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Clinical Science and Techniques

Short (5.0 × 5.0 mm) Implant Placements and Restoration With Integrated Abutment Crowns

Yi, Young S. BA*; Emanuel, Kim M. RDH; Chuang, Sung-Kiang DMD, MD

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doi: 10.1097/ID.0b013e31820fb67e
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Abstract

Primitive dental implants date back to more than 2000 years ago. Over the past years, dental implant designs and implantation techniques have undergone significant improvements, resulting in current survival rates surpassing 95%.1–3

However, the field of dental implants still faces a critical limitation: individuals with decreased alveolar bone levels around a desired implantation site may be ineligible for dental implants. Although various measures have been formulated to overcome this obstacle, these alternative procedures often present with new sets of constraints. For instance, despite its proven efficacy, bone augmentation—the most frequent intervention used to increase the alveolar bone levels—is expensive and requires an extended idle period for healing because of its invasiveness.4

Another option available for individuals without adequate alveolar bone level is to use shorter implant lengths. Short implants have several advantages over implants of conventional length. These include decreased procedural invasiveness and subsequent shorter osseointegration and healing periods. Furthermore, shorter implant lengths can help dentists avoid maxillary sinus or inferior alveolar canal perforations.5

Because of new brands and designs of dental implants, the clinical efficacy of short implants has significantly improved over the years. Recent studies have shown the effectiveness of short implants to be comparable to that of conventional implant lengths.5–14 Furthermore, subsequent studies have elucidated ways to use short implants in non-edentulous patients, such as using short implants in orthodontic treatments in patients with low alveolar bone levels.15

Bicon LLC (Boston, MA) recently designed a 5.0-mm length implant. Notably, in contrast to other implant companies, Bicon defines implant length to be total length, including the implant shoulder. This difference in definition makes the 5.0-mm implant the shortest dental implant currently available. Before this development, Bicon consecutively introduced 8.0-, 5.7-, 6.0-, and 5.0- mm implants to the market. If proven comparable in their effectiveness and stability, the 5.0-mm short implant could signify yet another major shift in modern implant trends.

This article presents a case of a patient with four 5.0 × 5.0-mm and four 4.5 × 6.0-mm short implants.

Case Reports

A 56-year-old man presented with partial edentulism at the left mandibular second and first molars, left mandibular second premolar, right mandibular first and second premolars, and right mandibular first and second molars (#18, 19, 20, 28, 29, 30, and 31, respectively). Initial examinations and panoramic radiographs of these sites revealed a fracture in the left mandibular first premolar (#21) and extensive caries under the right mandibular bridge (Fig. 1). Further radiographs revealed furcation involvement and an abscess at #31.

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Fig. 1.:
Preoperative panoramic radiograph.

Short implants were selected for this case to easily avoid the inferior alveolar nerve and to prevent penetration of the submandibular fossa. Hence, the 5.0 × 5.0-mm and 4.5 × 6.0-mm short implants were placed as a treatment option. All areas of proposed implant placement were edentulous before the day of surgery, with the exception of #21, which was extracted on the day of implantation. Two tablets of 500 mg amoxicillin were administered preoperatively, and the patient's mouth was rinsed with 0.12% chlorhexidine gluconate (Peridex; Zila Pharmaceuticals, Scottsdale, AZ).

At the initial treatment visit, the patient was first given a combination of benzocaine topical anesthetic (Benzo-Jel; Henry Schein, Melville, NY), ½ carpules of 2% lidocaine, 1:100,000 epinephrine, and ¼ carpules of 3% mepivacaine. Throughout the procedures, ¼ carpules of 3% mepivacaine were given additionally.

After a crestal incision was made on the tissue of the implant sites, a 2.0-mm pilot drill was used to create the initial osteotomy at each location; the pilot drill rotated at 1100 rotations per minute and was used with external irrigation while preparing the initial site (Fig. 2). The implants were placed 1 to 2 mm below the crest of the alveolar bone to enhance favorable occlusal loading of the bone, although they could have been placed at the crest. A paralleling pin was then subsequently inserted into each osteotomy, which facilitated visualization of the proper trajectory of the osteotomies (Fig. 3). A series of reamers with increasing diameters, in 0.5-mm increments, were used to widen the diameter of the osteotomies. A slow-speed drill rotating at 50 rotations per minute was used without irrigation (as described in the Bicon Surgical Manual).16 Without irrigation, the clinician was able to harvest autogenous bone from the flutes of the reamers, which could be used for a graft, if necessary (Fig. 4). After the osteotomies were prepared with the last reamer, the osteotomy was curetted to remove any loose fragments of autogenous bone left behind by the reamers. The osteotomy was widened to 5.0 mm in diameter for the placement of the 5.0 × 5.0-mm implants and to 4.5 mm for the 4.5 × 6.0-mm implants.

