Short implants compared to regular dental implants after bone augmentation in the atrophic posterior mandible: umbrella review and meta-analysis of success outcomes

Abstract

Purpose To assess the body of evidence of short versus regular implants after bone augmentation (BA) in the atrophic posterior mandible in the context of implant treatment success outcomes. Methods Seven databases, two registries, and reference lists were searched for systematic reviews and meta-analysis (SR/MA), randomized controlled trials (RCTs) and longitudinal studies published in English, Spanish or German since 2012. Confidence in the SR/MA methodology was evaluated using AMSTAR-2 and the risk of bias of primary studies using Cochrane’s RoB 2.0 and ROBINS-I. A random-effects meta-analysis and a meta-regression were performed for continuous and dichotomous outcomes. GRADE approach was used to assess the certainty of the evidence. Results Eighteen SRs/MAs, most of them “critically low” and “low” confidence with substantial overlap, included 14 relevant RCTs with a high risk of bias. A cohort study with moderate risk of bias was added. Quantitative synthesis of 595 implants and 281 hemiarches/patients indicates that the use of short implants (< 10 mm) compared to regular implants and BA may reduce implant failure at 1-year follow-up, and marginal bone loss (MBL) at 3-, 5-, and 8-year follow-up; is likely to reduce the risk of biological complications at 1-, 3-, 5-, and 8-year follow-up; and may be the patient's preferred alternative. There is a correlation between bone height, MBL and biological complications. Conclusions The available evidence partially suggests that the use of short implants could decrease implant failure, MBL, and biological complications, and increase patient satisfaction. However, given the need for further RCTs and real-world evidence to fully evaluate short- and long-term outcomes, it would be prudent for clinicians to carefully consider the individual needs and circumstances of the patients before deciding whether to use short implants. Trial registration PROSPERO CRD42022333526 Graphical Abstract

Partial Implant Rehabilitations in the Posterior Regions of the Jaws Supported by Short Dental Implants (7.0 mm): A 7-Year Clinical and 5-Year Radiographical Prospective Study

“…There are other treatment alternatives available to rehabilitate partially edentulous jaws with, such as standard implants in grafted bone with open or closed sinus elevation with or without regeneration, nerve transposition (mandible), and alveolar distraction osteogenesis. Several studies compared the performance between short implants inserted in residual bone and standard implants inserted in augmented bone with differing results [ 24 , 32 , 33 , 34 , 35 , 36 ]. Terheyden et al [ 24 ] registered no significant difference in implant survival at 8 years of follow-up using short implants (≤7 mm) or standard implants in augmented bone; however, less complications and decreased marginal bone loss occurred in short implants.…”

“…Terheyden et al [ 24 ] registered no significant difference in implant survival at 8 years of follow-up using short implants (≤7 mm) or standard implants in augmented bone; however, less complications and decreased marginal bone loss occurred in short implants. Sáenz-Ravello et al [ 36 ] reported a decreased risk of implant failure, marginal bone loss, and biological complications for short implants in residual bone in the posterior mandible. Buser et al [ 32 ] and Hallman et al [ 33 ], in 5-year prospective studies, both registered cumulative survival rates of 86% and 100% for implants placed in augmented bone, and in patients subjected to maxillary sinus floor augmentation, respectively.…”

Short and Extra Short Dental Implants in Osseous Microvascular Free Flaps: A Retrospective Case Series

“…As mentioned for patients with OMFFs, we try to avoid further surgical procedures due to a fundamental concern minimizing a patient's exposure to additional morbidities. Short dental implants have the unmistakable advantage of size, which most often precludes the need for augmentation surgeries and their associated morbidity [48,49]. According to Malet, the most important clinical recommendations for placing short implants [50] is to avoid generating heat.…”

Survival Rates of Short Dental Implants (≤6 mm) Used as an Alternative to Longer (>6 mm) Implants for the Rehabilitation of Posterior Partial Edentulism: A Systematic Review of RCTs

“…It is also recommended to splint prosthetic restorations of adjacent short implants [ 10 ]. Concerning the type of prosthetic restoration, it has been reported that cemented restorations are associated with increased survival rates and lower MBL values than screwed prostheses [ 73 ].…”