A naïve comparison to assess the success of ultra-short implants.

Introduction: Conventional implants are associated with ridge augmentation/sinus lift procedures in vertically insufficient ridges, which increase morbidity and healing time. Short implants provided some hope in this context. The present study considered the use of ultra-short implants in vertically insufficient posterior mandibular ridges and evaluated their success. Hence, study was done to evaluate the success of ultra-short implants in partially edentulous posterior mandible clinically and radiographically. Materials and Methods: The study is a "Naïve direct comparison" of ultra-short implants to conventional implants for assessing their success in vertically insufficient posterior mandibular ridges. A total of 10 ultra-short implants were placed in a partially edentulous posterior mandibular ridge with at least 8-mm horizontal (at crest) and vertical dimensions. A delayed loading was done at three-month follow-up. Data acquisition was done at baseline (immediately after loading), 6-, 9-, 12-month intervals. Parameters assessed were marginal bone loss (MBL), probing pocket depth reduction (PPDR), modified plaque index (mPI), modified gingival index (mGI). Results: All the placed 10 implants survived, and no failure was observed. "Independent sample t-test" and "paired sample t-test" was done for intergroup and intragroup analysis, respectively. Intergroup comparison between the ultra-short and conventional implants presented a statistically insignificant difference between all the parameters at all the follow-up visits (baseline, 6-, 9-, 12 months). Conclusions: Within the limitations, it was thus concluded that ultra-short implants may be considered as a viable treatment option for vertically insufficient mandibular ridge. Further, long-term randomized controlled trials are required to establish the evidence.

Outcomes of treatment with short dental implants compared with standard-length implants: a retrospective clinical study.

BACKGROUND: The size of dental implants is a key success factor for appropriate osseointegration. Using shorter implants allows the possibility of avoiding complex surgical procedures and reduces the morbidity of treatment. Shorter implants also enable implant-prosthetic rehabilitation after maxillofacial reconstructions where only limited bone is available. In this study, the success rates of short implants were examined and compared to those of standard-sized implants. METHODS: Patients who received dental implants between 2007 and 2016 at the Department of Oro-Maxillofacial Surgery and Stomatology Semmelweis University were enrolled in the study. Several clinical parameters were recorded and supplemented with radiological examinations. The data were statistically analysed. RESULTS: Thirty-four patients with a total of 60 implants were included. The average time after prosthetic loading was 39.33 ± 21.96 months in the group with 8-mm implants and 41.6 ± 27.5 months in the group with > 8-mm implants. No significant differences were observed between the two groups in terms of probing depth (short implants, 2.84 ± 0.09 mm; standard implants, 2.91 ± 0.35 mm) or mean marginal bone loss (short implants, 1.2 ± 1.21-mm mesially and 1.36 ± 1.47-mm distally; standard implants: 0.63 ± 0.80-mm mesially and 0.78 ± 0.70-mm distally). CONCLUSIONS: In this study, the success rate of short dental implants was comparable to that of standard-sized implants. Consequently, it can be claimed that the long-term success of short dental implants does not differ significantly from the long-term success of standard implants.

Analysis of ultra-short implants with different angulations: a retrospective case-control study with 2 to 9 years of follow-up.

OBJECTIVES: Does the angulation of ultrashort implants influence the stability of the peri-implant bone? The present study aimed to evaluate the effectiveness of non-axial ultrashort implants after 2 to 9 years of follow-up in resorbed alveolar ridges. MATERIALS AND METHODS: All partially edentulous patients with ultrashort implants (< 6 mm) used in the posterior region of an atrophic mandible or maxilla, to support partial dentures in conjunction with standard implants, were included in this study. Peri-implant bone loss, success and survival rates, crestal bone levels, crown-to-implant ratio and implant angulation were measured for each implant. Implants were divided into two groups: straight implants with angulation < 17° (control group) and tilted implants with angulation > 17° (test group). Statistical analysis was used to find any significant differences between the two study groups and to investigate significant linear correlations among all the variables (p = 0.05). RESULTS: A total of 42 ultrashort implants with a mean of 4 years of follow-up were included: 20 ultrashort axially loaded implants and 22 tilted implants. Mean crestal bone levels from baseline loading to maximum follow-up did not reveal statistical differences in regard to PBL; mean success and survival rates were 100% in all groups. CONCLUSIONS: PBL, success and survival rates of axial ultrashort implants and tilted ultrashort implants are comparable to those of conventional implants. CLINICAL RELEVANCE: This retrospective study revealed that ultrashort implants, even when placed with an angulation > 17°, can safely be used to support partial fixed prostheses. Further prospective clinical studies with larger samples and prospective design are needed to confirm these findings.

