Elevación de seno transcrestal con inserción de implantes ultracortos de 4.5 mm de longitud en zonas maxilares posteriores con hueso residual menor o igual a 3 mm de altura / Transcrestal sinus lift with insertion of 4.5 mm long ultrashort implants in posterior maxillary areas with residual bone less than or equal to 3 mm in height

Introducción: La atrofia posterior del maxilar con la neumatización del seno maxilar es un problema frecuente. Los protocolos para rehabilitar esta zona han ido cambiando desde la elevación de seno convencional, hasta la elevación transcrestal. Aun así, existen casos con un volumen óseo disponible en altura muy disminuido que precisan de nuevos procedimientos como los implantes de 4,5 mm. En la siguiente serie de casos clínicos se muestran pacientes tratados con este procedimiento. Material y métodos: Se presenta un estudio retrospectivo en el que se han evaluado implantes de 4,5 mm de longitud, insertados en sectores posteriores maxilares con una altura ósea residual igual o menor a 3 mm, realizándose al mismo tiempo una elevación de seno transcrestal. Posteriormente, se realiza un seguimiento radiográfico estimándose la pérdida ósea crestal y la supervivencia de los implantes.La variable principal fue la supervivencia del implante y como variables secundarias se registraron la pérdida ósea mesial y distal. Resultados: Fueron reclutados 13 pacientes en los que se insertaron 15 implantes. La media de la altura inicial de la cresta, en el estudio fue de 2,85 mm (+/- 0,20) con un rango entre 2,50 y 3 mm. Los implantes presentaron un seguimiento medio de 13,33 meses tras la carga (+/- 3,09) no encontrándose complicaciones ni fracasos durante este tiempo, por lo que la supervivencia fue del 100%. Conclusiones: Los datos preliminares obtenidos en el presente estudio muestran una alternativa a la elevación de seno mediante ventana lateral con una menor morbilidad para los pacientes. (AU)

Introduction: PPosterior maxillary atrophy with pneumatization of the maxillary sinus is a common problem. The protocols for rehabilitating this area have changed from conventional sinus lift to transcrestal lift. Even so, there are cases with a very low available bone volume in height that require new procedures such as 4.5 mm implants. The following case series shows patients treated with this procedure. Material and methods: A retrospective study is presented in which 4.5 mm long implants inserted in maxillary posterior sectors with a residual bone height equal to or less than 3 mm were evaluated and a transcrestal sinus lift was performed at the same time. Subsequently, a radiographic follow-up was carried out, estimating crestal bone loss and implant survival. The primary variable was implant survival and mesial and distal bone loss were recorded as secondary variables. Results: Thirteen patients were recruited and 15 implants were inserted that met the previously established inclusion criteria. The mean initial ridge height where the implants included in the study were placed was 2.85 mm (+/- 0.20) with a range between 2.50 and 3 mm. No complications related to the surgery were reported in any of the cases. The implants had a mean follow-up of 13.33 months after loading (+/- 3.09) with no complications or failures during this follow-up time, so survival was 100%. Conclusions: Preliminary data obtained in the present study show a predictable alternative to lateral window sinus lift with less morbidity for patients. (AU)

Elevación de seno transcrestal con inserción de implantes ultracortos de 4.5 mm de longitud en zonas maxilares posteriores con hueso residual menor o igual a 3 mm de altura / Transcrestal sinus lift with insertion of 4.5 mm long ultrashort implants in posterior maxillary areas with residual bone less than or equal to 3 mm in height

