J Clin Periodontol 2014; 41: 404–411 doi: 10.1111/jcpe.

12222

Long-term retrospective Eduardo Anitua1,2, Laura Piñas1,

Leire Begoña2 and Gorka Orive2

evaluation of short implants in

1
Private Practice in Implantology and Oral
Rehabilitation in Vitoria, Vitoria, Spain;
2
Foundation Eduardo Anitua, Vitoria, Spain

the posterior areas: clinical

results after 10–12 years
Anitua E, Pi~nas L, Bego~ na L, Orive G. Long-term retrospective evaluation of short
implants in the posterior areas: clinical results after 10–12 years. J Clin
Periodontol 2014; 41: 404–411. doi: 10.1111/jcpe.12222.

Abstract
Aim: To evaluate the long-term clinical results of short implants in the posterior
areas and analyse the possible influence of different variables on implant success
rate and marginal bone loss (MBL).
Methods: A retrospective study design was used. Patients were included if they
had received one or more short implants (≤8.5 mm long) in the posterior jaws at
least 10 years earlier. All implants were embedded in plasma rich in growth fac-
tors (PRGF). The cumulative success rate was the primary outcome. MBL and
the influence of different variables as secondary outcomes were assessed.
Results: A total of 111 short implants (7.0, 7.5 and 8.5 mm in length) placed in
75 patients met the inclusion criteria. Of which, 94 were splinted to longer ones.
The mean follow-up was 123.3 months (SD = 10.4 months). The mean crown-
implant ratio was 1.4 (SD = 0.3). The mean MBL was 1.0 mm at mesial
(SD = 0.7) and 0.9 mm (SD = 0.6) at distal aspect. One short implant failed. Suc-
cess rate was 98.9% and 98.2% for the implant and patient-based analysis respec-
tively. No relationship was observed between the studied variables and the MBL. Key words: long-term; PRGF; short implants
Conclusions: These clinical results support the use of short implants as an effec-
tive and safe long-term treatment option. Accepted for publication 12 December 2013

In patients with long-standing eden-
tulous arches, alveolar bone resorp-
tion (both vertical and horizontal or
combined defects) is frequently
Conflict of interest and source of
funding statement
This study was funded by Foundation
Eduardo Anitua (Vitoria, Spain). Edu-
ardo Anitua is the president of this
foundation. EA and LB are scientists
at Biotechnology Institute, the com-
pany that produces the dental
implants used in the present study.
404
observed (Reich et al. 2011). The
insertion of dental implants in
patients with reduced alveolar bone
height is challenging and may
require additional invasive bone aug-
mentation procedures (Tonetti &
Hammerle 2008, Esposito et al.
2009). By modifying patient’s anat-
omy, it is possible to insert longer
implants, but an extra surgical inter-
vention may also lead to greater
patient morbidity, higher costs and
longer treatment periods (Esposito
et al. 2010, Telleman et al. 2011).
The introduction of short
implants has represented a very
important progress in the implant
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
dentistry field and a new therapeutic
alternative for these cases (Anitua
2010). Situations including the pos-
terior mandibular and maxillary
regions, which are characterized by
the difficult access, limited visibility,
reduced space, poor bone quality
and the risk of affecting the inferior
alveolar nerve candidate for treat-
ment with short implants. However,
the predictability of short implants
was initially controversial. In fact,
some studies using short implants
reported lower survival rates than
longer ones (Romeo et al. 2010).
These results were explained by
different reasons including less bone

