The Implant Book was Wrong, Longer is Not Better

Hi, I am Rainier Urdaneta, a prosthodontist at the Implant Dentistry Center in Boston, Massachusetts. While I was doing my residency in prosthodontics, I was trained to use the longest implant that the bone permitted. It made sense to me then that a fifteen millimeter long implant would outlast a six millimeter long implant. After all, isn’t a longer screw better at holding a picture on a wall than a shorter screw? So I subscribed to that theory for so many years. My patients, however, have taught me a completely different lesson. A lot of them came to me with very little bone, especially in posterior maxilla and or not enough money to do grafting procedures. So that forced me to look into different treatment alternatives. And that is how I started using Bicon dental implants, Bicon short implants. I remember the first time I restored a maxillary molar with a five millimeter long implant. I felt I was breaking every rule in the implant book. After more than ten years of working with Bicon short implants, I am glad to say that my patients were right and the implant book was not. In implant dentistry, we have been so concerned with overloading bone that we have forgotten that loads are necessary for bone maintenance. We have forgotten that when it comes to bone, the more loads, the better. What I learned from my patients over the years was not only that a short implant is capable of supporting a maxillary molar, but also the bone around a short implant is better than the bone that I used to see surrounding the longer implants I was placing. It seems that shorter implants distribute more loads to bone and then the bone responds positively to these extra loads. I believe pictures speak louder than words, so let’s look at a case. In two thousand and six, a surgeon at the implant dentistry center where I work placed a six millimeter long implant in an area where there were five millimeters of bone available. I had to uncover the implant and I had to restore the implant with a porcelain-fused-to-metal crown. I remember I uncovered the case and I placed a non shouldered abutment and following the recommended technique, I prepared the crest of the bone to match the size and the shape of the base of the abutment, which was polished titanium. I inserted the abutment and then I restored the case with a metal ceramic crown. I was taught that bone is not supposed to stay when it is in intimate contact with polished titanium, so what’s going to happen here over the years? I also remember thinking, in this six millimeter long implant, which has seven threads, right, only three of the threads in the mesial area were actually in contact with bone. So I remember thinking, are three threads enough to support the molar? I have, over the years, obviously underestimated bone. When the patient came back for the checkups in the year twenty eleven and twenty fifteen, after five and eight years respectively of functioning in the mouth and I realized that not only did we not lose bone, the bone had more density, the bone was better quality after five and eight years of loads than before loading. The other thing that caught my attention was that the bone remained in intimate, you know, proximity with the base of the abutment, which was polished titanium. I remember feeling when I look at the x-ray back then, I remember saying, wow, this amazing that, you know, that’s another rule from the implant book that goes off the window. I’ve learned from my patients over the years that the most conservative treatment is always the best one. And I think that’s what happens with short implants. And now I use them all the time instead of using grafting and longer implants.