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Fig. 2.:
Drilling pilot holes in right mandible.
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Fig. 3.:
Paralleling pins showing proper trajectory of osteotomies in right mandible.
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Fig. 4.:
Reamer flutes filled with autogenous bone fragments.

Bicon's 5.0 × 5.0-mm short implants were inserted into the osteotomy at the #18, 19, 30, and 31 sites. Similarly, Bicon's 4.5 × 6.0-mm short implants were inserted into the sites of #20, 21, 28, and 29. Titanium healing abutments were inserted into the implant wells to protect the implant wells during the integration period. After the insertion of the healing abutments, autogenous bone harvested during the preparation of the osteotomies was packed around and over the top of implants. Synthograft 0.5 grams (Beta-Tricalcium Phosphate), a synthetic bone grafting material (Bicon LLC) mixed only with the patient's blood was used for site #31. The surgical site was closed using chromic gut sutures. Although the 2-staged implants were scheduled to be uncovered in ∼3 months, the uncovering of the implants was delayed because of the patient's availability.

At 7-month postinsertion, radiographs revealed complete osseointegration of the 8 implants. After a crestal incision, mesiodistal and buccolingual forces were applied to the implants, which confirmed the stability of their integration. The healing abutments were removed from the implants, and titanium impression posts and plastic sleeves were inserted into implant wells. A full arch impression was then made, and Integrated Abutment Crowns (IACs; Bicon LLC) were fabricated by a laboratory technician, based on the impressions and study models. The implant wells were dried with cotton tip applicators. During the patient's third clinical visit, the 8 IAC's were evaluated for their appropriate implant, tissue, occlusal, and interproximal fit before the engagement of their locking taper connection by the patient's occlusal forces (Fig. 5). Articulating paper (Bausch Köln, Germany, 40 μ) was used to assess occlusal contacts, and the presence of interproximal contacts of the unsplinted IAC's was assessed with dental floss. Postoperative panoramic and periapical radiographs were taken (Figs. 6, 7).

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Fig. 5.:
Integrated Abutment Crowns (IACs) inserted in left mandible.
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Fig. 6.:
Postoperative panoramic radiograph.
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Fig. 7.:
Postoperative periapical radiographs of right and left mandible.

Conclusion

This case demonstrates the feasibility and efficacy of unsplinted 5.0 × 5.0-mm and 4.5 × 6.0-mm short implants. Long-term studies on these implants are unavailable because of their recent development; however, 1-year and 5-year survival and periimplant studies of short implants suggest their safety and efficacy.17,18 The 5.0 × 5.0-mm and the 4.5 × 6.0-mm implants not only exhibited osseointegration comparable to that of conventional length implants but also contributed to the patient's satisfaction with treatment time, aesthetics, and cost. Although further assessments with an expanded patient pool are essential, we remain optimistic about the clinical effectiveness of the 5.0-, 5.7-, and 6.0-mm short implants.

Disclosure

The authors claim to have no financial interest in any company or any of the products mentioned in this article.

Acknowledgments

The authors thank the clinicians of the Implant Dentistry Centre, Faulkner Hospital and Arborway, Boston, MA, for providing clinical photographs, radiographs, and their technical assistance.

