Long-term retrospective evaluation of short implants in the posterior areas: clinical results after 10-12 years

Biomechanical analysis of different fixed dental restorations on short implants: a finite element study

OBJECTIVES

Although the use of short implants is becoming more common for patients with atrophic alveolar ridges, their use is still quite limited. This is due to the lack of data of long-term survival compared to standard-length implants. The aim of this study was to determine the load in the bone and implant system with different superstructures.

METHODS

Three kinds of prosthetic restorations were created on short implants based on CT-Data. Two short implants with different macro-geometries were used. The implants were inserted in idealised posterior lower mandibular segments and afterwards restored with a crown, a double splinted crown, and a bridge.

RESULTS

The analysis was performed under load of 300 N either divided between a mesial and distal point or as a point load on the pontic/mesial crown. The different design of the implant systems had a noticeable influence on the stress in the cortical bone, in the implant system, and the displacement of the superstructure as well.

CONCLUSIONS

Compared with implants of standard length, higher stresses were observed, which can lead early failure of the implant during the healing period or a late cervical bone resorption. Precise indications are essential for short implants to avoid the failure of short implants.

Implant-Supported Prostheses in the Edentulous Mandible: Biomechanical Analysis of Different Implant Configurations via Finite Element Analysis

This study explores the implant-supported prosthetic treatment alternatives of the edentulous mandible from a biomechanical point of view by means of a Finite Element Analysis (FEA). Finite element (FE) models were used to simulate cases treated with six, five, and four, implants and a fixed prosthesis with a cantilever. In the four implant treatments, three cases were analyzed; the posterior implants were placed in axial positions, angled at 30° and 45°. Cases with six and four axially placed implants were also analyzed by placing the posterior implants distally to the foramen, thus eliminating the cantilever in the prostheses. In the cases with implants between foramina, the highest values for the principal strains and von Mises stresses were observed in the case with four implants where the posterior implants were angled at 45°. Cases with implants placed distally to the foramen and without a cantilever showed much lower bone stress and strain levels compared to cases with implants between foramina. From a biomechanical point of view, it seems to be a better option to use implants positioned distally to the foramen, eliminating cantilevers.

1-Year Post-loading of Short and Ultrashort Implants in Posterior Mandibular and Maxillary Regions

BACKGROUND: Short implants have been proposed as an option for management of deficient alveolar ridges without the need for complex augmentation procedures. AIM: In this study, we aim to assess the use of short and ultrashort implants for the management of deficient alveolar ridges in posterior mandibular and maxillary areas with a 1-year post-loading follow-up. METHODOLOGY: Ten patients were recruited in this trial with a total of 14 implants to be placed. The patients all needed implants in the maxillary/mandibular posterior regions for prosthetic rehabilitation with deficient alveolar ridge heights. Implants of 5 mm diameter and lengths either 6 or 8.5 mm were to be placed in the edentulous spaces after proper radiographic assessment. Two-stage surgeries were followed with ¾ months between implant placement and loading. The follow-up lasted for a year to allow for peri-implant clinical assessment and radiographic analysis. RESULTS: All patients showed uneventful healing and no infection, wound dehiscence or inflammation was noted. Prosthetic rehabilitation was successful and satisfactory to the patients. None of the cases showed excessive marginal bone loss and stability was maintained at acceptable levels to the end of the follow-up period. CONCLUSION: Within the limitations of this study, short and ultrashort implants seem like a valid option for management of posterior edentulous regions with deficient ridge heights.

Single-crown restorations supported by short implants (6 mm) compared with standard-length implants (13 mm) in conjunction with maxillary sinus floor augmentation: a randomized, controlled clinical trial

BACKGROUND

The purpose of the present study was to test the H0-hypothesis of no difference in the clinical and radiographical treatment outcome of single-crown restorations supported by short implants compared with standard length implants in conjunction with maxillary sinus floor augmentation (MSFA) after 1 year of functional implant loading. Forty patients with partial edentulism in the posterior part of the maxilla were randomly allocated to treatment involving single-crown restorations supported by short implants or standard length implants in conjunction with MSFA. Clinical and radiographical evaluation were used to assess survival of suprastructures and implants, peri-implant marginal bone loss (PIMBL), biological, and mechanical complications.