Long-term clinical performance of short 6-mm implants supporting single crowns in the posterior region: A 10-year cohort study.

INTRODUCTION: Long-term clinical success of non-splinted, posterior, and short implants still is unclear. This prospective cohort study reports the 10-year follow-up of 6-mm implants supporting single crowns in the posterior region, and patient-reported outcomes. METHODS: Baseline sample comprised 20 patients treated with 46 screw-retained crowns supported by 6-mm implants with moderately rough implant surface. Participants were recalled for a 10-year clinical follow-up to assess survival rates, biologic and mechanic conditions, quality of life (OHIP-14), and treatment satisfaction. Data were collected with clinical-radiographic exams and analyzed using descriptive and inferential statistics. RESULTS: Fourteen patients with 35 implant-crown units were examined after 127.6 ± 11.8 months. For the entire cohort period, 7/46 implants were lost (survival estimate: 77.7% at 133 months), and mechanic complications occurred in 14/46 units (survival estimate: 66.4% at 116 months). In the Cox models, "maximum occlusal force" had a significant effect for implant loss (p = 0.038) and for prosthetic screw loosening (p = 0.038); "arch" and "bruxism" were not significant. Peri-implant bone loss was 0.4 ± 0.6 mm at 10 years. For peri-implant bone level, "crown-to-implant ratio" (p < 0.001) and "time" (p = 0.001) were significant. Bone levels differed from baseline to 12, 48, and 120 months. Satisfaction VAS was 94.0 ± 7.9 mm and OHIP-14 was 2.3 ± 2.2. CONCLUSION: Single screw-retained crowns supported by 6-mm implants have an acceptable long-term clinical performance, with stable peri-implant bone levels after 10 years of function.

Clinical performance of splinted 4.5-mm extra-short implants. A controlled retrospective cohort study.

PURPOSE: To compare survival, marginal bone loss (MBL) and prosthetic complications of 4.5-mm extra-short implants and longer implants splinted to the same type of implant. MATERIALS AND METHODS: A retrospective controlled cohort study was performed. The 4.5-mm extra-short group (study group; SG) included 48 consecutively placed implants that met inclusion criteria. Control group (CG) included 48 implants splinted to them. The same surgical team treated the 39 patients included, and all the implants were restored with a screw retained fixed restoration and intermediate abutments. Immediate and conventionally loaded implants were included. RESULTS: All the implants were in function during the follow-up period (14 ± 3.4 SD and 17 ± 13 SD months for SG and CG). No differences in technical complications were observed between both groups (1 and 2 screw loosening for SG and CG; 2 fractures in provisional prosthesis for SG; p=0.310). Marginal bone stability was similar for SG and CG at mesial level (SG: Mean -0.01 ± 0.28 SD mm Vs CG Mean -0.18 ± 0.72 SD mm; p=0.270) and at distal level (SG: Mean 0.02 ± 0.39 SD mm Vs CG Mean -0.18 ± 0.68 SD mm; p=0.076). CONCLUSIONS: The same good clinical performance could be observed for 4.5-mm implants and longer implants under the same prosthesis.

Clinical, Radiographic Peri-Implant Parameters and Patient Satisfaction with Splinted and Non-splinted Short Dental Implants in the Maxillary Premolar-Molar Region: A Long-Term Retrospective Clinical Study.

