Short Dental Implants? Is the tide turning?

Short dental implants were looked upon unfavorably until very recently. But gradually with newer designs, surfaces and better evidence it seems that this is gradually changing. In fact when I first began in implant dentistry 10mm was considered a short implant. Today anything shorter than 7 is a short implant. That's a significant change ! Some systems offer implants as short as 5mm albeit in wide diameters only. Ante's law and rules about Crown to Implant ratio seem not to apply in the same way to implants as to teeth. Advertisements for companies such as Bicon and Endopore regularly feature pictures of implant restorations that seem to defy every rule of conventional prosthodontics and still seem to thrive if the votaries of the system are to be believed !

Finally it is the gradual accretion of studies such as the one below that will convince us of the effectiveness of 'short implants' as an accepted modality of treatment.

Short Dental Implants

A Systematic Review

1. S. Annibali1,*
2. M.P. Cristalli1
3. D. Dell’Aquila1
4. I. Bignozzi1
5. G. La Monaca1
6. A. Pilloni2

1. ¹Department of Odontostomatological and Maxillofacial Sciences, Oral Surgery Unit, “Sapienza” University of Rome, Via Caserta, 6, 00161-Rome, Italy
2. ²Department of Odontostomatological and Maxillofacial Sciences, Periodontology Unit, “Sapienza” University of Rome, Rome, Italy

1. ↵* susanna.annibali@uniroma1.it

Abstract

Growing evidence has suggested the utility of short dental implants for oral reconstructive procedures in clinical situations of limited vertical bone height. The aim of this review was to systematically evaluate clinical studies of implants < 10 mm in length, to determine short implant-supported prosthesis success in the atrophic jaw. Implant survival, incidence of biological and biomechanical complications, and radiographic peri-implant marginal bone loss were evaluated. Screening of eligible studies, quality assessment, and data extraction were conducted by two reviewers independently. Meta-analyses were performed by the pooling of survival data by implant surface, surgical technique, implant location, type of edentulism, and prosthetic restoration. Two randomized controlled trials and 14 observational studies were selected and analyzed for data extraction. In total, 6193 short-implants were investigated from 3848 participants. The observational period was 3.2 ± 1.7 yrs (mean ± SD). The cumulative survival rate (CSR) was 99.1% (95%CI: 98.8-99.4). The biological success rate was 98.8% (95%CI: 97.8-99.8), and the biomechanical success rate was 99.9% (95%CI: 99.4-100.0). A higher CSR was reported for rough-surfaced implants. The provision of short implant–supported prostheses in patients with atrophic alveolar ridges appears to be a successful treatment option in the short term; however, more scientific evidence is needed for the long term.

Small Mirrors ?

Most of us use No.4 or No.5 mouth mirrors. Most of the time these are exactly what we need. But working in the posterior of the mouth, in a patient with restricted mouth opening AND while using an microscope it might be mighty difficulty to use these large mirrors. A more useful size are size 2 or Size 3 front surface rhodium coated coated mirrors.
I've been trying to get these sizes locally for some time without success. Can anyone who is reading this help
?

Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study

Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study:

Abstract

Objective

The study aimed to assess the clinical results after osteotome technique to lift sinus floor, without graft materials in the residual bone height (RBH), below 8 mm.

Material and methods

Twenty-two patients aged from 19 to 70 years old in need of maxillary sinus floor augmentation were enrolled in this study. Preoperative and postoperative cone beam computerized tomography (CBCT) were taken to guide the surgery. Twenty-seven implants were inserted and followed clinically, another CBCT exam was taken at 6 months postoperatively. The diameter of the implants was 4.7 mm (SD 0.4 mm), the length was 10 mm (SD 1.0 mm). The average residual bone height was 6.7 mm (SD 1.2 mm).

Results

No implants were lost after the surgery and the 2 years follow-up. There was no obvious marginal bone loss during the 6 months follow-up verified by CBCT. The mean bone gain at the implant sites was 2.5 mm (SD 1.5 mm).

Conclusion

The study verified the good and stable clinical result of the OSFE technique without using bone grafting materials when the RBH was only 4.1–8 mm.

Implant Survival Rates after Osteotome-Mediated Maxillary Sinus Augmentation: A Systematic Review

Implant Survival Rates after Osteotome-Mediated Maxillary Sinus Augmentation: A Systematic Review:

ABSTRACT

Purpose: The aim of the present study was to systematically evaluate the implant survival rate after osteotome-mediated maxillary sinus augmentation with or without using grafting materials.

Materials and Methods: MEDLINE database was searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective and retrospective clinical studies with at least 20 patients treated by osteotome-mediated sinus floor elevation were included.

Results: Nineteen studies were selected for data analysis. A total of 1,822 patients, accounting for 3,131 implants were considered. Mean weighted cumulative implant survival at 1, 2, 3, and 5 years was estimated as 98.12%, 97.40%, 96.75%, and 95.81%, respectively. No significant difference was found in relation to the use of grafting material nor in relation to implant length. Overall implant survival was 92.7% for 331 implants placed in <5 mm ridge height and 96.9% for 2,525 implants inserted in ≥5 mm ridge height. The difference was significant (p = .0003).

Conclusions: The transalveolar sinus augmentation technique could be a viable treatment in case of localized atrophy in the posterior maxilla even in case of minimal residual bone height. The prognosis can be more favorable when the residual ridge is at least 5 mm high.