RESULTS

Both treatment modalities were characterized by 100% survival of suprastructures and implants after 1 year. Mean PIMBL was 0.60 mm with short implants compared with 0.51 mm with standard length implants after 1 year of functional loading. There were no statistically significant differences in survival of suprastructure and implants, PIMBL, and mechanical complications between the two treatment modalities. However, a higher incidence of biological complications was associated with standard length implants in conjunction with MSFA.

CONCLUSION

Within the limitations of the present study, it can be concluded that single-crown restorations supported by short implants seems to be comparable with standard length implants in conjunction with MSFA. However, long-term studies are needed before final conclusions can be provided about the two treatment modalities.

TRIAL REGISTRATION

Clinicaltrials.Gov ID: NCT04518020 . Date of registration: August 14, 2020, retrospectively registered.

Comparative Analysis of Peri-Implant Bone Loss in Extra-Short, Short, and Conventional Implants. A 3-Year Retrospective Study

Objective: To evaluate the influence of implant length on marginal bone loss, comparing implants of 4 mm, 6 mm, and >8 mm, supporting two splinted crowns after 36-month functional loading. Materials and Methods: this retrospective clinical trial evaluated the peri-implant behavior of splinted crowns (two per case) on pairs of implants of the same length placed in the posterior maxilla (molar area). Implants were divided into three groups according to length (Group 1: extra-short 4 mm; Group 2: short 6 mm; Group 3: conventional length >8 mm). Marginal bone loss was analyzed using standardized periapical radiographs at the time of loading and 36 months later. Results: 24 patients (19 women and 5 men) were divided into three groups, eight rehabilitations per group, in the position of the maxillary first and second molars. The 48 Straumann^® Standard Plus (Regular Neck (RN)/Wide Neck (WN)) implants were examined after 36 months of functional loading. Statistical analysis found no significant differences in bone loss between the three groups (p = 0.421). No implant suffered biological complications or implant loss. Long implants were associated with less radiographic bone loss. Conclusions: extra-short (4 mm); short (6 mm); and conventional length (>8 mm) implants in the posterior maxilla present similar peri-implant bone loss and 100% survival rates in rehabilitation, by means of two splinted crowns after 36 months of functional loading. Implants placed in posterior positions present better bone loss results than implants placed in anterior positions, regardless of the interproximal area where bone loss is measured. Conventional length (>8 mm) implants show better behavior in terms of distal bone loss than short (6 mm) and extra-short (4 mm) implants.

Placement of Short Implants: A Viable Alternative?

The placement of short implants, which measure less than 10 mm in length, requires the practitioner to have a thorough comprehension of implant dentistry to achieve acceptable results. Innovation of the rough-surface implant and the progression of the implant-abutment interface from an external hex to an internal connection have considerably influenced the longevity of short implants. Dentists are better equipped to serve their patients because the utilization of short implants may preclude the need for advanced surgical bone-grafting procedures.

Biomechanical Behavior of Bioactive Material in Dental Implant: A Three-Dimensional Finite Element Analysis

Dental implants are widely accepted for the rehabilitation of missing teeth due to their aesthetic compliance, functional ability, and great survival rate. The various components in implant design like thread design, thread angle, pitch, and material used for manufacturing play a critical role in its success. Understanding these influencing factors and implementing them properly in implant design can reduce cases of potential implant failure. Recently, finite element analysis (FEA) is being widely used in the field of health sciences to solve problems in designing medical devices. It provides valid and accurate assessment in the clinical and in vitro analysis. Hence, this study was conducted to evaluate the impact of thread design of the implant and 3 different bioactive materials, titanium alloy, graphene, and reduced graphene oxide (rGO) on stress, strain, and deformation in the implant system using FEA. In this study, the FEA model of the bones and the tissues are modeled as homogeneous, isotropic, and linearly elastic material with a titanium implant system with an assumption of it 100% osseointegrated into the bone. The titanium was functionalized with graphene and graphene oxide. A modeling software tool Catia® and Ansys Workbench® is used to perform the analysis and evaluate the von Mises stress distribution, strain, and deformation at the implant and implant-cortical bone interface. The results showed that the titanium implant with a surface coating of graphene oxide exhibited better mechanical behavior than graphene, with mean von Mises stress of 39.64 MPa in pitch 1, 23.65 MPa in pitch 2, and 37.23 MPa in pitch 3. It also revealed that functionalizing the titanium implant will help in reducing the stress at the implant system. Overall, the study emphasizes the use of FEA analysis methods in solving various biomechanical issues about medical and dental devices, which can further open up for invivo study and their practical uses.

