Shorter Dental Implants ?

Ted, a dentist, asks:
A doc friend of mine recently recommended that I try shorter dental implants. So I’ve been trying to get some opinions on these implants. Dentists on OsseoNews.com: What has been your experience with these shorter dental implants?

Are these shorter dental implants just as stable and tight fitting as the longer ones? Supposedely, the shorter implants help do away with bone grafting in the sinus area. But do they really work in the upper jaw area in the molar regions? In what other settings would these shorter dental implants be appropriate? Are there any studies supporting the use of these implants and the benefits thereof? Thanks.

49 thoughts on “Shorter Dental Implants ?

  1. Dear Ted,

    Please, please note that I do not work for Bicon, I am not a “paid consultant” for them and I am not a sales person.

    I place their implants (amongst others) and as of today I have now placed 998 implants (yes two to go!), over 900 of which are Bicons. You should look at what these short implants can do.

    Are they the only short implant out there? No – but in my humble opinion they are probably the best.

    Kind Regards,

    Bill Schaeffer

  2. Murray Arlin just published an article in JOMI 2006 Sep-Oct;21(5):769-76

    Short dental implants as a treatment option: results from an observational study in a single private practice.

    Arlin ML.

    PURPOSE: The purpose was to evaluate clinical outcome of short (6- and 8-mm) dental implants placed in sites with low bone availability (7 to 11 mm) in a single private practice and to compare their survival with that of longer implants. MATERIALS AND METHODS: Implants were placed by a single private practitioner in a variety of clinical indications. Exclusion criteria included uncontrolled diabetes mellitus, alcoholism, and systemic immune disorders. Clinical data relating to implant placement and follow-up appointments, including adverse events, were entered into an electronic database. Two-year survival rates were calculated and life table analyses undertaken for implants measuring 6, 8, and 10 to 16 mm. RESULTS: A total of 630 Straumann implants were placed in 264 patients between April 1994 and December 2003. Of these, 35 implants were 6 mm long, 141 were 8 mm long, and 454 were 10 to 16 mm long. Maximum follow-up was 64.6 months, 83.7 months, and 102 months for implants measuring 6 mm, 8 mm, and 10 to 16 mm, respectively. Two-year survival rates were 94.3%, 99.3%, and 97.4% for 6-mm, 8-mm, and 10- to 16-mm implants, respectively. DISCUSSION: The results indicated that the 2-year outcome for 6-mm and 8-mm implants was comparable to that for longer (10- to 16-mm) implants in this patient population. CONCLUSION: In this study, short (6- or 8-mm) implants were used with good reliability in patients with limited bone availability, without the need for ridge augmentation. Shorter implant length was not associated with reduced survival at 2 years, compared with longer implants.

  3. I put in a web address showing up to 8 year follow-ups on 6mm and 5.7mm implants.

    This one page on short implants has 70 pictures of what they can do.

    go to Bicon.com
    then go to “Case Studies”.
    then go to “Special Topics”.
    then go to “Short Implants”
    then go to No. 7 “Proven Clinical Success Since 1997″

    I hope this helps answer your valid queastion.

    Kind Regards,

    Bill Schaeffer

  4. Please note, outside links are not allowed in posts because of “comment spam”. They are removed automatically by our software. Thanks for your understanding.

  5. There does appear to be a lot of recent studies which suggest shorter is not a problem both in europe and the US. In fact 98% of the load stress is taken by the top 4 to 5 threads and the rest of the implant is “sleeping”. But the vital issue is the crestal bone plate , we must not “chase the biologic width down” by placing the implant too deep. placing the last thread at the crestal level is the key and uf you have super thin gingival bio type then just ” ridge fit” the abutment rather than place the implant higher which will cause bone loss.
    As for the sinus area I routinely mve the sinus up gently by 1 or 1.5 mm to avoid a sinus lift (with patient consent) In the last few years of doing this at least every fortnight I have had no problems on post op pain.
    Thus you have say a 4.5 by 10 mm (or 8mm) implant with bi-cortical fixation.
    stress management is another vital area and utilsing titaniums properties effectively is important

  6. Dr.Ted:
    You should try Endopore implants that are designed to work with as little as 4 to 5 mm and no more than 9mm.
    They work great, and they have great support after 15 years of studys.
    cheers

  7. Nice that my article in JOMI was mentioned. I have documented well over 200 “short” implants i.e. Straumann 6mm and 8mm lengths. I found that if the bone quality is reasonable and fairly good initial stability is achieved, then on can anticipate good results. My updated statistics (the article is at least 2 years behind the times) show a cumulative survival rate at 8 years of about 93% for the 6mm lengths and over 96% for 8mm lengths.

