Short implants as an alternative to reconstructive surgeries: biomechanical implications and clinical outcomes

Implantes curtos como alternativa às cirurgias reconstrutivas: implicações biomecânicas e desfechos clínicos

ABSTRACT

Short implants represent a viable approach for the rehabilitation of areas with severe bone resorption, particularly in the posterior regions of the mandible and maxilla, as a minimally invasive alternative. The objective of this review was to analyze the available evidence on the use of short implants compared to long implants placed after bone reconstruction procedures, discussing their indications, advantages, and limitations. Searches were conducted in the PubMed, SciELO, and Lilacs databases using descriptors related to short implants and atrophic ridges, resulting in the selection of 55 articles. Evidence indicates that short implants exhibit survival rates comparable to conventional implants, with a lower incidence of surgical complications, reduced marginal bone loss, decreased postoperative morbidity, shorter surgical time, and lower costs. Despite potential biomechanical limitations associated with the reduced bone-implant contact area and increased crown-to-implant ratio, advances in implant design, microtopography, and surgical protocols have promoted osseointegration and improved load distribution, ensuring predictable clinical outcomes. Thus, short implants are established as a safe and effective strategy for the rehabilitation of atrophic ridges, provided they are applied following individualized planning that considers the patient’s anatomical, prosthetic, and systemic factors.

Indexing terms
Bone transplantation; Dental Implants; Oral surgical procedures

RESUMO

Os implantes curtos representam uma proposta para a reabilitação de áreas com reabsorção óssea acentuada, especialmente em regiões posteriores de mandíbula e maxila, como uma alternativa minimamente invasiva. O objetivo desta revisão foi analisar as evidências disponíveis sobre o uso de implantes curtos em comparação a implantes longos instalados após procedimentos de reconstrução óssea, discutindo suas indicações, vantagens e limitações. As buscas foram realizadas nas bases PubMed, SciELO e Lilacs, utilizando descritores relacionados a implantes curtos e cristas atróficas, o que resultou na seleção de 55 artigos. As evidências indicam que os implantes curtos apresentam taxas de sobrevivência comparáveis às de implantes convencionais, com menor incidência de complicações cirúrgicas, menor perda óssea marginal, redução da morbidade pós-operatória, diminuição do tempo cirúrgico e custos. Apesar de limitações biomecânicas potenciais associadas à menor superfície de contato osso-implante e à maior relação coroa/implante, avanços no design, microtopografia e protocolos cirúrgicos têm favorecido a osseointegração e a distribuição de cargas, garantindo resultados clínicos previsíveis. Assim, os implantes curtos se consolidam como uma estratégia segura e eficiente para a reabilitação de cristas atróficas, desde que aplicados após planejamento individualizado que considere fatores anatômicos, protéticos e sistêmicos do paciente.

Termos de indexação
Transplante ósseo; Implantes dentários; Procedimentos cirúrgicos bucais

INTRODUCTION

Dental implants not only provide prosthetic rehabilitation of edentulous areas but also preserve bone structure, maintain masticatory function, and restore oral esthetics [¹]. However, after tooth loss, progressive bone resorption occurs, gradually reducing the height and thickness of the available alveolar ridge [²]. This reduction limits the distance between the implant bed and critical anatomical structures, such as the inferior alveolar nerve and the maxillary sinus, restricting the placement of longer implants and necessitating specific clinical strategies for rehabilitation [³-⁵].

To promote bone gain in atrophic alveolar ridges, various surgical techniques have been developed, including guided bone regeneration [⁶], sinus floor elevation [⁷], block bone grafts [⁸], and distraction osteogenesis [⁹]. These procedures can be performed prior to or simultaneously with implant placement [¹⁰,¹¹]. Currently, one of the most commonly used strategies consists of placing conventional endosseous implants (8-13 mm) in areas previously subjected to bone reconstruction procedures, aiming to increase the three-dimensional volume available [¹]. However, these approaches are associated with significant complication rates, ranging from 6.8% to 57.1% for distraction osteogenesis, 2.5% to 100% for block bone grafts, and 5.8% to 27.3% for guided bone regeneration [¹²-¹³]. Moreover, many patients are reluctant to undergo these procedures due to donor site morbidity, high cost, pain, and prolonged treatment time [¹⁴,¹⁵].

