YIJOM-4651; No of Pages 9

Int. J. Oral Maxillofac. Surg. 2019; xxx: xxx–xxx

https://doi.org/10.1016/j.ijom.2021.02.014, available online at https://www.sciencedirect.com

Meta-Analysis
Dental Implants

Short implants (6 mm) as an P. Carosia, C. Lorenzia, F. Lioa,

M. Lauretib, N. Ferrignob, C. Arcuric
a
Department of Chemical Science and

alternative treatment option to Technologies, University of Rome Tor

Vergata’, Rome, Italy; bDepartment of Oral
and Maxillo-Facial Sciences, Sapienza’
University of Rome, Rome, Italy; cDepartment

maxillary sinus lift of Clinical Sciences and Translational

Medicine, School of Dentistry, University of
Rome Tor Vergata’, Rome, Italy

P. Carosi, C. Lorenzi, F. Lio, M. Laureti, N. Ferrigno, C. Arcuri: Short implants

(6 mm) as an alternative treatment option to maxillary sinus lift. Int. J. Oral
Maxillofac. Surg. 2019; xxx: xxx–xxx. ã 2021 International Association of Oral and
Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Abstract. The aim of this systematic review was to evaluate survival rate of short
dental implants placed in the posterior area of the maxilla. The electronic literature
search of studies published between January 1, 2010 and February 29, 2020 was
performed using specific word combinations. The outcome was to meta-analyse the
implant survival rate (ISR). The search generated 238 potential studies. After
screening procedures, only nine randomized controlled trials fulfilled the inclusion
criteria and were selected for qualitative and quantitative analysis. ISR of short
implants ranged from 91.9% to 100%, while standard-length implants ISR ranged
from 82.9% to 100% with a follow-up from 1 to 5 years in function. The risk ratio
difference was 1.24 (95% confidence interval: 0.63–2.45, P = 0.52) for short dental
implants failure when compared with standard dental implants, and was not Keywords: Short implants; Sinus lift; Dental
statistically significant. Based on the evidence of the included studies, short implants; Bone augmentation procedures.
implants (6 mm) reported high survival rates over short to medium follow-up in
posterior maxilla, but the long-term success is as yet not demonstrated. Accepted for publication

Rehabilitation of missing teeth by means
of dental implants is a safe and well-
documented treatment. Nowadays,
patients ask for implant therapy that is
minimally invasive and results in less
morbidity. Expectations are increasing
but nevertheless the patients may be re-
luctant to go through implant surgery es-
pecially if bone augmentation procedures
are required.1 The posterior area of the
maxilla is often compromised by severe
resorption due to tooth loss and increased
pneumatization of the maxillary sinus.2
Ridge atrophy and maxillary sinus pneu-
matization result in several issues with
regard to the rehabilitation of posterior
maxilla areas by means of functional
and aesthetic implant-supported prosthe-
ses.3 Through the years, several techni-
ques have been proposed to overcome
these anatomical limitations. The first
technique was described by Tatum in
19864 and it recommended accessing the
sinus through the ridge crest and to place
dental implants after the healing period.5
The lateral window approach gradually
replaced the crestal approach and it is still
recommended in case of severe maxillae
resorption.6 Later, Summers proposed a
less invasive technique which is widely
accepted as an alternative option for sinus
floor elevation and immediate dental im-
plant placement.7 The simultaneous ap-
proach proposed by Summers is possible
when posterior areas of the maxillae are
affected by mild resorption and there is the
possibility to achieve sufficient primary
stability.8 In both cases, the sinus floor
elevation techniques require elevated

