Evidence Supports the Use of Short Implants as a Graftless Solution - A Narrative Review.

Purpose: The clinical problem that all clinicians must resolve is loss of bone after teeth are removed. The volume of bone available to support implants may be limited and due to anatomical restrictions, options include grafting procedures or the use of short implants with minimal need for bone augmentation. The importance of this narrative review is to document the success of using short implants to rehabilitate patients with limited bone volume to avoid a grafting procedure. The importance of this analytical narrative review is to document the success of using short implants to rehabilitate patients with limited bone volume to avoid a grafting procedure, and to estimate the relative risk when using short implants for single tooth restorations compared to splinted short implants to support a restoration. The objective is to provide clinicians with guidance, based on evidence in the literature, to select when to use short implants, or when to graft and use longer implants. The study design was an analytical review of articles that reported clinical data with at least one year follow up. Pubmed.gov was the information source. Years reviewed included 1990 to 2023. Inclusion criteria for analytical analysis included retrospective or prospective studies.

Predictor variable: The predictor variable was the use of short implants for fixed restorations.

Outcome variable: The primary outcome variable was implant status coded as survived or failed. Covariates: The covariates were type of restoration using either splinted short implants or short implants used as single tooth replacements, and time to failure either less than 1 year or greater than one year.

Analyses: Bivariate statistics assessed the association between splinting or single implants and failure with significance at p-value < 0.05.

Results: Fifty articles1-50 were collated and summarized to answer specific clinical situation questions. Of those, 18 articles with retrospective or prospective data were available for analysis with 11 articles for single implant restorations and 7 for splinted implant restorations. After applying exclusion criteria, the sample size was 1683 implants as reported in these articles. Single implants included 853 (50.7%) and splinted implants included 830 (49.3%). Sixty-two (7.3%) single short implants failed compared to 36 of 830 (4.3%) splinted short implants. Implants greater than 8 mm in length included 565 with 11 (1.9%) failure. The comparison between splinted and single implant restorations for short and long implants was significant (p < .05) for all comparisons except for comparing splinted vs single long implants. The comparison of covariates single and splinted for both short and long implants separating failure less than one year to longer loading indicated that short implants had more failure after loading (p < .05). The longer implants did have not significant differences comparing early to loading time periods.

Conclusion: Short implants, when splinted together, have similar success compared to longer implants, based on evidence from refereed reports. Single short implants did have an increased risk for failure.

Methods: Pubmed.gov was the information source. Years reviewed included 1990 to 2023. Inclusion criteria included only articles in journals referenced in pubmed.gov. Articles were excluded that did not include a statistical analysis. The specific population were patients who had received short implants to restore missing teeth. Interventions included the use of short implants splinted together compared to short implants used to restore single teeth. Outcomes reviewed included survival and the use of success rates based on the health of the soft and hard tissues over time, as reported by the authors of the articles reviewed.

Results: The search identified articles for review using terms which included short dental implants (n=2,333), short dental implant failures (n=814), single short dental implant failures (n=223), splinted short implant failures (n=55), and short dental implant survival (n=775). From this search, 50 articles1-50 were collated that satisfied the inclusion criteria. Short implants when splinted together had similar long term success compared to longer implants, in the presence of attached gingiva and limited muco gingival problems. For single restorations short implants had an increased risk for failure secondary to loss of integration over time. Short implants had a similar success rate compared to longer implants placed into grafted sinuses. Short splinted implants placed into ridge augmentations had a success rate similar to longer implants.

Conclusion: Short implants can be used when splinted together based on evidence from refereed reports. Single short implants did have a small increased risk for failure. Short implants could be used splinted to other implants to avoid sinus grafting.