In this context, the placement of short implants in atrophic alveolar ridges, without the need for prior reconstructive surgeries, has emerged as a predictable and less invasive alternative, with reduced morbidity and shorter recovery time compared to reconstructive techniques [¹, ¹⁶-²⁰]. Initially defined as implants with an intraosseous portion of up to 8 mm, short implants are indicated in regions with limited bone height [²¹,²²], where the conventional alternative would involve bone reconstruction procedures prior to implant placement [¹].

From a biomechanical perspective, shorter implants could theoretically present a reduced bone–implant contact area, potentially compromising the dissipation and distribution of occlusal loads [²³]. However, advances in surface treatments and implant microtopography, combined with minimally invasive surgical protocols, have enhanced osseointegration and the clinical performance of these implants [²³-²⁵]. As a result, survival rates of short implants have significantly increased [²⁴,²⁵], allowing for their predictable and safe use, with additional benefits such as reduced morbidity and shorter healing time [¹⁶].

Despite these advantages, managing atrophic ridges with short implants requires individualized planning, knowledge of biomechanical and anatomical considerations, and incorporation of the latest scientific evidence and technological resources, ensuring safe and effective solutions tailored to each patient’s needs [²⁶]. Clinically and from the patient’s perspective, the possibility of rehabilitating atrophic maxillae and mandibles using short implants, instead of undergoing bone augmentation followed by delayed implant placement, represents a significant therapeutic and clinical advantage [²⁰].

Therefore, the aim of this critical review is to analyze the available evidence regarding the use of short implants compared to long implants placed after bone reconstruction procedures, discussing their indications, advantages, and limitations, in order to guide evidence-based clinical practice.

METHODS

Searches were conducted in the PubMed, Scientific Electronic Library Online (SciELO), and Literature in Health Sciences in Latin America and the Caribbean (Lilacs) databases using the descriptors: (“Short implants” AND (“atrophic bone ridges” OR “atrophic maxilla” OR “atrophic mandible”) in July 2025. Studies published in English in peer-reviewed journals, directly addressing the topic, were included without any date restrictions. Excluded were non-indexed articles, unpublished manuscripts, books, dissertations, theses, and publications without a scientific protocol, such as opinion articles, correspondence, editorials, and letters to the editor.

A total of 335 articles were identified in the databases. The search results were initially reviewed by two independent reviewers, who evaluated titles and abstracts to select studies potentially relevant for this review. Full texts of these studies were then obtained and analyzed in detail to confirm eligibility according to the pre-established criteria. After this screening process, 55 studies were included in the final analysis, representing the most consistent evidence regarding the use of short implants in atrophic alveolar ridges.

RESULTS

Influence of Implant Length on the Biomechanics of Dental Implants

The biomechanical interaction between the dental implant and the surrounding bone is considered one of the most critical factors for treatment success [²⁷]. Several design parameters, including implant geometry, length, diameter, thread configuration, and surface roughness, directly influence the magnitude and distribution of stresses transmitted to the bone [²⁷].

Although it is assumed that longer implants provide better stress distribution, experimental and computational evidence indicates that this relationship is neither linear nor absolute [²⁸]. Studies have shown that reducing implant length tends to increase stress in the cortical region [²⁷,²⁹], but that the implant body itself has a more relevant influence on load dissipation [²⁹]. In this sense, the study by Capatti et al. [³⁰] observed that extra-short implants, only 4 mm in length, can be a viable alternative for single-unit crowns under favorable biomechanical conditions. Similarly, the study by Lee et al. [³¹] reported that short implants exhibit deformations compatible with physiological limits for bone remodeling.

The literature shows that increasing the diameter is more effective in reducing bone stress than merely increasing length [³²]. Thus, short implants with larger diameters represent a biomechanically favorable alternative in cases of insufficient bone height [³²]. Furthermore, primary stability, which is fundamental for successful osseointegration, is influenced by bone quality, implant design, and the ratio between implant diameter and the recipient site [³³,³⁴].

Biomechanically, an increased crown-to-implant ratio may act as a vertical lever effect, favoring crestal bone loss and increasing the risk of implant failure. However, advances in implant systems, surface treatment modifications, and correct load distribution obtained through occlusal adjustment have enabled the successful use of elevated crown-to-implant ratios [³⁵]. The study by Meijer et al. [³⁶] demonstrated that a ratio ranging from 0.9 to 2.2 was not associated with a higher incidence of biological or technical complications. In addition, the study by Blanes et al. reported that the crown-to-implant ratio does not significantly influence marginal bone loss and is considered safe even at ratios up to 3:1 [³⁷].

