http://dx.doi.org/10.

30681/2526101011159 ORIGINAL ARTICLE

Associated short and regular implants for complete denture retention

in an atrophic mandible: clinical follow-up

Implantes corto y regular asociados para retención de prótesis

completa en mandíbula atrófica: seguimiento clínico

Implantes curto e regular associados para retenção de prótese total em

mandíbula atrófica: acompanhamento clínico

Valdimar da Silva Valente1, Carmem Dolores Vilarinho Soares de Moura2,

Walter Leal de Moura3, Graça Maria Lopes Mattos4, Antonio Materson da
Silva5, Cyrene Piazera Silva Costa6, Sebastião Marinho Pinheiro Neto7,
Rudys Rodolfo de Jesus Tavarez8

ABSTRACT
Objective: to present the radiographic clinical follow-up of the prosthetic
rehabilitation of a patient with an atrophic mandible, with the installation of
short implants associated with an implant of regular length. Method: case
report of a completely edentulous patient with an atrophic mandible and a 6-
year radiographic clinical follow-up conducted at the dental clinic of the
Federal University of Piauí, Teresina, from February 2011 to January 2020.
After collecting sociodemographic data, health records, clinical radiographic
examinations, and prosthetic surgical planning, four dental implants were
installed between the mental foramina. After three months, mini-conical
abutments and a fixed prosthesis screwed onto the implants were installed
and monitored every six months for a period of six years. Results: the clinical
evaluation revealed tissue stability without significant peri-implant changes

1Dentist. PhD in Oral Biology. Professor at the Federal University of Piauí (UFPI). Teresina, Piauí, Brasil. ORCID ID:
https://orcid.org/0000-0002-8200-2004
2Dentist. PhD in Dental Sciences. Professor at the Federal University of Piauí (UFPI). Teresina, Piauí, Brasil. ORCID ID:

https://orcid.org/0000-0002-8621-9788
3Dentist. PhD in Dentistry. Professor at the Federal University of Piauí (UFPI). Teresina, Piauí, Brasil. ORCID ID:

https://orcid.org/0000-0002-3993-8974
4Dentist. PhD student in Dentistry at Ceuma University (Uniceuma). São Luís, Maranhão, Brasil. ORCID ID:

https://orcid.org/0000-0003-2460-0169
5Dentist. PhD in Dentistry. Professor at the Federal University of Ceará (UFC). Fortaleza, Ceará, Brasil. ORCID ID:

https://orcid.org/0000-0002-5009-8785
6Dentist. PhD in Dentistry. Professor at Ceuma University (Uniceuma). São Luís, Maranhão, Brasil. ORCID ID:

https://orcid.org/0000-0002-9632-8304
7Dentist. Master's student in Dentistry at Ceuma University (Uniceuma). São Luís, Maranhão, Brasil. ORCID ID:

https://orcid.org/0000-0002-1923-9498
8Dentist. PhD in Dentistry. Professor at Ceuma University (Uniceuma). São Luís, Maranhão, Brasil. E-mail:

rudysd@uol.com.br ORCID ID: https://orcid.org/0000-0002-3525-9245 Corresponding author – Address: R.

Anapurus, 1 - Renascença II, São Luís - MA, 65075-120.

This article is licensed under a Creative Commons Attribution 4.0 International license,
which allows unrestricted use, distribution, and reproduction in any medium, provided
the original publication is correctly cited.

Journal Health NPEPS. 2023 jan-jun; 8(1):e11159. ISSN 2526-1010

Valente VS, Moura CDVS, Moura WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short and regular
implants…

after the follow-up period. Radiographically, bone resorption was not

observed around the implant. Stability of the prosthesis and absence of
prosthetic complications were observed during the follow-up period.
Conclusion: short implants associated with regular-length implants can be
placed in the anterior region of an atrophic mandible for rehabilitation with
fixed complete dentures.
Descriptors: Dental Implants; Prostheses and Implants; Jaw, Edentulous;
Mouth Rehabilitation.