  8. I have placed quite a few short implants. The majority of what I place are 8mm. In hundreds of implants placed I have found no difference in short or long implants. THe only reason I use longer than 10mm are in sites of immediate placement after extraction and I am looking to get rigid fixation. Still, in these situations I have never used more than 14mm. I have had some long-term failures with the endopore implants. Once the peads are in communication with the oral cavity it’s over. period. For short implants 6mm I have had success with Strauman and Astra.

  9. I can also recommend Bicon’s short implants. The abutment connection also seems to more or less eliminate crestal bone loss due to the absence of a ‘microgap’, an advantage that Straumann, Endopore etc cannot boast.

    A numb lip/bone graft or a short implant; now what would I rather have done in my mouth?

  10. thought the “microgap” was last year only Bicon talks about it….it is not an issue if the implants are placed at the correct level.

  11. Dear Ted,

    I have to agree that if you would like to use dental implants below 8mm you should try and use Endopore from Oraltronics. Now anything from 8mm and above you should use Pitt-Easy with FBR or Puretex surface, again from Oraltronics. You will have no problems at all with these, they are fantastic implants with excellent primary stability and very quick augmentation. Implants with FBR surface we have placed more than 2,000 and Puretex which is a new surface 250 implants. Just take a look and ask around, you will be amazed.

    Thank you.

  12. Dear Ted,
    How could one restore the smaller jaws of the Japanese without shorter implants? I’ve been using, where the anatomy required, the 7mm implants from BioHorizons, with the same high success rate as the 9mm, 10.5mm, and longer implants.

  13. I have been using the Branemark 7mm implants since they were introduced in the 90’s (they are now under the name of ‘SHORTY”) and my clinical success is approx 97%. Simple explanation, follow the protocol + proper pt. selection= SUCCESS.
    I also use the Replace 8mm when the situation lends itself to this length. My referrals love the internal connection and the fact that the company (Nobel) has such great support for them. Since working exclusively with Noble, I have tripled my implant placements all because of the support my rep(s) give to me and my valuable referral base.

  14. Peter,
    Not sure what you mean when you say the microgap was last year…
    If you read the implant press Ankylos/Dentsply, 3i, Astra, and most recently Osteo-Ti have spent a fortune advertising how they deal or avoid the microgap to prevent bone loss.
    Obviously there is a market for those of us who prefer not to see any bone shrinking from around the necks of our implants – or perhaps we all just place our implants at the incorrect level?

  15. It would seem that Bicon, Astra and Ankylos have solved the microgap issue by eliminatating it.
    Straumann etc. are yet again playing catch-up. I would put money on Nobel, Straumann etc bringing in an abutment taper to try and eliminate the microgap in the next 5 years.

  16. Straumann/ITI was one of, if not the first system to ackowledge and address the microgap by adding the the polished collar. Crestal bone height is predictably preserved – and there are plenty of studies demonstrating this.

    So-called platform switching simply moves the microgap horizontally as opposed to vertically.

    It’s funny how external hex systems denied the existence of biologic width for so long (calling it “bone remodelling”), and now claim to have solved it.

  17. Problem with Strauman implants is that you have to place them supra-crestally to get reasonable esthetics.
    I don’t recall Bicon, Astra etc having ever produced an implant with an external hex, but I do recall straumann’s disastrous implants, with plenty of studies demonstrating this!
    Ultimate esthetics are achieved by placing implants at crestal level and not to have any bone loss. You can only do this with Astra, Ankylos, Bicon – all of whom use a morse taper to form a cold-weld between the implant and the abutment, producing NO microgap. Straumann’s polished collar is a disaster.

  18. Quick clarification to whomever posted the comment above: Astra and Ankylos have a Morse Taper, Bicon has a Locking Taper. Bicon is the only system definitively proven to have a bacterial seal, as far as I know.

  19. Not so at the AAID meet in Dublin if you go subcrestal you lose the benefit of the crestal plate maybe just a Euro thought ..there is no microgap issue…figment of marketing

  20. Disastrous Straumann polished collar? 2,800 so far and no disasters on my end.

    Someone obviously has an axe to grind.

