Shorter Implants: Viable Alternatives to Sinus Lifts?

I think for an upper molar a 8mm long implant, over 4,5mm diameter can be enough, if the crown length is not too much. But, only, if this enosseal length will not be shorter after a half year. That means no overloading, enough bone around the implant, no polished collar enosseal, mini threads/groves, no micro gap, no residual cement ... I have now some cases with ImplantDirect's S-plant, and it works. It's not a simple question, but the system can also not be a weak point.

Recent artcle from Dr. Paul Fugazzotto on this topic. Int J Oral Maxillofac Implants. 2008 May-Jun;23(3):487-96. It all depends on the case and the implant you are using.

Thanks for pointing out the Fugazzotto article. You can find the abstract for this article by clicking here.

As I understand the article from Fugazotto includes ALL patients with short implants in both the mandible and maxilla. As a typical example is Prof. Branemarks first case in the mandible, short implants in the mandible held the patients protheses for over 40years (the rest of the patents life). As we all know the bone quality differs a hole lot between the mandible and the posterior maxilla. However if You have a wide crest with more than 6mm of bone below the sinus and place one implant/tooth with bicortical anchorich I would say You are on the safe side. Place implants with a rough surface and let them heal without load for at least three month. However if You place implants more and more often I personally would recommend You to attend courses and learn how to manage sinuslifts. Best of luck!

Short implants certainly work well if you have sufficient width. I've placed quite a number of Bicon 6x5.7mm. In the mandible, the failure rate is virtually zero. Bicon also has 5x6mm and even 4.5x6mm. Surprisingly, these work well too. I'm also placed some 6x6mm Korean implants, but I have not restored sufficient numbers to say that they definitely work. So far, the results look promising. One problem with short and wide implants is that it's difficult to obtain primary stability. Like Bicon implants, they often spin in the osteotomy. To play safe, I never do 1 stage surgery with short implants even if the manufacturer swears that it's OK to do so. Nevertheless, I would not hesitate to do a sinus lift and place a 10mm implant if circumstances permit. My short implants are usually placed in the posterior mandible.

Dear all, If you lose bone on short implant, you will lose your implant. If you lose bone on normal implant, you only lose satisaction of perfection. So what's wrong with the sinus lift? It's so easy game...

I am a GP and I have placed more than 2000 implants. THe posterior Maxilla is where I have had the most commoncly gotten burned. I have numerous delayed failures - mostly lifecore stage one implants 8mm. I have changes my protocol ot ASTRA, at least 9mm, but preferably 11 or more. You must be able to do a sinus lift at least an internal. If you lose an implant you have to be able to go back in and replace it. Then you go from short to shorter with out a sinus lift. Bone quality can really be poor back there allow 6 months for integration. Don't use short implants. I don't think Fugazattos results apply to the real world - don't learn the hard way.

Think of the blood supply associated with 4-6mm of mostly cortical maxillary bone between the sinus and the mouth. How predictably will that heal or handle periodontal disease or......... In my opinion, The predictability and low morbidity and mortality of a sinus lift does not support the use of implants shorter than 9mm (Used to be 10mm until Astra sucked me in:)). Plan for the worst and don't hope for the best....

I would suggest that firstly you look at using Endopore implants. These are particularly suited where there is limited bone height. I have been using these for over 14 years and if correctly placed they are very successful . Although they do have a 5mm long implant, I would suggest that you don't use shorter than 7mm in the post maxilla. Also you should be familiar with the Summers osteotome sinus lift procedure. Endopore Implants are ideally suited for this procedure and it is a conservative and simple sinus lift procedure where there is at least 4mm of bone present.

As a specialist, I have seen a lot of posterior max. cases done with short/wide fixtures by other surgeons. Often times I have seen the fixture offset to the palatal to compensate for limited ridge width. So while there was no need for a sinus lift, off axis loading was increased. I think the technology works, but it may set us up for long-term issues.

I use Endopores, and regularly avoid sinus lifts by using 5x5 o 4.1x7 mm implants. Just remember that this implants are great and work even better when used as stand alone(not in bridges) but with those you can make full sized molars. best of luck

During a period of 8 years I have placed & restored in the maxillary molar area more than 400 short bicon implants at Beirut Implant Dentistry Center where I practice .The length varied between 5.7mm,6mm & 8mm .Failure rate was only 4.3% .About 23% were single molars while 77% were splinted to other implants(bridges).Dr Shulte who teaches at The restorative department at Minnosotta University published a study on 889 single short bicon implants placed and restored over a period of 12 yrs. The success rate he had was 98.2 % .That was published 2007 at the journal of prosthetic dentistry .Another publication on bicon short implants was published 2005 by Dr Dodson & c0-workers at I JOMI . This publication showed that there was no statistical difference in success rate between bicon 6X5.7mm(short) & non 6X5.7mm implants .Proper surgical techniques & skillful operator with correct diagnosis & treatment planning is a must.

My only addition would be to view the CT scans of those posterior maxillas. Most of the ones I see only HAVE three or four mm of bone thickness to begin with! (We see many elderly patients, fully or partly edentulous for decades.) Thanks everyone for real-life stats on Bicon-we're considering those also. I wonder how many posterior maxilla implant placements included a fortutous accidental internal lift by tenting the Schneiderian membrane....