References

1. Sullivan RM. Implant dentistry and the concept of osseointegration: A historical perspective. J Calif Dent Assoc. 2001;29:737–745.
2. Hita-Carrillo C, Hernandez-Aliaga M, Calvo-Guirado JL. Tooth-Implant connection: A bibliographic review. Med Oral Patol Oral Cir Bucal. 2010;15:e387–e394.
3. Sbordone L, Toti P, Menchini-Fabris G, et al. Implant success in sinus-lifted maxillae and native bone: A 3-year clinical and computerized tomographic follow-up. Int J Oral Maxillofac Implants. 2009;24:316–324.
4. Wallace SS, Froum SJ. Effect of maxillary sinus augmentation on the survival of endosseous dental implants. A systematic review. Ann Periodontol. 2003;8:328–343.
5. Arlin ML. Short dental implants as a treatment option: Results from an observational study in a single private practice. Int J Oral Maxillofac Implants. 2006;21:769–776.
6. Corrente G, Abundo R, des Ambrois AB, et al. Short porous implants in the posterior maxilla: A 3-year report of a prospective study. Int J Periodontics Restorative Dent. 2009;29:23–29.
7. Degidi M, Piattelli A, Iezzi G, et al. Immediately loaded short implants: Analysis of a case series of 133 implants. Quintessence Int. 2007;38:193–201.
8. Fugazzotto PA. Shorter implants in clinical practice: Rationale and treatment results. Int J Oral Maxillofac Implants. 2008;23:487–496.
9. Grant BT, Pancko FX, Kraut RA. Outcomes of placing short dental implants in the posterior mandible: A retrospective study of 124 cases. J Oral Maxillofac Surg. 2009;67:713–717.
10. Malo P, de Araujo Nobre M, Rangert B. Short implants placed one-stage in maxillae and mandibles: A retrospective clinical study with 1 to 9 years of follow-up. Clin Implant Dent Relat Res. 2007;9:15–21.
11. Renouard F, Nisand D. Short implants in the severely resorbed maxilla: A 2-year retrospective clinical study. Clin Implant Dent Relat Res. 2005;7 (suppl 1):S104–S110.
12. Stellingsma C, Meijer HJ, Raghoebar GM. Use of short endosseous implants and an overdenture in the extremely resorbed mandible: A five-year retrospective study. J Oral Maxillofac Surg. 2000;58:382–387; discussion 387–388.
13. Tawil G, Aboujaoude N, Younan R. Influence of prosthetic parameters on the survival and complication rates of short implants. Int J Oral Maxillofac Implants. 2006;21:275–282.
14. Tawil G, Younan R. Clinical evaluation of short, machined-surface implants followed for 12 to 92 months. Int J Oral Maxillofac Implants. 2003;18:894–901.
15. Bernhart T, Freudenthaler J, Dörtbudak O, et al. Short epithetic implants for orthodontic anchorage in the paramedian region of the palate. A clinical study. Clin Oral Implants Res. 2001;12:624–631.
16. Bicon Dental Implants. Surgical placement: Latch reamers. In: Bicon Surgical Manual. Boston, MA: Bicon Dental Implants; 2006:24.
17. Gentile MA, Chuang SK, Dodson TB. Survival estimates and risk factors for failure with 6 × 5.7-mm implants. Int J Oral Maxillofac Implants. 2005;20:930–937.
18. Venuleo C, Chuang SK, Weed M, et al. Long term bone level stability on short Implants: A radiographic follow-up study. J Maxillofac Oral Surg. 2008;7:340–345.

Abstract Translations

GERMAN / DEUTSCH

AUTOR(EN): Young S. Yi, BA, Kim M. Emanuel, RDH, Sung-Kiang Chuang, DMD, MD

Implantatsetzung unter Verwendung kurzer (5,0mm mal 5,0mm) Implantate und Wiederherstellung mit integrierten Ankerkronen

ZUSAMMENFASSUNG: Die durchschnittliche Länge der in der Zahnheilkunde verwendeten Implantate hat sich über die Jahre verringert. Der Grund für die kürzeren Zahnimplantate liegt in der Ausweitung der Patientengruppe, die dann von Zahnimplantaten, verringerter Prozessinvasivität und nachfolgenden kürzeren Zeiträumen für Knochengewebsintegration und Heilungsperioden profitieren kann. Nachdem die Stabilität und Effizienz kürzerer Implantate ein Gegenstand der Kritik waren, wurde die Forschung in Bezug auf kürzere Implantate fortgesetzt und hat zu zahlreichen klinischen Studien geführt, die eine vergleichbare klinische Effizienz bei kurzen wie bei langen Implantaten gezeigt haben. Die vorliegende Studie überprüft die klinische Eignung der kürzesten, verfügbaren Zahnimplantate. Dieser Artikel berichtet über den Erfolg der Anwendung von vier 5,0 × 5,0mm Implantaten bei einem 56 Jahre alten Patienten, der unter teilweiser Zahnlosigkeit litt. Die gesamte Behandlung umfasste 3 klinische Besuche und schloss mit Einsetzen einer Integrated Abutment Crown an jeder Implantierungsstelle ab. Der Erfolg dieser Fallstudie legt den Schluss nahe, dass es ein Potential für die Verringerung der Häufigkeit von Komplikationen, wie die einer Perforation des unteren alveolären Kanals, gibt und dass man damit in der Lage sein kann, den Menschen die Alternative einer Behandlung mit Zahnimplantaten zu bieten, deren alveolären Knochenhöhen nicht für konventionelle längere Implantate ausreichen.