0901-5027/000001+09 ã 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
YIJOM-4651; No of Pages 9
2 Carosi et al.
surgical skills by the surgeon to avoid
several complications such as perforation
of the Schneiderian membrane, intra- and
postoperatorial bleeding and augmented
costs and morbidity for the patient.9 To
overcome the possible complications, the
use of short dental implants was proposed
as an alternative treatment option to reha-
bilitate posterior areas of the maxilla.10,11
The definition of short implants is still not
completely defined and interpretation of
literature is complicated by several differ-
ent definitions. Strietzel and Reichart
reported that an implant with a length of
11 mm is considered short.12 However,
Group 1 of the 6th ITI Consensus Confer-
ence considered ‘‘short dental implants’’
to be all dental implants that are 6 mm.13
The clinical application of short dental
implants to rehabilitate mandibular
resorption and to avoid any inferior
alveolar nerve injury had been well docu-
mented and investigated by several stud-
ies.14,15 In recent years, the use of short
dental implants has been studied as an
alternative treatment option also in the
Fig. 1. PRISMA Preferred Reporting Items for Systematic Review and Meta-Analyses) search strategy flow chart.
Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
posterior areas of the maxilla where bone
augmentation procedures were required to
place a standard-length dental implant
(>10 mm). Several randomized con-
trolled trials (RCTs) investigated the
short-implant survival rate through the
years and compared it to standard-length
dental implants placed in augmented bone
sites.16–24 The aim of this study was to
systematically review the literature con-
cerning the survival rate of short dental
implants (6 mm) in the posterior areas of
the maxilla.
Materials and methods
The study protocol followed the PRISMA
(Preferred Reporting Items for Systematic
Review and Meta- Analyses) statement
1886.25 The question of the research was
reported in PICOS (Population, Interven-
tion, Comparison, Outcomes and Study
design) format: ‘‘do standard implants after
sinus lift (I) report the same clinical out-
comes (O) in randomized controlled trials
(S) in posterior maxillae atrophy (P) as short
dental implants(C)?’’. The inclusion and
exclusion criteria were defined before the
start of the study. To be included in the
review, the studies had to be published in
the English language, randomized con-
trolled trials, based on human subjects
and have at least 10 patients and 1 year of
follow-up after prosthesis delivery. The
main research subject had to evaluate clini-
cal effectiveness of short dental implants
(6 mm) to rehabilitate severe posterior
maxillae atrophy. All studies analysed were
published between January 1, 2010 and
February 29, 2020. Studies were not includ-
ed if they reported the same data as later
publications by the same authors; system-
atic reviews, commentaries and letters to
the editor, case reports or series, in vitro
studies, and studies in animal models were
also excluded. Relevant systematic
reviews, as well as the reference lists of
all included articles, were searched by hand
to identify further publications. Full-text
screening, study selection and data extrac-
tion was performed in duplicate and dis-
agreements were resolved by consensus.
 YIJOM-4651; No of Pages 9
Table 1. Population and study characteristics of the selected studies.
Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014

Groups characteristics
1. Test group patients total (male,
female)
2. Age (mean in years) Implant Implant length
3. Control group patients total (male, 1. No. of short implants total (in mm)
female) 2. No. of regular implants 1. Short Follow-up
Study Study design 4. Age (mean in years) total Implant manufacturer 2. Regular (in months)
Shi et al. (2019) Randomized controlled trial 1. 75 (30,45) 1. 75 Straumann 1. 6 12
2. 38.1 2. 150 2. 8-10
3. 150 (67,83)
4. 41.85
Guljé et al. (2019) Randomized controlled trial 1. 20 (7, 13) 1. 21 Dentsply Sirona 1. 6 60
2. 50 2. 20 2. 11
3. 18 (11, 7)

Short implants (6 mm) as an alternative treatment option to maxillary sinus lift
4. 48
Thoma et al. (2018) Randomized controlled trial 1. 50 (21, 29) 1. 67 Dentsply Sirona 1. 6 60
2. 50 2. 70 2. 11
3. 51 (28, 23)
4. 51
Gastaldi et al. (2017) Randomized controlled trial 1. 10 (3, 7) 1. 16 Zimmer Biomet 1. 6 36
2. 53.4 2. 18 2. 10
3. 10 (5, 5)
4. 58.6
Bechara et al. (2016) Randomized controlled trial 1. 33 (10, 23) 1. 45 MegaGen 1. 6 36
2. 47.5 2. 45 2. 10
3. 20 (9, 11)
4. 49.2
Felice, Barausse, Pistilli Randomized controlled trial 1. 15 (7, 6) 1. 34 MegaGen 1. 5 60
et al. (2019) 2. 56 2. 38 2. 10 -11.5 -13
Bolle et al. (2018) Randomized controlled trial 1. 20 (10, 10) 1. 37 Global-D 1. 4 12
2. 60.75 2. 41 2. 10- 11.5- 13
3. 20 (9, 11)
4. 56.40
Felice, Pistilli, Barausse Randomized controlled trial 1. 20 (11, 9) 1. 36 MegaGen 1. 6 60
et al. (2019) 2. 57.6 2. 37 2. 10-13
Esposito et al. (2019) Randomized controlled trial 1. 20 (5, 15) 1. 39 MegaGen 1. 5 60
2. 61.1 2. 44 2. 10- 11-5–13- 15
3. 20 (10, 10)
4. 58.5

