8 MM Implants: Would Splinting Improve Stability?

The quality of bone in the maxillary posterior regions are at best, can be compared to pine, but may have the density of balsa wood. Due to the limited height of bone available,in my experience, doing a sinus lift and augmenting the maxilla with grafting might be a better situation before attempting to put short implants into unstable bone,

well splinting will help in long term load distribution. in literature Bo Rangert suggest in helps to reduce chances of bone loss . especially when u put 8 mm implant you dont want to loose bone around it. Having said that Rangert concept are not that strictly believed now. long clinical crown height, wide occlusal table and narrow platform are other sensible indication. we can also create tripod effect with splinting to manage excursion load better. splinted crowns give you built in anti-rotation as well. i hope it helps

oh yeh coming back to 2nd part of ur question. 8mm is not regarded as short short anymore by most manufacturers

I have been using the Bicon implant system for almost 6 years now with excellent results. (Not sure if that manufacturer's name will make it through the editor, but feel free to contact me directly with any questions) In a nutshell, I have routinely been placing their 8x5x3mm implants since the beginning and have found them to be incredibly predictable. In fact, I place nothing longer than 8mm in the posterior. And often utilize an even shorter length if I want to avoid vital structures. (they offer 6x5.7x3mm and even a 5x5x3mm for premolar areas) Their implants are coated with various materials (see their website for more info) to help the integration process which allows for final restoration to begin in as little as 8 weeks, all things being equal; healthy bone, good volume of bone, free of defects - Any circumstance that might normally call for an extended period of time. The point being, a length of 8mm has been found to be more than enough to use in the posterior of both the upper and lower arches. This has been demonstrated in thousands of instances both by myself and other doctors. You mention that the area you will be working in will accommodate a 4.5mm wide implant. If you do not have an option for a 5mm, then I would go to a hand instrument for the last one or two reamers where you will have more control with regard to perforating a plate. In the Bicon system, the hand reamers have the added bonus of acting as a bone expander, where only 1/2 the reamer actually cuts. This way, you are able to monitor the buccal (or lingual) plate with your second hand. Lastly, if you are working in an area that will not require a flap to place the implant, ie. you can use a tissue punch or semilunar incision, you may be afforded just that little bit more leeway and get that 5mm wide implant in there. Without disturbing the blood supply to the buccal or lingual plate with a full thickness flap and causing subsequent bone width loss, I believe you can push that 1mm collar of bone clearance, which is the rule of thumb, to .5mm and have a very good result.

I have used 8.5mm nobel active in the maxillary posterior without problems. Always splint if you can, and remember that the healing caps are a form of loading. Yes your patients chew on them..just ask, they will tell you. Some degree of loading helps bone growth and maturity.

I realized that throughout my bloviation, I did not answer your question on splinting. Not to directly contradict David's comments above, but I do not believe that splinting is necessary if it is just to address the fact that you are going to use a "short" implant. (as Ben stated above, 8mm implants are not considered "short" implants by a great number of guys now). I'd say approach splinting implants the same as you would crown and bridge indications, whatever yours may be. As we all know, these things are rock solid when they integrate. If you're concerned about bone quality in the maxilla, bury that thing and let it sit there for 6 months. No healing plug, nothing. Don't give the patient an opportunity to contact it. Once I placed implants above bridgework as the ideal treatment to restore missing teeth, the food trap and increased challenge to clean connected teeth became an obvious thing to avoid if at all possible. I might even go so far as to say that if you're going to splint implants to gain stability, you probably do not have a good situation to restore the implant in the first place.

Dr. S The primary concern with a short implant is not force transfer to the bone. Studies show that the force transfer to the bone in implants longer than 8 mm is minimal and of little consequence. What is of great concern is the potential for future bone loss. If there is 2 mm of bone loss in a supra-crestal placement of an implant that is only 8 mm long, 25% of the available support is lost. Both Bicon and Ankylos are sub-crestally placed implants. Both systems show minimal, if any, bone loss over many years. They are best able to survive over the long term. Your choice of system here would be based upon the prosthetic flexibility, options for restoration, retrievability should that be necessary, and re-restorability potential. With regard to splinting, it is not necessary. Splinting prevents screw loosening in platform implant/abutment systems and systems that have a "conical connection", but whose anti-rotation and abutment retention come from the screw. The splinting sacrifices interproximal cleansability for preventing screw loosening. A slightly tapered abutment, grit blasted to improve cement retention, will not allow funtional torque to dislodge a crown from the abutment. Specialist, Implant Prosthodontics DENTSPLY/ Tulsa Dental Specialties

Do a google search about "short dental implant success rate" and you will easily find multiple studies that show that short implant have the same success rate as long implants. It is the coronal 3-4 mm that take a beating. Any implant length beyond 8 mm is icing on the cake.