PURPOSE: The goal of this study was to assess the peri-implant condition, peri-implant bone loss (PBL), and complication rates of short dental implant-supported splinted crowns (SDI-SCs) and non-splinted crowns (SDI-NSCs) in the maxillary premolar-molar region. MATERIALS AND METHODS: Patients who had short implants placed near their maxillary sinuses were evaluated. Both patient satisfaction and presence of any technical complication, e.g. porcelain wear and chipping, loss of retention and loosening of the abutment, fixture or screw, were noted. The peri-implant plaque index (PIPI), probing depth (PIPD), bleeding on probing (PIBP), and peri-implant bone loss (PBL) were evaluated. To assess the impact of prosthesis type and SDI placement on technical problems, a log-rank test was computed. p < 0.05 was considered statistically significant. RESULTS: A total of 72 patients agreed to be followed-up, showing a mean follow-up time of 3.1 years. Ninty-five implants in total (55 SDI-SCs, and 40 SDI-NSCs) with moderately rough surfaces were evaluated. The average PBL score for implant and patients was 1.27 (0.02-3.97) and 1.25 (0.03-4.41), respectively. More technical complications were observed with single crowns than with splinted crowns. There were no statistically significant differences in the peri-implant parameters between SDI-SCs and SDI-NSCs (p > 0.05). PBL at molar sites was substantially higher than at premolar sites (p = 0.048). Sixty patients (83.3%) were satisfied with the appearance of the crowns, while 57 patients (79.1%) were satisfied with the crowns' performance. CONCLUSION: The peri-implant conditions, bone levels, technical complication rates and patient satisfaction were comparable between the SDI-SCs and SDI-NSCs. However, implants placed in the molar sites had statistically significantly greater bone loss in comparison to those at the premolar sites.

Immediate placement of extra-short implants in refined scapula tip microvascular free flaps: In house virtual planning and surgical technique - Proof of concept.

Scapula tip flaps have been introduced in the literature as an ideal surgical treatment option for large defects in the horizontal plane of the maxilla. This article aims to present a unique step by step protocol for a near total maxillectomy with a pterygoid bone resection and consecutive microvascular reconstruction with a harvested scapula tip flap. The protocol includes immediate placement of extra-short implants in donor bone with the aid of Virtual Surgical Planning (VSP), and an in-house 3D printing of medical 3D models and surgical guides. So far, there has been no presented surgical technique combining immediate implant placement in the scapula region with simultaneous microvascular repair. This technique allows: tumour resection; flap harvesting; extra-short implant placements and reconstruction to be performed in one simultaneous procedure. The technique is presented with illustrations, VSP (presented on videos), radiographs, and surgical findings. We discovered that this refinement of the scapula tip surgery has enabled reconstructive procedures to be performed at the same time as implant placements, providing expedited functional and aesthetic outcomes in selected cases. Moreover, modification of the surgical technique could enhance the competence of the oropharyngeal edge. In conclusion, this new surgical protocol utilizing VSP, 3D models and simultaneous extra-short implant placement provides indispensable advantages for such a complicated surgical procedures, while significantly shortening the duration of surgery.

LIMITED EVIDENCE SUGGESTS SURVIVAL OF NON-SPLINTED SHORT IMPLANTS (≤8.5 MM) IS COMPARABLE TO THAT OF SPLINTED IMPLANTS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Li QL, Yao MF, Cao RY, Zhao K, Wang XD. Survival Rates of Splinted and Nonsplinted Prostheses Supported by Short Dental Implants (≤8.5 mm): A Systematic Review and Meta-Analysis. J Prosthodont. 2022;31(1):9-21. doi:10.1111/jopr.13402. Epub 2021 Jul 16. PMID:34160869. SOURCE OF FUNDING: This work was supported by the National Natural Science Foundation of China under grants No. 82071156, No. 81470767, and No. 81271175. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data (SRMA).

Three-dimensional finite element analysis of stress distribution on short implants with different bone conditions and osseointegration rates.