3
YIJOM-4651; No of Pages 9
4 Carosi et al.
Types of interventions
The analysed studies were randomized
controlled clinical trials or split-mouth
randomized controlled clinical trials.
The test group was treated with short
dental implants and the control group
was treated with bone augmentation
procedures and regular dental implants
in severe posterior maxillae atrophy.
Outcome measures
The primary outcome was the implant sur-
vival rate (ISR) of short dental implants. All
the collected and analysed data were mea-
sured before intervention and at every year
of recall, for at least 1 year of follow-up.
Search strategy
Electronic research was performed involving
different databases (MEDLINE, Embase, and
Cochrane Library). The following combina-
tion of words was used: ‘‘short implant OR
short implants OR extrashort implant OR
extrashort implants OR extra-short implant
OR extra-short implants AND maxilla’’. In
addition, bibliographies of reviews were an-
alysed and cross-checked. The following
combination of words was used for the search
in the Cochrane database: ‘‘Short dental
implants AND Trials’’. Moreover, bibliogra-
phies of relevant systematic reviews were
analysed to cross-check the data.
Selection criteria and data extraction
A three-stage screening of the studies was
carried out by two reviewers independently
Table 2. Quality assessment of the included studies following the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials.
Green = low risk; yellow = unclear risk; red = high risk.
Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
(P.C. and C.L.). Any disagreement
was resolved after discussion. The first
stage involved the title analysis. Then,
the abstracts were analysed and only the
selected studies were included for the full-
text reading.
Risk of bias
The quality of the included studies was
assessed by the reviewers (P.C. and C.L.)
using the Cochrane Collaboration tool for
assessing risk of bias in randomized trials.
The risk of bias was classified as low, high or
unclear. Any disagreement was discussed
until it was resolved by consensus.
Statistical analysis
The ISR was analysed using a fixed-
effects meta-analysis, with the difference
between the results quantified by a risk
ratio (RR) with 95% confidence interval.
The heterogeneity was calculated by
means of Cochran’s Q-statistic and the
I2 statistic. P-values <0.05 were consid-
ered statistically significant. The meta-
analysis of the data was performed using
a fixed effects model with inverse-
variance methods. MedCalc (MedCalc
Software Ltd, Ostend, Belgium) software
was used to perform the analysis.
Results
Included studies
The search resulted in 238 titles. After
screening of titles and abstracts, a total
of 24 potentially relevant studies were
identified. Nine studies were included in
the qualitative analysis (Fig. 1). The nine
studies that satisfied the inclusion criteria
are presented in Table 1. Quality assess-
ment of the included studies is presented
in Table 2. All studies were RCTs and
published between 2010 and 2020 and
conducted in a university environment.
Two studies had a split-mouth design18,19
in which both treatment modalities were
performed in all patients. Seven studies
had only one treatment modality being
performed in the involved patients ran-
domly. A total of 370 short implants
(6 mm) were placed in 263 patients,
while 463 standard-length implants
(>10 mm) were placed in 324 patients.
In five studies17–19,23,24 implants were
placed both in maxilla and in mandible.
Only results from the maxillary implants
were taken. Two studies20,21 had 1-year of
follow-up, two studies22,24 had 3 years of
follow-up and the other five stud-
ies16,18,19,23 had 5 years of follow-up.
Concerning dental implant length, the
short-implant group included implants of
lengths ranging from 4 to 6 mm: one
study17 reported data on 4-mm implants,
two studies18,24 reported data on 5-mm
implants and six studies16,19–23 reported
data on 6-mm implants. The control
groups had a variety of implant lengths
ranging from 8 to 15 mm. No immediate
loading was performed in any of the stud-
ies. The prosthetic design was assessed in
order to splint multiple adjacent implants
in four studies17,19,22,24. Three stud-
ies16,20,21 reported single crowns as the
exclusive treatment modality, while the
other two studies18,23 reported both
YIJOM-4651; No of Pages 9

Short implants (6 mm) as an alternative treatment option to maxillary sinus lift 5

Table 3. Main results of the included studies.

Mean marginal
Implant survival rate bone loss (in mm) Prosthetic success (in %) Prosthetic complication
(in %) 1. Short implant 1. Short implant 1. Short implant 1. Short implant
Study 2. Standard implant 2. Standard implant 2. Standard implant 2. Standard implant
Shi et al. (2019) 1. 96 1. 0.51 1. 96 1./
2. 100 2. 0.52–0.47 2. 100 2./
Guljé et al. (2019) 1. 94.7 1. 0.12 1. 89.4 1. 4
2. 100 2. 0.14 2. 100 2. 1
Thoma et al. (2018) 1. 98.5 1. 0.54 1. 100 1. 21
2. 100 2. 0.46 2. 100 2. 14
Gastaldi et al. (2017) 1. 100 1. 0.89 1. 100 1. 2
2. 88.8 2. 1.08 2. 100 2. 1
Bechara et al. (2016) 1. 97.8 1. 0.20 1. 100 1. 0
2. 95.6 2. 0.27 2. 100 2. 0
Felice, Barausse, 1. 92.1 1. 1.31 1. 94.7 1. 5
Pistilli et al. (2019) 2. 97.1 2. 1.79 2. 100 2. 2
Bolle et al. (2018) 1. 91.9 1. 0.63 1. 97.3 1. 4
2. 82.9 2. 0.72 2. 87.8 2. 11
Felice, Pistilli, 1. 94.4 1. 1.93 1. 95 1. 2
Barausse et al. (2019) 2. 100 2. 2.28 2. 100 2. 5
Esposito et al. (2019) 1. 97.2 1. 1.58 1. 94.4 1. 2
2. 100 2. 2.11 2. 100 2. 7

