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ePaper created 2014-11-23, 21:56:20 | version 1.30.01
research I I 13implants4_2014 Fig. 4_Buccal view of the permanent bridge two years after implant placement. (precise) surgical guides has contributed to the in- creased survival and success of short implants. This improvementinhard-tissuemanagementhasbeen accompanied by more precise soft-tissue diagnosis (thinbiotype)management,whichinturnmayhave contributed to the improved survival and success rates observed in recent publications. Nomechanicaladvantageforlongerimplants Studies using finite element analysis have gen- erally found that the highest stress is only exerted onthecrestalpartofthedentalimplant,whereaslit- tle force is transmitted to the apical part. In accor- dancewiththisfinding,longerimplantsthusshould not show any mechanical advantage if only this as- pectisconsidered.Thisparticularpointissupported by the results of the case series presented in this ar- ticle. We have demonstrated that the success of short implants is similar to that of long implants. Moreover, the crown–implant ratio of < 2 does not appear to be of any importance, leaving open the questionoftheneedtosplintshorttolongimplants. Survival rate of short implants is similar to longer ones Our findings support the feasibility of treating single missing teeth with short implants. In a re- cently published clinical investigation of short den- tal implants restored as single-unit non-splinted crowns,221short(L6.0–9.0mm;D3.7–5.6mm)im- plants placed and restored in 168 patients were fol- lowed for 27 months.33 The survival rate in the max- illae was 88.6%, whereas it was 96.0% in the mandible. Cigarette smoking, diabetes mellitus and boneaugmentationprocedureswerenotassociated withanincreased(early)implantfailurerate.There- searchers concluded that the survival rate of short implants restored as single crowns over an average of 37 months was favourable and comparable with that of longer implants. Lessinvasivesurgicalprotocol The case illustrated demonstrates the high pre- dictability of the selected treatment protocol (Figs. 2–4).Wereshortimplantsnotavailable,amuchmore invasive surgical protocol would have been needed. Consequently, a significant clinical risk was avoided and the treatment was more advantageous finan- cially. Peri-implantitis Theeventualdevelopmentofperi-implantitisre- mains a major problem. Two factors are to be con- sidered:theabilitytoprovideoptimalplaquecontrol, which may be difficult owing to the posterior loca- tion of these implants, and adequate periodontal support. This aspect should be addressed by appro- priate hard- and soft-tissue management, that is, ensuring sufficient surrounding bone on the facial and lingual/palatal aspects and optimal soft-tissue biotype. _Conclusion Within the limitations of this case series, the re- liableandpredictableuseofshortimplantsforupto two years was confirmed. The results obtained in a multicentresettingconfirmedthepositiveobserva- tions reported by other authors. Minimal periapical bone loss (< 1 mm) was found radiographically. Long-term studies are still needed to establish whetherthereareanyspecificriskfactorspertinent to the use of short implants._ Editorialnote:Alistofreferencesisavailablefromthepub- lisher. Dr Jean-Nicolas Hasson received his degree in Periodontics at the University of Southern California in1981.HispracticeisdedicatedtoPeriodonticsand Dental Implants in Mulhouse (France) and he is teaching at the University Louis Pasteur Dental School (Strasbourg). _about the author implants Dr Jean-Nicolas Hasson 5,rue duWerkhof F-68100 Mulhouse,France hasson@hrnet.fr _contact implants Fig. 4