Take a look at the panoramic radiograph of the patient in figure 1. This lady was treated over 10 years ago for a failing upper dentition. The treatment involved strategic extraction, provisional bridgework on the remaining teeth and serially placed implants coupled with bilateral sinus grafts before eventually making the final bridgework. Is this a typical dental implant patient?
Well the answer is of course not. For the vast majority of patients dental implants are used to restore one or two missing teeth, often purely for functional purposes.
In fact replacing missing posterior teeth is becoming more and more the most frequent use of the dental implant. This is because people are living longer and posterior teeth, often treated initially for caries at a young age, go beyond their repairable limits, whilst replacing posterior teeth is becoming simpler. Gone are the days where every case with limited available bone needed some sort of bone graft in order to place a long dental implant. This is not to say that all implants can be placed with ease but more that, with the advent of predictable short implants, replacing posterior teeth is not so limited by anatomy.
For instance, in the case illustrated in figure 2 the anterior implant is already short at 8mm but the posterior implant is 6mm in height. This 6mm is short enough to allow placement without encroaching on the maxillary sinus.
This is fairly typical of what happens after the failure of teeth in the upper posterior, the teeth fail and the residual bone is limited. Until recently such a case would require sinus grafting and that may either put the patient off because of the extra surgery or for reasons of finance. However, since the advent of well-designed short implants a case like this can be treated predictably with fewer stages.
Conversely, in the lower jaw, in most cases, the inferior alveolar canal and contents can be avoided with short implants. With limited bone, this area is extremely difficult to treat with longer implants because bone grafting is very difficult and unpredictable. The use of short implants for this kind of scenario is well illustrated in figure 3. These implants are 6mm long. They do not put the inferior dental nerve at risk and they are perfectly able to support these single unsplinted crowns due to the design of the implant (Bicon Dental).
Compare the radiographs in figures 4 and 5. The longer implant, placed 13 years ago is almost twice as long as the more recent short implant. Both work just as well but the longer one is more difficult to place and requires almost twice as much bone. Often that is not possible.
In these two cases the outcomes have been the same. The patients have a fully functioning artificial tooth that looks, behaves and feels like their own. The patient and dentist often have to be reminded of that fact. Figures 6 and 7 are the clinical pictures of these two cases. One has now been functioning for 13 years, the other for two.