index, and modified gingival index. The esthetics of peri-implant soft tissues were evaluated by using the modified pink esthetic score. The paired t test or Wilcoxon signed-rank test was used for comparing the 2 study groups at each point of time depending on the normality of the variables (α=.05). To compare each variable at different time points within each group separately, repeated measures ANOVA or Friedman tests were used according to the normality of the variables, followed by post hoc pairwise comparisons by using the Bonferroni adjusted significance (α=.05).

RESULTS

Five peri-implant soft tissue indices were followed up throughout the study. No statistically significant differences were found among the mean values of the tested indices in the anodized and unanodized groups throughout the evaluation periods (P>.05). The collective mean values of the modified pink esthetic score also showed no statistically significant differences between the groups (P>.05).

CONCLUSIONS

Based on this split-mouth clinical study, pink anodized titanium abutment collars do not produce a clinically significant effect on the health or esthetics of peri-implant soft tissues.

Sustainable Surface Modification of Polyetheretherketone (PEEK) Implants by Hydroxyapatite/Silica Coating-An In Vivo Animal Study

Polyetheretherketone (PEEK) has the potential to overcome some of the disadvantages of titanium interbody implants in anterior cervical and discectomy and fusion (ACDF). However, PEEK shows an inferior biological behavior regarding osseointegration and bioactivity. Therefore, the aim of the study was to create a bioactive surface coating on PEEK implants with a unique nanopore structure enabling the generation of a long-lasting interfacial composite layer between coating material and implant. Seventy-two PEEK implants-each thirty-six pure PEEK implants (PI) and thirty-six PEEK implants with a sprayed coating consisting of nanocrystalline hydroxyapatite (ncHA) embedded in a silica matrix and interfacial composite layer (SPI)-were inserted in the femoral condyles of adult rats using a split-side model. After 2, 4 and 8 weeks, the femur bones were harvested. Half of the femur bones were used in histological and histomorphometrical analyses. Additionally, pull-out tests were performed in the second half. Postoperative healing was uneventful for all animals, and no postoperative complications were observed. Considerable crestal and medullary bone remodeling could be found around all implants, with faster bone formation around the SPI and fewer regions with fibrous tissue barriers between implant and bone. Histomorphometrical analyses showed a higher bone to implant contact (BIC) in SPI after 4 and 8 weeks (p < 0.05). Pull-out tests revealed higher pull-out forces in SPI at all time points (p < 0.01). The presented findings demonstrate that a combination of a bioactive coating and the permanent chemical and structural modified interfacial composite layer can improve bone formation at the implant surface by creating a sustainable bone-implant interface. This might be a promising way to overcome the bioinert surface property of PEEK-based implants.

The Effect of Different Cleaning Protocols of Polymer-Based Prosthetic Materials on the Behavior of Human Gingival Fibroblasts

Dental implant abutment and prosthetic materials, their surface treatment, and cleaning modalities are important factors for the formation of a peri-implant soft tissue seal and long-term stability of bone around the implant. This study aimed to investigate the influence of a polymeric material surface cleaning method on the surface roughness, water contact angle, and human gingival fibroblasts (HGF) proliferation. Polymeric materials tested: two types of milled polymethylmethacrylate (PMMA-Ker and PMMA-Bre), three-dimensionally (3D) printed polymethylmethacrylate (PMMA-3D), polyetheretherketone (PEEK), and polyetherketoneketone (PEKK). Titanium (Ti) and zirconia oxide ceramics (ZrO-HT) were used as positive controls. A conventional surface cleaning protocol (CCP) was compared to a multi-step research cleaning method (RCP). Application of the RCP method allowed to reduce S_a values in all groups from 0.14-0.28 µm to 0.08-0.17 µm (p < 0.05 in PMMA-Ker and PEEK groups). Moreover, the water contact angle increased in all groups from 74-91° to 83-101° (p < 0.05 in the PEKK group), except ZrO-HT-it was reduced from 98.7 ± 4.5° to 69.9 ± 6.4° (p < 0.05). CCP resulted in higher variability of HGF viability after 48 and 72 h. RCP application led to higher HGF viability in PMMA-3D and PEKK groups after 48 h, but lower for the PMMA-Ker group (p < 0.05). After 72 h, no significant differences in HGF viability between both cleaning methods were observed. It can be concluded that the cleaning method of the polymeric materials affected surface roughness, contact angle, and HGF viability at 48 h.

Peri-implant soft tissue integration in humans - influence of materials: A study protocol for a randomised controlled trial and a pilot study results

Background

Recently, there has been a growing interest in mucointegration as the formation of an early and long-standing soft tissue barrier seems essential for both the initial healing and long-term implant survival.

Aim

To develop an experimental method to characterize the mucointegration of different transgingival materials (titanium (Ti), polyetheretherketone (PEEK), polymethylmethacrylate (PMMA), zirconia (Zi), polymer infiltrated ceramic network (PICN), cobalt-chrome (Co–Cr), and lithium disilicate (LD)) in a human model.