Prosthetic Rehabilitation of the Posterior Atrophic Maxilla, Short (≤6 mm) or Long (≥10 mm) Dental Implants? A Systematic Review, Meta-analysis, and Trial Sequential Analysis: Naples Consensus Report Working Group A

PURPOSE

To compare the clinical and patient-reported outcomes of ≤6-mm implants with those of ≥10-mm implants placed after both lateral and transcrestal sinus floor elevation.

MATERIALS AND METHODS

Using PubMed (MEDLINE), EMBASE, and Cochrane, a literature search for randomized controlled trials was performed. All the outcome variables were evaluated through a quantitative meta-analysis, and the influence of other clinical covariates were determined with a metaregression. For the survival outcomes, trial sequential analysis (TSA) was performed to adjust results for type I and II errors and to analyze the power of the available evidence.

RESULTS

After full-text reading, 12 studies were included in the analyses. No statistically significant difference was found after 3 years between the 2 study groups (P = 0.36). Short implants displayed fewer biological complications (P = 0.05), less marginal bone loss (MBL) from implant placement (P < 0.01), and reduced surgical time and treatment cost. However, long implants showed a statistically significant smaller number of prosthetic complications (P = 0.03). TSA confirmed the results of the meta-analysis, revealing that additional studies are needed due to low statistical power of the available evidence.

CONCLUSION

The placement of short implants is a predictable option in treating patients with maxillary atrophy up to a 3-year follow-up. Studies with a longer observational period are needed to study the long-term performance of these implants.

Fifteen-Year Follow-up of Short Dental Implants in the Completely Edentulous Jaw: Submerged Versus Nonsubmerged Healing

PURPOSE

Short implants are a minimally invasive alternative in the management of alveolar bone atrophy. This study aimed to assess the influence of the surgical approach (1-stage vs 2-stage) on the 15-year survival and marginal bone loss of short implants in a fixed complete denture.

MATERIALS AND METHODS

A retrospective clinical study was conducted in a single private dental clinic that included short implants placed between January 2001 and December 2002.

RESULTS

Forty-one short implants supported 18 screw-retained complete dentures. The mean follow-up time was 15 ± 3 years. The surgical approach (1-stage vs 2-stage) did not significantly affect implant survival and marginal bone loss. The implant survival rate was 90.2%.

CONCLUSIONS

Short dental implants could be predictably indicated to support fixed complete dentures. The implants could be placed through a 1- or 2-stage surgery.

Evaluation of peri-implant condition in periodontally compromised patients

Aims:

The aim of the study is to evaluate the profile of peri-implant tissues in periodontally compromised patients.

Settings and Design:

In vivo – cross sectional study design.

Materials and Methods:

Fifty-eight implants were evaluated, clinically and radiographically, installed in seven individuals treated by the same team of professionals, during the years 1997 and 2005 in a private dental clinic in Vitória, ES, Brazil; that time of data collection, all implants were at least 10 years of functional loading. The variables related to the dental implants evaluated were: visible Plaque Index, Gingival Bleeding Index (GBI), probing pocket depth, bleeding on probing, and bone level, to relate them to the classification of dental implants.

Statistical Analysis Used:

The Chi-square and Kruskal–Wallis test were adopted.

Results:

The total of 58 implants were classified: 11 (18.9%) as healthy and 12 (20.7%) as clinically stable. The other 35 implants (60.4%) had some type of peri-implant inflammation, 20 of them (34.5%) were diagnosed with peri-implant mucositis and 15 (25.9%) with peri-implantitis. Among the variables studied, the results showed statistically significant differences for implant location (P = 0.001) and GBI (P = 0.03). Most of the maxillary implants (85.7%) were classified for some type of peri-implant disease. For the implants which resulted in Score 1 for GBI, most of them (75.0%) were also classified for some type of peri-implant disease.

Conclusions:

Dental implants placed in periodontally compromised patients may have high long-term survival rates. However, most implants were classified with some type of peri-implant inflammation.

