Rehabilitation of the atrophic posterior maxilla presents a significant clinical challenge. While standard implants combined with sinus floor elevation (SFE) represent a highly predictable treatment modality, they are often associated with increased surgical morbidity, longer treatment times, and higher costs. Consequently, short implants (≤ 8 mm) have emerged as a promising, minimally invasive alternative.

To systematically evaluate and compare the clinical outcomes of short implants (≤ 8 mm) versus standard implants with SFE in the severely atrophic posterior maxilla.

This systematic review and meta-analysis was conducted in strict accordance with the PRISMA guidelines. A comprehensive literature search yielded 517 records, from which eligible randomized controlled trials (RCTs) were identified. The primary outcomes evaluated were implant failure rates and marginal bone loss (MBL). Statistical analyses were conducted utilizing a random-effects model, and risk of bias was assessed using the Cochrane RoB 2.0 tool.

A total of 8 RCTs were included in the meta-analysis. Pooled data revealed no statistically significant difference in overall implant failure rates between the short implant group and the standard implant with SFE group (RR = 1.05, 95% CI: 0.68 to 1.75, P = 0.83),with low heterogeneity ( I ² = 0%). Furthermore, short implants exhibited significantlyless marginal bone loss (MD = -0.15 mm, 95% CI:0.26 to -0.04, P = 0.008), withan I ² = 0%.

Short implants (≤ 8 mm) serve as a predictable and reliable alternative to standard implants with SFE in the atrophic posterior maxilla. They achieve comparable implant survival rates while offering the distinct clinical advantage of significantly reduced marginal bone loss, supporting their use as a primary minimally invasive treatment option.