to implant contact associated with
short implants; the fact that short
implants are mostly placed in poster-
ior areas where the quality of the
alveolar bone is relatively poor, and
the fact that often a very outsized
crown has to be made to achieve
proper occlusion, which causes a
higher crown to implant (C/I) ratio.
Recent systematic reviews have
reported that short implants have
similar long-term prognosis as stan-
dard-length dental implants (Kotsov-
ilis et al. 2009, Menchero-Cantalejo
et al. 2011, Sun et al. 2011, Telleman
et al. 2011, Annibali et al. 2012,
Atieh et al. 2012, Karthikeyan et al.
2012, Srinivasan et al. 2012). Cur-
rent scientific knowledge suggests the
use of short implants as an alterna-
tive to more invasive bone augmen-
tation techniques (Esposito et al.
2009, 2010, 2011, Felice et al. 2010).
Furthermore, short implants may
provide additional advantages and
cause fewer complications than
longer implants when combined with
more complex techniques (Esposito
et al. 2010). These evidences have
been reinforced by the different bio-
mechanical studies suggesting that
maximum bone stress is practically
independent of implant length (Pier-
risnard et al. 2003) and even that
implant width is more important
than the additional length (Anitua
et al. 2010).
Interestingly, although there is an
increasing body of literature on
short implants and on their short-
and medium-term predictability, very
few studies have properly evaluated
their long-term clinical results. The
objective of this retrospective study
was to evaluate the safety and long-
term predictability (10–12 years of
follow-up after implant installation)
of short implants (≤8.5 mm) placed
in posterior regions of maxillae and
mandible. The main leading question
to address was: for short implants
placed in the posterior jaws, are
implant success rate and marginal
bone loss (MBL) after 10 years of
function affected by prosthetic and
implant variables?
Material and methods
This article was written following
the Strengthening the Reporting of
Observational studies in Epidemiology
guidelines (von Elm et al. 2007) and
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Long-term evaluation of short implants
included patients treated at the
Clınica Dental Eduardo Anitua at
Vitoria, Spain.
A retrospective case series study
design was used. To achieve the
objectives of the study, the patient’s
medical records database of the
clinic was reviewed to find poten-
tially eligible patients.
Patients were included in the
study if fulfilled they all of the fol-
lowing criteria:
• Patients over 18 years old.
• Presence of partial or complete e-
dentulism requiring treatment
with dental implants.
• One or more short implants
(≤8.5 mm in length) were placed
in the posterior areas of maxilla
or mandible.
• Implants were inserted at least
10 years earlier (before Septem-
ber 2002).
After case selection, each of the
patient’s medical records was care-
fully reviewed to obtain the neces-
sary clinical data and the predefined
variables for each implant-patient to
achieve the objectives of the study.
A total of 111 short BTI acid-etched
surface implants (Biotechnology Ins-
titute BTI, Vitoria, Spain) placed in
75 patients in maxilla and mandible
were included and evaluated.
The cumulative success rate was
considered the primary outcome.
MBL and the possible influence of
different patients, implant and pros-
thetic variables as secondary end-
points were also assessed.
Implant placement-surgical protocol
In all patients the same surgical pro-
tocol and treatment plan was fol-
lowed. Before surgery, patients
underwent a routine dental scaling to
start the implant treatment with an
adequate gingival status. A cone
beam computed tomography scan
was carried out to all patients prior
to the intervention to assess bone
quality and quantity and to measure
the ridge height and width of the sup-
porting bone using specialized soft-
ware for implant surgery planning
(BTI Scanâ; Biotechnology Institute
BTI). Panoramic X-rays were also
taken prior and after surgery for all
patients to allow careful planning of
the treatment. Rehabilitations were
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405
made by three equally experienced
prosthodontists.
During the days prior to the inter-
vention, all patients received ade-
quate prophylaxis and oral hygiene
instructions. Patients received 1 g of
amoxicillin and 1 g of acetaminophen
as prophylactic medication 1 h before
the intervention. Antibiotic adminis-
tration continued during 5 days after
surgery. At the time prior to the inter-
vention, all patients performed 1-min
rinses with chlorhexidine digluconate
0.20%. Lips and perioral area were
also cleaned with chlorhexidine. An
infiltrative anaesthesia was applied
to all patients and incisions were
made to elevate a full-thickness flap.
Implant sites were prepared using
a low-speed drilling procedure
(125 rpm) without irrigation (Anitua
et al. 2007a). Before installation,
implants were carefully embedded in
liquid plasma rich in growth factors
(PRGF-Endoretâ; Biotechnology
Institute BTI) with the aim of bioacti-
vating the implant surface (Anitua
et al. 2007b). PRGF was prepared
from each patient by taking blood by
venipuncture before surgery and
placing it directly into 9-ml blood-
collecting tubesâ (Biotechnology
Institute BTI) that contain 3.8% (wt/
vol) sodium citrate as anticoagulant.
Liquid PRGF was prepared by centri-
fugation (PRGF Systemâ, BTI) at
580 g for 8 min at room temperature.
The 2 ml plasma fraction located just
above the red cell fraction, but not
including the buffy coat, was col-
lected and deposited in a glass dish.
To initiate clotting, formation of a
three-dimensional fibrin matrix and
the release of growth factors and
proteins, PRGF activatorâ (calcium
chloride) was added to the liquid
PRGF preparation (50 ll PRGF
activator per millilitre of preparation)
(Anitua et al. 2007b). In general,
healing was allowed for a minimum
of 3 months, after which the surgi-
cal abutments were fixed. Shortly
thereafter, the suprastructure was
placed.
Most implants (74.9%) were
loaded between 3 and 7 months after
insertion [mean value 4.91 months
(SD = 2.12)]. Prior to the final pros-
thesis placement, implants were
loaded with a provisional screwed
prosthesis to promote a progressive
implant loading. The provisional
prosthesis was made of titanium and