Conventional and Short Implants

From a clinical and patient perspective, short dental implants present several advantages, including reduced surgical complexity, lower morbidity by avoiding extensive bone augmentation procedures, easier removal in case of failure, and increased number of sites available for rehabilitation with implants [³⁸]. Conversely, clinicians may be concerned about potential disadvantages, such as a higher crown-to-implant ratio and the relative risk of biological and technical complications associated with occlusal overload [³⁸]. However, systematic reviews indicate that marginal bone loss tends to be greater in conventional implants, possibly due to bone augmentation procedures and variable loading protocols [³⁸-⁴¹].

Additional evidence reinforces the clinical predictability of short implants. The study by Nisand et al. [⁴²] reported survival rates of 96.24% for short implants and 95.09% for implants in vertically augmented sites over follow-ups of 1 to 5 years, without significant differences in prosthetic survival rates. However, surgical complications occurred more frequently in vertical augmentation procedures, affecting 56 patients compared to 18 cases involving short implants [⁴²]. Similarly, a systematic review involving eight randomized clinical trials in the posterior maxilla, with follow-ups of up to 18 months, demonstrated average survival rates of 99.0% for short implants and 99.5% for long implants in augmented sinuses, with restorative survival ranging from 97% to 100% for both groups [⁴³]. Surgical complications, such as membrane perforation, occurred predominantly in sinus lift procedures, with short implants involved in only 33% of the complications, while sinus augmentation presented up to three times higher risk of intraoperative complications [⁴³].

In this regard, the study by Pieri et al. [⁴⁴] compared short implants with conventional implants placed in areas subjected to vertical augmentation with autogenous bone block grafts, both supporting fixed partial prostheses in the posterior mandible. Although both approaches achieved long-term clinical success, the short implant group presented a lower incidence of surgical complications and reduced marginal bone loss, with no relevant differences in survival rates or biological and prosthetic complications [⁴⁴]

These findings were reinforced by the study by Toledano et al. [⁴⁵], which observed equivalent survival rates between short implants and standard-length implants associated with maxillary sinus elevation. However, marginal bone loss was significantly higher in conventional implants. The authors also highlighted additional benefits of short implants, such as lower postoperative morbidity, less invasive approach, reduced treatment time, and lower costs, making them a viable alternative for the rehabilitation of the atrophic posterior maxilla [⁴⁵].

Overall, the literature supports that, at least in the short- and medium-term, short implants offer clinical results comparable to long implants, with additional advantages related to reduced morbidity, lower costs, and shorter treatment time [⁴⁰].

Prosthetic Considerations

Regarding prosthetic complications, the studies reported abutment fracture and loosening, metal framework fracture, decementation, chipping or ceramic fracture, screw loosening, and prosthesis loss due to implant failure, without evidence of predilection for short or long implants [³⁹,⁴³]. However, due to higher stress concentration, short implants present an increased risk of fractures of prosthetic components, such as abutments and screws [³⁹].

The use of splinted crowns on adjacent implants is another relevant factor for the long-term success of short implants, since non-splinted single crowns are associated with a higher occurrence of technical complications [⁴⁶]. Finite element analysis studies conducted by Toniollo et al. [⁴⁷] and Lemos et al. [⁴⁸] demonstrated that splinting crowns promotes a more uniform distribution of occlusal loads among implants, reducing stress concentration at the implant-abutment interface, the implant neck, and the surrounding bone.

Regarding prosthetic components, short implants present more limited options. This is mainly due to reduced height and connection surface, which restrict the types of abutments and prostheses that can be used [⁴⁹]. Therefore, prosthetic selection must be carefully planned, considering available space, load distribution, and the limitations of the short implant itself. Finally, in short implants, the internal connection seems more favorable, as the external connection is associated with greater marginal bone loss [⁵⁰].

Indications and Limitations

Short implants can be used in different types of rehabilitation, both fixed and removable, including single and multiple-unit prostheses in the posterior maxilla and mandible [³⁵]. In severely resorbed mandibles, four to six short implants can support overdentures, while in the edentulous maxilla, combinations of short and long implants can support overdentures or fixed prostheses [³⁵].

