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.

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.

Comparative analysis between extra-short implants (≤6 mm) and 6 mm-longer implants: a meta-analysis of randomized controlled trial.

The goal of this systematic study was to compare the survival rate (SR), marginal bone loss (MBL) and clinical complications between extra-short implants (≤6 mm) and 6-mm-longer implants in randomized clinical trials. A systematic electronic and manual search was performed using the PubMed, Web of Science, Scopus and DOAJ databases. A meta-analysis was conducted to compare the SR and MBL between both groups. We have selected 17 studies out of 1016 articles for qualitative and quantitative analysis. The data from 956 patients and 1779 implants were used with an overall mean clinical follow-up of 3.88 years ranging from 1 to 8 years. Overall, the SR of extra-short implants (93.12%) was lower than the observed in 6-mm-longer implants (95.98%); however, there was no statistical significance on these findings (P > 0.10). MBL analysis showed that extra-short implants and the 6-mm-longer group presented an average of -0.71 and -0.92 mm after 1-year respectively. Three years follow-up showed MBL of -0.42 mm (≤6 mm) and -0.43 mm (>6 mm); 5 years follow-up showed an MBL of -0.69 mm (≤6 mm) and -0.46 mm (>6 mm); and after 8 years of follow-up, it was found an MBL of -1.58 mm (≤6 mm) and -2.46 mm (>6 mm). Within the limitation of this study, the results indicated that SR of extra-short implants was similar to 6-mm-longer implants. In contrast, MBL and the presence of clinical complications were observed at a lessened rate on extra-short implants.

Are <7-mm long implants in native bone as effective as longer implants in augmented bone for the rehabilitation of posterior atrophic jaws? A systematic review and meta-analysis.

PURPOSE: To compare clinical and radiographic outcomes of <7 mm short (SH) implants inserted in native bone vs longer (ST) implants placed in vertically augmented partially edentulous posterior jaws. A further aim was to evaluate if the residual bone dimension plays a role in the outcomes of SH and extra-SH implants. MATERIALS AND METHODS: This review was registered with PROSPERO. An electronic literature search was performed on PubMed, Scopus and Web of Science. Randomized controlled trials (RCTs) with at least 1-year follow-up, comparing fixed prostheses supported by SH vs ST implants in augmented sites were included. Marginal bone level (MBL) changes, implant survival rate, and complications were evaluated through a meta-analysis. Subgroup analysis was performed dividing the SH implants according to length at each follow-up (1-, 3-, 5-year of function). RESULTS: Twenty-five articles fulfilled the inclusion criteria, featuring a total of 650 SH implants placed in 415 patients and 685 ST implants placed in 403 patients. There was a trend for a significantly lower MBL associated with SH implants respect to ST implants at each follow-up, whilst there was no evidence of a difference in failure rates between SH and ST implants, for any SH length considered and at any follow-up. There was evidence for a lower incidence of complications in favor of SH implants at both 1-year (P < .0001) and 3-year follow-up (P = .01), while at 5-year follow-up there was no evidence of a difference between SH and ST groups (P = .30). CONCLUSION: SH implants supporting partial fixed rehabilitations represent a valuable alternative to augmentation procedures in the medium term. While the performance of implants at least 5-mm long is well documented, more studies with at least 5-year follow-up are needed to confirm the promising outcomes observed with <5 mm-long fixtures.

Comparative clinical study using short and conventional implants in bilateral jaw posteriors

Abstract The aim of this study was to clinically and radiographically compare extra short and standards implants. Forty-two implants were installed in 10 selected patients. They received prosthetic loading only after the conventional waiting time for osseointegration and the prostheses were made ferulized. Radiographic shots were performed to evaluate vertical and horizontal bone losses at times T1 (prosthetic installation), T2 (6 months follow-up) and T3 (12 months follow-up). Biological parameters such as bone level around the implants (CBL) were evaluated, CBL alteration (CBLC), total crown length (TCL) and implant/crown ratio (ICR) were digitally calculated. All implants included in the study were submitted to the analysis of the implant stability quotient (ISQ) at the time of implant installation (T0) and at 12 months of prosthetic function (T3). Data were statistically tested. The ICR was higher in the test group than in the control group (p<0.0001). The CBL measurements at the beginning of the study were 0.21±0.19 mm and 0.32±0.38 mm and at 12 months 0.65±0.24 mm and 0.87±0.34 mm, respectively in the test and control groups. CBLCs and CBL were similar at all times (p>0.05). No correlation was found between CBLC and ICR parameters, as well as between ISQ and implant length. We may conclude that standards and extra short implants can provide similar clinical results in prosthetic rehabilitation of the atrophic jaw over 12 months of follow-up.