How do peri-implant biologic parameters correspond with implant survival and peri-implantitis? A critical review

Objectives

The aim of this critical review was to evaluate whether commonly used biologic diagnostic parameters correspond to implant survival and peri‐implantitis prevalence.

Materials and methods

Publications from 2011 to 2017 were selected by an electronic search using the Pubmed database of the US National Library of Medicine. Prospective and retrospective studies with a mean follow‐up time of at least 5 years and reporting prevalence of peri‐implantitis as well as mean bone loss and standard deviation were selected. The correlation between reported prevalence of peri‐implantitis and reported implant survival, mean follow‐up time, mean bone loss, mean probing depth, and mean bleeding on probing was calculated. Mean bone loss and standard deviation were used for estimation of proportion of implants with bone loss exceeding 1, 2, and 3 mm.

Results

Full‐text analysis was performed for 255 papers from 4,173 available ones, and 41 met all the inclusion criteria. The overall mean weighted survival rate was 96.9% (89.9%–100%) and the reported prevalence of peri‐implantitis ranged between 0% and 39.7%, based on 15 different case definitions. The overall weighted bone loss was 1.1 mm based on 8,182 implants and an average mean loading time ranging from 5 to 20 years. No correlation was found between mean bone loss and the reported prevalence of peri‐implantitis. The estimated prevalence of implants with bone loss above 2 mm was 23%. The overall weighted mean probing depth was 3.3 mm, and mean weighted bleeding was 52.2%. Only a weak correlation was found between survival and function time (r = −0.49). There was no relation between the probing depth or bleeding and the mean bone loss, mean follow‐up time, and reported prevalence of peri‐implantitis.

Conclusion

Biologic parameters mean probing depth and mean bleeding on probing do not correlate with mean bone loss and this irrespective of follow‐up. Case definition for peri‐implantitis varied significantly between studies indicating that an unambiguous definition based on a specified threshold for bone loss is not agreed upon in the literature.

Implantes extracortos en mandíbulas con extrema reabsorción vertical: serie de casos

Introducción: el uso de los implantes extracortos permite la rehabilitación de extremas reabsorciones. Esto obliga en ocasiones a la utilización de prótesis sobre los mismos con una proporción corona-implante desfavorable llegando a ratios de 2:1 o de 3:1 en los casos más extremos. Materiales y métodos: se realizó un análisis de casos clínicos donde se insertaron implantes extracortos con un reborde residual (menor o igual a 5,5mm) y tiempo de carga mínimo de seis meses. Se realizó una prueba de chi-cuadrado para las variables categóricas y una t de Student para las variables continuas. Posteriormente, se realizaron modelos de regresión lineal ajustados. Resultados: fueron reclutados seis casos a los que se les insertaron implantes extracortos. El 21,2% de los pacientes incluidos en el estudio fueron hombres y el 78,8% mujeres, con una edad media de 57 años. La proporción corona-implante medio fue de 3,19 (+/- 0,24). La media de la pérdida ósea mesial de los implantes estudiados fue de 0,86mm (+/- 0,33) y la media de la pérdida ósea prodistal fue de 0,83mm (+/- 0,47). Cuando se analizó la pérdida ósea mesial y distal en función proporción no se encontraron diferencias estadísticamente significativas (p=0,224). Conclusiones: el uso de implantes extracortos no es un factor de riesgo para la pérdida ósea crestal o para el fracaso de la prótesis o del implante según los datos aportados por este estudio aun cuando la proporción corona-implante sea superior a tres.

[Implant surgery in partially edentulous patients with alveolar bone deficiency]

The article presents the analysis of possible options of dental implant surgical treatment of partially edentulous patients with insufficient alveolar bone volume in the period from 2008 to 2017 (n=1004). Highlighted are three main options for surgical treatment: a staged approach, including alveolar ridge augmentation, subsequent dental implantation (n=562); dental implantation with simultaneous alveolar ridge augmentation (n=362); using of 'narrow/short' dental implants (n=80). The data on the frequency of intra - and postoperative complications before prosthetics are given. Over the past period, there has been a declining tendency in the number of staged procedures with an increase in the number of simultaneous operations installations of 'narrow/short' implants.

