10.14219/jada.archive.2013.

0014
2013;144(1):59-60 JADA
Sarah Gray
doi:10.1111/j.1600-051X.2011.01736.x.
2011;38(7):667-676.
print May 12, 2011). J Clin Periodontol
edentulous patient (published online ahead of
partially 10 mm) dental implants placed in the
systematic review of the prognosis of short (<
Hartog L, Huddleston Slater JJ, Meijer HJ. A
Telleman G, Raghoebar GM, Vissink A, den
partially edentulous: A critical summary of
Success of short implants in patients who are
September 12, 2014):
online at jada.ada.org (this information is current as of
The following resources related to this article are available
http://jada.ada.org/content/144/1/59
can be found in the online version of this article at:
including high-resolution figures, Updated information and services
http://jada.ada.org/content/144/1/59/#BIBL
, 1 of which can be accessed free: 3 articles This article cites
http://www.ada.org/990.aspx at:
permission to reproduce this article in whole or in part can be found
of this article or about reprints Information about obtaining
Association.
republication strictly prohibited without prior written permission of the American Dental
Copyright 2014 American Dental Association. All rights reserved. Reproduction or
on September 12, 2014 jada.ada.org Downloaded from on September 12, 2014 jada.ada.org Downloaded from
JADA 144(1) http://jada.ada.org January 2013 59
Clinical question. Are short
implants a reliable option for pa-
tients who are partially edentulous?
Review methods. One au-
thor and one database expert inde-
pendently searched MEDLINE and
Embase databases for articles pub-
lished from January 1980 through
October 2009. Included were ran-
domized controlled trials (RCTs)
and prospective cohort studies of
human participants who were par-
tially edentulous and who had been
followed up for more than one year.
The authors excluded alumina-
reinforced zirconia implants and
mini-implants used for orthodontic
anchorage, as well as those with
cantilever substructures. By using
two tools developed by the Dutch
Cochrane Centre, the authors inde-
pendently generated scores for
each study that they used as a
basis for study selection. The
authors assessed survival rates of
short implants after two years in
patients who had partially edentu-
lous maxillae and mandibles. The
authors also evaluated survival
rates of short implants in patients
who smoked versus patients who
did not, of implants with rough and
smooth surface topography and of
implants that were placed concur-
rent with bone augmentation
procedures.
Main results. The initial
search yielded a total of 1,353 pub-
lications, from which the authors
selected 29 for the systematic re-
view, including 28 prospective
cohort studies and one RCT. A total
of 2,611 short (< 10-mm) implants
were involved, and the mean
follow-up time was 3.7 years. Short
implants placed in the maxilla had
a significantly higher failure rate
than did those placed in the man-
dible. There was a positive associa-
tion between success rate and
implant length; longer implants
had a significantly higher survival
rate. The two-year survival rate for
5-mm implants was 93.1 percent;
for implants between 6.0 mm and
9.5 mm in length, the two-year sur-
vival rate consistently met or ex-
ceeded 97.4 percent. In studies that
included patients who smoked, the
number of implant failures was
higher than that in studies in-
volving only patients who did not
smoke. Implant surface topography
and bone augmentation did not
affect the survival of short im-
plants significantly in this review.
Conclusions. The survival rate
of short implants is higher when
implants are located in the man-
dible than when they are located in
the maxilla. Short implants placed
in patients who did not smoke had a
higher chance for long-term sur-
vival. The greater the length of the
implant (within the range of 5.0-8.5
mm), the longer its survival. Nei-
ther surface topography nor pre-
ceding bone augmentation pro-
cedures had a significant effect on
the survival rate of short implants.
No sources of funding for this systematic
review were listed.
Dr. Gray is an associate professor, Office of Graduate Education, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia. She also is an
evidence reviewer for the American Dental Association. Address reprint requests to Dr. Gray, Office of Graduate Education, Maurice H. Kornberg School of
Dentistry, Temple University, 3223 N. Broad St., Philadelphia, Pa. 19140, e-mail sagray@temple.edu.
Systematic review conclusion. Short implants (< 10 millimeters) can be used
successfully in patients who are partially edentulous. Greater survival rates are
associated with implants in the mandible, with implants in patients who are non-
smokers and with implants of at least 6 mm in length.
Critical summary assessment. The survival rate of short implants in partially
edentulous patients is similar to that of standard implants, with two-year sur-
vival rates generally increasing with implant length and being greater for im-
plants placed in the mandible.