OBJECTIVE: This experiment aimed to investigate the effects of bone conditions and osseointegration rates on the stress distribution of short implants using finite element analysis and also to provide some reference for the application of short implants from a biomechanical prospect. MATERIALS AND METHODS: Anisotropic jaw bone models with three bone conditions and 4.1 × 6 mm implant models were created, and four osseointegration rates were simulated. Stress and strain for the implants and jaws were calculated during vertical or oblique loading. RESULTS: The cortical bone area around the implant neck was most stressed. The maximum von Mises stress in cortical bone increased with bone deterioration and osseointegration rate, with maximum values of 144.32 MPa and 203.94 MPa for vertical and inclined loading, respectively. The osseointegration rate had the greatest effect on the maximum principal stress in cortical bone of type III bone, with its value increasing by 63.8% at a 100% osseointegration rate versus a 25% osseointegration rate. The maximum and minimum principal stresses under inclined load are 1.3 ~ 1.7 and 1.4 ~ 1.8 times, respectively, those under vertical load. The stress on the jaw bone did not exceed the threshold when the osseointegration rate was ≥ 50% for Type II and 100% for Type III. High strain zones are found in cancellous bone, and the maximum strain increases as the bone condition deteriorate and the rate of osseointegration decreases. CONCLUSIONS: The maximum stress in the jaw bone increases as the bone condition deteriorates and the osseointegration rate increases. Increased osseointegration rate reduces cancellous bone strain and improves implant stability without exceeding the yield strength of the cortical bone. When the bone condition is good, and the osseointegration ratio is relatively high, 6 mm short implants can be used. In clinical practice, incline loading is an unfavorable loading condition, and axial loading should be used as much as possible.

Anatomically Driven Immediate Implant Placement in the Esthetic Zone: Two Case Reports as Proof of Principle.

Achieving favorable and stable esthetic outcomes with immediate implants used to replace maxillary anterior teeth can be challenging. Osteotomies need to be initiated along the palatal socket wall, and it is often difficult to stabilize initial drilling. An immediate implant was planned for a hopeless maxillary incisor. Using a flapless surgery technique, the tooth was removed and decoronated, and an entry point was made in the root to guide the osteotomy drills. The root was reinserted and stabilized while a precision drill and 2-mm twist drill were used in sequence to drill through the tooth root, establishing the osteotomy location but stopping 3-4 mm short of final depth. The root was then removed, and the final implant bur for a 3.5 × 11.5-mm implant was drilled to depth, engaging the necessary native bone apically. The original tooth crown was then used to prepare and insert a transitional crown. Reinserting the extracted root of a maxillary anterior tooth and using it as a guide for osteotomy preparation is an excellent method to optimally position an immediate implant palatally in the socket wall.

The evaluation of stress on bone level and tissue level short implants: A Finite Element Analysis (FEA) study.

PURPOSE: This study aimed to evaluate the difference between the stress level and distribution around the BL and TL short implants, and their surrounding structures, using finite element analysis. METHODS: Two different study models were constructed: BL model and TL model. Two dental implant systems (ITI (Straumann, Waldenburg, Switzerland) and NTA Short) with a diameter of 4.1 mm and 4 mm and with a length of 6 mm were used in this study. In each model, implants were placed in the mandibular 1st molar region. The von Mises stress and maximum principal (tensile) and minimum principal (compressive) stresses were evaluated. RESULTS: The highest stress values recorded in the BL implants (von Mises: 342.77 MPa), in the peri­implant bone around the BL implants (maximum principal stress: 114.1 MPa), as a result of oblique loading, and overall stress values were found to be higher in the BL model. However, these measured values appeared to be low to cause a fracture, when considering the yield strengths of the materials and bone. CONCLUSIONS: The stress values were higher in the BL model, but not high enough to cause failure. Short implants could be an effective method of treatment for patients unsuitable for advanced surgical techniques.

Carga inmediata de implantes extra cortos en sectores posteriores. Estudios retrospective con tres modelos de carga: 24, 48 hs y 7 días / Immediate loading of extra short implants in posterior sectors. Retrospective study with three loading models: 24 hs, 48 hs and 7 days