SCHLÜSSELWÖRTER: Kurzes Implantat, Zahnheilkunde, Zahnlosigkeit, Komplikation

SPANISH / ESPAÑOL

AUTOR(ES): Young S. Yi, BA, Kim M. Emanuel, RDH, Sung-Kiang Chuang, DMD, MD

Colocación de implantes cortos (5,0 mm × 5,0 mm) y restauración con coronas linderas integradas

ABSTRACTO: La longitud promedio de los implantes dentales ha disminuido durante los años. La justificación de los implantes dentales más cortos incluye una expansión de la cantidad de pacientes que pueden beneficiarse de los implantes dentales, reducción en la invasividad del procedimiento y períodos posteriores más cortos de oseointegración y curación. Si bien se ha criticado la estabilidad y eficacia de implantes más cortos, la investigación sobre los implantes cortos continuó y llevó a numerosos estudios clínicos que han demostrado una eficacia clínica comparable entre los implantes cortos y largos. Este estudio confirma la viabilidad clínica de los implantes dentales más cortos. Este artículo explica el éxito en el uso de cuatro implantes de 5,0 mm × 5,0 mm en un paciente de 56 años parcialmente si dientes. Todo el tratamiento se logró en tres visitas clínicas, terminando con la colocación de una Integrated Abutment Crown en cada lugar del implante. El éxito de este caso sugiere la posibilidad de reducir la frecuencia de complicaciones, tales como la perforación del canal alveolar inferior y de poder ofrecer implantes dentales a individuos que tienen niveles inadecuados de hueso alveolar para recibir implantes convencionales más largos.

PALABRAS CLAVES: Implante corto, odontología, sin dientes, complicación

PORTUGUESE / PORTUGUÊS

AUTOR(ES): Young S. Yi, Bacharel em Letras, Kim M. Emanuel, Higienista Dentário Registrado, Sung-Kiang Chuang, Doutor em Medicina Dentária, Médico

Colocações Curtas (5,0mm por 5,0 mm) de Implante e Restauração Com Coroas de Suporte Integrado

RESUMO: A duração média dos implantes dentários diminuiu no decorrer dos anos. O fundamento por trás de implantes dentários mais curtos inclui uma expansão do grupo de pacientes que podem se beneficiar de implantes dentários, invasão de procedimento diminuída e subsequentes osseointegração e períodos de cura mais curtos. Enquanto a estabilidade e eficácia de implantes mais curtos têm sido criticadas, a pesquisa sobre implantes curtos continuou e levou a inúmeros estudos clínicos que demonstraram uma eficácia clínica comparável entre implantes curtos e longos. Este estudo valida a viabilidade clínica do implante dentário mais curto disponível. Este artigo relata sobre o sucesso de usar quatro implantes de 5,0 × 5,0 mm em um paciente com 56 anos de idade com desdentamento parcial. Todo o tratamento foi realizado em 3 visitas clínicas, concluindo com a inserção de uma Coroa de Suporte Integrado em cada local de implante. O sucesso deste estudo de caso sugere um potencial para diminuir a frequência de complicações, tais como perfuração do canal alveolar inferior e de ser capaz de fornecer implantes dentários a indivíduos que têm níveis de osso alveolar inadequado para implantes convencionalmente mais longos.

