Situation
A patient presented a conventional 11 mm long implant positioned to restore the first right mandibular molar was referred to me. This implant was loosing bone due to perimplantitis.
Pre-operative Radiograph
Some weeks later she returned to my office with the implant lost.
It is possible to notice on the radiography the conical bone loss shape and the apical proximity with the inferior alveolar nerve. I decided to let the wound heal and then to insert another implant.
The colleague placed a removable partial prosthesis and I decided to let the bone heal for 3 month.
After that period a radiography was taken: it is possible to see the correct bone healing as well as the crestal high reduction, leaving a residual bone high over the inferior alveolar nerve and the mandibular lingual undercut extremely reduced.
White line connected pre and post periimplant bone crest.
Yellow line shown pre and post available bone height.
Using the provisional removable prostheses as surgical guide, an IS II Active 4.5 mm x 7.3 mm long implant was placed with I stage approach. The smooth collar was supra-crestal.
2 years control radiograph: the implant has been loaded with a PFM cemented crown with molar shape. No bone loss occurred around the implant, considering the reduced residual bone height and width and the occlusal stresses.
Short implants represent a viable and predictable option in replacing longer lost implants, with less bone needed, more secure surgery and less complication.
Considering the crystal bone loss due to the implant loss, the distance of the implant apex to the nerve is still comfortable using short implants (red line).