Los implantes extra-cortos son cada vez más utili-zados en la práctica clínica diaria. La utilización de estos implantes con carga inmediata supone un reto añadido. Clásicamente se ha postulado que la carga inmediata debe realizarse después de 24 horas de la cirugía. En la siguiente serie de casos analizamos diferentes tiempos a la hora de realizar la carga in-mediata y su posible repercusión. Fueron recolec-tados de forma retrospectiva datos sobre casos de implantes extra-cortos (5,5 y 6,5 mm) en los que fue realizada una carga inmediata en sectores poste-riores. El implante fue la unidad de análisis para la estadística descriptiva en cuanto a la localización, dimensiones del implante, y mediciones radiográ-ficas. El paciente fue la unidad de medida para el análisis de la edad, sexo y la historia clínica. La prin-cipal variable estudiada fue la supervivencia de los implantes extra-cortos con carga inmediata en tres períodos de tiempo determinados: 24 hs, 48 hs y 7 días y como variables secundarias se han estudiado, la estabilidad del hueso crestal en general y en los tres períodos de carga anteriormente mencionados, las complicaciones protésicas y la supervivencia de las prótesis. Fueron reclutados 74 pacientes en los que se insertaron 146 implantes que cumplieron con los criterios de inclusión. Todos los implantes fueron cargados mediante carga inmediata en tres perío-dos determinados de tiempo: 24 hs (40 implantes), 48 hs (42 implantes) y 7 días (42 implantes). Todos los implantes fueron ferulizados a otros implantes ge-nerándose puentes de dos o más unidades, con di-ferente longitud. En el grupo de implantes con carga inmediata en 24 hs la media de la pérdida ósea distal de todos los implantes fue de 0,21 mm (+/-0,84) y la media de la pérdida ósea mesial en este grupo fue de 0,33 mm (+/- 0,53). En el grupo de carga inmediata en 48 hs, la media de la pérdida ósea distal de todos los implantes fue de 0,20 mm (+/- 0,82) y la media de la pérdida ósea mesial fue de 0,22 mm (+/- 0,81). En el grupo de carga de 7 días, la pérdida ósea me-sial del grupo fue de 0,28 mm (+/- 0,51) y la media de la pérdida ósea distal fue de 0,17 mm (+/- 0,81). Cuando comparamos las medias de pérdida ósea me-sial y distal entre los tres grupos, no se observaron diferencias estadísticamente significativas (mesial p=0,062, distal p=0,067). En conclusión, no se obser-varon diferencias significativas en la pérdida ósea crestal ni en la supervivencia de los implantes cortos entre los 3 tiempos estudiados de aplicación de car-ga inmediata. Por ello, utilizar cualquiera de los tres protocolos puede ser adecuado, mientras se realice un correcto análisis de la situación clínica de cada paciente (AU)

Extra-short implants are increasingly used in daily clinical practice. The use of these implants with immediate loading poses an added challenge. Classically it has been postulated that immediate loading should be performed 24 hrs after surgery. In the following case series, we analyze different times of immediate loading and their possible repercussions. We retrospectively collected data on cases of extra-short implants (5.5 and 6.5 mm) in which immediate loading was performed in posterior sectors. The implant was the unit of analysis for descriptive statistics in terms of location, implant dimensions, and radiographic measurements. The patient was the unit of measurement for the analysis of age, sex and medical history. The main variable studied was the survival of immediately loaded extra-short implants in three specific time periods: 24 hrs, 48 hrs and 7 days. Secondary variables studied were crestal bone stability in general and in the three loading periods mentioned above, prosthetic complications and prosthesis survival. Seventy-four patients were recruited and 146 implants that met the inclusion criteria were inserted. All implants were loaded by immediate loading in three specific time periods: 24 hrs (40 implants), 48 hrs (42 implants) and 7 days (42 implants). All implants were splinted to other implants generating bridges of two or more units, with different lengths. In the 24-hr immediate loading group the mean distal bone loss of all implants was 0.21 mm (+/- 0.84) and the mean mesial bone loss in this group was 0.33 mm (+/- 0.53). In the 48-hr immediate loading group, the mean distal bone loss for all implants was 0.20 mm (+/- 0.82) and the mean mesial bone loss was 0,22 mm (+/- 0,81). In the 7-day loading group, the mesial bone loss of the group was 0.28 mm (+/- 0.51) and the mean distal bone loss was 0.17 mm (+/- 0.81). When we compared the mean mesial and distal bone loss between the three groups there were no statistically significant differences (mesial p=0.062, distal p=0.067). In conclusion, no significant differences were observed in crestal bone loss or in the survival of short implants between the 3 immediate load application times studied. Therefore, using any of the three protocols can be appropriate, as long as a correct analysis of the clinical situation of each patient is performed (AU)

Radiographic density changes may be associated with overloading and implant loss on short implants: A 5-year analysis of a randomized controlled clinical trial.