prosthetic design as treatment modalities. was excluded because the outcomes et al.21 reported an overall short-implant
Concerning the retentions of the restora- were different from those established. survival rate in reabsorbed posterior maxil-
tions, six studies17,18,20–22,24 reported only One study37 was excluded because the la of 94.7% after 5 years in function. Oth-
cement-retained restorations, while the follow-up period was less than one year. erwise, the standard-length implant group
other three studies16,19,23 reported combi- One study38 was retracted and thus it was had an overall implant survival rate of 100%
nations of screw- or cement-retained not considered in the qualitative and quan- after the same follow-up period. Thoma
restorations. The main results are summa- titative analysis. One study39 was exclud- et al.16 reported a similar implant survival
rized in Table 3. ed because bone augmentation procedures rate after 5 years of follow-up between the
were not performed in the control group test and the control group of 98.5% and
(Table 4). 100%, respectively. Slight differences be-
Excluded studies tween the test and the control group were
Two studies26,27 were excluded because found at 5 years of follow-up by Felice
they reported a unitary static analysis of
Implant survival rates et al.18 and Esposito et al.23, at 3 years of
maxillary and mandibular implant surviv- Survival rates of short dental implants ran- follow-up by Bechara et al.24, and at 1 year
al and marginal bone loss (MBL). Seven ged from 91.9% to 100% with a follow-up of follow-up by Shi et al.20. More significant
studies28–34 were excluded because the from 1 to 5 years in function. The standard- differences were found by Felice et al.,19
same data were reported in studies with length dental implant groups had an implant after 5 years in function, by Gastaldi et al.22
longer follow-up. One study35 was exclud- survival rate ranging from 82.9% to 100% at 3 years of follow-up and at 1 year of
ed because it only described the prelimi- with a follow-up from 1 to 5 years in follow-up by Bolle et al.17
nary study protocol and another study36 function. At 5 years of follow-up, Guijé The test for heterogeneity revealed a
Cochran’s Q-statistic index of 7.6234
and a I2 statistic index of 0.00%. No
Table 4. Excluded studies and reasons for exclusion. publication bias was found in the included
studies (Fig. 2). The meta-analysis
Studies Exclusion reason revealed a not statistically significant
Naenni et al., 201826 Statistical analysis is comprehensive of both maxilla RR difference of 1.24 (95% confidence
Shah et al., 201827 and mandible interval: 0.63–2.45, P = 0.52) for short
Gastaldi et al., 201832 Patients or data reported in other studies with longer dental implants failure when compared
Felice et al., 201829 follow-up with standard dental implants (Fig. 3).
Thoma et al., 201531
Esposito et al., 201530
Felice et al., 201533
Gulje et al., 201429 Discussion
Pohl et al., 201734
Shi et al., 201535 It only reports preliminary study protocol The purpose of this study was to system-
Sharmann et al., 201736 The outcomes reported are different from those atically review the literature concerning
established the survival rate of short dental implants
Zhang et al., 201637 The study has less than 1 year follow-up (6 mm) in the posterior areas of the
Pieri et al., 201238 The article was retracted maxilla. The main limitations of this study
Rossi et al., 201539 Bone augmentation procedures were not performed are the follow-up of the included studies,
in the control group
ranging from 1 to 5 years, and the overall

Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
YIJOM-4651; No of Pages 9

6 Carosi et al.

Fig. 2. Funnel plot with all the included studies showing high homogeneity and symmetry.

Fig. 3. Forest plot with included studies. CI, confidence interval.

risk of bias classified as ‘unclear or high’
in some included studies. However, the
collection and the description of the data
in most of the studies were classified as
‘low risk’ and no publication bias was
detected (Fig. 2) providing a high-quality
statement on the results. In addition, only
RCTs were included in this review in
order to achieve high-quality results. Of-
ten, tooth loss is followed by severe
resorption of the posterior area of the
maxilla. In addition, pneumatization of
maxillary sinus contributes to reduce bone
quantity to insert standard length dental
implants. Through the years, the use of
short dental implants (6 mm) has been
largely investigated by several clinical
studies.40–42 The objective was to reduce
the number of clinical stages not perform-
ing bone augmentation procedures, such
as maxillary sinus lifting, maintaining
high-quality standards for successful im-
plant-supported rehabilitations. The suc-
cess of a rehabilitation is directly
connected to implant survival and pros-
thetic success. In a recent systematic re-
view, Ravidà et al.43 reported values of
ISR from 1 to 5 years in function of 96.9%,
96.9%, 92.9%, 91.7%, and 90.6%, respec-
tively, of short dental implants placed in
atrophic maxillae. Similar results were
recorded by Papaspyridakos et al.14 in
another systematic review where mean
ISR was 96%, ranging from 86.7% to
100%. A systematic review conducted
by Nielsen in 201944 concluded that
‘‘there was no statistically significant dif-
ference between the two treatment modal-
ities - short implants (8 mm) compared
to standard length implants (>8 mm) in
conjunction with maxillary sinus floor
augmentation - with regard to overall
patient satisfaction. Similar results were
reported by several prospective studies by
Han et al.,45 Torassa et al.46 and Nizam
et al.47 with 36 months, 24 months and 18
months of follow-up, respectively, and the
ISR values ranged from 95.8% to 100%.

Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
YIJOM-4651; No of Pages 9
Short implants (6 mm) as an alternative treatment option to maxillary sinus lift
The aim of this study was to assess short
dental implant survival rate when used as
an alternative treatment option in posterior
areas of the maxilla. The meta-analysis
showed a slightly higher failure risk of
short dental implants compared with stan-
dard dental implants placed after bone
augmentation procedures. The high mean
ISR value of 96% suggests that the use of
short implants in the posterior maxilla is a
reliable treatment, but the values range
and the RR could indicate a low predict-
able treatment option instead. However, it
must be pointed out that the results of this
review and the results of the included
studies are not statistically significant. In
addition, not going through at least
two surgeries per patient to perform bone
augmentation procedures leads to less
morbidity, time and costs for the treated
patients.3
The bone augmentation procedures re-
quire high surgical skills by the clinicians
and there is an increased risk of several
complications in the postoperative peri-
ods. In fact, the selected studies reported a
higher number of biological complications
in patients treated with bone augmentation
procedures. The sinus membrane perfora-
tion was the most common complication
reported.16,19,20,23,24 In addition, higher
morbidity was recorded among patients
in the augmented groups.18,21,22 In fact,
Bechara et al.24 also reported the loss
of two implants due to chronic sinusitis
infection.
The mean MBL values reported in the
included studies ranged from 0.12 to
1.93 mm and it seems that the main
resorption of peri-implant bone occurs
during the first year of function. The ac-
cepted values for bone loss are defined as
1–1.5 mm during the first year in function
and <0.2 mm annually thereafter.48 The
results are in accordance with several
prospective studies. Han et al.45 reported
a mean MBL of 0.07  0.49 mm for
6-mm dental implants after 3 years in
function. After 2 years in function, Tor-
assa et al.46 reported a mean MBL of
0.30 mm for 4-mm dental implants while
Nizam et al.47 reported a mean MBL of
0.54  0.46 mm after 18 months of fol-
low-up for single short dental implants.
Peri-implant bone health plays a crucial
role when short implants (6 mm) are
involved because of the reduced available
bone-to-implant surface that allows
implant survival. An overall bone loss
of 2 mm around a 4-mm-long implant
means that almost 50% of the implant
surface is no longer osseointegrated. In
addition, marginal bone levels may be
affected by the prosthetic design.
Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
The ITI Consensus13 recommended that
short dental implants should be splinted
together in order to avoid the risk of
occlusal overload in the single molar
rehabilitation and/or if the patient has
parafunctional tendency. Splinting short
dental implants seems to reduce the stress
generated by the occlusal load on to the
implant bodies and on to the peri-implant
bone, as suggested by several finite-ele-
ment analyses.49–51 The data reported by
Torassa et al.46 and Han et al.45 seem to be
in accordance with this hypothesis. In fact,
after 2 and 3 years in function the mean
MBL values are extremely low. Maintain-
ing an elevated number of dental implants
rigidly joined together seems to positively
affect implant survival and prosthetic
success.52 However, more data from
studies with longer follow-up are required
to provide a comprehensive approach to
prosthetic design.
It seems logical to observe that in both
cases occlusion checks need to be
performed routinely in order to avoid
overload and to prevent prosthetic com-
plications and/or peri-implant bone
resorption. Most of the time, the use of
short implants to rehabilitate posterior
jaws leads to a prosthetic solution with
a non-favourable crown-to-implant (C/I)
ratio. A systematic review by Garaicoa-
Pazmiño et al.53 and a retrospective study
by Anitua et al.10 suggested that C/I ratio
should not influence implant survival.
In conclusion, the short dental implants
(6 mm) placed in resorbed posterior
areas of the maxilla avoiding bone aug-
mentation procedures reported high sur-
vival rates during a short to medium
follow-up. However, it seems that there
is a high variability in the overall treat-
ment compared with standard dental
implants placed after bone augmentation
procedures. Several randomized con-
trolled trials and prospective studies with
longer follow-up are required to assess the
predictability of the short implants in the
