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Short Implants Performance: Systematic Review of Essential Parameters





Alfredo Natali Ugo Consolo

34 PUBLICATIONS 17 CITATIONS Universit degli Studi di Modena e Reggio Emilia


Available from: Thais Goncalves

Retrieved on: 05 April 2016
and Removable
IMPLANTSImplant-supported Partial Dentures:
and Nutritional Assessment
Gonalves TMSV*, Bortolini S, TMSV*, Rodrigues
Rodrigues Garcia Garcia
RCM, Martinolli RCM
M, Natali A, Berzaghi A, Bianchi
R, Dimakopoulou C, Multianu
DENTAL L, Georgakopoulos
SCHOOL, I, Furgone
UNIVERSITY R, Franchi M, Consolo U.

Background: Lack of standard criteria in the outcome assessment makes it difficult to
draw conclusions on the clinical performance of short implants and, under these
circumstances, determine the reasons for implant failure. Aims: This study evaluated,
through a systematic review of the literature, the essential parameters required to assess
the long-term clinical performance of short and extra-short implants. Methods:
Electronic databases (Pubmed-MEDLINE, Cochrane Library Database, Embase, and
Lilacs) were searched by two independent reviewers, without language limitation, to
identify eligible papers. References from the selected articles were also hand searched.
The review included clinical trials, published between January 2000 and March 2014,
involving short dental implant (<8 mm in length), placed in humans, by which described
the parameters applied for outcomes measurements and provide data on survival rates.
Results: Thirteen methodologically acceptable studies were selected and 24 parameters Fig1. Flow chart of the search strategy.
were identified. The most frequent parameters assessed were the marginal bone loss and
the cumulative implant survival rate, followed by implant failure rate and biological
complications such as bleeding on probing and probing pocket depths. Mechanical
complications and crown-to-implant (C/I) ratio measurement were also commonly
described. Conclusions: Considering the available evidence, several parameters were
highlighted to be used during the short implant analysis, especially on clinical trials.
Standard criteria might be helpful to regiment further investigations, allowing the
comparison of data. Fig 2. Forest plot of Cumulative Implant Survival Rate and subgroup analysis per
study design.
INTRODUCTION Table 1. Summary of the implant characteristics of the 13 included studies.
Prosthesis Follow-up Drop-

In the past, short implants were commonly associated with lower survival rates due
Study Subjects Implants Length Surface Location Loading Failure CRS %
material (Years) outs
Porous sintered implant
to the reduced bone-to-implant contact allied to the fact that short implants are Deporter et al.
24 48
7 and 9
treated with spherical Posterior mandible
Two-stage 2 0 0 100%
(2001) mm metal crowns
mostly installed in the posterior zone, once the quality of the alveolar bone is titanium particles
Posterior mandible Porcelain-fused-to- Not Not 95.5 % (Tawil et
relatively poor. Tawil et al. (2006) 106 262 < 10 mm Machined-surface
maxilla metal crowns reported
al. 2003)

On the other hand, recent literature has demonstrated no significant differences in the Corrente et al. 5 and 7
Porous sintered implant
48 48 treated with spherical Not reported Not reported Two-stage 1 1 97.92%
survival rate reported by short and standard implants probably due to the (2009) mm
titanium particles

development of modified implant designs and surfaces. SLActive-modified


Nevertheless, standard outcome criteria to assess the clinical performance of the