406 Anitua et al.
composite resin. The final prosthesis,
also made of a titanium structure,
was placed after 6–9 months. Occlu-
sion was always checked and the
majority of implants were splinted.
After the intervention, patients
were encouraged to take in case of
pain, acetaminophen (1 g/8 h) or Ib-
uprofen (600 mg/8 h). Patients were
also instructed how to maintain
proper oral hygiene around implants.
In addition, just after the interven-
tion, a panoramic radiograph was
taken to verify the adequate place-
ment of the implant.
Once the surgical phase was con-
ducted patients were referred to peri-
odic evaluations, consisting of: one
evaluation 5–10 days after interven-
tion, at 1 month, at 3 months, at
6 months and from this moment
ahead, once a year. The post-implant
assessment included at each follow-
up visit different clinical assessments
to verify the status of the implant
(gingival health, prosthesis mobility,
pain, infection, alveolar ridge resorp-
tion and any complications) as well
as periodic panoramic radiographs
to verify the appropriate state of the
implant in the follow-up period.
For success rate calculation, the
implant was considered to be success-
ful if it complied with the following
success criteria: a stable prosthe-
sis, absence of pain, infections or
any other pathology related to the
implants, absence of a radiolucent
line around the implant and if none
of the following events occur: implant
loss, fracture that makes support of
the prosthesis impossible, significant
bone loss (>2–3 mm) and lack of
osseointegration.
For survival rate calculation,
implant failure was considered any
implant lost due to any cause, either
biological (failure to achieve osseoin-
tegration or loss of acquired osseoin-
tegration) or biomechanical causes.
For MBL quantifications, mar-
ginal bone levels were measured on
the panoramic radiograph made just
after the surgery and the last
patient’s available radiograph.
All panoramic radiographs were
performed using a positioning pin
(with patient’s chin resting on a
standard device) and with the Frank-
furt plane parallel to the ground.
Measurements on the panoramic
radiographs were performed by
computer software (Sidexis XG;
Sirona Dental Systems, Bensheim,
Germany), which conducts a calibra-
tion of the X-ray by a known length
(implant length). Once the radio-
graph was calibrated to a 1:1 mea-
sure, eliminating the possible
presence of magnification, measure-
ments were made mesially and dis-
tally to the implants, calculating the
distance between the uppermost
point of the implant platform and
the most coronal contact between
the bone and the implant. The bone
level recorded just after the surgical
insertion of the implant was the
basal value to compare with subse-
quent measurements over time.
Demographic, surgery and imp-
lant dependent variables, as well
other prosthetic-biomechanical vari-
ables were also registered from
patient’s clinical records.
Statistical analysis
Data collection and analysis were per-
formed by two independent examin-
ers (other than restorative dentists).
Descriptive statistics were performed
when necessary considering the
implant and the patient as the unit of
analysis. Absolute and relative fre-
quency distributions were calculated
for qualitative variables (either nomi-
nal as patient’s gender, implant’s
maxilla type or ordinals as prosthesis
type) and mean values and standard
deviations for quantitative variables
(either discrete or continuous as MBL
or crown height). Survival and success
rate were estimated both by an
implant-based and subject-based
analysis. In the patient-based analy-
sis, the patient was considered the
unit of analysis if they had at least
one short implant inserted that met
the study selection criteria. For these
calculations, the dates of the first
implant inserted and the first to fail or
not meet the criteria of success (even
if they were the same one or not) were
considered. In both types of analysis,
the cumulative survival rate as a func-
tion of the time was analysed using a
life-table analysis (Actuarial method).
Mann–Whitney non-parametric test
was used to evaluate the possible dif-
ferences in bone loss in both mesial
and distal points in categorical vari-
ables. To assess the possible associa-
tion between quantitative variables
and bone loss, linear regression analy-
sis was used. The potential influence
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of different variables on implant
success rate was evaluated using Cox
regression analysis. Statistical level of
significance was set at p < 0.05. SPSS
v15.0 for Windows statistical software
package (SPSS Inc., Chicago, IL,
USA) was used for statistical analysis.
Results
A total of 111 short implants and 97
prostheses placed in 75 patients were
included and evaluated. The diameter
of short implants ranged between
3.30 and 5.00 mm, and the lengths
between 7.0 and 8.5 mm. The
frequency of the lengths and diame-
ters of the included short implants is
shown in Table 1. A total of 134
implants of standard size (from 3.30
and 5 mm diameter and from 10 to
15 mm length) were also used in
combination with short implants in
94 rehabilitations (78 fixed partial
bridges and 16 complete overden-
tures). Sixty-one patients were
females (81.3%) and the mean age at
insertion time was 58.2 years
(SD = 9.8, range 28–84). Twenty-one
patients were smokers (28.0%).
On implant basis, the mean
follow-up time since insertion was
123.3 months (SD = 10.4; range
86–141 months), more than 10 years,
while the mean follow-up time since
loading was 118.0 months (SD =
11.0; range 83–137 months). On a
patient basis the mean follow-up time
since insertion was 122.6 months
(SD = 12.4 months) and it was
117.5 months (SD = 12.2 months)
from loading.
A total of 67 implants (60.4%)
were placed in the posterior areas of
the mandible, whereas 44 were placed
in the posterior maxilla (39.6%). Fig-
ure 1 shows the anatomical location
of short implants. Eleven implants
(9.9%) were placed using special tech-
Table 1. Distribution of diameters and
lengths of included short implants
Length (mm) Total
7.00 7.50 8.50
Diameter 3.30 0 0 15 15
(mm) 3.75 2 0 43 45
4.00 0 0 29 29
4.50 0 7 12 19
5.00 0 0 3 3
Total 2 7 102 111
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Long-term evaluation of short implants 407

