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Five-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws

Journal article
Authors P. Felice
C. Barausse
R. Pistilli
D. R. Ippolito
Marco Esposito
Published in European Journal of Oral Implantology
Volume 12
Issue 1
Pages 25-37
ISSN 1756-2406
Publication year 2019
Published at Institute of Clinical Sciences, Department of Biomaterials
Pages 25-37
Language en
Keywords bovine anorganic bone, inlay graft, short dental implants, sinus elevation, vertical augmentation, controlled clinical-trial, dental implants, sinus lift, autogenous bone, 1-stage, maxilla, hydroxyapatite, rehabilitation, Dentistry, Oral Surgery & Medicine
Subject categories Biomaterials

Abstract

Purpose: To evaluate whether 5-mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10-mm long implants in posterior atrophic jaws. Materials and methods: Fifteen patients with bilateral atrophic mandibles (5 to 7 mm bone height above the mandibular canal) and 15 patients with bilateral atrophic maxillae (4 to 6 mm bone height below the maxillary sinus), and bone thickness of at least 8 mm, were randomised according to a split-mouth design to receive one to three 5-mm short implants or at least 10-mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after another 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures, any complication and pen-implant marginal bone level changes. Results: In five augmented mandibles the planned 10-mm long implants could not be placed and shorter implants (7.0 and 8.5 mm) had to be used instead. Five years after loading, six patients, five treated in the mandible and one in the maxilla, dropped out. Three prostheses (one mandibular and two maxillary) failed in the short-implant group versus none in the long-implant group. In mandibles one long implant failed versus two short implants in one patient. In maxillae one long implant failed versus three short implants in two patients. There were no statistically significant differences in implant (n = 26; P = 1.00, difference = 3.85%, 95% CI: -12.95% to 20.64%) and prosthetic (n = 26; P = 0.250, difference = 11.54%, 95% CI: -0.74% to 23.82%) failures. Eleven patients had 16 complications at short implants (one patient accounted for six complications) and 12 patients had 14 complications at long implants. There were no statistically significant differences in complications (n = 28; P = 1.00, difference = -3.57%, 95% CI: -30.65% to 23.51 %). Five years after loading, patients with mandibular implants lost on average 1.72 mm at short implants and 2.10 mm at long implants of ped-implant marginal bone. This difference was statistically significant (difference = 0.37 +/- 0.43 mm; 95% CI: 0.07 to 0.68 mm; P = 0.022). In maxillae, patients lost on average 1.31 mm at short implants and 1.79 mm at long implants. This difference was statistically significant (difference = 0.48 +/- 0.43 mm; 95% CI: 0.22 to 0.74 mm; P = 0.002). Conclusions: Five years after loading, 5-mm short implants achieved similar results to longe implants in augmented bone. The choice of short implants might be preferable to vertical bone augmentation, especially in mandibles, since the treatment is faster and cheaper.

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