Resumo O objetivo deste estudo foi comparar clínica e radiograficamente implantes extra curtos e padrões. Quarenta e dois implantes foram instalados em 10 pacientes selecionados. Eles receberam carga protética somente após o tempo de espera convencional para a osseointegração e as próteses foram feitas ferulizadas. As imagens radiográficas foram realizadas para avaliar as perdas ósseas verticais e horizontais nos tempos T1 (instalação protética), T2 (6 meses de acompanhamento) e T3 (12 meses de acompanhamento). Parâmetros biológicos como nível ósseo ao redor dos implantes (CBL) foram avaliados, alteração CBL (CBLC), comprimento total da coroa (TCL) e relação implante / coroa (ICR) foram calculados digitalmente. Todos os implantes incluídos no estudo foram submetidos à análise do quociente de estabilidade do implante (ISQ) no momento da instalação do implante (T0) e aos 12 meses de função protética (T3). Os dados foram testados estatisticamente. A ICR foi maior no grupo teste do que no grupo controle (p<0,0001). As medidas de CBL no início do estudo foram de 0,21±0,19 mm e 0,32±0,38 mm e em 12 meses 0,65±0,24 mm e 0,87±0,34 mm, respectivamente nos grupos teste e controle. CBLCs e CBL foram semelhantes em todos os momentos (p>0,05). Não foi encontrada correlação entre os parâmetros CBLC e ICR, bem como entre o ISQ e o comprimento do implante. Podemos concluir que padrões e implantes extra curtos podem fornecer resultados clínicos semelhantes na reabilitação protética da mandíbula atrófica ao longo de 12 meses de acompanhamento.

Implant-Guided Vertical Bone Augmentation Around Extra-Short Implants for the Management of Severe Bone Atrophy.

The purpose of this study is to describe the conservative treatment of severe vertical bone atrophy by combining the insertion of extra-short implants and implant-guided bone augmentation. For that, a low-speed drilling protocol was selected to facilitate the collection of bone particles and to maintain graft osteogenic properties. Extra-short implants were incompletely inserted because of the severe atrophy, and the denuded implant surface was covered by autologous bone particles held together by the adhesive properties of plasma rich in growth factors. The surgical site was then covered with resorbable fibrin membrane, and the flap was repositioned and sutured. Eight patients with a mean residual bone height of 4.19 ± 0.97 mm were treated according to the described treatment protocol. The distance between the implant shoulder and the bony crest was 1.77 ± 0.18, 2.16 ± 0.23, and 1.97 ± 0.26 mm at the mesial, central, and distal aspects, respectively. Vertical bone augmentation resulted in the coverage of 85% of exposed surface by stimulating 1.6 ± 0.5 mm of supra-alveolar bone growth. All 10 extra-short implants placed were successfully osseointegrated. After a mean of 5 ± 1.6 months, provisional screw-retained prostheses were placed. Within the limitations of this study, we conclude that the minimally invasive approach described may successfully rehabilitate extreme vertical bone atrophy in the posterior mandible.

Retrospective study of short and extra-short implants placed in posterior regions: influence of crown-to-implant ratio on marginal bone loss.

AIM: The aim of this study is to evaluate the influence of crown-to-implant (CI) ratio as well as other surgical, prosthetic and biomechanical variables on marginal bone loss (MBL) and on the survival rates of implant-supported prostheses in short implants (≤8.5 mm in length) placed in posterior areas of maxilla and mandible. MATERIAL & METHODS: This was a retrospective study based on clinical charts and follow-up recordings from a single private practice over a period of 10 years. Patients rehabilitated in the posterior region of the jaws by means of prostheses supported by implants of ≤8.5 mm length were included. Patients-related, surgery-related. and implant-related variables, as well as other prosthetic and biomechanical variables. were registered. The data were split into two groups according to the value of CI ratio (CI < 2 and CI ≥ 2). MBL was measured from radiographs using an image analysis software. Implant and prosthesis survival rates were recorded. RESULTS: One hundred twenty-eight short implants placed in 63 patients were evaluated. The mean follow-up period was 21.88 months (standard deviation (SD): 22.9, range 7-113 months). Eighty-six implants (67.2%) had a CI ratio of <2, whereas it was ≥2 in 42 implants (32.8%). The mean value of CI ratio was 1.82 (SD: 0.42; range 1.04-3.31). The average MBL after 1 year of follow-up was 0.35 (SD: 0.50), and it was 0.45 (SD: 0.46) mm for subsequent evaluations. Survival rates of implants and prosthesis were 100%. The presence of a cantilever had a negative influence on the first year MBL (p < .05). CONCLUSIONS: The CI ratio had not a significant influence on MBL in Biotechnology Institute (BTI; Vitoria, Spain) short implants humidified with PRGF-Endoret and placed in posterior areas. The only variable that showed a significant negative influence on first year postloading MBL was the use of cantilever for rehabilitations.