niques (sinus elevation, immediate

post-extraction or crest-split expan-
sion). Only three implants (2.7%)
were submitted to immediate loading
protocol, whereas 33 implants
(29.7%) underwent two surgical
phases.
Regarding the type of prosthesis,
87 (78.4%) implants were involved
in a total of 78 fixed partial bridges
supported by two to four splinted
implants, 75 of them cemented,
whereas 21 implants were involved
in 16 screwed complete overdentures
(18.9%), and the three remaining
implants were cemented single
crowns (2.7%).
Most implants (108 implants,
97.3%) were splinted to other
implants (to one or two implants).
Specifically, 14 of these implants were
splinted only to other short implants
(12.6%, 10 implants to one short
implant and four implants to two Fig. 1. Anatomic distribution of the 111 short dental implants.
short implants). The remaining 94
implants were splinted to one or more Table 2. Cross-tabulation showing mean CIR values and its standard deviations by implant
long implants (84.7%, 12 implants to length and different jaws (maxilla and mandible)
one short and one long implants, 42
Jaw Implant length (mm)
implants to only one long implant
and 40 implants to two long 7.00 (2) 7.50 (7) 8.50 (102)
implants).
The mean length of the crown Maxilla (44) – 1.77  0.34 1.44  0.32
was 11.9 mm (SD = 2.7; range Mandible (67) 1.57  1.16 1.96  0.72 1.36  0.31
between 7.2 and 19.4 mm). The cal-
culated crown to implant ratio (C/I
ratio) ranged between 0.9 and 2.5,
showing a mean C/I ratio of 1.4
(SD = 0.3). The C/I ratio of nine
implants (8.1%) was less than one,
whereas it was ≥1 in 102 implants
(91.9%). Table 2 shows mean C/I
ratio values by implant length and
jaw (maxilla and mandible).
In the opposing jaw, implant-sup-
ported bridge was the most frequent
antagonist prostheses (in 33 prosthe-
ses, 34.0%), followed by natural
tooth (28 prostheses, 28.9%) and
implant-supported complete prosthe-
ses (15 prostheses, 15.5%).
For the assessment of long-term
MBL, only those cases where the
last available radiograph was
performed after at least 8 years of
functional loading were taken into
account. A total of 87 implants that
satisfied this requirement were analy- Fig. 2. Box-plot diagram of the marginal bone loss in mm at mesial and distal points.
sed showing that the mean MBL
was 1.0 mm at the mesial side (SD =
0.7, median 0.9, range between 0.0 and 3.0 mm) at the distal side gical or biomechanical dependent
and 4.0 mm), and 0.9 mm (SD = (Fig. 2). variables on MBL in both mesial
0.6, median 0.8, range between 0.0 Analysing the possible influence and distal points, no significant
of the different patient, implant, sur- influence was observed. Table 3
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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408 Anitua et al.