posterior maxillae.
Funding
This research was not funded.
Competing interests
There were no conflicts of interest regard-
ing this study.
Ethical approval
This study is a systematic review and it
does not require ethical approval.
7
Patient consent
Patients consents were recorded in each
study analysed by this systematic review.
References
1. Neldam CA, Pinholt EM. State of the art of
short dental implants: a systematic review of
the literature. Clin Implant Dent Relat Res
2012;14(4):622–32.
2. Renouard F, Nisand D. Short implants in the
severely resorbed maxilla: a 2-year retro-
spective clinical study. Clin Implant Dent
Res 2005;7(s1):s104–10.
3. Ferrigno N, Laureti M, Fanali S. Dental
implants placement in conjunction with
osteotome sinus floor elevation: a 12-year
life-table analysis from a prospective study
on 588 ITI implants. Clin Oral Implants Res
2006;17(2):194–205.
4. Tatum H. Maxillary and sinus implant recon-
structions. Dent Clin N Am 1986;30(2):207–
29.
5. Rosen PS, Summers R, Mellado JR, Salkin
LM, Shanaman RH, Marks MH, et al. The
bone-added osteotome sinus floor elevation
technique: multicenter retrospective report
of consecutively treated patients. Int J Oral
Maxillofac Implants 1999;14(6):853–8.
6. Scott RA. ITI treatment guide, volume 5:
sinus floor elevation procedures. Br Dent J
2012;212(10):512.
7. Summers RB. The osteotome technique: Part
3—Less invasive methods of elevating the
sinus floor. Compendium 1994;15(6):710.
698, 700, 702–4 passim; quiz.
8. Pommer B, Mailath-Pokorny G, Haas R,
Buseniechner D, Millesi W, Fürhauser R.
Extra-short (<7mm) and extra-narrow diam-
eter (<3.5mm) implants: a meta-analytic
literature review. Eur J Oral Implantol
2018;11(Suppl 1):S137–46.
9. Stacchi C, Andolsek F, Berton F, Perinetti G,
Navarra CO, Lenarda RD. Intraoperative
complications during sinus floor elevation
with lateral approach: a systematic review.
Int J Oral Maxillofac Implants 2017;32(3):
e107–18.
10. Anitua E, Piñas L, Orive G. Retrospective
study of short and extra-short implants
placed in posterior regions: influence of
crown-to-implant ratio on marginal bone
loss. Clin Implant Dent Relat Res 2013;17
(1):102–10.
11. Anitua E, Flores J, Alkhraisat MH. Tran-
screstal sinus lift using platelet concentrates
in association to short implant placement: a
retrospective study of augmented bone
height remodeling. Clin Implant Dent Relat
Res 2015;18(5):993–1002.
12. Strietzel FP, Reichart PA. Oral rehabilitation
using Camlog screw-cylinder implants with
a particle-blasted and acid-etched micro-
structured surface. Results from a prospec-
tive study with special consideration of short
YIJOM-4651; No of Pages 9
8 Carosi et al.
implants. Clin Oral Implants Res 2007;18
(5):591–600.
13. Jung RE, Al-Nawas B, Araujo M, Avila-
Ortiz G, Barter S, Brodala N, et al. Group
1 ITI Consensus Report: the influence of
implant length and design and medications
on clinical and patient-reported outcomes.
Clin Oral Implant Res 2018;29(S16):69–77.
14. Papaspyridakos P, Souza A, Vazouras K,
Gholami H, Pagni S, Weber H. Survival rates
of short dental implants (6mm) compared
with implants longer than 6mm in posterior
jaw areas: a meta-analysis. Clin Oral Im-
plant Res 2018;29(S16):8–20.
15. Slotte C, Grønningsaeter A, Halmøy A-M,
Öhrnell L-O, Mordenfeld A, Isaksson S,
et al. Four-millimeter-long posterior-mandi-
ble implants: 5-year outcomes of a prospec-
tive multicenter study. Clin Implant Dent
Relat Res 2015;17(Suppl 2):e385–e395.
16. Thoma DS, Haas R, Sporniak-Tutak K,
Garcia A, Taylor TD, Hämmerle CHF. Ran-
domized controlled multicentre study com-
paring short dental implants (6mm) versus
longer dental implants (11-15 mm) in com-
bination with sinus floor elevation proce-
dures: 5-year data. J Clin Periodontol
2018;45(12):1465–74.
17. Bolle C, Felice P, Barausse C, Pistilli V,
Trullenque-Eriksson A, Esposito M. 4mm
long vs longer implants in augmented bone
in posterior atrophic jaws: 1-year post-load-
ing results from a multicentre randomised
controlled trial. Eur J Oral Implantol
2018;11(1):31–47.
18. Felice P, Barausse C, Pistilli R, Ippolito DR,
Esposito M. Five-year results from a ran-
domised controlled trial comparing prosthe-
ses supported by 5-mm long implants or by
longer implants in augmented bone in pos-
terior atrophic edentulous jaws. Int J Oral
Implant New Malden Lond Engl 2019;12
(1):25–37.
19. Felice P, Pistilli R, Barausse C, Piattelli M,
Buti J, Esposito M. Posterior atrophic jaws
rehabilitated with prostheses supported by 6-
mm-long 4-mm-wide implants or by longer
implants in augmented bone. Five-year post-
loading results from a within-person ran-