Bone quality is a determining factor for the success of short implants [⁵¹]. Areas with type III or IV bone present a higher risk of failure, regardless of the implant surface treatment [³⁵]. The combination of short implants with low bone density compromises primary stability during placement and may affect the healing period [⁴⁶]. In the posterior maxilla, short implants are particularly subject to reduced primary stability and delayed osseointegration, especially under unfavorable biomechanical conditions at the bone-implant interface [⁵²].

DISCUSSION

The placement of standard-length dental implants in an axial position may be limited by the reduced remaining bone availability or by the proximity of critical anatomical structures, such as the inferior alveolar nerve, the mental nerve, and the maxillary sinus [⁵³,⁵⁴]. Alveolar bone resorption, which begins shortly after tooth loss, is a continuous and progressive process, as this tissue depends on the presence of the tooth to maintain its structural function [⁵⁵]. This phenomenon exacerbates the limitation of bone volume and may compromise the placement of conventional implants.

Under these circumstances, bone augmentation procedures have been employed to enable the placement of standard-length implants [⁵⁶,⁵⁷]. Although clinically effective, these techniques present important disadvantages, including high morbidity, longer treatment time, and additional costs [⁵⁸]. Furthermore, their execution requires greater technical complexity, which may limit their applicability. Thus, even though bone augmentation procedures may achieve satisfactory results, their negative impact on the patient experience and treatment predictability justifies the search for less invasive surgical alternatives [¹].

In this context, short implants have become a predictable and less invasive strategy, reducing the need for augmentation procedures and decreasing postoperative morbidity [¹,¹⁶-²⁰,⁵⁶]. For a long time, however, comparisons between short and standard-length implants were predominantly conducted in non-grafted areas, which generated bias in result interpretation and contributed to hesitation in indicating short implants. More recent studies, however, have directly compared short implants with conventional implants in augmented areas, revealing important differences in clinical outcomes [¹⁷,¹⁸,²⁰].

In this regard, the study by Sahrmann et al. [⁵⁹] observed a higher degree of bone mineralization around short implants, suggesting that, in addition to the already consolidated clinical predictability, these devices may promote a more stable peri-implant environment. Furthermore, other studies indicate that short implants may represent a superior alternative to reconstructive techniques in situations of advanced resorption, showing clinical outcomes similar to conventional implants, but with lower morbidity and reduced costs [⁵⁸,⁶⁰,⁶¹].

In addition to simplifying the surgical procedure, the use of short implants reduces operative time and the risk of postoperative complications, providing a safer and less traumatic experience for the patient [¹⁶]. This approach favors predictable healing and decreases the occurrence of failures associated with complex reconstructive interventions, such as infections or bone resorption [⁶²]. From an economic perspective, eliminating the need for bone grafts or regenerative membranes significantly reduces treatment costs, making this modality more accessible and expanding therapeutic possibilities [⁴⁵].

Despite favorable evidence, short implants present limitations related to reduced bone-implant contact surface, which increases biomechanical demands, especially in posterior regions and in patients with high occlusal forces [²⁷,²⁹]. Although they present survival rates similar to long implants in the short and medium term, some studies report a slight reduction in success over long-term follow-ups [⁶³, ⁶⁴], which reinforces the need for careful planning that considers bone quality, load distribution, and prosthetic design [⁶⁵,⁶⁶].

Therefore, the indication for short implants should be individualized, integrating local and systemic conditions with the biomechanical principles of rehabilitation, since implant length is not the only determinant factor for clinical success [⁴⁶].

CONCLUSION

Short implants constitute a predictable and minimally invasive clinical alternative for the rehabilitation of areas with significant bone resorption. This approach reduces surgical complexity, operative time, and the incidence of postoperative complications, in addition to lowering treatment costs and expanding therapeutic access. However, implant selection should consider not only its length but also surgical, prosthetic, anatomical, and systemic patient factors to ensure clinical predictability and long-term rehabilitation success.

• How to cite this article
  Rangel BT, Ramos MAR, Neppelenbroek KH, Tinoco EJF, Sugio CYC. Short implants as an alternative to reconstructive surgeries: biomechanical implications and clinical outcomes. RGO, Rev Gaúch Odontol. 2026;74:e20260018. Doi: http://dx.doi.org/10.1590/1981-86372026001820250092

Data Availability

The research data are available from the corresponding author upon reasonable request.

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Edited by

• Assistant editor
  Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  27 July 2026
• Date of issue
  2026

History

• Received
  30 Sept 2025
• Accepted
  23 Dec 2025