RESUMEN
Objetivo: presentar el seguimiento clínico radiográfico de la rehabilitación
protésica de un paciente con mandíbula atrófica con la instalación de
implantes cortos asociados a un implante de longitud regular. Método: relato
de caso de paciente totalmente edéntulo con mandíbula atrófica, y
seguimiento clínico radiográfico de seis años, realizado en la clínica
odontológica de la Universidad Federal de Piauí, Teresina, de febrero de 2011
a enero de 2020. Después de recolectar datos sociodemográficos y registros
de salud, exámenes clínicos radiográficos y planificación quirúrgica protésica,
se instalaron cuatro implantes dentales entre los forámenes mentonianos.
Luego de un período de tres meses, se colocaron mini pilares cónicos y se
atornilló una prótesis fija sobre los implantes, la cual fue monitoreada
semestralmente durante un período de seis años. Resultados: las
evaluaciones clínicas mostraron estabilidad tisular sin cambios
periimplantarios significativos después del período de seguimiento.
Radiográficamente se observó mantenimiento sin reabsorción ósea alrededor
de los implantes. La estabilidad de la prótesis y la ausencia de
complicaciones protésicas se observaron clínicamente durante el período de
seguimiento. Conclusión: los implantes cortos asociados a implantes de
longitud regular pueden ser colocados en la región anterior de la mandíbula
atrófica para rehabilitación con prótesis fija completa.
Descriptores: Implantes Dentales; Prótesis e Implantes; Arcada Edéntula,
Rehabilitación Bucal.

RESUMO
Objetivo: apresentar o acompanhamento clínico radiográfico da reabilitação
protética de um paciente com mandíbula atrófica com a instalação de
implantes curtos associados a um implante de comprimento regular. Método:
relato de caso de uma paciente desdentada total com mandíbula atrófica, e
acompanhamento clínico radiográfico de seis anos, realizado na clínica
odontológica da Universidade Federal de Piauí, Teresina, no período de
fevereiro de 2011 a janeiro de 2020. Após coleta de dados sociodemográficos
e registro de saúde, exames clínicos radiográficos e planejamento cirúrgico
protético, foram instalados quatro implantes dentários entre os forames
mentonianos. Após o período de três meses foram instalados mini pilares
cônicos e uma prótese fixa aparafusada sobre os implantes que foi
acompanhada a cada seis meses por um período de seis anos. Resultados: as
avaliações clínicas mostraram estabilidade tecidual sem alterações peri-
implantares significativas após o período de acompanhamento.
Radiograficamente foi observada a manutenção sem reabsorção óssea ao
redor dos implantes. A estabilidade da prótese e a ausência de complicações

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Valente VS, Moura CDVS, Moura WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short and regular
implants…

protéticas foram observadas clinicamente durante o período de

acompanhamento. Conclusão: os implantes curtos associados a implante de
comprimento regular podem ser colocados na região anterior da mandíbula
atrófica para reabilitação com prótese total fixa.
Descritores: Implantes Dentários; Próteses e Implantes; Arcada Edêntula,
Reabilitação Bucal.

INTRODUCTION The use of short implants in

edentulous patients with atrophic
Dental loss causes serious jaws may present fracture risk
aesthetic problems and during the surgical procedure or in
physiological changes in patients. the immediate postoperative
The severity of damage due to period6. This treatment has been
chewing, phonation, and joint proposed as an alternative to
disorders depends on the number reconstructive surgery followed by
and location of the missing teeth1. prosthetic rehabilitation7].
Long-term use of removable dental Therefore, to obtain satisfactory
prostheses leads to bone resorption results in such cases, surgical and
and a decrease in keratinized prosthetic planning is essential.
mucosa, which impairs the This study aimed to present the
retention and stability of the dental radiographic clinical follow-up of
prosthesis. Constant mucosal the prosthetic rehabilitation of a
trauma can lead to pain and patient with an atrophic mandible
functional limitations2. with the installation of short
Different treatment options implants associated with an implant
for dental rehabilitation of patients of regular length.
with severe mandibular resorption
have been reported, including bone METHOD
grafting, alveolar osteogenic
distraction, inferior alveolar nerve A single case study of a
lateralization, and the use of short patient, toothless, wearing a
implants3,4. Anatomical factors complete denture, and complaining
should be considered when of masticatory, aesthetic, and
selecting the best treatment functional difficulties due to
option5. instability of the lower complete

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Valente VS, Moura CDVS, Moura WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short and regular
implants…