domised controlled trial Int J Oral Implantol
(Berl) 2019;12(1):57–72.
20. Shi J-Y, Li Y, Qiao S-C, Gu Y-X, Xiong Y-Y,
Lai H-C. Short versus longer implants with
osteotome sinus floor elevation for moder-
ately atrophic posterior maxillae: a 1-year
randomized clinical trial. J Clin Periodontol
2019;46(8):855–62.
21. Guljé FL, Raghoebar GM, Vissink A, Meijer
HJA. Single crowns in the resorbed posterior
maxilla supported by either 11-mm implants
combined with sinus floor elevation or 6-mm
implants: a 5-year randomised controlled
trial. Int J Oral Implantol (Berl) 2019;12
(3):315–26.
22. Gastaldi G, Felice P, Pistilli R, Barausse C,
Trullenque-Eriksson A, Esposito M. Short
implants as an alternative to crestal sinus lift: a
Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
3-year multicentre randomised controlled trial.
Eur J Oral Implantol 2017;10(4):391–400.
23. Esposito M, Barausse C, Pistilli R, Piattelli
M, Simone SD, Ippolito DR, et al. Posterior
atrophic jaws rehabilitated with prostheses
supported by 55mm implants with a nano-
structured calcium-incorporated titanium
surface or by longer implants in augmented
bone. Five-year results from a randomised
controlled trial. Int J Oral Implantol 2019;12
(1):39–54.
24. Bechara S, Kubilius R, Veronesi G, Pires JT,
Shibli JA, Mangano FG. Short (6-mm) dental
implants versus sinus floor elevation and
placement of longer (10-mm) dental
implants: a randomized controlled trial with
a 3-year follow-up. Clin Oral Implant Res
2016;28(9):1097–107.
25. Moher D, Liberati A, Tetzlaff J, Altman DG,
Group P. Preferred reporting items for sys-
tematic reviews and meta-analyses: the
PRISMA statement. PLoS Med 2009;6(7):
e1000097.
26. Naenni N, Sahrmann P, Schmidlin PR, Attin
T, Wiedemeier DB, Sapata V, et al. Five-year
survival of short single-tooth implants
(6mm): a randomized controlled clinical
trial. J Dent Res 2018;97(8):887–92.
27. Shah SN, Chung J, Kim DM, Machtei EE.
Can extra-short dental implants serve as
alternatives to bone augmentation?. A pre-
liminary longitudinal randomized controlled
clinical trial. Quintessence Int 2018;49
(8):635–43.
28. Guljé FL, Raghoebar GM, Vissink A, Meijer
HJA. Single crowns in the resorbed posterior
maxilla supported by either 6-mm implants
or by 11-mm implants combined with sinus
floor elevation surgery: a 1-year randomised
controlled trial. Eur J Oral Implantol 2014;7
(3):247–55.
29. Felice P, Barausse C, Pistilli V, Piattelli M,
Ippolito DR, Esposito M. Posterior atrophic
jaws rehabilitated with prostheses supported
by 6mm long4mm wide implants or by
longer implants in augmented bone: 3-year
post-loading results from a randomised con-
trolled trial. Eur J Oral Implantol 2018;11
(2):175–87.
30. Esposito M, Barausse C, Pistilli R, Sammar-
tino G, Grandi G, Felice P. Short implants
versus bone augmentation for placing longer
implants in atrophic maxillae: one-year post-
loading results of a pilot randomised con-
trolled trial. Eur J Oral Implantol 2015;8
(3):257–68.
31. Thoma DS, Haas R, Tutak M, Garcia A,
Schincaglia GP, Hämmerle CHF. Random-
ized controlled multicentre study comparing
short dental implants (6mm) versus longer
dental implants (11-15 mm) in combination
with sinus floor elevation procedures. Part 1:
demographics and patient-reported out-
comes at 1 year of loading. J Clin Period-
ontol 2014;42(1):72–80.
32. Gastaldi G, Felice P, Pistilli V, Barausse C,
Ippolito DR, Esposito M. Posterior atrophic
jaws rehabilitated with prostheses supported
by 55mm implants with a nanostructured
calcium-incorporated titanium surface or by
longer implants in augmented bone: 3-year
results from a randomised controlled trial.
Eur J Oral Implantol 2018;11(1):49–61.
33. Felice P, Pistilli R, Barausse C, Bruno V,
Trullenque-Eriksson A, Esposito M. Short
implants as an alternative to crestal sinus lift:
a 1-year multicentre randomised controlled
trial. Eur J Oral Implantol 2015;8(4):375–84.
34. Pohl V, Thoma DS, Sporniak-Tutak K, Gar-
cia-Garcia A, Taylor TD, Haas R, et al. Short
dental implants (6mm) versus long dental
implants (11-15mm) in combination with
sinus floor elevation procedures: 3-year
results from a multi-center, randomized,
controlled clinical trial. J Clin Periodontol
2017;44(4):438–45.
35. Shi J-Y, Gu Y-X, Qiao S-C, Zhuang L-F,
Zhang X-M, Lai H-C. Clinical evaluation of
short 6-mm implants alone, short 8-mm
implants combined with osteotome sinus
floor elevation and standard 10-mm implants
combined with osteotome sinus floor eleva-
tion in posterior maxillae: study protocol for
a randomized controlled trial. Trials 2015;16
(1):324.
36. Sahrmann P, Schoen P, Naenni N, Jung R,