  21. “Short” implants of 7mm and 8mm have been around for as long as I can have been involved in placing implants. Some are better than others. I have been placing Bicon “ultra short” 6mm implants since 1998 including the research protocol. I have noticed no difference in initial and long term success in all bone types. I also am not paid by any implant company.

  22. The Microgap is a connection point between the implant and abutment, the crown and abutment, or both, or the crown and implant (in the case of Straumann.). Straumann, in most situations has only. The study on the Bicon 1.5 degree taper shows that bacteria will not leak into or out of the well of the implant in a 72 hour period, In Vitro study. Thus the use of the word seal. Bacteria seems to like ledges on natural teeth and do not need a well in order to destroy tissue. Why would an implant be different? The Bicon design leaves an area between the crown/abutment connection and the implant/abutment connection that would make a great ledge in addition the concavity would appear to be difficult to clean. I couldn’t find any histology studies that demonstrate that bacteria will not form in this indentation only that their is no leak from the well of the implant. Is that the only consideration? The idea of a 1.8mm polished collar from Straumann moves the bone away from the microgap, whether it is sealed from the well of the implant or not. Platform switching does the same only in a horizontal aspect and with specific implant sizes from Astra, 3i etc… But the microgap, or interface between the implant and the abutment is not eliminated by sealing the well of the implant. I don’t know that what is posted on the Bicon website answers all questions about implant to abutment interfaces. It only addresses the well of the implant which could be a reposatory for bacteria that can not be cleaned during follow-up visits.

  23. Please let this not degenerate into a “my implant’s better than your implant” spat.

    For simple info about what lengths are available (and note I am not saying whether they work or not), here is what I believe to be true for the following manufacturers and what their shortest implant length available is;

    3i = 8.5mm
    Astra = 8.0mm
    Ankylos = 8.0mm
    Nobel Biocare = 7.0mm
    Straumann = 6.0mm
    Bicon = 5.7mm
    Innova = 5.0mm

    I hope that’s helpful.

    Kind Regards,

    Bill Schaeffer

  24. Bill,

    If you could get hold of the surface area measurements of these implants that may be even more revealing!

  25. Dear MS,

    I absolutely agree that surface area would be enlightening, but unfortunately, I don’t have that data.

    Kind Regards,

    Bill Schaeffer

    p.s. also of note is that some of the manufacturers do not advise the use of their short implants unless they can be splinted to other units.

  26. To whoever posted the following on Dec 18:

    “But the microgap, or interface between the implant and the abutment is not eliminated by sealing the well of the implant. I don’t know that what is posted on the Bicon website answers all questions about implant to abutment interfaces. It only addresses the well of the implant which could be a reposatory for bacteria that can not be cleaned during follow-up visits. Posted by: | Dec 18, 2006 10:49:49 AM”

    QUESTION: So are you saying that Bicon really has NOT solved the microgap issue with their implant system? If yes, has any compnay really solved the implant microgap issue totally? If so, which compnay?

    Thanks in advance for your thoughts.

  27. A non-segmented implant abutment design concept. Its one piece. Has no microgap to host the unicellular stuff.
    In addition, the bone cells are more interested in enhanced surface volume rather than area. This was relative to the short implant issues.

  28. The macro geometry is a key factor in the success of Bicon’s short implants. Because of the plateau design of Bicon there is 33% more surface area than a non-plateaued implant of a comparable length and diameter. Also, the bone around plateaued implants heals at a faster rate and is Haversian bone (bone with central vascular systems) as opposed to the appositional bone that is around non-plateaued implants.

    Consult with Dr. Jack Lemons at UAB about his research and published papers on this subject.

  29. How short is short?
    Dr. Schaeffer gave a list of different implants with it height.
    I want to add disc implant and BOI (basal osseointergration implant) less than 1mm.
    what if you have posterior mandible height less than 5mm, 4mm, 3mm?
    do we tell the patient that they are not candidate for “short implant” or that they need bone graft?
    I have recently been introduced to disc implants and BOI.
    anyone have any experience with know anyone in the US with this alternative disc implant or BOI implant experience?
    in case you want to find out more about this you can google
    the above or the two clinicians:
    Gerard Scortecci of France and Ihde of Switzerland.