OBJECTIVES: To analyze changes in radiographic bone density around short implants with and without cantilevers at 5 years post-loading. MATERIALS AND METHODS: Thirty-six patients with two adjacent posterior missing teeth participated in this randomized controlled clinical trial. All patients were randomly allocated to receive either two short implants (6 mm) with single-unit restorations (group TWO) or one single short implant (6 mm) with a cantilever restoration (group ONE-C). Patients were followed up at 6 months, 1, 3, and 5 years. Radiographic analysis was performed, through an arbitrary gray scale value (GSV) of the peri-implant bone, assessing the changes in radiographic density between groups and between time points. Differences in GSV between groups and over time were calculated using a generalized estimating equation to allow for adjustments for the correlation within individuals and between time points. RESULTS: At 5 years, 26 patients remained in the study (15 in group ONE-C; 11 in group TWO). Implant survival rates were 80.4% in group TWO and 84.2% in group ONE-C (p = 0.894). The radiographic analysis revealed that GSVs increased in both groups over time (p < 0.001). The overall radiographic density was higher in group ONE-C than in group TWO in the maxilla (p = 0.030). Conversely, in the mandible, these significant differences between the groups were not found (p > 0.05). Compared to the implants that survived, the implants that failed demonstrated a distinct radiographic density pattern (p < 0.05). CONCLUSION: Within the limitations of the present study, the radiographic bone density in the maxilla appears to increase distinctly around short implants when cantilevers are used. In contrast, the radiographic density in the mandible appears to be unaffected by the use of a cantilever, suggesting a lower threshold of adaptation to occlusal forces and thus a higher susceptibility to overload and implant loss at earlier time points.

Single-crown restorations in premolar-molar regions: short (≤ 6.5) vs longer implants: retrospective cohort study.

PURPOSE: To compare the survival, changes in marginal bone level and prosthetic complications rate of short (≤ 6.5 mm) and longer implants (≥ 7.5) supporting a single-crown restoration in the maxillary/mandibular premolar or molar region. METHODS: This cohort study was conducted following the STROBE statement recommendations for observational studies. Clinical outcomes of 88 short implants in 78 patients and 88 long implants in 88 patients were examined. All the implants had been placed by the same surgeon and restored following the same prosthetic concept; using a transepithelial abutment (intermediate abutment) and a screw retained restoration. RESULTS: All the implants were in function after the follow-up period since insertion (median: 31 months; range 11 to 84 for SiG vs median: 35 months; range: 6-117 for CG; p = 0.139). No statistical differences (p = 0.342) were observed related to prosthetic complications (screw loosening 2/88 vs 5/88 CG, ceramic chipping 1/88 vs 0/88, temporary crown resin chipping 1/88 vs 0/88 for SiG and CG, respectively) or related to marginal bone level (Mesial or Distal MBL ≥ 2 mm in 1/88 implants for SiG vs 3/88 for CG; p = 0.312). CONCLUSIONS: Within the limitations of this study, no survival differences have been observed between short implants and longer implants in single-crown restorations in posterior maxilla/mandible.

Rehabilitation of Atrophic Mandible with Ultrashort Implants Combined with Photobiomodulation Therapy: A Split-Mouth Design Study.

Background: Atrophic edentulous mandible is a challenging clinical condition. Studies assessing the use of ultrashort implants to support overdentures are scarce; the optimum photobiomodulation (PBM) dose for enhancing osseointegration is yet unknown. Objective: This study aimed to evaluate and compare mandibular overdentures assisted by two versus four ultrashort implants with adjunctive PBM therapy using two doses. Materials and Methods: A total of 36 implants were placed in 12 edentulous male participants and they were randomly allocated to Group I (mandibular overdentures assisted by two ultrashort implants) or Group II (by four ultrashort implants). Fully guided implant placement was performed, and then a split-mouth design was implemented. The participants received PBM by diode laser (660 nm). Dose A (3.75 J/cm2) and Dose B (7.5 J/cm2) were applied to the right and left implant (s), respectively. Implant stability, peri-implant probing depth (PIPD), and modified gingival index (MGI) were evaluated at baseline, and at 6 and 12 months after loading. Results: After 12 months, the implant stability values were significantly higher in Group II compared with Group I (P < 0.001). A significant difference was observed in between the PIPDs of both groups (Group I: 2.35 ± 0.54 mm; Group II: 1.69 ± 0.35 mm;P= 0.001). The mean MGI values were low for both groups (Group I: 0.75 ± 0.58; Group II: 0.51 ± 0.41). Conclusions: Mandibular overdentures supported by four ultrashort implants had a more favorable clinical outcome, while PBM doses A and B were comparable in all evaluated parameters. Trial Registration: ClinicalTrials.gov Identifier: NCT03540316.