denture was conducted, who visited level; d) bleeding on probing (score

the dental clinic of the Federal of 0 to 3); e) percussion with
University of Piauí, Teresina, evidence of metal (functional
between February 2011 (patient's ankylosis) or dull sound (fibrous
first dental visit) and January 2020 integration in the area of implant
(patient's last visit for dental placement); f) persistent pain8.
follow-up). All cases showing peri-
In the first dental visit, implant inflammation were treated
during the clinical examination, according to the guidelines of
severe resorption of the residual Mombelli and Lang8. Intraoral
alveolar ridges was observed. radiographs were taken using the
Complete dentures were parallel technique to control
planned for the rehabilitation of projection geometry.
the patient, and the lower one was A single experienced
implant-supported owing to evaluator, a specialist in prosthesis
difficulties in obtaining retention and dental implants, was
and stability. Because these are responsible for collecting data at
severely reabsorbed ridges, it is each evaluation moment (intervals
necessary to identify short of six months during for six years).
implants. This same professional, at each
For clinical follow-up of the evaluation, checked the gingival
patient, it was necessary to use a clinical situation with the removal
form with sociodemographic data, of the prosthesis and requested an
follow-up data on implant survival annual radiographic examination to
and prosthetic complications were control bone stability.
collected, and a form for assessing The present study was
clinical conditions. At follow-up approved by the Ethics and
examinations, peri-implant tissues Research Committee of Ceuma
and implant health were assessed University (UNICEUMA) with CAAE
using the following parameters: a) n. 71011823.0.0000.5084 and
suppuration (presence/absence); b) opinion n. 6.159.658. Participants’
plaque index (score of 0 to 3); c) names were coded to guarantee
probing depth and attachment anonymity and secrecy. The patient

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Valente VS, Moura CDVS, Moura WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short and regular
implants…

was informed of the risks and treatments were not functional and
possible factors associated with their esthetics were unsatisfactory.
treatment failure. An informed Radiographic and clinical
consent form was presented and examinations revealed severe bone
signed. resorption in the maxilla and
mandible (Figure 1 AB).
CASE REPORT

An edentulous 59-year-old
female resident of Teresina (PI)
reported having lost her teeth
many years ago; the previous

Figure 1 A and B: Initial clinical and panoramic X-ray evaluation. Patient

with severe bone resorption in the mandible.

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implants…

Different treatment options Three implants with external

were discussed after anamnesis and hexagon connection with 3.75 mm ×
clinical and radiographic 8.5 mm and one 3.75 × 10 mm
examinations, considering dimensions were used (Sistema de
mandibular atrophy risks and Implante Nacional [SIN], Sao Paulo,
treatment costs. We chose Brazil). The soft tissue flap was
rehabilitation with a superior reduced during the surgical
conventional total prosthesis procedure to preserve muscle
combined with an implanted fixed insertion and to avoid undesirable
prosthesis for the mandible effects on the atrophic mandible.
installed on four short implants Care regarding the fracture risk was
between the mental foramina area. also considered (Figure 2).

Figure 2 - Clinical characteristics after implant installation and healing caps.

A 3mm high healing cap necessary for osseointegration of

(SIN, São Paulo, Brazil) (Figure 02) the implants.
was installed, and a provisional After the osseointegration
temporary total denture was period, mini-conical abutments
relined with soft resin (Soft (Figure 3 AB) were installed (Micro
Comfort-Dencril, São Paulo, Brazil) Unit, SIN, Sao Paulo, Brazil).
for a period of 4 months which is Procedures for impressing and
creating the preliminary and

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Valente VS, Moura CDVS, Moura WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short and regular
implants…

definitive fixed implant-supported (Figure 4 and 5).

total prostheses were conducted

Figure 3 AB - Installation of the conical abutments and Panoramic X-ray.

Figure 4 - Static and functional evaluation of the superior conventional

total prosthesis occluding with reduced arch implant supported
prosthesis.

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Valente VS, Moura CDVS, Moura WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short and regular
implants…

Figure 5 - Panoramic X-ray immediately after installation of the

prosthesis.

Due to the atrophy and explained at each visit, followed by

small mandible, we chose to make professional tooth cleaning. Screw
a denture with a reduced arch (only loosening or prosthetic
one premolar and one molar in complications were not observed
each hemiarch). The antagonist during the 6-year follow-up period,
arch was rehabilitated using an and no changes were observed in
arch-reduced conventional the peri-implant region. The
prosthesis. Oral hygiene guidance patient reported hygiene
and follow-up visits were provided difficulties at the implant–
to the patients. prosthesis interface, and biofilm
The first maintenance accumulation was observed in this
return visit was scheduled six area (Figure 6 AB). Considering the
months after prosthesis placement, limitations of the panoramic
followed by clinical evaluations radiographic image, minimal bone
each year. All assessments followed resorption was observed, after 6
the same assessment protocol years, when compared to the initial
established at the beginning of radiograph (Figure 7).
treatment8. Panoramic radiographs
were obtained at three and six
years. The hygiene guidelines were

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implants…

Figure 6 AB - Clinical aspect of the peri-implant region and biofilm

accumulation on the prosthesis, after six years of follow-up.

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Figure 7 - Panoramic X-ray evaluation of the implants, at six years of follow-up.