  30. Having used basal implants (e.g. BOI) for 10 years in over 1300 CASES now, my experience is, that 2-3 mm are enough. In addition to this advantage, these implants are immediately loadable, in fact they must be loaded in order to integrate under regular functional load in order to direct the bony healing.
    Please keep in mind, that the load transmission areas of those implants amay become extremely small and this means, that the prothetical work has to be designed exactly according to the rules of BOI, in order to not overload the bony interface. Success of BOI (especially in immediate load cases with very little or poor bone), lies in the prosthetical work. In cases of poor bone, we also reduce the masticatory forces during the healing phase (for aprox. 2 months) by applying botox to the chewing muscles (mainly to the M. masseter). The journal “CMF Implant directions” has started regular publishing on this technique. I use approximately 70% BOI and 30% screws in my office.

  31. I’ve been researching Bicon 5.7 mm short implants for my Masters thesis. Out of over 600 implants analyzed, over 95% showed negligible bone loss, which is hard to grasp when you are used to having bone recede down to the first thread. Also, with the 98% success rate, and the ease of the restorative portion, with the implementation of the IAC, I believe it makes this system an amazingly well kept secret. Even though this implant system is not being used in our residency program, there is no doubt in my mind that it will be the one I use in private practice.

    Hope this helps!

  32. Have you ever restored one of these in the Anterior? Have you ever replaced an abutment/crown? There is a reason why this system is rarely used by specialists. Building emergence profile with the crown is not the answer, it should originate from the abutment implant interface.

  33. Mr. Snyder (AS),

    What are you on about again? What has Bicon done to you? You need to come clean, rather than just spewing forth nonsense and trying to dicredit the company. Is this what your bosses at 3i have briefed you to do? Shame on you if it is. If not, explain why you have such a nasty little axe to grind…

    Bicon is used by plenty of ‘specialists’ as well as GDPs who enjoy fantastic success rates and superb aesthetics. Bicon’s market share is greater in many countries than 3i’s…

    Please explain why you say that the emergence profile should come from the abutment-implant interface and not the crown (as it does with Bicon, Astra, Ankylos, Alpha-Bio, Osteo-Ti etc..) If you are going to make such comments please explain your rationale.

    You keep referring to ‘specialists’, and presumably you would like to include yourself in this category. Explain what you mean. What are you credentials? Are you a 3i Rep or a 3i Clinician or both?

    I use Bicon alongside 3i and can honestly say that the Bicon implants yield the best aesthetic results; long-term and short-term. There is nothing to distinguish 3i from most of the other manufacturers apart from its high prices and aggressive sales techniques.I’m not sure that we’ll continue using 3i for much longer, as there are plenty of other manufacturers who have a near-identical product.

    As you work for 3i I presume you know that almost 50% of the company’s income is spent on marketing? This means that 50% of the cost of an implant I buy from 3i goes towards adverts and sales Reps like you. Something wrong here!

  34. MS,

    Let me know where you practise so I can open shop next to you. Your stmts speak for themselves. Marketshare with Bicon….have you lost your mind. Aesthetics…lol. I will not waste my time discussing this with you. Use Bicon, you will make everyone of your competitors thrilled. I wish i had someone in VA who used this too. What a gift from God that would be.

    Salute

  35. Snyder,

    You keep being shot down in flames and exposed as a 3i Rep who has a big chip on his shoulder about Bicon for some reason.

    I am also a ‘Specialist’ and have used Bicon successfully for 12+ years. It’s a great system, but aren’t most of them these days?

    Previous posters have asked you some very sensible questions to back up your assertions (opinions) and you have chosen not to answer any of them. Why could that be we’re all asking?

    Please grow up, if you’re going to make assertions and air your obviously vitriolic opinions, BACK THEM UP with some science!

  36. You have to map the area of paresthesia and note any changes over time. Discuss referring the patient to an oral surgeon who has treated cases of paresthesia just to cover yourself!Have the patient sign that acknowledge the conversation.

  37. Dear Dr Ihde-i heard a Dr from Nice France lecture this weekend in San Francisco on these disk implants-can they be ordered in the USA? I have placed many implants-zimmer,nobel, mis, straumann, ankylos astra and implant direct-these disk implants look like a completely different concept. how are they inserted? and how much bone is needed-hprizontally and vertically. I like to keep the number of surgeries on my patients to a minimum. thanks scott hamblin dds

  38. What is the most reliable implant? I am missing three teeth in the upper front of my mouth. I also lost some bone. This was due to a car accident about 29 years ago. Thank you for your time and consideration.