Table 3. Marginal bone loss (MBL) values. Mean values of MBL for different qualitative titis probably caused by a very thin
and quantitative variables in both mesial and distal points, and their corresponding values gingival biotype and an excessive
of statistical significance (p value) plaque and food accumulation due
Mean MBL (mm) to a very poor hygiene.
The evaluation of the potential
Qualitative variables (n = 87) Mesial SD p value Distal SD p-value influence of different variables on
implant success rate revealed that
Gender none of them resulted to be statisti-
Female 1.07 0.72 0.10 0.91 0.60 0.77
cally associated with implant success.
Male 0.83 0.68 0.88 0.54
Smoking habits
This result was probably due to the
Yes 1.22 0.86 0.21 0.89 0.59 0.46 reduced number of implant los (only
No 0.97 0.66 0.96 0.60 one implant), which reduces the
Special techniques power of statistical analysis and thus
Yes 0.99 0.82 0.49 0.85 0.46 0.83 the possibility of detecting potential
No 1.03 0.71 0.91 0.60 risk factors. Figures 4 and 5 illus-
Immediate loading trate the clinical situation of two
Yes 0.64 0.66 0.46 0.71 0.71 0.82 patients involved in the study before
No 1.04 0.71 0.91 0.59 and after 10 years of treatment with
Surgical phases
One 1.02 0.70 0.96 0.89 0.58 0.93
short implants.
Two 1.06 0.75 0.93 0.62
Maxilla Discussion
Upper jaw 0.91 0.59 0.31 0.90 0.51 0.73
Mandible 1.10 0.78 0.90 0.64 The introduction of short implants
Ratio use in oral implantology was initially
<1 1.14 0.60 0.45 0.97 0.64 0.80 controversial because the tendency
≥1 1.02 0.72 0.90 0.59 was to think that the longer implants
Fixation will always show better clinical
Screwed 1.08 0.80 0.65 0.86 0.64 0.77
results due to better anchorage to
Cemented 1.01 0.69 0.91 0.57
Ferulization to
bone and better distribution of
One implant 1.01 0.57 0.91 0.82 0.45 0.29 occlusal load. This controversy
Two implants 1.06 0.84 1.00 0.70 remained when initial studies with
Short implants 1.07 0.77 0.9 0.91 0.44 0.73 short implants were published, as
Long implants 1.03 0.71 0.91 0.61 survival values were slightly lower
Quantitative variables (n = 87) Mesial p value Distal p-value than for standard length implants
(Tong et al. 1998, Winkler et al.
Implant diameter 0.927 0.73 2000, Herrmann et al. 2005).
Crown length 0.62 0.93 Recent systematic reviews evalu-
Crown/implant ratio 0.67 0.95 ating short implants report that pre-
dictability of short implants is
comparable to that of standard
length implants. Monje et al. (2013)
shows the different mean values of woman, with an oral rehabilitation have recently reported in a meta-
MBL in both mesial and distal including nine implants. The short analysis of prospective clinical trials
points and its statistical significance implant which failed was inserted in that implants less than 10 mm were
(p values) for qualitative and quanti- May 2001 in position 46 of mandible as predictable as longer implants,
tative variables. (right molar) (8.5 mm of length and but they fail at an earlier stage
Biological complications (a peri- 3.75 mm of diameter) in a single compared to standard ones. In addi-
implantitis) occurred in one implant surgical phase. It was restored in a tion, Srinivasan et al. (2012) have
(0.9%). No mechanical or technical cemented bridge and splinted to a reported a critical appraisal of the
complications were registered. long implant (13.0 mm). The implant literature concluding that implants
One short implant in one patient was loaded 5 months post-insertion. of less than 8 mm showed survival
was failed leading a survival rate of The implant remained stable until rates comparable to longer ones.
98.9% and 98.2% at the end of the May 2008, when began to show Focusing on posterior partial edent-
follow-up for the implant and patient- bone loss (1 mm). In May 2009, the ulism, Atieh et al. (2012) have pub-
based analysis respectively (Fig. 3). MBL was 3 mm and in Novem- lished a systematic review evaluating
One implant did not meet the ber 2011, bone loss reached to implants of ≤8.5 mm, showing high
defined success criteria, yielding an 5–5.5 mm, and suppuration was survival rate values for short
implant success rate of 98.9% and observed. Curettage was performed implants, not related to implant sur-
98.2% at the end of the follow-up and patient received antibiotic treat- face, design or width. As reported in
