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: maria.penarrocha@uv.es
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
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