Tilted Implants in the Immediate Loading Rehabilitation of the Maxilla: A Systematic Review

University of Genoa, L. Rosanna Benzi 10, Genova, 16132, Italy.
Journal of dental research (Impact Factor: 4.14). 07/2012; 91(9):821-7. DOI: 10.1177/0022034512455802
Source: PubMed


Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.

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    • "The drawbacks of these procedures are more complications, longer treatment time, more costs, higher morbidity and post-operative discomfort for the patient (Milinkovic & Cordaro 2014). The question could rise whether in cases without aesthetic demands these invasive treatments are justified when less invasive options are available such as tilted implants (Menini et al. 2012), short implants (Annibali et al. 2012b), cantilever extensions on implants (Aglietta et al. 2009) and the,rarely used, cantilever extensions on natural teeth (Pjetursson et al. 2004;Tan et al. 2004). "
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    ABSTRACT: Whenever bone of sufficient quantity and quality is available, oral implants are considered to be a valuable treatment option to replace missing teeth. Consequently implants became part of mainstream dentistry (Adell et al. 1981;Albrektsson et al. 1981). Survival rates of over 95% in non-compromised patients have been reported (den Hartog et al. 2008). Unfortunately, an oral implant does not always osseointegrate. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2015 · Journal Of Clinical Periodontology
    • "Nowadays, immediate loading procedures are widespread in clinical practice (Mal o et al. 2011; Tealdo et al. 2011; Menini et al. 2012). However, in the earliest reports, the implant loss has, in general, tended to be higher than when a delayed loading has been applied (Balshi & Wolfinger 1997; Schnitman et al. 1997). "
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    ABSTRACT: Objectives Short-term results indicated that the Brånemark Novum® protocol (Nobel Biocare AB, Goteborg, Sweden) allowed successful rehabilitation of mandibular edentulism with immediately loaded implants. Yet, long-term studies are lacking. The aim of the present retrospective study was to report the 11-year outcomes for patients treated according to this protocol. Material and methodsFour patients treated according to the Brånemark Novum protocol (Nobel Biocare AB) were followed-up to evaluate implant and prosthesis cumulative survival rate (CSR), implant stability (RFA), marginal bone loss by periapical radiographs, probing depth (PD), and possible complications. Clinical and radiographic parameters were evaluated immediately after completion of the treatment and 1, 5, and 11 years after loading. ResultsThe 11-year implant and prosthesis CSRs were 100%. Implant stability (RFA values) remained stable over the 11-year follow-up. Small bone resorption was found next to distal implants (median 1 mm) after 11 years, while central implants showed greater bone resorption (median 4.5 mm). The PD (mean 3.75 mm at 11 years) grew together with marginal bone loss. One implant complication was detected on a central implant (crater-form bone destruction), and 10 prosthetic complications (fractures of resin or teeth), 80% of which registered on the same parafunctional patient. Conclusions The 11-year results demonstrated that the Brånemark Novum protocol (Nobel Biocare AB) is a predictable technique with favorable long-term outcomes. This was a rigid protocol, which could be applied only in patients with specific anatomical characteristics of the lower jaw, but it had the merit of indicating the key factors for full-arch immediate loading rehabilitations.
    No preview · Article · Nov 2013 · Clinical Oral Implants Research
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    ABSTRACT: PurposeThis retrospective study deals with the issue of how to realize the transition from a failing dentition to an implant-supported prosthesis. The main aim was to assess the reliability of immediate implant and immediate loading (IL) protocols in the edentulous jaws. A further aim was to investigate the role of patient-related, implant-related, and surgery-related secondary variables in the occurrence of implant failure. Materials and Methods Patients with at least a 4-year post-loading follow-up undergoing the transition from a failing dentition to an implant-supported prosthesis were retrospectively investigated. Primary variables of implant failure were immediate placement and IL. Secondary variables were categorized as demographic, anatomic, site, and prosthetically related. Cumulative survival rates (CSRs) were compared using the Kaplan-Meier survival estimate method. Predictors of failure were included in a multivariate Cox regression model to evaluate the simultaneous effects of multiple covariates and control for correlated observation. Crestal bone loss was also measured at the delayed and the immediately loaded implants. ResultsFive hundred nineteen implants rehabilitating 91 jaws in 80 patients were followed. The Kaplan-Meier survival estimate method showed that immediate implant and IL decreased the CSR significantly in the maxilla but not in the mandible. Some secondary variables were found to affect the CSR: maxillary location, age over 70 years, prostheses supported by only immediate implants or a majority of them, temporary cementation, implant diameter, and length. Crestal bone loss was not significantly related to the outcomes. Conclusions The present data may provide clinical recommendations to the practitioner treating the transitional patient. In the mandible, the use of immediate implants and IL does not increase the failure rate. In the maxilla however, combining immediate placement and IL may significantly increase the failure rate.
    Full-text · Article · Mar 2013 · Clinical Implant Dentistry and Related Research
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