for the implant and patient-based ment (metronidazole 500 mg), but the systematic review published by
analysis respectively. the infection persisted, so it was Annibali et al. (2012), a higher sur-
The patient in whom the implant decided to remove the implant. The vival rate was obtained with rough-
was failed was a 62-year-old smoker failure cause could be a peri-implan- surfaced short implants, and the pro-
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Fig. 3. Survival graph for the implant and subject-based analysis.
vision of short implant-supported
prostheses in patients with atrophic
alveolar ridges appears to be a suc-
cessful treatment option in the short
term.
There are, however, very few
studies evaluating the long-term
prognosis of short implants. In par-
ticular, Lops et al. (2012) performed
in 2012 a study evaluating 108 short
implants (8 mm in length) placed in
anterior and posterior regions, being
the 20-year cumulative survival rate
92.3%. Furthermore, Mertens
et al. (2012) carried out a study to
evaluate long-term prognosis of
short implants (8–9 mm) in severely
atrophic alveolar ridges retaining
restorations on these short implants
only. As no failures were reported,
(a)
Fig. 4. Example of a case involved in the study. (a) Initial radiograph where tooth loss is observed corresponding to the 25 and 26
localizations. In this case, the sinus was pneumatized and had occupied much of the bone volume of the 26 piece. (b) Image of the
diagnostic planning of implant insertion (c) final radiograph 10 years after the start of the treatment with short implants, with the
final prosthesis.
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Long-term evaluation of short implants
and MBL values were adequate, the
authors concluded that these results
were comparable to those previously
reported for longer implants. More
recently, Lai et al. (2013) have pub-
lished a retrospective study evaluat-
ing long-term outcomes of short
implants supporting single crows in
posterior regions showing a 10 year
cumulative survival rate of 98.3%
and 97.6% for implant and patient-
based analysis respectively.
As far as we know, our study
might be the first evaluating the
long-term clinical results of short
implants alone or in combination
with long implants, in which the pos-
sible influence of prosthetic or
implant variables on MBL is
assessed. An important point to
(b)
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409
highlight is the definition of short
implants given in each clinical study.
In some studies, implants of 10 mm
are included as short implants, while
in our study, this definition is more
restrictive as only implants of
8.5 mm or less are regarded as short
implants and 10 mm implants are
considered as standard ones. Our
results show high success rate either
in implant and patient-based analysis
and adequate MBL values in the
long term. In fact, only one out of
the 111 short implants failed in one
patient during the observation per-
iod. The main cause of this failure
could be a peri-implantitis, probably
due to a very thin gingival biotype
and excessive accumulation of pla-
que due to a poor hygiene. These
results are in accordance with those
reported for short implants both in
recent systematic reviews and in the
few long-term published studies.
A key point of this study was to
assess the possible relationship of
different prosthetic, implant and
patient-dependent variables in the
long-term MBL at mesial or distal
points. In this regard, no association
was found between any of the stud-
ied variables and MBL values
including the C/I ratio. Imbalances
between the lengths of the crowns
and the implants are frequently
observed in prosthetic rehabilitations
especially when short implants are
involved. It has been suggested that
this C/I ratio imbalance could induce
poor biomechanical behaviour with
a potential impact on MBL and
implant survival rate (Blanes et al.
2007). Interestingly, no relationship
between MBL and the type of
implant splinting (only to other
short implants, or to long implants)
has been found.
(c)
 1600051x, 2014, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.12222 by National University Of Singapo, Wiley Online Library on [12/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
410 Anitua et al.

