Comparative Evaluation of the Clinical Efficacy of Short Implants With Standard-Length Implants - a Randomised Controlled Trial

Periodontal disease , especially in its advanced stages , is one of the main cause for tooth loss .Tooth replacement options include dental implants , fixed partial denture , removable partial denture and complete dentures . Dental implants have become more common treatment for replacing missing teeth and aim to improve chewing efficiency, physical health and esthetic. Although conventional implants cannot be placed in every site due to resorption of the alveolar socket after extraction. Thus short implants can be used as an alternative . Hence, this study aims at comparing the clinical efficacy of short implants with standard length implants placed in native or augmented bone in patients with a history of periodontitis.

Implant supported prosthesis have proven as an esthetic , functional restoration with long term predictability by re-establishing appearance , comfort and mastication .

Following extraction , the bony socket undergoes significant horizontal and vertical reduction . This 3D resorption of alveolar sockets after extraction often lead to limitations for implant placement . Severe ridge atrophy complicates rehabilitation of posterior edentulous regions . This lack of adequate bone necessitates additional reconstructive surgeries such as guided bone regeneration, vertical ridge augmentation , sinus floor elevation , block grafts , distraction osteogenesis and transposition procedures of the inferior alveolar nerve to allow anatomically sound placement of dental implants . These complex surgical procedures can result in intra-operative complications like infections of graft/membranes and it's exposure and post-operative complications such as swelling , pain , nerve disturbances with an associated increased reluctance of the patient to undergo them . Also these procedures, has significantly increased treatment duration, morbidity, risk of complications and costs.

Currently , alternative procedures to avoid these additional surgeries and the associated complications encourages the use of less invasive procedures such as short implants. Short implant placements can reduce morbidity and recovery time associated with bone augmentation procedures. Thus use of shorter dental implant has shown to be a plausible solution in cases of confined space , as well as those associated with unavoidable anatomical structures , such as lingual concavities or the maxillary sinus proximation which can be prone to surgical difficulties. Short implants offer a minimally invasive approach with ease of handling , reduced surgical invasiveness and low risk of trauma to vital structures . Evidence suggests that short implants could decrease implant failure , marginal bone loss , biological complications and improve patient satisfaction. The evidence from the literature must be interpreted with caution due to the variable protocols. Clinicians require a thorough comprehension of implant dentistry to achieve predictability.Thus there is a need for well designed RCT's analysing and comparing the clinical outcomes of short implants placed in native bone with long implants placed in native or augmented bone .

Thus, the aim of the current randomised controlled clinical trial (RCT) study will be to analyse the clinical efficacy of short implants (≤6 mm) and compare it with standard length implants (≥10mm) placed in native / augmented bone in patients with history of periodontitis.

Eligibility Criteria:
Inclusion Criteria:

1. Age group - 18 years and above
2. Presence of \>2 mm keratinised tissue to allow flap management.
3. Systemically healthy patients
4. The residual vertical bone height at the implant sites ranging from 6 to 9 mm for short implant placement ; \> 9 mm for standard implant placement.
5. History of periodontitis

Exclusion Criteria:

1. Medical conditions contraindicating surgical interventions

   1. Uncontrolled diabetes
   2. Hemorrhagic disorders
2. Intravenous and oral bisphosphonate therapy.
3. Irradiation in head and neck
4. Pregnant and lactating women
5. Subjects with known bone metabolic disorders (paget's disease , fibrous dysplasia etc.)
6. Known smokers and alcoholics