Converting Bilateral Free-End Removable Partial Dentures to Implant-Assisted Removable Partial Dentures Using 6 mm Short Implants: Patient-Reported Outcomes of a Prospective Clinical Study.

The study assessed oral health-related quality of life (OHRQoL) of patients who received two 6 mm short implants in mandibular molar sites, converting existing bilateral free-end removable partial dentures (RPDs) to implant-assisted RPDs (IARPDs). After a postsurgical healing period of 4 months, the participants received a non-retentive dome abutment for 8 weeks, and then a retentive ball abutment for another 8 weeks. Afterwards, the participants made their final choice on which abutment to keep. The final follow-up was 1 year after implant placement. OHRQoL was evaluated with the 49-items version of the Oral Health Impact Profile (OHIP-49) at the abutment exchanges and the final follow-up. Furthermore, numerical rating scales were used to analyze patient satisfaction after 1 year. Questionnaire data of 13 participants were evaluated. Overall, OHRQoL increased with both the dome (p = 0.02) and the ball abutments (p < 0.001), without a significant difference between the abutments (p = 0.953). The questionnaires revealed an improvement in terms of oral situation, quality of life, and masticatory capacity (all p < 0.01). Patients showed a significant preference for the ball abutments (p < 0.001). Converting RPDs to IARPDs resulted in significant improvement of OHRQoL. Patients seem to prefer retentive over non-retentive abutments, although no differences in terms of OHRQoL were observed.

Short Implants versus Longer Implants with Sinus Floor Elevation: A Systemic Review and Meta-Analysis of Randomized Controlled Trials with a Post-Loading Follow-Up Duration of 5 Years.

This study compared the outcome of fixed prostheses supported by short implants (<8 mm) and longer implants (≥8 mm) with an elevated sinus floor after 5 years of follow-up. The literature searches were performed electronically and manually in PubMed, EMBASE, and Web of Science databases to identify relevant articles published from 1 January 2013 to 31 January 2020. We selected eligible studies using inclusion criteria and assessed their quality. From 1688 identified studies, five randomized controlled trials were included. Between the short implant group and the control group, the implant failure-related pooled risk ratio (RR) was 3.64 (p = 0.07). The RR for technical complications was 2.61 (p = 0.0002), favoring longer implants. Marginal peri-implant bone loss after 1 and 5 years of function showed statistically significant less bone loss at short implants (1 year: mean difference = 0.21 mm; p < 0.00001; 5 years: mean difference = 0.26 mm; p = 0.02). The implant failure and the biological failure of both groups were similar after 5 years of follow-up. Short implants could be an alternative to long implants with an elevated sinus floor for atrophic maxillae in aging populations. Studies with larger trials and longer periods of follow-up (10 years) remain essential.

One-stage versus two-stage technique using two splinted extra-short implants: A multicentric split-mouth study with a one-year follow-up.