PALAVRAS-CHAVE: implante curto, odontologia, desdentamento, complicação

RUSSIAN /SYMBOL

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АВТОРЫ: Young S. Yi, бакалавр гуманитарныЏequals; наук, Kim M. Emanuel, аттeстованный стоматолог-гигиeнист, Sung-Kiang Chuang, доктор стоматологии, доктор мeдицины

Установка короткиЏequals; имплантатов (5,00 мм на 5,00 мм) и восстановлeниe с помощЏapos;ю совмeщeнныЏequals; коронок-абатмeнтов

РEЗЮМE. За послeдниe годы срeдняя длина имплантатов умeнЏapos;шиласЏapos;. Логичeскоe обоснованиe исполЏapos;зования болee короткиЏequals; имплантатов включаeт увeличeниe числа пациeнтов, способныЏequals; получитЏapos; полЏapos;зу от зубныЏequals; имплантатов, снижeниe инвазивности процeдуры и, как рeзулЏapos;тат, болee короткий пeриод остeоинтeграции и заживлeния. В то врeмя как стабилЏapos;ностЏapos; и эффeктивностЏapos; болee короткиЏequals; имплантатов подвeргаeтся критикe, иЏequals; исслeдованиe продолжаeтся, в рeзулЏapos;татe чeго были провeдeны многочислeнныe клиничeскиe исслeдования, показавшиe сравнитeлЏapos;ную клиничeскую эффeктивностЏapos; короткиЏequals; и длинныЏequals; имплантатов. В данном исслeдовании проводится оцeнка клиничeской пригодности самыЏequals; короткиЏequals; имплантатов из имeющиЏequals;ся в наличии. В данной статЏapos;e сообщаeтся об успeшном исполЏapos;зовании чeтырeЏequals; имплантатов размeром 5,0 × 5,0 мм при лeчeнии 56-лeтнeго пациeнта с частичной адeнтиeй. Полноe лeчeниe было провeдeно за 3 клиничeскиЏequals; посeщeния, в завeршeнии чeго в области каждого имплантата была провeдeна установка коронки-абатмeнта Integrated Abutment Crown™. УспeЏequals; этого конкрeтного случая прeдполагаeт потeнциалЏapos;ноe снижeниe частоты такиЏequals; осложнeний, как пeрфорация нижнeго алЏapos;вeолярного канала, а такжe потeнциалЏapos;ную возможностЏapos; установки зубныЏequals; имплантатов пациeнтам с уровнeм алЏapos;вeолярного грeбня, нe подЏequals;одящим для установки болee длинныЏequals; имплантатов.

КЛЮХEВЫE СЛОВА: короткий имплантат, стоматология, адeнтия, осложнeниe

TURKISH / TÜRKÇE

YAZARLAR: Young S. Yi, BA, Kim M. Emanuel, RDH, Sung-Kiang Chuang, DMD, MD

Kisa (5.0 mm ile 5.0 mm) İmplant Yerleştirme ve Entegre Abutman Kronlari ile Restorasyon

ÖZET: Geçtiğimiz yillarda dental implantlarin ortalama uzunluğu giderek azalmiştir. Daha kisa dental implant kullanmanin gerekçeleri arasinda implantlardan yararlanabilecek hasta sayisinin daha fazla olmasi, girişimin invazivliğinin azalmasi ve daha kisa osseoentegrasyon ve iyileşme dönemleri sayilabilir. Kisa implantlarin stabilitesi ve etkinliği eleştirilmiş olmakla beraber, kisa implantlara ilişkin araştirmalar devam etmiş ve bunlar kisa ile uzun implantlar arasindaki klinik etkinliğin benzer olduğunu kanitlayan sayisiz klinik çalişmaya neden olmuştur. Bu çalişma, mevcut en kisa dental implantin klinik fizibilitesini teyit etmektedir. Bu rapor, kismen dişsiz 56 yaşindaki bir hastada kullanilan 5.0 × 5.00 mm boyutundaki dört implantin başarisini anlatmaktadir. Tedavinin tümü 3 klinik ziyarette gerçekleştirilmiş ve her bir implant yerine bir Integrated Abutment Crown yerleştirilerek sonuçlanmiştir. Bu olgudan elde edilen başari, inferior alveoler kanal delinmesi gibi komplikasyonlarin sikliğini azaltabilme potansiyelini düşündürdüğü gibi, ayrica konvansiyonel uzun implantlar için yeterli alveoler kemik düzeyi mevcut olmayan hastalarda dental implant yerleştirebilme olanağina da işaret etmektedir.

ANAHTAR KELİMELER: kisa implant, dişçilik, dişsizlik, komplikasyon

JAPANESE /SYMBOL

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CHINESE /SYMBOL

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KOREAN /SYMBOL

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Keywords:

short implant; dentistry; edentulism; complication

© 2011 Lippincott Williams & Wilkins, Inc.