Rossi et al. (2010) 35 40 6 mm Mandible Maxilla Gold palladium Two-stage 2 0 2 95%
surface implants

short implants are still missing in literature, becoming difficult to draw conclusions. Anodically oxidised
Acrylic crowns and
Mal et al. (2011) 127 217 7 mm Mandible Maxilla metal-ceramic 5 3 10 95.4%
surface loading
Porous sintered implant
Perelli et al. (2011) 40 55 treated with spherical Mandible Two-stage 5 0 9 84%
mm restorations
titanium particles
The aim of this study was to evaluated, through a systematic review of De Santis et al.
46 107
7 and 8.5
Oxidized surface
Posterior mandible
Not reported Two-stage 3
4 96.3%
(2011) mm maxilla reported
the literature, the essential parameters required to assess the long-term Cannizzaro et al.
Dual-etched covered Acrylic crowns and Immediate
30 60 6.5 mm with nanoscale calcium Mandible Maxilla metal ceramic and early 4 0 2 93.3%
clinical performance of short and extra-short implants. (2012)
phosphate crystal crowns loading
Mertens et al. 8 and 9 Moderately rough
14 52 Mandible Maxilla Not reported Two-stage 10.1 ( 1.9) 2 0 100%
(2012) mm titanium-blasted surface
METHODS Pieri et al. (2012) 25 61 6 mm Not reported Posterior mandible
Two-stage 2 0 2 96.8%
Dual-acid surface with Control group
Search Strategy and Study Selection Telleman et al.
92 149 8.5 mm deposition of nanometer-
Posterior mandible
Two-stage 1 1 9 92.1%; Test
sized CaP particles group 95.9%


80 115 8.5 mm Dual-acid etched surface
Posterior mandible Metal-ceramic
Two-stage 1 0 7
Control group
93.1%; Test
(2012) maxilla crowns
Short dental implants, treatment outcomes, failures, complication, biologic group 94.5%
One and Not
complication, alveolar bone loss, bone loss, success, clinical success. Kim et al. (2013) 20 46 7 mm SLA surface treatment Posterior mandible Not reported
1 year
1 97.8%

Applied Filters
Humans, Clinical Trials, Randomized Clinical Trials, and Prospective Studies. Table 2. Summary of the principal methods of analysis applied in the 13 included studies.
Reference X-ray technique Calibration Marginal bone Mean marginal bone loss Crown-implant (C/I) ratio
ratio results
Customized templates
and standard long cone Not reported
Position of the alveolar bone at
the machined/porous surface
Mean bone loss of 0.03 mm
(baseline and 6 months); bone Not reported Not reported
al. (2001)
Without language limitation, using: paralleling technique junction
Border of the conical and
gain of 0.12 mm, (1 to 2 years)
Anatomical CI ratio: relationship Relatively few
Long-cone technique
Medline (from January 2000 to March 2014) Tawil et al.
and noncustomized
paralleling device
Not reported
cylindric parts of the implant
head or abutment-implant
Mean bone loss was 0.74
0.65 mm
between crown length (top of the
restoration to the abutment-implant
C/I ratios were
< 1 or > 2

Lilacs (from January 2000 to March 2014)

connection interface) and implant length (16.2%)
Mean bone loss of 1.0 mm (5-
Corrente et Paralleling technique
Not reported Not reported mm implants) and 2 mm (7- Not reported Not reported
Embase (from January 2000 to March 2014) al. (2009) and Rinn film holders
mm implants)
Clinical CI ratio: relationship

EBM reviews (Cochrane Database of Systematic Reviews)

Mean bone loss of 0.750.71
between anatomic crown (top of the C/I ratio was
Rossi et al. Bone loss around the implants at mm (insertion to 2-year follow-
Individually film holders Not reported restoration to the most coronal bone- 10.2 (range
(2010) mesial and distal aspects up) and 0.430.49 mm
to-implant contact) and total length of 0.71.4)
(loading to 2-year follow-up)
the implant embedded in bone.
Inclusion Criteria Mal et al.
Paralleling technique
and film holder
Not reported
Implant platform and marginal Mean bone loss 1.27 0.67 mm
bone remodelling (1 year of follow-up)
Not reported Not reported