OBJECTIVE: To compare the clinical outcomes of extra-short implants (≤6.5 mm) inserted with one-stage versus two-stage technique in adjacent sites of the upper or lower jaw. MATERIALS AND METHODS: In this split-mouth multicenter study, implants were randomly divided into two groups according to the healing phase: two-stage and one-stage technique. Primary outcome measures were implant survival, implant success, and prosthodontic complications. Secondary outcome measurements were: implant stability quotient (ISQ) collected at surgery time (T0), and after 3 (T3) and 12 (T12) months, marginal bone level (MBL) evaluated at T0, T3, T6, and T12, marginal bone loss evaluated at T6 and T12, plaque index (PI), probing depth (PD), bleeding on probing (BoP) evaluated at T3, T6, and T12. Significances of differences between groups were tested by linear mixed model with random intercept. RESULTS: Nineteen patients (8 males and 11 females) were included. A total of 38 implants were inserted. At T12 implant cumulative survival and implant success rate were 100% in both groups. No statistically significant differences were recorded for any of the analyzed parameters between the two groups at any time point. ISQ values were similar at T0 (two-stage: mean 67.53 ± SD 19.47; one-stage: mean 66.53 ± 19.07 p = 0.8738) and increased in both groups at the 12-month follow-up appointment (two-stage: 81.1 ± 7.04; one-stage: 81.39 ± 0.9266). MBL values were similar in the two groups at any time point. At T12 marginal bone loss was 0.46 ± 0.41 (two-stage) and 0.45 ± 0.38 (one-stage) mm (p = 0.9417), while mean PD was 2.7 ± 0.85 (two-stage) and 2.69 ± 0.89 (one-stage) mm. CONCLUSIONS: Within the limits of the present short-term report, extra-short implants demonstrated optimal clinical outcomes using the one-stage technique, without statistically significant differences compared with the traditional two-stage approach.

Evaluation of the survival rate of short implants placed in the posterior atrophic mandible: 5-year clinical study.

OBJECTIVE: The aim of the study was to assess the long-term prognosis of short implants (5 to 6 mm) placed in the posterior region of the atrophic mandible. METHOD AND MATERIALS: The study included 81 patients with severe vertical atrophy of the bone in the posterior region. The patients had 248 short implants (5 to 6 mm) implants placed in the mandibular posterior region and 256 implants with length greater than 10 mm in the mandibular anterior region. Analysis of implant and prosthesis failures, cumulative survival rate, and marginal bone loss was determined at 1 year and 5 years of follow-up (58 ± 7 months). RESULTS: Mean marginal bone loss after 1 year of prosthetic loading was 0.74 mm for short implants and 0.72 mm for implants with length greater than 10 mm; after 5 years of prosthetic loading this was 1.27 mm for short implants and 1.31 mm for implants with length greater than 10 mm. Of 248 short implants (5 to 6 mm), six failed: four due to peri-implantitis and two due to lack of osseointegration (early rejection). Of 256 implants with length greater than 10 mm, five failed: three due to peri-implantitis and two due to lack of osseointegration (early rejection). On average, over the observation period (58 ± 7 months), the 5-year cumulative implant survival rate was 97.8% in short implants, and 98.1% in longer implants; the prosthesis cumulative survival rate was 98.2%. CONCLUSIONS: Based on the results, it was concluded that the prognosis of the use of short implants for prosthetics in the posterior resorbed mandible can be considered favorable and reasonable.

Short versus Longer Implants in Sites without the Need for Bone Augmentation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVES: The present systematic review and meta-analysis aims to analyse the clinical performance of short compared to longer implants inserted in sites without the need for bone augmentation. METHODS: The protocol of the present PRISMA-driven meta-analysis was registered on PROSPERO (CRD42021264781). Electronic and manual searches were performed up to January 2022. All Randomized Controlled Trials (RCTs) comparing short (≤6 mm) to longer (≥8.5 mm) implants placed in non-atrophic and non-augmented sites were included. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized clinical trials (RoB 2) and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was performed on implant survival rate, marginal bone level change (MBLc), and technical and biological complications at the available follow-up time points. The power of the meta-analytic findings was determined by trial sequential analysis (TSA). RESULTS: From 1485 initial records, 13 articles were finally included. No significant difference was found in the survival rate between short and long implant at any follow-up (moderate quality of evidence). Significantly more bone loss for long implants at 1 and 5 years from implant placement and more technical complications with short implants at 10 years were found. No other significant inter-group differences in terms of MBLc and biological complications were detected. CONCLUSIONS: Moderate evidence exists suggesting that short implants perform as well as longer ones in the rehabilitation of edentulous sites without the need for bone augmentation. Further long-term, well-designed RCTs, however, are still needed to provide specific evidence-based clinical recommendations for an extended use of short implants in non-atrophic sites.