Journal of Oral Implantology October 2013 - (Page 625)

LITERATURE REVIEW Rehabilitation of the Atrophic Maxilla With Tilted Implants: Review of the Literature ˜ David Penarrocha-Oltra, DDS ´ Eugenia Candel-Martı, DDS Javier Ata-Ali, DDS ´ ˜ Marıa Penarrocha-Diago, DDS, MD, PhD* We review the evidence-based literature on the use of tilted implants in the rehabilitation of patients with maxillary atrophy. Studies from 1999 to 2010 on patients with atrophic maxilla rehabilitated with tilted implants were reviewed. Clinical series with at least 10 patients rehabilitated using tilted implants and a follow-up of at least 12 months after prosthetic load were included. Case reports and studies with missing data were excluded. In each study the following was assessed: surgical technique, prosthesis type, timing of implant loading, success rate and marginal bone loss of tilted and axial implants, complications and patient satisfaction level. Thirteen studies were included, reporting a total of 782 tilted and 666 axial implants in 319 patients. Success rates went from 91.3% to 100% for axial implants and from 92.1% to 100% for tilted implants; radiographic marginal bone loss went from 0.4 mm to 0.92 mm in tilted implants and from 0.35 mm to 1.21 mm in axial implants. No statistically significant differences were found in any of the studies. No surgical complications and only minor prosthetic complications were reported. High patient satisfaction was found with all types of prosthesis (fullarch fixed, partial fixed and overdentures) placed over tilted implants. The literature on tilted implants shows that implants placed with this technique, both used alone and combined with axially placed implants, and rehabilitated with different prosthetic options have high success rates, minimal complications and high patient satisfaction. However, lack of homogeneity among studies and relatively short follow-up periods for most studies make necessary more studies. Key Words: tilted implants, angulated implants, angled implants, maxillary atrophy INTRODUCTION I n the severely atrophic maxilla, alveolar ridge resorption, maxillary sinus pneumatization, presence of nasal cavities, and type 3 or 4 bone quality, according to Lekholm and Zarb classification,1 encumber or disable conventional dental implant placement. According to the ˚ original Branemark System concept implants should be placed fairly upright.2 Consequently, in a completely edentulous atrophic maxilla, long distal cantilevers would be necessary to provide the patient with acceptable chewing capacity in the Department of Stomatology, Valencia University Medical and Dental School, Valencia, Spain. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-11-00068 molar regions; however, cantilevers longer than 15 mm have been associated with increased implant failure rates.3 Several treatment options have been proposed to solve this situation, including bone grafting techniques—block bone grafts and sinus lifting via crestal or lateral approach—and nongrafting techniques, which are modifications of the conventional implant procedure, such as placement in the zygomatic bone, the pterygoid process or the maxillary tuberosity, and use of short or tilted implants.4–7 Grafting procedures have higher complication rates, higher risk of morbidity, higher costs, and a longer delay until prosthetic rehabilitation, so patients may be reluctant to accept them.4 Furthermore, according to Widmark et al8 maxillary implants placed in native bone have a greater Journal of Oral Implantology 625

Table of Contents for the Digital Edition of Journal of Oral Implantology October 2013

Food and Drug Administration: Reclassification of Blade Form Dental Implants
Optimizing Platelet-Rich Plasma Gel Formation by Varying Time and Gravitational Forces During Centrifugation
Effect of Surface Roughness and Low-Level Laser Therapy on Removal Torque of Implants Placed in Rat Femurs
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part I: Comparison of Three Direct Methods
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part II: Comparison of Four Acrylic Resins
A Pig Model for the Histomorphometric Evaluation of Hard Tissue Around Dental Implants
In Situ Tooth Replica Custom Implant: A 3-Dimensional Finite Element Stress and Strain Analysis
Influence of Different Soft Liners on Stress Distribution in Peri-Implant Bone Tissue During Healing Period. A 3D Finite Element Analysis
Influence of Surface Nano-Roughness on Osseointegration of Zirconia Implants in Rabbit Femur Heads Using Selective Infiltration Etching Technique
Modified Titanium Surfaces Alter Osteogenic Differentiation: A Comparative Microarray- Based Analysis of Human Mesenchymal Cell Response to Commercial Titanium Surfaces
Hemorrhage Secondary to Interforaminal Implant Surgery: Anatomical Considerations and Report of a Case
Rehabilitation of a Patient With Mandibular Resection Using Osteointegrated Implants: A Case Report
Two-Stage Bone Expansion Technique Using Spear-Shaped Implants Associated With Overlapped Flap: A Case Report
Implant Esthetic Restoration in Ridge Deficiencies in Cases of Trauma: A Case Report
Rehabilitation of the Atrophic Maxilla With Tilted Implants: Review of the Literature

Journal of Oral Implantology October 2013