Methods

The study is designed as a multi-part randomized controlled clinical trial. Ninety bone level Straumann implants will randomly receive an experimental, custom-made abutment to allow for the removal of the abutment together with the surrounding soft tissues using a punch biopsy device at 8 weeks of healing (10 per material). The specimens will be further processed for non‐decalcified histology, followed by histomorphometric analysis. The same protocol will be used for additional 90 implants-abutments, but during harvesting, soft tissues will be separated from the abutment and processed for immunohistochemistry in order to study tissue inflammation and vascularization, while the abutments will undergo SEM analysis. Additionally, in vitro analyses, including SEM and profilometry, will be performed in order to characterize surface topography of all experimental materials.

Conclusion

The limited number of pilot samples presented herein indicate that the use of custom-made abutments in humans is a reproducible method to study peri-implant soft tissue integration. This further intensifies the rationale to compare different abutment materials, used as transgingival components in daily practice, under the same conditions.

Compromised Epithelial Cell Attachment after Polishing Titanium Surface and Its Restoration by UV Treatment

Titanium-based implant abutments and tissue bars are polished during the finalization. We hypothesized that polishing degrades the bioactivity of titanium, and, if this is the case, photofunctionalization-grade UV treatment can alleviate the adverse effect. Three groups of titanium disks were prepared; machined surface, polished surface and polished surface followed by UV treatment (polished/UV surface). Polishing was performed by the sequential use of greenstone and silicon rubber burs. UV treatment was performed using a UV device for 12 min. Hydrophobicity/hydrophilicity was examined by the contact angle of ddH₂O. The surface morphology and chemistry of titanium were examined by scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS), respectively. Human epithelium cells were seeded on titanium disks. The number of cells attached, the spreading behavior of cells and the retention on titanium surfaces were examined. The polished surfaces were smooth with only minor scratches, while the machined surfaces showed traces and metal flashes made by machine-turning. The polished surfaces showed a significantly increased percentage of surface carbon compared to machined surfaces. The carbon percentage on polished/UV surfaces was even lower than that on machined surfaces. A silicon element was detected on polished surfaces but not on polished/UV surfaces. Both machined and polished surfaces were hydrophobic, whereas polished/UV surfaces were hydrophilic. The number of attached cells after 24 h of incubation was 60% lower on polished surfaces than on machined surfaces. The number of attached cells on polished/UV surfaces was even higher than that on machined surfaces. The size and perimeter of cells, which was significantly reduced on polished surfaces, were fully restored on polished/UV surfaces. The number of cells remained adherent after mechanical detachment was reduced to half on polished surfaces compared to machined surfaces. The number of adherent cells on polished/UV surfaces was two times higher than on machined surfaces. In conclusion, polishing titanium causes chemical contamination, while smoothing its surface significantly compromised the attachment and retention of human epithelial cells. The UV treatment of polished titanium surfaces reversed these adverse effects and even outperformed the inherent bioactivity of the original titanium.

Hybrid Polyetheretherketone (PEEK)-Acrylic Resin Prostheses and the All-on-4 Concept: A Full-Arch Implant-Supported Fixed Solution with 3 Years of Follow-Up

Background: The aim of this three-year prospective study was to examine the outcome of a solution for full-arch rehabilitation through a fixed implant-supported hybrid prosthesis (polyetheretherketone (PEEK)-acrylic resin) used in conjunction with the All-on-4 concept. Methods: Thirty-seven patients (29 females, 8 males), with an age range of 38 to 78 years (average: 59.8 years) were rehabilitated with 49 full-arch implant-supported prostheses (12 maxillary rehabilitations, 13 mandibular rehabilitations and 12 bimaxillary rehabilitations). The primary outcome measure was prosthetic survival. Secondary outcome measures were marginal bone loss, plaque and bleeding scores, veneer adhesion issues, biological complications, mechanical complications, and the patients’ subjective evaluation. Results: There were two patients (maxillary rehabilitations) lost to follow-up, while one patient withdrew (maxillary rehabilitation). One patient with bimaxillary rehabilitation fractured the mandibular PEEK framework, rendering a 98% prosthetic survival rate. Implant survival was 100%. Average (standard deviation) marginal bone loss at 3-years was 0.40 mm (0.73 mm). Veneer adhesion was the only technical complication (n = 8 patients), resolved for all patients. Nine patients (n = 11 prostheses) experienced mechanical complications (all resolved): fracture of acrylic resin crowns (n = 3 patients), prosthetic and abutment screw loosening (n = 4 patients and 3 patients, respectively), abutment wearing (n = 1 patient). One patient experienced a biological complication (peri-implant pathology), resolved through non-surgical therapy. A 90% satisfaction rate was registered for the patients’ subjective evaluation. Conclusions: Based on the results, the three-year outcome suggests the proposed rehabilitation solution as a legitimate treatment option, providing a potential shock-absorbing alternative that could benefit the implant biological outcome.