Extra-long implants (20, 22, and 25 mm) for fixed implant-supported total rehabilitation

7 min read01 September 2025

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Original article is written in PT language (link to read it) .

Introduction

The use of dental implants to improve the quality of life of patients has been widely published in Dentistry. The use of extra-long implants in fixed implant-supported total rehabilitation offers patients improvements in chewing, comfort, aesthetics, and phonetics. The use of this type of implant reduces treatment time and cost compared to other modalities of conventional implant treatments. The literature reports favorable parameters in hard tissues and molds for both axial and angled implants.

Very high success rates have been reported in 10-year studies for the mandible and five years for the maxilla. The use of angled implants allows for the avoidance of complicated anatomical structures and maximizes the A-P distance in total rehabilitation, also allowing for the avoidance of highly complex bone grafts, increasing the acceptance of treatment plans by patients. The use of extra-long implants allows for easier achievement of immediate function, as the anchorage of the implants will be located in anatomical areas of greater bone density, meaning there is high primary stability in low-density maxillary bone with bicortical anchorage using extra-long implants (20, 22, and 25 mm).

Clinical case

A 47-year-old male patient, smoker, with no relevant medical history, presents to the consultation with mobility of all teeth in the upper jaw. He sought definitive treatment because "the teeth were always shaking." After a pre-treatment evaluation (medical history and patient complaints, dental history, radiographic analyses, intraoral and extraoral examination, and treatment plan), periodontal treatment was performed and extraction of all dental pieces in the upper jaw was proposed, with immediate placement of four implants and a fixed provisional restoration on the day of surgery. After six months, a fixed prosthesis with a Nobel Procera implant bridge, made of layered zirconia with ceramic, was placed.

During the dental implant placement surgery, local-regional anesthesia was performed, and all dental pieces in the upper jaw were extracted. The four implants placed were Nobel Speedy, with the anterior ones being axial at 18 mm and the posterior ones angled at 20 mm. Primary stability was greater than 35 N. Subsequently, angled posterior and straight anterior multi-unit abutments were placed, and a provisional acrylic fixed prosthesis was installed on the day of surgery.

The healing occurred over six months without any significant negative aspects.

After this period, final rehabilitation was carried out, starting from the duplication of the immediate acrylic prosthesis, which was mounted on an articulator to maintain the same vertical dimension.

After a consultation for the approval of a try in model, the final rehabilitation was performed with a Nobel Procera bridge made of layered zirconia.

Discussion/conclusion

The literature reports very high rates in total implant-supported rehabilitation with four dental implants. The use of extra-long implants seems to allow for greater primary stability in maxillary bone with low density through bicortical anchorage, as it allows access to anatomical areas with better quality and bone density, although there are no studies for long implants (20, 22, and 25 mm).

Figs. 1 to 4. Initial extraoral photographs.

Figs. 5 and 6. Initial intraoral photograph and orthopantomogram.

Figs. 7 and 8. Immediate fixed acrylic prosthesis on the day of surgery.

Figs. 9 and 10. Assembly in articulator for replication of the immediate load provisional. It presents the same vertical dimension as the immediate acrylic prosthesis.

Fig. 11. Try-in model for definitive rehabilitation (after six months).

Figs. 13 to 15. Color proof with ceramic try-in made in the laboratory.

Fig. 16. Color comparison in Photoshop Lightroom.

Fig. 18. Light dynamics of the zirconium structure.

Fig. 19. Polarized color photograph of a ceramic try-in made in the laboratory.

Fig. 21. Definitive total fixed prosthesis.

Fig. 22. Appearance of the texture of the definitive total fixed prosthesis.

Figs. 23 and 24. Final extraoral photographs.

Figs. 25 and 26. Final vs initial extraoral photograph.

Fig. 27. Comparison of definitive prosthesis with ceramic try-in.

Fig. 28. Value of the definitive fixed prosthesis.

Figs. 29 and 30. Initial vs final extraoral photograph.

Figs. 31 and 32. Close-up of the final result (side views).

Fig. 33. Close-up of the final result (frontal view).

Figs. 34 and 35. Close-up of the initial vs final result.

Figs. 36 to 41. Examples of the use of extra long implants.

João Mouzinho, Catarina Vitorino, Pedro Brito

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Technologies in implantology Materials for implantology Digital implantology Implantation Guided implant dentistry