This document contains a presentation on short dental implants given by Dr. Mohammed Alshehri at the ITI Congress Middle East in Abu Dhabi, UAE in December 2012. The presentation defines short implants, reviews the available evidence on their success rates compared to longer implants or bone augmentation procedures, and identifies factors that can affect the success of short implants such as surgical protocol, implant design, surface characteristics, crown-to-implant ratio and occlusal forces. Studies show short implants have high success rates, especially when placed in the mandible, and may be preferable to more complex augmentation procedures.

1. ITI
Congress Middle East
Abu Dhabi
December 7 – 8
2012
Dr. Mohammed Alshehri
Riyadh, Saudi Arabia

2. Short implant vs sinus elevation
Outline
• Situations that limit placement of long implants.
• Short implants as an alternative.
• Definition of short implants according to the literatures.
• The available evidence on short dental implants.
• Contributing factors affecting success of short implant.

3. Situations that limit placement of long implants
• Height of existing available bone
I. Maxillary sinus
II. Mandibular canal

4. Situations that limit placement of long implants
• history of Chronic sinusitis.
• Allergic sinusitis.
• Cystic fibrosis.
• Pathological lesions.
• Patients acceptance for adjunctive surgical procedures to place longer
implant.

5. Short implants as an alternative
Short Implant
• Increases patient’s acceptability
• Less surgical procedures
• Lower costs
• Fewer complications
• Quicker rehabilitation time

6. Definition of short implants according to the literatures
Implant length
• A dental implant with length of 7 mm or less.
(Friberg et al. 2000)
• Any implant under 10 mm in length referred to as a ‘‘short’’ implant >
(Griffin TJ, Cheung WS. 2004)
• A device with an intra-bony length of 8 mm or less.
(Renouard and Nisand 2006)

7. Definition of short implants according to the literatures
Implant width
• Wide implant defined as a fixture with 4.5 mm or more in diameter, and a
‘narrow’ implant as one in which this was less than 3.5 mm in diameter
(Renouard and Nisand 2006)

8. The available evidence on short dental implants
Short implant versus long Implant or
Short implants versus adjunctive surgical procedures that required to place a
longer implant
• Survival rates of implants placed in augmented sites
• 92.1% to 100% for GBR
• 76% to 100% for onlay bone grafts
over 1–7 years (Rocchietta et al. 2008) a systematic review

9. The available evidence on short dental implants
•Cumulative Survival Rate of implants placed in the augmented maxillary sinus
was 95% (follow-up, 6-144 months); and that in the guided bone regeneration
technique protocols ranged from 92% to 100% (follow-up, 6-133 months)
(Chiapasco et al. 2009) a systematic review.
•They concluded that priority should be given to simpler approaches.

10. The available evidence on short dental implants
Short implant - early research
• Review of short implants in clinical studies between 1981 and 1997 - a higher
failure rate and implant loss with short implants than with long implants
(Goodacre et al. 1999)
• Higher failure rate with poor bone quality and short implant placement in the
atrophic maxilla or following bone-grafting procedures (Sennerby et al. 1998)

11. The available evidence on short dental implants
• 91.4% cumulative survival rate for 8- mm-long implants with a plasma-sprayed
surface reported by (Buser et al.1997)
• Friberg et al. also found a high success rate for short implants, with a 95.5%
five-year survival rate

12. The available evidence on short dental implants
Short implants – recent data
Telleman et al. (2011) A systematic review of the prognosis of short (10 mm) dental
implants placed in the partially edentulous patient
• A growing evidence that short implants can be placed successfully in the
partially edentulous patients
• Increasing survival rate per implant length.
• short dental implants in the mandible has a better prognosis over maxilla.
• The results of studies excluding smokers revealed higher implant survival rates

13. The available evidence on short dental implants
Short implants – recent data
Jokstad (2011) The evidence for endorsing the use of short dental implants
• There is growing evidence that placement of short (<10mm) implants can be
successful in the partially edentulous patient. Beyond the first years following
implant placement the current scientific data are insufficient for providing
clinical guidance.

14. The available evidence on short dental implants
Short implants – recent data
Monje et al. (2012) Are Short Dental Implants (<10mm) Effective? A Meta-Analysis
on Prospective Clinical Trials
• Short dental implants had an estimated survival rate of 88.1% at 168 months
while standard dental implants had a similar estimated survival rate of 86.7%.
• The peak failure rate of short dental implants was found to occur between 4-6
years of function compared to 6-8 years for standard implants.
• The smoking double the failure.
• in the long-term, implants less than 10 mm were as predictable as longer
implants.

15. The available evidence on short dental implants
Short implants – recent data
Esposito et al. (2012) Posterior atrophic jaws rehabilitated with prostheses supported
by 6 mm-long, 4 mm-wide implants or by longer implants in augmented bone.
• Short-term data (5 months after loading) indicate that 6 mm-long implants with
a conventional diameter of 4 mm achieved similar result to longer implants
placed in augmented bone.
• Short implants might be a preferable choice to bone augmentation, since the
treatment is faster, cheaper and associated with less morbidity.
• 5- to 10-year post-loading data are necessary before making reliable
recommendations.