Introducción: La atrofia posterior del maxilar con la neumatización del seno maxilar es un problema frecuente. Los protocolos para rehabilitar esta zona han ido cambiando desde la elevación de seno convencional, hasta la elevación transcrestal. Aun así, existen casos con un volumen óseo disponible en altura muy disminuido que precisan de nuevos procedimientos como los implantes de 4,5 mm. En la siguiente serie de casos clínicos se muestran pacientes tratados con este procedimiento. Material y métodos: Se presenta un estudio retrospectivo en el que se han evaluado implantes de 4,5 mm de longitud, insertados en sectores posteriores maxilares con una altura ósea residual igual o menor a 3 mm, realizándose al mismo tiempo una elevación de seno transcrestal. Posteriormente, se realiza un seguimiento radiográfico estimándose la pérdida ósea crestal y la supervivencia de los implantes.La variable principal fue la supervivencia del implante y como variables secundarias se registraron la pérdida ósea mesial y distal. Resultados: Fueron reclutados 13 pacientes en los que se insertaron 15 implantes. La media de la altura inicial de la cresta, en el estudio fue de 2,85 mm (+/- 0,20) con un rango entre 2,50 y 3 mm. Los implantes presentaron un seguimiento medio de 13,33 meses tras la carga (+/- 3,09) no encontrándose complicaciones ni fracasos durante este tiempo, por lo que la supervivencia fue del 100%. Conclusiones: Los datos preliminares obtenidos en el presente estudio muestran una alternativa a la elevación de seno mediante ventana lateral con una menor morbilidad para los pacientes. (AU)

Introduction: PPosterior maxillary atrophy with pneumatization of the maxillary sinus is a common problem. The protocols for rehabilitating this area have changed from conventional sinus lift to transcrestal lift. Even so, there are cases with a very low available bone volume in height that require new procedures such as 4.5 mm implants. The following case series shows patients treated with this procedure. Material and methods: A retrospective study is presented in which 4.5 mm long implants inserted in maxillary posterior sectors with a residual bone height equal to or less than 3 mm were evaluated and a transcrestal sinus lift was performed at the same time. Subsequently, a radiographic follow-up was carried out, estimating crestal bone loss and implant survival. The primary variable was implant survival and mesial and distal bone loss were recorded as secondary variables. Results: Thirteen patients were recruited and 15 implants were inserted that met the previously established inclusion criteria. The mean initial ridge height where the implants included in the study were placed was 2.85 mm (+/- 0.20) with a range between 2.50 and 3 mm. No complications related to the surgery were reported in any of the cases. The implants had a mean follow-up of 13.33 months after loading (+/- 3.09) with no complications or failures during this follow-up time, so survival was 100%. Conclusions: Preliminary data obtained in the present study show a predictable alternative to lateral window sinus lift with less morbidity for patients. (AU)

A 5-year randomized controlled clinical trial comparing 4-mm ultrashort to longer implants placed in regenerated bone in the posterior atrophic jaw.

BACKGROUND: Short implants (up to 5-mm long) have shown good results when compared to longer implants placed in augmented bone. PURPOSE: To evaluate if 4-mm ultrashort implants could also be an alternative to bone augmentation in the severely atrophic posterior jaws. The primary aim of the study was to compare implant survival rates between study groups. MATERIALS AND METHODS: Eighty partially edentulous patients with posterior atrophic jaws (5-6 mm of bone above the mandibular canal and 4-5 mm below the maxillary sinus) were included: 40 patients in the maxilla and 40 in mandible. The patients were randomized to receive one to three 4-mm ultrashort implants or one to three implants at least 10-mm long in augmented bone. Results are reported 5 years after loading with the following outcome measures: implant and prosthetic failures, complications and peri-implant marginal bone level changes. RESULTS: Thirty-two complications were reported for the control group in 18 patients versus 13 complications in 10 patients in the test group, the difference being not statistically significant (p = 0.103). In the augmented group, 12 implants failed in 6 patients versus 7 short implants in 6 cases, and 9 prostheses failed in the control group while 4 in the test one, without statistically significant differences (p = 1.000 and 0.363, respectively). At 5 years after loading, short implants lost on average 0.58 ± 0.40 mm of peri-implant marginal bone and long implants 0.99 ± 0.58 mm, the difference was statistically significant (p = 0.006). CONCLUSION: Four-millimeter ultrashort implants showed similar if not better results when compared to longer implants placed in augmented jaws 5 years after loading. For this reason, their use could be in specific cases preferable to bone augmentation since the treatment is less invasive, faster, cheaper and associated with less morbidity. However, longer follow-ups and larger trials are needed.