Murray Arlin published a retrospective study using evaluating the excellent success rates of short Straumann implants. Int J Oral Maxillofac Implants. 2006 Sep-Oct;21(5):769-76 (go to www.pubmed.com and search "Arlin" for the abstract)

Bisphosphonates: The NEJM published this the results of a ten year oral bisphosphonate study. A large patient group was used. All took the medication for five years. Then BMD was measured. Half then continued on the bisphosphonate and the others did not. At the end of another five years BMD and fracture rates were compared. The results showed that the patients in this test had the same benefit from five years as of ten. The BMDs and fracture rates were extremely close in the two groups. There is a company in Houston - ADT - that helps set up partnerships to make CBCT ownership and use more cost effective. They also help integrating the use into the practice.

this paper may be useful.part one is also interesting A 10-year prospective study of ITI dental implants placed in the posterior region. II: Influence of the crown-to-implant ratio and different prosthetic treatment modalities on crestal bone loss. Blanes RJ, Bernard JP, Blanes ZM, Belser UC. Clin Oral Implants Res. 2007 Dec;18(6):707-14. Epub 2007 Aug 13.

Dear Xabier, I also love this paper - a recent, 10-year prospective cohort study (i.e. good quality research) - which shows that the crazier your crown:implant ratio, the BETTER the crestal bone appears to be. Counter-intuitive from everything we've learned about teeth, but as we're all discovering, implants aren't teeth and short implants work great. Kind Regards, Bill

I have quickly read through most of the above comments, basically stating that solid engineering principles of crown/root ratios in natural teeth do not apply to implant/crown ratios. I am always amazed to see a stubby little Bicon implant or an Endopore midget supporting a crown that is double their length....fascinating, but I still believe in proven with time engineering principles and the advantage and ease of sinus elevations... of course this is only my opinion, and yes there are still those of us around who believe in Jack and the Beanstock..... I call him "Jackie Beans" Gerald Rudick dds Montreal

please don't quote engineering principle if you really don't know them. Did you ever see a lamp post or fence post they don't get placed deep in the ground, they don't follow crown root ratio at all because they don't have a "pdl" . They are solid just like a well anchored short implant. Endopore implants work as long as they stay fully sub gingival if the rough surface becomes exposed they FAIL. I neve used Bicon they are placed 2mm below bone and their prosthetics is too different. But they work acoording to sound engineering principles . Ok Jack.

THIS ALSO HAS TO DO WITH YOUR COMFORT LEVEL AND WHAT DOES THE PATIENT WANT TO ENDURE AS WELL AS COST. A SIMPLER METHOD IS USUALLY BETTER FOR THE PATIENT. THIS DESERVES A LONG TERM, HONEST CLINICAL STUDY.

i have used quite a few Bicon implants shorter ones and they work exceeding well. the emergence profile with the anteriors is amazing. i used to wonder how it would work keeping in mind the crown and root length ratio. But have seen it working well. an alternative if one does not want to carry out a sinus lift procedure.

My original JOMI article in 2006 reported on up to a 7 year follow-up on 35 Straumann 6mm length implants demonstrating a 94.29% cumulative survival rate. My updated results, with up to a 14 year follow-up, show 109 Straumann 6mm length implants demonstrating an absolute survival rate of 94.50%. Most of these were splinted restorations in the posterior mandible. I agree that initial stablity is critical.

Dr. Arlin, Have you compared the survival of posterior mandibular implants vs. posterior maxillary implants?

I am a "layman" but know more than most about implants because of my own research. Now I'm in an area I don't know at all and need some general imput. I have serious periodontal desease and haave just had osseous surgery. I am considering an implant in # that was pulled a year ago and bone graft inserted. I think it cratered a bit. My periodontist "thinks" I have about 6mm of bone below the sinus and says he can do a sinus lift (not the lateral incision type) but up through the existing bone. He says he can probably get 4 mm more with the "Lift". Then he said that my crown would have to be longer than normal. I have gone to Mexico to have this done because of costs. Having spoken to numerous patients of his he is well regarded by all "really is an excellent periodontist)...I just can't afford the prices in my county. I'm concerned about a sinus lift and also about the lengh of the crown (don"t know the lengh). Can you give me some imput. Can I just have a 7 or 8 mm implant and have success. I have had two previous implants by a different doctor and one failed and the other has been in a year and I'm not too certain about it although it's not moving at all. I'd appreciate your imput asap Thank you John Paul Pola

I am a "layman" but know more than most about implants because of my own research. Now I'm in an area I don't know at all and need some general imput. I have serious periodontal desease and haave just had osseous surgery. I am considering an implant in # 3 that was pulled a year ago and bone graft inserted. I think it cratered a bit. My periodontist "thinks" I have about 6mm of bone below the sinus and says he can do a sinus lift (not the lateral incision type) but up through the existing bone. He says he can probably get 4 mm more with the "Lift". Then he said that my crown would have to be longer than normal. I have gone to Mexico to have this done because of costs. Having spoken to numerous patients of his he is well regarded by all "really is an excellent periodontist)...I just can't afford the prices in my county. I'm concerned about a sinus lift and also about the lengh of the crown (don"t know the lengh). Can you give me some imput. Can I just have a 7 or 8 mm implant and have success. I have had two previous implants by a different doctor and one failed and the other has been in a year and I'm not too certain about it although it's not moving at all. I'd appreciate your imput asap Thank you John Paul Pola