Purpose: The aim of this study was to prospectively evaluate clinical and radiographic outcomes of ultrashort implants (4-mm diameter, 6-mm length) supporting fixed partial dentures in severely atrophic posterior mandibles. Materials and Methods: Twenty-five
patients with posterior edentulous mandibular spans and 7- to 8-mm residual bone heights above the mandibular canal were enrolled. In total, 61 submerged implants were placed and loaded 5 to 6 months later. Patients were followed for 2 years after prosthesis connection with clinical, radiographic, and resonance frequency analysis (RFA) examinations. Results: Two implants failed in one patient before loading; all other implants showed favorable clinical and radiographic findings throughout the observation period (2-year survival and success rate: 96.8%). Postoperative pain and swelling were negligible. Mean changes in marginal bone levels were stable (0.40 ± 0.23, 0.51 ± 0.38, and 0.60 ± 0.13 mm after 6 months and 1 and 2 years, respectively) and were unaffected by measured crown-to-implant ratios (range: 1.31 to 3.12). Mean RFA values increased significantly from implant placement (67.35 ± 6.67) to 2 years (72.91 ± 5.07, P < .0001). Prosthetic complications included two prosthesis decementations, three ceramic veneer chippings, and one prosthesis screw loosening. Conclusion: Within the limitations of the short follow-up period, the use of 6-mm-long implants was a predictable treatment method for patients with atrophic posterior mandibles and increased crown-to-implant ratios. Int J Prosthodont 2012;25:279–289.