Relationship Between Crestal Bone Levels and Crown-to-Implant Ratio of Ultra-Short Implants With a Microrough Surface: A Prospective Study With 48 Months of Follow-Up

The aim of this cohort study was to investigate the relationship between crestal bone levels and crown-to-implant ratio of ultra-short implants, after functional loading. Sixty patients with single or partial edentulism and alveolar bone atrophy were enrolled and treated between December 2009 and January 2016. Without using bone-grafting procedures, patients were rehabilitated with ultra-short implants characterized by a microrough surface and a 6-mm length. Clinical and anatomical crown-to-implant (C/I) ratios and crestal bone levels (CBL) were measured after a follow-up period ranging from 12 to 72 months; all peri-implant and prosthetic parameters were recorded. The data collected were statistically analyzed ( P = .05). A total of 47 patients with 66 ultra-short implants were completely followed up according to described protocol. The mean follow-up was 48.5 ± 19.1 months. The mean anatomical C/I ratio was 2.2, while the mean clinical C/I ratio was 2.6 ± 0.6 at baseline and 2.8 ± 0.6 at the last follow-up appointment. Mean CBL as calculated at the baseline was 0.7 ± 0.5 mm, while at the last appointment it measured 1.0 ± 0.5 mm. The overall implant-based success rate was 96.9%, and the mean peri-implant bone loss (PBL) was 0.3 ± 0.3 mm. No statistically significant relationship was found between anatomical or clinical C/I ratio and PBL. Ultra-short implants appear to offer a predictable solution for implant-prosthetic rehabilitation in patients with edentulism and bone atrophy. A high percentage of implants were successful, with minimal crestal bone loss. The high C/I ratio did not appear to influence either peri-implant bone loss or prosthetic complication rates.

Minimally Invasive Approach Based on Pterygoid and Short Implants for Rehabilitation of an Extremely Atrophic Maxilla: Case Report

INTRODUCTION

Extremely atrophic maxillae can be considered the most important indication for three-dimensional maxillary reconstruction. Different bone-augmentation techniques have been suggested to accomplish this. This article illustrates a minimally invasive approach to rehabilitation of the extremely atrophic maxilla.

MATERIAL AND METHODS

A 63-year-old male patient was referred for restoration of his totally edentulous maxilla with a fixed full-arch implant-prosthetic rehabilitation. Four short implants in the premaxillary region and 2 longer implants in the pterygomaxillary regions were inserted with piezoelectric implant site preparation.

DISCUSSION

At the 1-year follow-up appointment, no clinical or radiographic changes in the soft-tissue contours or crestal bone levels were observed.

CONCLUSION

This surgical approach, based on the combination of short implants in the premaxillary regions and pterygoid implants in the pterygomaxillary regions, represents a way to shorten treatment timing, minimize the risk of surgical complications, and reduce patient discomfort and costs.

Clinical and Radiographic Evaluation of Short Implants Placed in the Posterior Mandible: A 1-Year Pilot Split-Mouth Study

In many cases, due to anatomical limitations, the placement of regular-length implants cannot be facilitated without the performance of advanced surgical procedures. However, these are associated with morbidity, prolonged treatment time, and costs. To overcome such disadvantages, short implants were introduced. The aim of this prospective pilot split-mouth study was to compare the clinical outcome between short implants (7 mm) and regular-length (≥10 mm) implants placed in the posterior mandible after 1 year of prosthetic delivery. Ten patients received 4 implants in the posterior mandible. Two short implants were placed in one side and 2 regular-length implants were placed contralaterally. These were restored by means of splinted screw-retained metal-ceramic crowns. Marginal bone loss (MBL) and soft-tissue parameters were compared. No implant failed. Both types of implants showed success rates of 90% and survival rates of 100%. From prosthetic delivery to 1 year post-loading a bone gain of +0.29 mm for short implants and +0.19 mm for regular-length implants was present without showing any statistically significant differences in MBL between the 2 implant types ( P > .05). Bleeding on probing, clinical attachment level, probing depth, and crown-to-implant ratio did not show any statistically significant differences between the 2 implant lengths ( P > .05). One case of chipping occurred in the regular-length implant group, leading to a prosthetic survival rate of 95%. Short implants showed a prosthetic survival rate of 100%. After 1 year, short implants showed comparable clinical outcomes to that of regular-length implants, making them a viable treatment option in the posterior mandible.