Mean bone loss of 1.0 mm (5-

1. Randomized or Prospective Clinical Trials, conducted in humans, with a clear aim Perelli et al.
Paralleling technique
and Rinn film holders
Not reported Not reported
mm implants) and 2 mm (7-
mm implants) (never exceeding
Not reported Not reported

smooth collar)
of investigating the long-term performance of short implants exclusively (less than De Santis et Bone levels in the lowest point Mean bone loss of 0.6 0.2
Not reported Not reported Not reported Not reported
10 mm in total length and 8 mm intrabone length); al. (2011) in contact with implant mm (range 0.0 to 1.9 mm)
X-rays images calibrated by the Coronal margin of implant collar Mean bone loss of 0.37 mm
2. Studies with reported implant survival rates and criteria for implant failure; Cannizzaro
et al. (2012)
Paralleling technique known distance of two
consecutive treads.
and the most coronal point of
bone-implant contact
(immediate loading) and 0.31
mm (early loading)
Not reported Not reported

3. Studies presenting minimum sample size of 10 healthy patients and a minimum Mertens et Long-cone technique
Linear dimensions calibrated
based on the known threads
Distance from implant shoulder
and the first visible bone-to-
Mean bone loss of 0.3 0.5
Not reported Not reported
al. (2012) and a film holder mm (range 0 to 1.4 mm)
number of 10 short implants installed, with mentioned mean follow-up period of at distance
Calibration based on the known
implant contact
Mean bone loss: 0.27 0.10 Clinical CI ratio: relationship
Distance from
least 1 year after implant loading with the prosthesis. Pieri et al.
Long-cone paralleling
technique and an
diameter of implant head.
Method error assessed on
implant-abutment junction and
mm (prosthetic loading); 0.40 between crown length (top of the
0.23 mm (6 months), 0.51 restoration to the most coronal bone-
Mean clinical
CI ratio was
(2012) the most coronal level of bone in
individual film holder duplicate measure of one implant 0.38 mm (1 year), and 0.60 to-implant contact) and implant 1.94 0.46
contact with implant surface
randomly selected in each patient 0.13 mm (2 years) length embedded in bone.

Exclusion Criteria Telleman et

Paralleling technique
Calibration based on the known
threads distance. Reliability of X-
Mean bone loss was less
around platform-switched (0.5
and an individualized ray measures assessed in 30 X- Not specified Not reported Not reported
al. (2012) 0.53 mm) than in control
holder rays of 20 patients by two
Retrospective studies, case reports, reviews, non-clinical studies, explanation of examiners (ICC = 0.87)
implants (0.74 0.61 mm)
Calibration based on the known Mean inter-proximal bone loss
technique or clinical trials with insufficient information regarding the long-term Telleman et
Paralleling technique threads distance. Reliability were less around platform-
and an individualized assessed in 30 X-rays of 20 Not reported switched (0.51 0.51 mm) Not reported Not reported
performance of short implants were not considered to avoid any risk of bias. Studies al. (2012)
holder patients by two examiners (ICC = than in control implants (0.73
0.87) 0.48 mm)
using short and standard implants to support the same prostheses were also excluded. Kim et al. Distance from implant platform
Mean bone loss of 0.04 mm
Anatomic CI ratio: relationship
between crown and implant length
CI ratios 1.5
Parallel cone technique Not reported (two-stage) and 0.16 mm (one- Higher pocket
(2013) to first bone-to implant contact. regardless the bone level, (CI ratio <
stage) depth
1.5 or 1.5)
Statistical Analysis
Cohens Kappa-coefficient was calculated as a measure of agreement between the 2 readers. CONCLUSION
Only cumulative implant survival rate percentage (CSR% - confidence interval 95%) based
on failure time reported allows meta-analysis. Descriptive data analysis was chosen for the Considering the available evidence, no strong conclusions could be drawn
remaining parameters. Meta-analysis was performed considering fixed and random effects since different methods were used to assess each parameters. Thus, a
and statistical heterogeneity was assessed by means of I2 statistics, performed with standard protocol should be developed, being helpful to regiment further
Comprehensive Meta-Analysis Software (Version 3, BioStat, Englewood, NJ, USA). investigations and comparisons on future studies.