DISCUSSION anterior region were selected based

on these factors.
The atrophic mandible Bone grafting before
reported in this case presented rehabilitation with implants showed
with factors that limited prosthetic good results, with predictable and
rehabilitation with implants. The acceptable levels of resorption.
presence of the mandibular canal One study showed that implants
and submandibular gland fossa in preserve the graft in the same way
the posterior region of the that natural teeth preserve alveolar
mandible is associated with low bone11. However, reports have
bone quality due to disuse atrophy, shown that bone grafts in the
which compromises implant mandible have unpredictable
installation 9. results. In addition, many patients
Several treatment options are unable to accept the treatment
have been reported, including bone because of the high cost and need
grafting, osteogenic distraction, for additional surgical procedures
inferior alveolar nerve or general health conditions12.
lateralization, and the use of short These questions were fundamental
implants10. All treatment to planning the reported case.
alternatives were discussed with Atrophic bone ridges of at
respect to age, general health least 9 mm in height and adequate
status, treatment duration, and thickness can be rehabilitated with
surgical risk. Short implants in the short implants8. This is a simple and

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Valente VS, Moura CDVS, Moura WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short and regular
implants…

predictable alternative that premolar and one molar), occluding

reduces costs, procedural the inferior prosthesis fixed to the
morbidity, and treatment time. In implants.
these cases, bone quality plays a The ideal minimum ratio
key role in treatment success. between the size of the crown and
Adequate bone height and thickness the implant installed is 1 to 1.
were observed during installation of When the alveolar ridge is
the short implants. reabsorbed and an implant is
Even without reconstructive installed in the remaining bone, the
surgical procedures, this mode of crown-to-implant ratio is altered.
treatment for atrophic bone ridges This is considered a biomechanical
has a significant success rate and is risk15. When prosthetic parameters
accepted as a reliable and of the crown-to-root ratio are
predictable solution13. Short altered, occlusal loads should be
implants are defined as those with placed as close as possible to the
a length of ≤10 mm; others consider long axis of the implant to promote
short implants with an extension of better distribution of forces16.
<8 mm10. Although there is no These parameters were considered
consensus on the length to be in the planning of the case in
considered short, masticatory force question.
and antagonist arch type are the Some of these findings are
determinants of implant selection. important in cases of short implant
In this case report, three 8.5 mm placement. First, the diameter of
and one 10 mm long implants were the implant is more efficient than
used. the length in the dissipation of
Masticatory load, vertical tension because the region that
dimension, and unsatisfactory bone receives the most effort is next to
density are associated with failure the bone crest. Short implants
of atrophic jaw rehabilitation. present success rates close to those
Therefore, the load on a prosthesis of conventional implants, and
must be reduced14. In this case, the splinting, elimination of horizontal
antagonist was a conventional total occlusal contacts, and reduction of
prosthesis with a short arch (one the arch increase the biomechanics

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implants…

and predictability of the has a reliable and predictable

treatment17. prognosis18.
After 6 months of follow-
up, the patient was highly satisfied CONCLUSION
with the treatment results. No
complications were found clinically Clinical and radiographic
or radiographically, suggested follow-up after 6 years of function
procedure failure18. showed that it is possible to
A systematic review was consider rehabilitation of the
performed of studies on clinical atrophic mandible using short
rehabilitation with implants of <10 implants and fixed prosthetic
mm in length in atrophic jaws19. rehabilitation with good
The longevity of the implants, predictability and maintenance of
biological and biomechanical tissue integrity.
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Funding: The authors declare no conflict of interest.

Conflict of interest: The authors declare no conflicts of

interest.

Authors' participation:
 Design: Valente VS, Moura CDVS, Moura WL, Mattos GML,
Silva AM, Costa CPS, Pinheiro Neto SM, Tavarez RRJ.
 Development: Valente VS, Moura CDVS, Moura WL, Mattos
GML, Silva AM, Costa CPS, Pinheiro Neto SM, Tavarez RRJ.
 Writing and proofreading: Valente VS, Moura CDVS,
Moura WL, Mattos GML, Silva AM, Costa CPS, Pinheiro Neto
SM, Tavarez RRJ.

How to cite this article: Valente VS, Moura CDVS, Moura

WL, Mattos GML, Silva AM, Costa CPS, et al. Associated short
and regular implants for complete denture retention in an
atrophic mandible: clinical follow-up. J Health NPEPS. 2023;
8(1):e11159.

Submission: 02/03/2023
Accepted: 31/05/2023

Journal Health NPEPS. 2023 jan-jun; 8(1):e11159.