Evidence quality rating. Good.
Success of short implants in patients
who are partially edentulous
A critical summary of Telleman G, Raghoebar GM, Vissink A, den Hartog L,
Huddleston Slater JJ, Meijer HJ. A systematic review of the prognosis of short (< 10 mm) dental
implants placed in the partially edentulous patient (published online ahead of print
May 12, 2011). J Clin Periodontol 2011;38(7):667-676. doi:10.1111/j.1600-051X.2011.01736.x.
Sarah Gray, DDS, MS
C R I T I C A L S U M M A R I E S R E S E A R C H
Copyright 2013 American Dental Association. All rights reserved.
on September 12, 2014 jada.ada.org Downloaded from
60 JADA 144(1) http://jada.ada.org January 2013
C R I T I C A L S U M M A R I E S R E S E A R C H
COMMENTARY
Importance and context. Implant
prosthodontics rapidly is becoming routine
practice for replacement of missing teeth, and
practitioners are looking for effective ways to
restore to full function their patients who are
partially edentulous, particularly those who
have atrophic alveolar ridges. With smaller
implants, surgeries are less invasive, healing
time is decreased and patient satisfaction may
be improved.
Strengths and weaknesses of the system-
atic review. The authors used accepted search
methods with well-defined inclusion and exclu-
sion criteria. They independently assessed
selected studies for risk of bias, and they studied
sources of heterogeneity by using stratified
analyses for the determinants of surface topog-
raphy, jaw arch, smoking status and bone aug-
mentation procedures. The authors included
only studies that met their risk-of-bias criterion,
thereby limiting the number of studies available
for analysis. An alternative would have been to
include patient data from all RCT and prospec-
tive cohort studies and perform subgroup analy-
ses according to risk of bias. Implant failure
data included implants that had been removed
for psychological reasons, which could affect the
reported survival rates negatively.
Strengths and weaknesses of the evi-
dence. Of the 29 publications selected for data
analysis, only one was a randomized controlled
trial; the other 28 were prospective cohort
studies. Most of the studies included in this
review were not limited to short implants, and
the authors made no distinction regarding the
prosthetic rehabilitation of the implants (for
example, short implants could be splinted to
longer implants). Each participant had at least
five short implants, which may have skewed
results negatively because implant loss tended
to cluster within the same patients. In addition,
some short implants were used to support
single-tooth restorations, whereas others were
used in combination to support multiple-tooth
restorations. Thus, the results of this review
may not necessarily pertain to any specific
clinical situation.
Implications for dental practice. Consis-
tent with results from other systematic re-
views,
1-3
the authors found that the survival rate
for short implants was similar to that of stand-
ard implants. Short implants are a predictable
treatment modality for partially edentulous
patients, and they tend toward an increased sur-
vival rate when placed in the mandible and in
patients who do not smoke. I
Disclosure. Dr. Gray did not report any disclosures.
These summaries, published under the auspices of the American
Dental Association Center for Evidence-Based Dentistry, are pre-
pared by practitioners trained in critical appraisal of published sys-
tematic reviews who work under the mentorship of experts. The sum-
maries are not intended to, and do not, express, imply or summarize
standards of care, but rather provide a concise reference for dentists
to aid in understanding and applying evidence from the referenced
systematic review in making clinically sound decisions as guided by
their clinical judgment and by patient needs.
For more information on the evidence quality rating provided above
and additional critical summaries, please visit http://ebd.ada.org.
1. Sun HL, Huang C, Wu YR, Shi B. Failure rates of short ( 10
mm) dental implants and factors influencing their failure: a system-
atic review. Int J Oral Maxillofac Implants 2011;26(4):816-825.
2. Menchero-Cantalejo E, Barona-Dorado C, Cantero-Alvarez M,
Fernandez-Caliz F, Martinez-Gonzalez JM. Meta-analysis on the sur-
vival of short implants. Med Oral Patol Oral Cir Bucal 2011;16(4):
e546-e551.
3. Annibali S, Cristalli MP, DellAquila D, Bignozzi I, La Monaca G,
Pilloni A. Short dental implants: a systematic review. J Dent Res
2012;91(1):25-32.
Copyright 2013 American Dental Association. All rights reserved.
on September 12, 2014 jada.ada.org Downloaded from