Short versus standard implants at sinus augmented sites: a systematic review and meta-analysis

Abstract

Background Short implants are proposed as a less invasive alternative with fewer complications than standard implants in combination with sinus lift. The aim of this systematic review and meta-analysis was to state the efficacy of placing short implants (≤ 6 mm) compared to standard-length implants (≥ 8 mm) performing sinus lift techniques in patients with edentulous posterior atrophic jaws. Efficacy will be evaluated through analyzing implant survival (IS) and maintenance of peri-implant bone (MBL). Methods Screening process was done using the National Library of Medicine (MEDLINE by PubMed), EMBASE, the Cochrane Oral Health, and Web of Science (WOS). The articles included were randomized controlled trials. Risk of bias was evaluated according to The Cochrane Collaboration’s tool. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). A random-effects model was applied. Secondary outcomes such as surgical time, patient satisfaction, mucositis and peri-implantitis, pain, and swelling were analyzed. Results Fourteen studies (597 patients and 901 implants) were evaluated. IS was 1.02 risk ratio, ranging from 1.00 to 1.05 (CI 95%) (p = 0.09), suggesting that IS was similar when both techniques were used. MBL was higher in patients with standard-length implants plus sinus lift elevation (p = 0.03). MBL was 0.11 (0.01–0.20) mm (p = 0.03) and 0.23 (0.07–0.39) mm (p = 0.005) before and after 1 year of follow-up, respectively, indicating that the marginal bone loss is greater for standard-length implants. Discussion Within the limitations of the present study, as relatively small sample size, short dental implants can be used as an alternative to standard-length implants plus sinus elevation in cases of atrophic posterior maxilla. Higher MBL was observed in the groups where standard-length implants were used, but implant survival was similar in both groups. Moreover, with short implants, it was observed a reduced postoperative discomfort, minimal invasiveness, shorter treatment time, and reduced costs. Clinical Clinical relevance The low MBL promoted by short implants does contribute to a paradigm shift from sinus grafting with long implants to short implants. Further high-quality long-term studies are required to confirm these findings.

Short Implants versus Standard Implants and Sinus Floor Elevation in Atrophic Posterior Maxilla: A Systematic Review and Meta-Analysis of Randomized Clinical Trials with ≥5 Years’ Follow-Up

“…In the analysis, the authors included implants inserted in the mandibular region. In the meta-analysis of Toledano and coworkers [ 22 ], the authors included RCTs with a follow-up longer than 1 year with a RR value of 1.02 [95% CI: (1.00, 1.05); p = 0.09], suggesting that the ISR was similar for both types of implants. The meta-analysis of Bitinas et al [ 9 ] included 3 RCTs with a follow-up of 5 years and also showed a statistically insignificant difference with a RR value of 0.03 [95% CI: −0.07 to 0.13, ( p = 0.52)].…”

“…Other RCTs have indicated that the ISR for both implants are the same [ 25 , 26 ]. These inconsistencies around systematic reviews may be due to the study population and type of implant system used [ 22 ]. However, standard implants with sinus lifts showed better outcomes, and the sinus lift procedure still remains a sensitive technique.…”

“…Guida et al [ 21 ] reported a higher MBL at 5 years for standard implants comparted to short implants [0.6 mm (95% CI: 0.42, 0.78; p < 0.00001)]. Toledano et al reported the MBL of 0.23 mm [95% CI: (0.07, 0.39); p = 0.005], indicating that the MBL was higher for standard implants [ 22 ]. Bitinas et al [ 9 ] obtained a MBL of −0.45 mm [95% CI: (−0.87, −0.02); p = 0.04].…”

Sinus Mucosal Damage Triggered by Synthetic or Xenogeneic Bone Substitutes: A Histological Analysis in Rabbits

“…Complications might be associated with sinus floor elevation [ 33 ]. Short implants have been shown to represent a valid alternative, exhibiting lower marginal bone loss compared to standard-length implants and similar survival rate [ 34 ].…”

Posterior rehabilitation using 3D-printed dental implants and synthetic regenerative membranes

“…Teeth loss in the posterior region may leads an alveolar bone resorption associated with maxillary sinus' pneumatization. These conditions may present vertical bone defects that make rehabilitation with osseointegrated implants impossible or difficult [2]. To overcome these conditions, new implant geometries allow their stability in minimal bone remnants and the development of new surfaces favor osseointegration, minimizing the stability drop between primary and secondary stability [3,4].…”