Tilted implants as an alternative treatment to sinus lift

Abstract

The purpose of this investigation was to modify the method for implant placement in the posterior maxilla to extend fixed implant connected prosthesis further distally and to reduce the length of cantilevers in complete – arch prostheses without performing any bone graft procedures in the posterior maxilla. One hundred eighteen patients were treated with 256 maxillary implants placed in tilted positions. There were identified from a search of more than 10 years archive materials based on retrospective study reporting on implants with a follow up time from 1to 10 years of functional loading. The posterior implants were placed close to and parallel with the sinus walls were tilted anteriorly /posteriorly approximately 30 to 35 degree. As a result of implant tilting patients gained a mean distance of 9.5 mm of prostheses support. Panoramic radiographs and maxillary computerized tomograms had been made for all patients prior to treatments. One hundred eighteen patients with severely resorbed maxilla were included in the study. Two hundred fifty six implants (two to eight in each patient) were placed to support 118 fixed prostheses; 125 were tilted anteriorly and 131 were tilted posteriorly. The success rate of tilting implants was 97 % (250/256). Secondary stability (SS) through Periotest values (PV) were recorded. All patients had stable prostheses at the end of observation period. Patients were satisfied with comfort and stability. Satisfactory medium-term results concerning osteointegration and significant extension of prostheses support show that the method can be recommended. Anteriorly/posteriorly tilted implants in the atrophied posterior maxilla may be a viable alternative to bone grafting procedure in posterior maxilla.