Introduction: Traditionally, implant placement in the atrophic maxilla and mandible requires bone augmentation with additional healing time, costs and morbidity. An alternative approach is placement of tilted implants, which results in less morbidity, cost and total treatment time. The success of tilted implants has been outlined in clinical reports using various approaches. Recent systematic reviews show angled implants might not affect the survival rate or marginal bone loss.
Case 1: A 72 y.o. edentulous male presented with chief complaint of loose upper and lower dentures. All on five and all on four implants with implant fixed complete denture were planned for maxilla and mandible respectively. 5 Nobel Active implants were placed: two angulated implants at #4, 13 and 3 axial implants at # 7,10,11 sites. 17 and 30-degree multi-unit abutments were placed on anterior and distal implants respectively. For Mandible, 4 implants were placed: two tilted implants at # 21, 28 and 2 axial implants at # 23, 26 sites. Straight and 30-degree multi-unit abutments were placed on anterior and distal implants respectively. Screw retained provisional prostheses were fabricated using patient’s existing dentures. Definitive screw-retained prosthesis with titanium framework and acrylic teeth were delivered after 8 months.
Case 2: A 75 y.o. male patient presented with generalized sever chronic periodontitis and hopeless mandibular teeth. Implant fixed complete denture was planned for mandible. 4 implants were placed: tilted implant at # 29, axially implants at # 20, 22, 27 sites. Straight and 30-degree multi-unit abutments were placed on implants. Screw retained provisional prostheses was delivered after fabricating immediate denture.
Case 3: A 51 y.o. male patient presented with generalized chronic periodontitis and hopeless maxillary teeth. Four implants with implant fixed complete denture prosthesis was planned. 4 Nobel Active implants were placed including two tilted and two straight ones. Straight and 17-degree multi-unit abutments were placed on axial and tilted implants respectively. Screw retained provisional prostheses was delivered using immediate denture. Definitive screw-retained prosthesis with titanium framework and acrylic teeth was delivered after 11 months.
Results: At 3 months, all evaluation was consistent with Osseointegration with were no signs of delayed healing or infection. All patients were satisfied with esthetics and function of prosthesis.
Conclusions: Tilted implants allow positioning of fixtures in the available native bone avoiding additional bone grafting and reducing morbidity and time without compromising the prosthesis. It also allows for use of longer implants, which enhances primary stability and cantilever reduction with optimal prosthetic support.