Tilted Implants for Full-Arch Rehabilitations in Completely Edentulous Maxilla: A Retrospective Study

Abstract

Purpose. The aims of this study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants in the edentulous maxilla and to evaluate the incidence of biological and prosthetic complications. Materials and Methods. Thirty-four patients (18 women and 16 men) were included in the study. Each patient received a maxillary full-arch fixed bridge supported by two axial implants and two distal tilted implants. A total of 136 implants were inserted. Loading was applied within 48 hours of surgery and definitive restorations were placed 4 to 6 months later. Patients were scheduled for followup at 6, 12, 18, and 24 months and annually up to 5 years. At each followup plaque level and bleeding scores were assessed and every complication was recorded. Results. The overall follow-up range was 12 to 73 months (mean 38.8 months). No implant failures were recorded to date, leading to a cumulative implant survival rate of 100%. Biological complications were recorded such as alveolar mucositis (11.8% patients), peri-implantitis (5.9% patients), and temporomandibular joint pain (5.9% patients). The most common prosthetic complications were the fracture or detachment of one or multiple acrylic teeth in both the temporary (20.6% patients) and definitive (17.7% patients) prosthesis and the minor acrylic fractures in the temporary (14.7% patients) and definitive (2.9% patients) prosthesis. Hygienic complications occurred in 38.2% patients. No patients' dissatisfactions were recorded. Conclusions. The high cumulative implant survival rate indicates that this technique could be considered a viable treatment option. An effective recall program is important to early intercept and correct prosthetic and biologic complications in order to avoid implant and prosthetic failures.

Tilted versus axially placed dental implants: A meta-analysis

“…All studies but two 16,52 provided information of the patients' age, and none of them included non-adults patients. Some patients in thirty-three studies 1, 3,7,8,14,15,17,18,[20][21][22][23][24][25][27][28][29][30][32][33][34]36,[40][41][42][44][45][46][47][48][49]51,52 were smokers. Five studies 16,42,44,46,49 reported the presence of bruxers among the patients, and six studies 1, 28,42,46,48,49 the presence of diabetic patients.…”

“…In twenty-three studies 1, 3,8,16,18,21,22,[24][25][26][27][28]30,31,35,39,42,45,46,[48][49][50]52 the patients were exclusively rehabilitated with fixed full-arch prostheses receiving 2 distal tilted implants and 2 mesial axially placed implants. Patients were submitted to grafting procedures at the implant site in only two studies.…”

“…In two studies 33,51 the tilted implants had intrasinus insertion. Seventeen studies 3,7,14,17,19,20,23,29,32,33,36,37,39,45,47,49,51 exclusively evaluated implants inserted in maxillae, and exclusively evaluated implants inserted in mandibles in eleven studies. 1, 18,21,28,30,31,42,44,46,48,50 Implants were not immediately loaded in eight studies 7,13,37,38,43,47,48,51 In one study 36 some implants were immediately or delayed loaded, and another study 41 did not provide information about the healing/loading time.…”

“…1, 18,21,28,30,31,42,44,46,48,50 Implants were not immediately loaded in eight studies 7,13,37,38,43,47,48,51 In one study 36 some implants were immediately or delayed loaded, and another study 41 did not provide information about the healing/loading time. Twenty-three studies 8,13,[15][16][17]20,21,23,25,26,31,33,37,38,[41][42][43][45][46][47][50][51][52] did not provide information about the opposing dentition to the implants being evaluated. Information about the implant inclination in degrees was not provided in eight studies.…”

“…There were no implant failures in twelve studies. 17 Nobel Biocare AB (Gö teborg, Sweden) were the most commonly used, in twenty-seven studies, 1, 3,7,14,[16][17][18]21,22,26,27,[29][30][31][32][33]35,37,39,40,42,43,[45][46][47]50,52 most of them with an oxidised surface. Four studies 25,36,38,51 did not inform what kind of implants was used.…”