Transalveolar Osteotomy of the Mandibular Canal Wall for the Treatment of Severely Atrophied Posterior Mandible

PURPOSE

Treatment of severe bone atrophy of the posterior mandible requires an advanced surgical bone augmentation technique. This report describes a minimally invasive approach for a residual alveolar height less than 5 mm.

MATERIAL AND METHODS

A retrospective case series was conducted in a single private dental clinic. Outcome variables were dental implant survival rate, intraoperative complications, occurrence of neurosensory disturbances, and marginal bone loss. Descriptive analysis was performed for patients' demographic data, postoperative healing, and implant details. Kaplan-Meier method was used to assess the implant survival rate.

RESULTS

The mean age of the 19 patients was 60 ± 13 years. Twenty-eight implants (5.5 mm long) were placed in a residual alveolar bone height of 4.5 ± 0.6 mm. The implant survival rate was 96% at 5-year follow-up.

CONCLUSIONS

Extra-short implants and transalveolar preparation of the inferior alveolar cortical bone could be a safe and effective treatment of severe mandibular atrophy.

Long-Term Effect of Surface Roughness and Patients' Factors on Crestal Bone Loss at Dental Implants. A Systematic Review and Meta-Analysis

Publications from 2011 to 2015 were selected to evaluate effect of implant surface roughness on long-term bone loss as surrogate for peri-implantitis risk. 87 out of 2,566 papers reported the mean bone loss after at least 5 years of function. Estimation of the proportion of implants with bone loss above 1, 2, and 3 mm as well as analysis the effect of implant surface roughness, smoking, and history of periodontitis was performed. By means of the provided statistical information of bone loss (mean and standard deviation) the prevalence of implants with bone loss ranging from 1 to 3 mm was estimated. The bone loss was used as a surrogate parameter for "peri-implantitis" given the fact that "peri-implantitis" prevalence was not reported in most studies or when reported, the diagnostic criteria were unclear or of dubious quality. The outcome of this review suggests that peri-implant bone loss around minimally rough implant systems was statistically significant less in comparison to the moderately rough and rough implant systems. No statistically significant difference was observed between moderately rough and rough implant systems. The studies that compared implants with comparable design and different surface roughness, showed less average peri-implant bone loss around the less rough surfaces in the meta-analysis. However, due to the heterogeneity of the papers and the multifactorial cause for bone loss, the impact of surface roughness alone seems rather limited and of minimal clinical importance. Irrespective of surface topography or implant brand, the average weighted implant survival rate was 97.3% after 5 years or more of loading. If considering 3 mm bone loss after at least 5 years to represent the presence of "peri-implantitis," less than 5% of the implants were affected. The meta-analysis indicated that periodontal history and smoking habits yielded more bone loss.

Predictability of short implants ( < 10 mm) as a treatment option for the rehabilitation of atrophic maxillae. A systematic review

BACKGROUND

Short implants (< 10 mm) are one of the treatment options available in cases of limited vertical bone. Although such implants are now widely used, there is controversy regarding their clinical reliability. The purpose of this paper is to evaluate the predictability of short implants as an alternative to technically more complex treatments in patients with atrophic maxillae, based on a systematic review of the literature and the analysis of the implant survival rates, changes in peri-implant bone level, and associated complications. It is postulated that short implants offer clinical results similar to those of longer implants.

MATERIAL AND METHODS

A Medline-PubMed search was made covering the period between January 2004 and December 2014 (both included). Studies in English published in indexed journals, involving at least 20 implants and with a follow-up period of at least 12 months were considered. A manual search in four high impact journals was also conducted.

RESULTS

A total of 37 studies meeting the inclusion criteria were included in this review. 9792 implants placed in over 5000 patients were analyzed.

CONCLUSIONS

Based on the results of this review, short implants are seen to offer clinical results in terms of survival, bone loss and complications similar to those of longer implants.

Evaluation of extrashort 4-mm implants in mandibular edentulous patients with reduced bone height in comparison with standard implants: a 12-month results

OBJECTIVE

The aim of this research was to evaluate the primary stability, the marginal bone loss, the survival, and the success criteria, of 4-mm-length implants compared with implants of conventional length supporting fixed prostheses.

