Effectiveness of Extra-Short (< 6 mm) Implants Compared to Standard-Length Implants Associated with Bone Graft: Systematic Review

Purpose: To evaluate the effectiveness of extra-short implants compared to standard-length implants in graft regions at different longitudinal follow-up times. Materials and Methods: A systematic review was performed, following PRISMA criteria. LILACS, MEDLINE/PubMed, Cochrane Library, and Embase databases, including gray literature and manual searches, were conducted without language or date restrictions. Study selection, risk of bias (Rob 2.0), quality of evidence (GRADE), and data collection were performed by two independent reviewers. Disagreements were resolved by a third reviewer. Data were combined using the random-effects model. Results: A total of 1,383 publications were identified, including 11 publications from 4 randomized clinical trials that evaluated 567 implants (276 extra-short and 291 regular implants with graft) in 186 patients. The meta-analysis showed that losses (risk ratio [RR]: 1.24; 95% CI: 0.53 to 2.89; P =.62; I2: 0%) and prosthetic complications (RR: 0.89; 95% CI: 0.31 to 2.59; P =.83; I2: 0%) were similar in both groups. Biologic complications were significantly higher in regular implants with graft (RR: 0.48; CI: 0.29 to 0.77; P =.003; I2: 18%), which also had lower peri-implant bone stability in the mandible at the 12-month follow-up (mean deviation [MD]: –0.25; CI: –0.36 to 0.15; P <.00001; I2 = 0%). Conclusion: Extra-short implants showed similar effictiveness compared to standard-length implants placed in grafted regions at different longitudinal follow-up times and present reduced biologic complications, shorter treatment times, and greater peri-implant bone crest stability.