    Sincerely, Edward Strine

  39. Thank you all for the information about short implants. Two dental surgeons said I needed bone grafting in order to then get dental implants; that this would involve a number of visits and quite a bit of money. Both went into a fair amount of detail, but neither mentioned these short implants, so I’m sort of assuming they don’t do these, or would have mentioned them to me as a way of avoiding bone grafting.

    My question is: since it sounds like the short implants take less work (at least in # of visits, and avoiding grafting step), do they generally cost less?

    thanks!

  40. Five-Year Clinical Evaluation of Short Dental Implants Placed in Posterior Areas: A Retrospective Study

    J Periodontol. 2008 Jan;79(1):42-48

    Background: The aims of this study were to evaluate the long-term survival rates of short dental implants in posterior areas and to analyze the influence of different factors on implant survival.

    Methods: A retrospective cohort study design was used. A total of 293 subjects received 532 short implants between 2001 and 2004. All implants were placed by two experienced surgeons, and rehabilitations were done by three prosthodontists. Each implant failure was analyzed carefully. The potential influence of demographic factors, clinical factors, surgery-dependent factors, and prosthetic variables on implant survival was studied. Implant survival was analyzed using a life-table analysis (Wilcoxon [Gehan] test).

    Results: The overall survival rates of short implants were 99.2% and 98.7% for the implant- and subject-based analyses, respectively. The mean follow-up period was 31 ± 12.3 months. Two of 532 implants were lost during the observation period. None of the variables studied were statistically associated with implant failure.

    Conclusion: Treatment with short implants can be considered safe and predictable if used under strict clinical protocols.

  41. I am currently undergoing dental treatment and have been told of some conflicting information. Is it possible to have 4 implants side by side? I have my 4 front teeth missing and have been told that it is not possible to have an implant next to another implant.
    I have been researching on the net and dental chat sites and have been told that it is possible to have 4 implants side by side.
    Any help would be greatly appreciated as I am starting to loose faith in my current prosthodontist for various reasons.

    Thanking you in advance.

  42. I am currently undergoing dental treatment and have been told of some conflicting information. Is it possible to have 4 implants side by side? I have my 4 front teeth missing and have been told that it is not possible to have an implant next to another implant.

    I have been researching on the net and dental chat sites and have been told that it is possible to have 4 implants side by side.

    Any help would be greatly appreciated as I am starting to loose faith in my current prosthodontist for various reasons.

    Thanking you in advance.

  43. Australian patient, as a general rule it is preferable to use 2 implants to replace the 4 incisors as this will make prosthetic management easier.
    Nevertheless it is possible to place 4 implants provided the available space allows respecting the minimum distance required between implants

  44. I need currently undergo dental treatment and I need 4 implants in the upper right of my mouth. The most last implant has to be installed under an angle as a doctor said. I have some doubt about it. Is it possible to have an implant installed under an angle? Will it be able to hold a bridge?

    Thanking you in advance.

  45. I must disagree with the comment above- “as a general rule it is preferable to use 2 implants to replace the 4 incisors”. This requires a cantilever structure- attaching a loose crown to a fixed one. The keyword is “lever”. Studies show that movement is one of the biggest factors affecting crestal bone loss and failure rates of implants. And a cantilever doesn’t just double the forces of movement on the implant, it multiplies it. Example: Think of a round door handle. If you double the size of the round handle, it doubles the turning force. But if you install a bar-shaped handle, which is a lever- it gives you incredible twisting force- many times more- not just double. So attaching an unattached crown to a fixed one is like installing the bar handle on your implant. Every time the unattached crown bites into something, it’s going to try to turn the handle.

  46. Every Case is different . You can absolutely place implants next to each other . It obviously depends on how much bone is available and how much room there is between the remaining teeth. Go to doctor that can offer you the full range of options. If someone is suggesting that you should cantilever , they probably are not comfortable doing large block grafts or if the space between the remaining teeth is inadequate you may need to consult an orthodontist. Implants require a team approach! Get second , and third opinions . Good luck. B. Vinci

  47. I’ve been impressed by Dr. Ihde’s work on basal implantology.
    Is there anybody in the US who has used the products?

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