Abstract
Abstract:
 Purpose: This study was accomplished to evaluate the bone height changes radiographically and the reliability of use either two posterior short or inclined implants with two conventional anterior implants retaining mandibular overdenture.
 
 Materials and methods: Ten male mandibular completely edentulous patients were divided in two equal groups after delivered complete dentures. For the first group (short implant design- group A) two vertical implants were inserted in the canine areas and two short vertical implants were inserted in the 1st molar area. For the second group (inclined implant design- group B) two vertical implants were inserted in the canine areas and two 30o distally inclined implants were inserted in the second premolar area. Digital standardized periapical radiographic assessment for horizontal and vertical alveolar bone height changes was carried out at T0 (immediately), T6 (6 months), T12 (12 months) and after mandibular complete overdenture insertion.
 Result: 1. VBL decrease significantly with advance of time in both groups during the time intervals. The highest VBL around the implants was noted in the 1st six months followed by the 2nd six months, the highest amount of total VBL observed with the interval T0-T12, followed by the interval (T0-T6) and the inclined implant group showed significant higher total VBL than short implant group at the intervals T0-T6 and T0-12.
 2- HBL decreased significantly with advance of time in both groups. For short and inclined implant group, the highest amount of total HBL observed with the interval T0-T12, followed by the interval (T0-T6). Short implant group showed significant higher total HBL than inclined group at the interval T0-T6 and T0-T12.
 
 Conclusion: Within the limitations of this clinical radiographic study it can be concluded that (1) The 30o distally inclined implants inserted in the posterior areas for assisting mandibular complete overdenture induce vertical bone loss more than the axially inserted implants (short or conventional implants). (2) The short implants inserted in the posterior areas for assisting mandibular complete overdenture induce horizontal bone loss more than the axially inserted implants.
 Keywords: Short implants, O-ring ball attachment, VBL, HBL.
Highlights
In mandibular alveolar ridge, placement of conventional long implants is hindered by severely resorbed alveolar ridges due to anatomical vital structures limitations such as the mental foramen, inferior alveolar nerve, mandibular canal and shape of the ridge. (1) An extensive surgical bone augmentation procedure is often necessary to achieve sufficient bone support to place standard implants in the posterior mandible
From the results of this study, it could be concluded that: 1- In regard to the accepted limits of peri-implant bone loss, two axial canine implants with either 1st molar short implant or premolar inclined implant design concepts can be used for assisting the mandibular complete overdentures. 2- The posterior short implant concept can be considered more promising design than inclined implant concept when designing the 4-implant assisted mandibular complete overdenture, regarding the preservation of periimplant alveolar bone height. 3- Using of bilateral posterior implants preserve the alveolar bone around the anterior implants used for assisting mandibular overdenture
One particular treatment option is marketed as the All-on-4 treatment concept.(2) If there is no enough quantity bone utilizing to All-on-4 treatment concept, Short implants have been proposed as an alternative to the long ones in an attempt to avoid some surgical procedures such as bone grafting
Summary
Placement of conventional long implants is hindered by severely resorbed alveolar ridges due to anatomical vital structures limitations such as the mental foramen, inferior alveolar nerve, mandibular canal and shape of the ridge. (1) An extensive surgical bone augmentation procedure is often necessary to achieve sufficient bone support to place standard implants in the posterior mandible. One particular treatment option is marketed as the All-on-4 treatment concept.(2) If there is no enough quantity bone utilizing to All-on-4 treatment concept, Short implants have been proposed as an alternative to the long ones in an attempt to avoid some surgical procedures such as bone grafting They reduce the morbidity, treatment time, costs and complications rates.(3) Short implant is simple, cost effective and highly predictable. In 20-year follow up study, no implant fractures or complications have been found for short implants.(3) Placement of short implants less than 8mm long may be considered an effective option to rehabilitate edentulous patients whenever conventional implants cannot be placed without prior bone augmentation procedures, such as autologous bone graft, osteogenic distraction or mental foramen transposition, which increase surgical morbidity and treatment time.(5)
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