ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Short Implants Exhibit Changes in Marginal Bone Levels Similar to Longer Implants With Vertical Bone Augmentation or Sinus Lift
Clinical Question In adults needing dental implants, do short implants (less than 10 mm) exhibit less change in marginal bone levels in comparison to vertical bone augmentation or sinus lift with longer implants (greater than 10 mm)?
Clinical Bottom Line Short implants exhibit about equal change in marginal bone levels in comparison to vertical bone augmentation or sinus lift with longer implants. The data also revealed that shorter implants had similar, if not better, success rates due to an increased risk of complications when performing sinus lifts and/or bone augmentation in the posterior maxilla.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 28081288Pohl/2017101 patients divided into 2 groups, bone height 5-7 mm in posterior maxilla Randomized Controlled Trial
Key results"In 101 patients, 137 implants were placed. At the 3-year follow-up (FU-3), 94 patients with 129 implants were re-examined. The implant survival rate was 100% in both groups. MBL at FU-3 was 0.45 mm (GG) and 0.44 mm (GS) (p > 0.05). A statistically significant loss of MBL was observed in both GG (-0.43 ± 0.58 mm) and GS (-0.44 ± 0.56 mm) from IP to FU-3, and from PR to FU-3 in GG (-0.25 ± 0.58 mm) but not in GS (-0.1 ± 0.54 mm)." Data is on marginal bone levels on single crowns only. MBL- Marginal Bone Loss GG-Patients with sinus grafting plus long implants GS-Patients receiving short implants PR- Implants loaded with single crowns IP- Implant placement
#2) 27740639Mendoza-Azpur/20162 groups, total 82 patients, non-smokersNonrandomized Clinical Trial
Key results"A statistically significant difference was found in favor of the standard-length implants after 12 months, with greater gingival recession around the implant; however, bone loss in the short implants did not exceed 0.53 mm. The treatment with 5.5- to 7-mm-length implants is as reliable as treatment with 10- or 12-mm implants." Data is on marginal bone levels on single crowns only.
#3) 26425812Schincaglia/2015132 implants in 97 subjects Randomized Controlled Trial
Key results"The CSR was 100%. The MBL from implant placement (IP) to (PR) was -0.22 ± 0.4 mm for GG and -0.3 ± 0.45 mm for GS (p < 0.001). MBL from IP to FU-1 was -0.37 ± 0.59 mm for GG and -0.22 ± 0.3 mm for GS (p < 0.001). Intergroup comparisons showed non-significant differences for MBL (p > 0.05), PPD (p = 1) and PCR (p = 0.09)." Data is on marginal bone levels on single crowns. CSR- Implant Survival Rate MBL- Marginal Bone Loss GG-Patients with sinus grafting plus long implants GS-Patients receiving short implants PR- Implants loaded with single crowns IP- Implant placement FU-1-Patients were re-evaluated 12 months after loading PPD- Periodontal Probing Depth PCR- Plaque Control Record
Evidence Search “short implants” AND “sinus lifting with longer implants” AND “marginal bone level”
Comments on
The Evidence
Validity: Pohl/2017 mentioned enrolled patients with partial edentulism, but the rest of the patient medical and dental history is unclear. The patients’ general health status and oral health should be considered with comparing results amongst the patients. Mendoza-Azpur/2016 compares short and long implants solely, with disregard to any vertical bone augmentation or sinus lift. It is possible that adding in the extra factor of either simultaneous vertical bone augmentation or sinus grafting would change the results. Perspective: When comparing implant success outcomes, specifically marginal bone loss, between (a) short implants and (b) vertical bone augmentation or sinus lift plus standard implants, some clinicians may think that the success rate decreases with the shorter implant due to an increased crown-to-root ratio. However, these trials show that there is not much difference in the marginal bone loss when comparing the two options. It is important to note that Pohl/2017 is a 3-year follow-up on the same pool of patients that were part of the Schincaglia/2015 study.
Applicability This study is very applicable to any patient that requires an implant in the maxillary posterior region. With many factors coming into consideration, such as treatment cost, treatment time, and even short-term patient morbidity, it is essential to have options when deciding which implant to place.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Short implants, sinus lift, long implants, marginal bone loss, success rate
ID# 3192
Date of submission: 04/26/2017spacer
E-mail allon@livemail.uthscsa.edu
Author Liel Allon
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Concepcion Barboza, DDS
Faculty mentor/Co-author e-mail BarbozaArgue@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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