JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Volume No: 8, Issue No: 2

REVIEW ARTICLE

SHORT IMPLANTS- EVOLVING TRENDS- A REVIEW

Swetha Thiagarajan, Godwin Alex Kiruba*, Manikandhan Ramanathan**

Junior Resident, Department of Prosthodontics, Crown, Bridge and Implantology, Government Dental College and

Hospital, Chennai, Tamilnadu, India

*Meenakshi Cleft and Craniofacial Centre, Meenakshi Academy of Higher Education and Research, Chennai,

Tamilnadu, India

**Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Meenakshi Academy of Higher Education and

Research, Chennai, Tamilnadu, India

DOI:1.37841/jidam_2021_V8_I

2_05

Address for Correspondence

Dr. Swetha Thiagarajan, BDS.,

Junior Resident, Department of Prosthodontics, Crown, Bridge

and Implantology, Government Dental College and Hospital,

Chennai

Email id: swethat2k14@gmail.com

Received:

23.05.2021 First Published

07.06.2021

Accepted:

03.06.2021

Published:

27.06.2021

ABSTRACT

Short implants have been proposed as one of the

positive  treatment  options  for  compromised  edentulous
regions. Decreased bone height, poor bone quality often
limits  the  use  of  conventional  implants  and  usually
necessitates performing complex surgical procedures like
sinus lift or bone augmentations which are associated with
increased morbidity, treatment time and cost. Though the
crown  root  ratio  of  short  implants  is  controversial,  they
have  demonstrated  a  high  success  rate  with  innovations
that  have  bolstered  its  effectiveness  through  the
modifications  in  micro  and  macro  surface  topography,
surgical  bone  drilling  protocols  and  implant  diameter.
Photo  functionalization  of  implants  and  customized
implants  using  3D  printing  are  a  few  of  the  promising
developments in short implants.

KEY WORDS:

Short Implants, Implant surface

topography, Bone grafting, Photo functionalization,
Customized Implants

JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Jaishree et al: Lipoxins for Resolution of Inflammation

Volume No: 8, Issue No: 2

Historical evolution

Dr. Branemark’s discovery of osseointegration in 1952

and the placement of the first Branemark implants in humans
in 1965 were the initial landmark events in the field of dental
implantology1.  Since  then,  this  discipline  has  made  great
strides  in  fulfilling  the  patient’s  esthetic  and  functional
needs.

What are Short Implants?

Dental implants have been classified by various

authors; yet there is no universally accepted consensus as to
what  constitutes  a  short  or  a  long  dental  implant.  Many
authors  have  categorically  referred  to  implants  with  length
less  than  11mm,  10mm,  8mm  and  7mm  as  short
implants.

2,3,4,5

There are many trials and systematic reviews

in the recent years, which consider implants with length
equal to or less than 8mm as short implants and the authors
have followed the same.

Why Short Implants weren’t preferred?

Historically, long implants were only preferred on

every edentulous area as the initial trials suggested that the
failure rates of short implants were more than long implants.

Most  of  the  earliest  documented  failures  of  short  implants
were  seen  in  areas  of  poor  bone  quality  with  less  density,
specifically in the posterior maxilla. These trials, though they
used  turned/machined  surface  implants,  they  also  had
followed the standard drilling protocols of the era. There was
no widely accepted protocol to differentiate site preparation
for soft versus normal bone.

Adjuncts to Short Implants

Later, the clinicians began to encounter specific

scenarios in which the anatomical constraints prevented the
placement  of  long  implants.  Pneumatized  maxillary  sinus
with resorbed posterior alveolar ridges, position of the nasal
floor, nasopalatine canal, inferior alveolar nerve and mental
foramen are some of the potential limitations for placement
of long implants. Many advanced surgical techniques were
incorporated  into  clinical  practice  to  counter  these
limitations,  which  include  maxillary  sinus  grafting,  guided
bone  regeneration,  usage  of  block  bone  grafts,  distraction
osteogenesis and inferior alveolar nerve transposition.