When interpreting the results from

the present study, some limitations
should be considered. One important
issue is that results come from a ret-
rospective study. This type of study
has less validity than randomized
prospective clinical trials, due to
issues of selection bias and confound-
ing factors. Furthermore, it also
(a) (b) should be taken into consideration
that most of the short implants stud-
ied were splinted to long implants
and the number of short implants
standing alone or splinted to other
short implants was reduced. More-
over, although the Authors believe
that the standardized method of
MBL calibrated measurement on
panoramic radiographs is reliable, it
(c) (d) is true that intra-oral periapical
radiographs is still the most advisable
method to minimize measurement
errors. Finally, one should also take
into consideration that a lack of a
relationship between studied vari-
ables on MBL could be due to a lack
of statistical power in the study.

Conclusions
(e) (f)
This study reports the long-term
Fig. 5. Example of a case treated with short implants. (a–b) Image of CT-scan pre- clinical evaluation of short dental
operative planning where the implant is planning to be located just above the dental implants humidified with PRGF
nerve and radiograph showing existing vertical bone atrophy in the molar region. (c) with 10–12 years of follow-up. Most
Intra-oral photography of the surgery. The implant is placed supracrestally in vestibu- of the short implants were splinted
lar location (1 mm). (d) Placement of particulate bone graft consisting of a mixture of to longer ones. High cumulative suc-
bone from drilling + plasma rich in growth factors (PRGF) on the area being treated. cess rates of 98.9% and 98.2% were
(e) Coverage with a fibrin membrane obtained from the PRGF-Endoret and posterior obtained for the implant and
suture with a non-absorbable monofilament 5/0. (f) Panoramic radiograph of the
patient-based analysis, respectively,
definitive prosthesis at 10 years of implant placement.
at the end of follow-up. Mean MBL
values were very small for the long-
Data showed herein may be than the effect of the implant’s term assessment. Prosthetic and
partially explained due to the length or its geometry. In addition, implant variables did not affect
biomechanical configuration of the the maximum stress is located implant success rate nor MBL.
short implants and also due the cor- around the neck of the implant and
rect choice of implant diameter. After the majority of the stress is distrib-
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Address:
Eduardo Anitua
Instituto Eduardo Anitua
c/ Jose Maria Cagigal 19, 01005 Vitoria
Spain
E-mail: eduardoanitua@eduardoanitua.com
additional and more invasive bone
augmentation procedures.