16. The available evidence on short dental implants

17. The available evidence on short dental implants
• Multicenter trial (six study centers)
• 95 subjects were included.
• Subjects were randomly allocated to receiving implants with lengths of either 6
or 11 mm both with a diameter of 4 mm (OsseoSpeedTM 4.0 S; Astra)
• In all cases
• sufficient bone height for placement of an implant of at least 11 mm in
length.
• 2 or 3 implants were placed per subject using one-stage surgery.
• They were restored with a screw-retained splinted fixed prosthesis.

18. The available evidence on short dental implants
• Clinical and radiographic examinations were performed preoperatively, post
surgery, at loading, and 6 and 12 months after prosthesis placement.
• A total of 208 implants were inserted in 49 subjects receiving 6-mm implants
and in 46 subjects receiving 11 mm implants
• Two 6-mm implants failed before loading and one 6 and 11 mm implants
failed before 1-year evaluation.
• From loading to the 12 months’ follow-up, a mean marginal bone gain of
0.06 mm in the 6 mm group and 0.02 mm in the 11 mm group was found (P
= 0.478).
• Soft tissue behavior was equal in both groups

19. The available evidence on short dental implants
•Clinical and One-year data indicate that treatment with the 6 mm implants is as
reliable as treatment with the 11 mm implants.
•future randomized controlled clinical trials required to validate predictability of the
findings.

20. The available evidence on short dental implants
Clinical Implant Dentistry and Related Research 2012

21. The available evidence on short dental implants
• Implant failures, complications, operation time, postoperative pain
and swelling, soft tissue parameters, marginal bone levels, and
implant stability (ISQ) values.
Patients were followed for 3 years after loading.

22. The available evidence on short dental implants
Result
Outcome measures Augmented group Short Implants group
Implant failures Three early implant failures one late failure
Surgical complications 8 (5 membrane perforations, 1 (membrane perforation)
2 bleedings, 1 sinusitis)
Biological 1 (peri-implantitis) 2 (1 peri-implantitis, 1
complications peri-implant mucositis)
Prosthetic 3 (1 abutment loosening, 2 3 (1 abutment loosening, 1
complications ceramic fractures) decementation, 1 ceramic
fracture)

23. The available evidence on short dental implants
Result
Outcome measures Augmented group Short Implants group
Operation time 60 min 30 min
postoperative pain Increased postoperative pain and Three times less pain and swelling
and swelling swelling during the first postoperative week
Marginal bone loss difference not statistically significant difference not statistically significant
Implant stability ISQ difference not statistically significant difference not statistically significant

24. The available evidence on short dental implants
Cont.
• Both treatment approaches achieved successful and similar outcomes after 3
years of function.
• Short implants take considerably lower operation time with decreased surgical
complications and postoperative patient discomfort.
• More RCTs with longer follow-up times and larger sample sizes are necessary to
validate the current findings.
• implant length engaged in alveolar bone does not appear to influence the degree
of peri-implant bone resorption after a medium-term period of 3 years.

25. Contributing factors affecting success of short implant
Surgical protocol
• Undersized implant bed preparation.
• lateral bone condensation.

26. Contributing factors affecting success of short implant
Implant selection
• Implant with geometrical designs that increased primary stability
• Modified shape
• Self-tapping threads
• Tapered profiles
• Flared necks

27. Contributing factors affecting success of short implant
Implant surface characteristics
• Rough implants offer extensive surfaces for osseointegration and therefore allow
the clinician to consider usage of short implants (Gentile et al. 2005)
• Survival rate of implants with roughened surface (96.6 %) is significantly higher
than the survival rate of implants with machined surface (88 %) (Chiapasco et al.
2009)
• It is apparent that rough-surfaced dental implants have significantly higher success
rates compared with implants with smoother surfaces (Javed et al. 2011)

28. Contributing factors affecting success of short implant
Crown to implant ratio and occlusal forces
• (Tawil et al. 2006) placed 262 Branemark implants (10 mm or less in length), the
patients were followed 12 to 108 months and evaluate marginal bone loss. They
concluded that when the load distribution is favorable, increased crown-to-implant
ratios are not a major risk factor
• reduction of the occlusal table
• flattening of the cuspal inclines

29. Contributing factors affecting success of short implant
Crown to implant ratio and occlusal forces
• (Nedir et al. 2006) 7-year study of ITI implants, the implant-to-crown ratio ranged
from 1.05 to 1.80, and no detrimental consequences on the final success rate were
noted.

30. Contributing factors affecting success of short implant
Crown to implant ratio and occlusal forces
• (Blanes et al. 2007) reported the results of 10 years prospective study with 192
implants placed in the posterior region, A total of 51 implants showed a clinical C/I
ratio equal to or greater than 2., three implants failed, giving a cumulative survival
rate of 94.1%.
• (Blanes 2009) Systematic review the current literature shows that the C/I ratios of
implant-supported reconstructions do not influence peri-implant crestal bone loss.

31. ITI Congress Middle East
Thank You!
Shukran!
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