Over the years, the demerits and complications

associated with these convoluted and invasive grafting
procedures became apparent. A few of these procedures are

time consuming, expensive, extremely technique sensitive,
necessitate advanced skills and training, with increased
surgical morbidity. Jepsen et al

and Louis et al

elaborated

on the usage and complications of bone grafting materials
and techniques with regards to the maxillae. Mazzone to and
colleagues reviewed the complications associated with
alveolar distraction osteogenesis

Evolution of Short Implants

There has been a tremendous transformation in implant

configuration  and  biomechanics  in  the  recent  years.
Advances  in  the  design  of  dental  implants  both  externally,
and  internally,  the  implant  to  abutment  connection  khave
been dramatically transformed. All of these changes have led
to  enhanced  implant  survivability.  A  multitude  of
improvements  in  the  external  implant  design  including
thread design, macro surface, and micro surface topography
and  in  the  internal  design  including  implant  to  abutment
connections  have  enhanced  the  implant  survivability.    The
development  and  adoption  of  modified  surgical  protocols
(soft  bone  drilling  protocols),  permit  improved  primary
mechanical  stability  and  have  been  advocated  by  several
researchers across the globe.9 Finite element analyses (FEA)
have revealed  that  increasing the  implant  diameter  is  more
efficient than increasing implant length for stress reduction
at  the  bone  to  implant  interface.  Wider  diameter  short
implants  have  increased  functional  surface  area  (FSA)  and
improved  primary  stability.  It  facilitates  the  creation  of  a
better  emergence  profile,  specifically  in  the  posterior
segment and also increases fracture resistance.10 A diameter
increase by 1 mm is supposed to increase the surface area by
30-200%  depending  upon  the  implant  design.  This  better
understanding  of  implant  to  bone  biomechanics  has
contributed to the increased usage of short implants.

Are Short Implants Better?

Multiple reviews and trials have been published

comparing short implants with long implants in augmented,
grafted or modified sites. Thoma et al

elicited that the short

implants in the posterior maxilla had a shorter operative time
and were extremely cost-effective. Hazdik and colleagues

published  that  short  implants  decreased  the  need  for
adjunctive surgical procedures thereby reducing the patient’s
post-operative  pain  and  morbidity.  A  few  more  reviews
found no significant difference between the two techniques
with  regards  to  implant  survival,  marginal  bone  loss  and
patient satisfaction.

Pieri and colleagues

observed no statistically

JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Jaishree et al: Lipoxins for Resolution of Inflammation

Volume No: 8, Issue No: 2

significant differences in the number of implant or prosthetic
failures, prosthetic or biological complications between long
implants  placed  in  augmented  sites  and  short  implants  in
non-augmented sites. The number of surgical complications
was  greater  in  the  long  implants  category  with  the  short
implants recording a statistically significant lesser marginal
bone  loss.  Annibali  et  al

reviewed and elaborated on the

utility of short implant-supported prostheses in atrophic jaw
and found them to be a valid treatment option. They reported
high  survival  rates  and  low  incidence  of  biological  and
biomechanical  complications.  Surgical  technique,  implant
location, type of edentulism and prosthetic restoration were
not observed to affect short-implant survival.

Recent Advances

Photo functionalization of implants

Implants that were treated with ultraviolet (UV) light

has  been  found  to  increase  the  bone  implant  contact  from
55%  to  98%,  thereby  increasing  the  strength  of
osseointegration. This can be attributed to the generation of
superhydrophilicity, improvement in the electrostatic status
of  titanium  surfaces  with  a  significant  decrease  in  surface
hydrocarbons.

Customized implants using 3D printing

Intra-oral scanning with CAD/CAM designs coupled

with three-dimensional printing had already been used for
making surgical guides and customized implant abutments.

We  can  fabricate  customized  implants  with  the  analog
mimicking  the  root  of  the  missing  tooth.  Pre-operative
CBCT  can  aid  in  designing  the  implant  based  on  the  root
morphology  of  the  tooth  to  be  extracted,  or  using  the
contralateral  tooth  root  morphology  in  case  of  a  missing
tooth.    They  can  offer  excellent  advantages  over  the
traditional implant designs.

Surface Topography

Alteration of the implant surface can influence the

success of osseointegration. This can be achieved either by
subtractive processes like etching, blasting and oxidation, or
additive  procedures  like  ion  deposition,  titanium  plasma
spraying, calcium phosphate and hydroxyapatite coating.10
Implant  surfaces  treated  with  silver  nanoparticles-based
composites  have  been  observed  to  decrease  the  biofilm
adhesion  and  lactate  production  by  microorganisms.
Implants treated with Silver Plasma have demonstrated anti-
bacterial effects and provide better osteointegration results.

ACKNOWLEDGEMENT

‘a’ designed the study, searched relevant articles and collected
data. ‘a’ and ‘b’ participated in the data interpretation and
analysis. ‘a’ and ‘c’ prepared the manuscript. All the three
authors read and approved the final manuscript.

CONFLICTS OF INTEREST

There are no conflicts of interest.

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