MATERIALS AND METHODS

Ten patients were selected for treatment of their atrophic edentulous jaws. Each patient received the following treatment: six dental implants were inserted, two anterior implants of conventional length (10-mm) in the interforaminal area and four posterior short implants of 4-mm length (Standard Plus, Roxolid, SLActive, Institut Straumann AG). The implants supported screw-retained fixed complete dentures. Examinations were conducted at day 0, three, six, and twelve months after surgery for the evaluation of the implant primary stability, secondary stability, crestal bone loss and survival by clinical evaluations, insertion torque values, resonance frequency analysis (RFA), and periapical radiography, respectively.

RESULTS

Sixty implants were inserted in ten patients. Mean insertion torque was slightly lower for 4-mm implants than 10-mm implants (38.1 Ncm vs. 42.2 Ncm) but without statistically significant difference. Implant stability was similar for extrashort and conventional implants. Marginal bone loss was similar for both groups for all the time periods. One short implant was lost before loading. The survival rates twelve months after implant placement were of 97.5% and 100% for short and conventional implants, respectively. Similarly, implant stability as measured by RFA was nonsignificantly lower for the 4-mm implants compared to the 10-mm implants. The marginal bone loss was lower for short implants three, six, and twelve months after the surgery without statistical significant difference.

CONCLUSIONS

Within the limitations of this study, we conclude that short dental implants (8 mm or less in length) supporting single crowns or fixed bridges are a feasible treatment option with radiographic and clinical success rates similar to longer implants for patients with compromised ridges. Long-term data with larger number of implants and subjects are needed to confirm these preliminary results.

Long-term outcome of transosteotomy bone augmentation of the inferior border of the severely resorbed mandible

We report a case of severe mandibular atrophy with residual crest height as short as 4.3 mm anterior to the mental foramens. The patient was reluctant to accept bone augmentation surgery and that was the motivation to perform transosteotomy bone augmentation of the inferior border of the mandible and the insertion of 4 short implants anterior to the mental foramens. The insertion torque of the 4 implants was about 65 N·cm, which allowed for the application of immediate loading protocol. Detailed follow-up during 8 years showed uneventful healing and successful prosthetic rehabilitation with screw-retained prostheses.

Short implants: are they a viable option in implant dentistry?

Short-length implants (<10 mm) can be used effectively in atrophic maxillae or mandibles even with crown/implant ratios that previously would have been considered excessive. Short implants can support either single or multiple units and can be used for fixed prostheses or overdentures. The use of short-length implants may avoid the need for complicated bone augmentation procedures, thus allowing patients who were either unwilling or unable for financial or medical reasons to undergo these advanced grafting techniques to be adequately treated.

Clinical study on survival rate of short implants placed in the posterior mandibular region: resonance frequency analysis

OBJECTIVE

Short implants are increasingly used, but there is doubt about their performance being similar to that of regular implants. The aim of this study was to compare the mechanical stability of short implants vs. regular implants placed in the edentulous posterior mandible.

MATERIAL AND METHODS

Twenty-three patients received a total of 48 short implants (5 × 5.5 mm and 5 × 7 mm) and 42 regular implants (4 × 10 mm and 4 × 11.5 mm) in the posterior mandible. Patients who received short implants had <10 mm of bone height measured from the bone crest to the outer wall of the mandibular canal. Resonance frequency analysis (RFA) was performed at time intervals T0 (immediately after implant placement), T1 (after 15 days), T2 (after 30 days), T3 (after 60 days), and T4 (after 90 days).

RESULTS

The survival rate after 90 days was 87.5% for the short implants and 100% for regular implants (P < 0.05). There was no significant difference between the implants in time intervals T1, T2, T3, and T4. In T0, the RFA values of 5 × 5.5 implants were higher than values of 5 × 7 and 4 × 11.5 implants (P < 0.05). A total of six short implants that were placed in four patients were lost (three of 5 × 5.5 mm and three of 5 × 7 mm). Three lost implants started with high ISQ values, which progressively decreased. The other three lost implants started with a slightly lower ISQ value, which rose and then began to fall.

CONCLUSIONS

Survival rate of short implants after 90 days was lower than that of regular implants. However, short implants may be considered a reasonable alternative for rehabilitation of severely resorbed mandibles with reduced height, to avoid performing bone reconstruction before implant placement. Patients need to be aware of the reduced survival rate compared with regular implants before implant placement to avoid disappointments.