Attin T, Schmidlin PR. Peri-implant bone
density around implants of different lengths:
a 3-year follow-up of a randomized clinical
trial. J Clin Periodontol 2017;44(7):762–8.
37. Zhang X-M, Shi J-Y, Gu Y-X, Qiao S-C, Mo
J-J, Lai H-C. Clinical investigation and pa-
tient satisfaction of short implants versus
longer implants with osteotome sinus floor
elevation in atrophic posterior maxillae: a
pilot randomized trial: short dental implants.
Clin Implant Dent Relat Res 2016;19
(1):161–6.
38. Rossi F, Botticelli D, Cesaretti G, Santis ED,
Storelli S, Lang NP. Use of short implants
(6mm) in a single-tooth replacement: a 5-
year follow-up prospective randomized con-
trolled multicenter clinical study. Clin Oral
Implant Res 2015;27(4):458–64.
39. Retraction. Rehabilitation of the atrophic
posterior maxilla using short implants or
sinus augmentation with simultaneous stan-
dard-length implant placement: a 3-year ran-
domized clinical trial. Clin Implant Dent
Relat Res Dec 2012;14(6):924.
40. Guida L, Annunziata M, Esposito U, Sir-
ignano M, Torrisi P, Cecchinato D. 6mm
short and 11mm long implants compared
in the full-arch rehabilitation of the edentu-
lous mandible: a 3-year multicenter random-
ised controlled trial. Clin Oral Implan Res
2019;31(1):64–73.
41. Rokn AR, Monzavi A, Panjnoush M,
Hashemi HM, Kharazifard MJ, Bitaraf T.
Comparing 4-mm dental implants to longer
implants placed in augmented bones in the
atrophic posterior mandibles: one-year
results of a randomized controlled trial. Clin
Implant Dent Res 2018;20(6):997–1002.
YIJOM-4651; No of Pages 9
Short implants (6 mm) as an alternative treatment option to maxillary sinus lift
42. Zadeh HH, Guljé F, Palmer PJ, Abrahamsson
I, Chen S, Mahallati R, et al. Marginal bone
level and survival of short and standard-length
implants after 3 years: an open multi-center
randomized controlled clinical trial. Clin Oral
Implant Res 2018;29(8):894–906.
43. Ravidà A, Barootchi S, Askar H, Amo FS-
LD, Tavelli L, Wang H-L. Long-term effec-
tiveness of extra-short (6mm) dental
implants: a systematic review. Int J Oral
Maxillofac Implants 2019;34(1):68–84.
44. Nielsen HB, Schou S, Isidor F, Christensen
AE, Starch-Jensen T. Short implants
(8mm) compared to standard length
implants (>8mm) in conjunction with max-
illary sinus floor augmentation: a systematic
review and meta-analysis. Int J Oral Max-
illofac Surg 2019;48(2):239–49.
45. Han J, Tang Z, Zhang X, Meng H. A pro-
spective, multi-center study assessing early
loading with short implants in posterior
regions. A 3-year post-loading follow-up
study. Clin Implant Dent Res 2017;20
(1):34–42.
46. Torassa D, Naldini P, Calvo-Guirado JL,
Fernández-Bodereau E. Prospective, clinical
Please cite this article in press as: Carosi P, et al. . . . , Int J Oral Maxillofac Surg (2021), https://doi.org/10.1016/j.ijom.2021.02.014
pilot study with eleven 4-mm extra-short
implants splinted to longer implants for pos-
terior maxilla rehabilitation. J Clin Med
2020;9(2):357.
47. Nizam N, Gürlek Ö., Kaval M. Extra-short
implants with osteotome sinus floor eleva-
tion: a prospective clinical study. Int J Oral
Maxillofac Implants 2020;35(2):415–22.
48. Misch CE, Perel ML, Wang H-L, Sammar-
tino G, Galindo-Moreno P, Trisi P, et al.
Implant success, survival, and failure: the
International Congress of Oral Implantolo-
gists (ICOI) Pisa Consensus Conference.
Implant Dent 2008;17(1):5–15.
49. Guichet DL, Yoshinobu D, Caputo AA. Ef-
fect of splinting and interproximal contact
tightness on load transfer by implant restora-
tions. J Prosthet Dent 2002;87(5):528–35.
50. Naert I, Koutsikakis G, Duyck J, Quirynen
M, Jacobs R, Steenberghe van D. Biologic
outcome of implant-supported restorations
in the treatment of partial edentulism. Part
1: a longitudinal clinical evaluation. Clin
Oral Implant Res 2002;13(4):381–9.
51. Bergkvist G, Simonsson K, Rydberg K,
Johansson F, Dérand T. A finite element
9
analysis of stress distribution in bone tissue
surrounding uncoupled or splinted dental
implants. Clin Implant Dent Relat Res
2008;10(1):40–6.
52. Sheridan RA, Decker AM, Plonka AB, Wang
H-L. The role of occlusion in implant thera-
py: a comprehensive updated review. Im-
plant Dent 2016;25(6):829–38.
53. Garaicoa-Pazmiño C, Suárez-López del
Amo F, Monje A, Catena A, Ortega-Oller
I, Galindo-Moreno P, et al. Influence of
crown/implant ratio on marginal bone loss:
a systematic review. J Periodontol 2014;85
(9):1214–21.
Corresponding author at: Department of
Chemical Science and Technologies
University of Rome ‘Tor Vergata’
Via della Ricerca Scientifica 1
00133 Rome
Italy
Tel.: +39 3277998699
E-mail: carosipaolo29@gmail.com