J Korean Assoc Oral Maxillofac Surg.  2023 Oct;49(5):278-286. 10.5125/jkaoms.2023.49.5.278.

Tilted implants for implant-supported fixed hybrid prostheses: retrospective review

• Seok WH
• Yun PY
• Chang NH
• Kim YK

• KMID: 2547572
• DOI: http://doi.org/10.5125/jkaoms.2023.49.5.278

Abstract

Objectives
This review assessed the performance of implant-supported fixed hybrid prostheses in 21 patients who received a total of 137 implants between 2003 and 2010. The implants were evaluated for marginal bone resorption, complications, success rate, and survival rate based on their vertical angularity, type of bone graft, and measured implant stability.
Materials and Methods
One-way ANOVA and chi-square tests were used to analyze the relationships among long-term evaluation factors and these variables. The mean initial bone resorption in the implant group with a vertical angle of more than 20° was 0.33 mm and mean final bone resorption was 0.76 mm. In contrast, the mean initial bone resorption in the implant group with a vertical angle of less than 10° was 1.19 mm and mean final bone resorption was 2.17 mm.
Results
The results showed that mean bone resorption decreased with an increase in the vertical placement angle of the implants used in fixed hybrid prostheses, as well as in the group without additional bone grafts and those with high implant stability. The success rate of implants placed after bone grafting was found to be higher than those placed simultaneously.
Conclusion
These results suggest that implant-supported fixed hybrid prostheses may be an effective treatment option for edentulous patients, and intentionally placing implants with high angularity may improve outcomes.

Keyword

Implant-supported dental prosthesis; Dental implant; Bone transplantation; Bone resorption

Figure

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  Fig. 1 The mean alveolar bone resorption was measured radiographically using the PACS program. The mesial and distal measurements of the linear distance between the implant shoulder and the bone–implant contact were taken and averaged to determine the mean bone resorption. a: assumed mesial bone resorption. b: assumed distal bone resorption. Mean bone resorption=(a+b)/2.

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  Fig. 2 Implant angulation was measured on peri-apical view radiographs using tools in a radiographic analysis program (PACS; INFINIT Co.). Through the program, two lines were drawn to represent the alveolar ridge line and the line that divides the implant fixture in half, and then the angle formed by those two lines was analyzed. The upper left side of the figure shows an implant with angulation of less than 10°, which was sorted to Group 1. The upper right side of the figure shows an implant in Group 2 because the angulation is between 10° and 20°. The lower part of the figure shows an implant with a vertical angle of more than 20°, so it was sorted to Group 3.

Reference

References

1. Kutkut A, Bertoli E, Frazer R, Pinto-Sinai G, Fuentealba Hidalgo R, Studts J. 2018; A systematic review of studies comparing conventional complete denture and implant retained overdenture. J Prosthodont Res. 62:1–9. https://doi.org/10.1016/j.jpor.2017.06.004. DOI: 10.1016/j.jpor.2017.06.004. PMID: 28666845.

2. Sivaramakrishnan G, Sridharan K. 2016; Comparison of implant supported mandibular overdentures and conventional dentures on quality of life: a systematic review and meta-analysis of randomized controlled studies. Aust Dent J. 61:482–8. https://doi.org/10.1111/adj.12416. DOI: 10.1111/adj.12416. PMID: 26836981.

3. Egilmez F, Ergun G, Cekic-Nagas I, Bozkaya S. 2015; Implant-supported hybrid prosthesis: conventional treatment method for borderline cases. Eur J Dent. 9:442–8. https://doi.org/10.4103/1305-7456.163324. DOI: 10.4103/1305-7456.163324. PMID: 26430378. PMCID: PMC4570001.

4. Hyun DG. 2018; Fixed hybrid prosthesis. J Korean Acad Esthet Dent. 27:24–40. https://doi.org/10.15522/jkaed.2018.27.1.24.

5. Aglietta M, Siciliano VI, Zwahlen M, Brägger U, Pjetursson BE, Lang NP, et al. 2009; A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 years. Clin Oral Implants Res. 20:441–51. https://doi.org/10.1111/j.1600-0501.2009.01706.x. DOI: 10.1111/j.1600-0501.2009.01706.x. PMID: 19522975.

6. Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P, et al. 2008; Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent. 17:5–15. https://doi.org/10.1097/id.0b013e3181676059. DOI: 10.1097/ID.0b013e3181676059. PMID: 18332753.

7. Mehta SP, Sutariya PV, Pathan MR, Upadhyay HH, Patel SR, Kantharia NDG. 2021; Clinical success between tilted and axial implants in edentulous maxilla: a systematic review and meta-analysis. J Indian Prosthodont Soc. 21:217–28. https://doi.org/10.4103/jips.jips_79_21. DOI: 10.4103/jips.jips_79_21. PMID: 34380808. PMCID: PMC8425376.

8. Chrcanovic BR, Albrektsson T, Wennerberg A. 2015; Tilted versus axially placed dental implants: a meta-analysis. J Dent. 43:149–70. https://doi.org/10.1016/j.jdent.2014.09.002. DOI: 10.1016/j.jdent.2014.09.002. PMID: 25239770.

9. Del Fabbro M, Ceresoli V. 2014; The fate of marginal bone around axial vs. tilted implants: a systematic review. Eur J Oral Implantol. 7 Suppl 2:S171–89. PMID: 24977252.

10. Del Fabbro M, Bellini CM, Romeo D, Francetti L. 2012; Tilted implants for the rehabilitation of edentulous jaws: a systematic review. Clin Implant Dent Relat Res. 14:612–21. https://doi.org/10.1111/j.1708-8208.2010.00288.x. DOI: 10.1111/j.1708-8208.2010.00288.x. PMID: 20491823.

11. Peñarrocha Diago M, Maestre Ferrín L, Peñarrocha Oltra D, Canullo L, Calvo Guirado JL, Peñarrocha Diago M. 2013; Tilted implants for the restoration of posterior mandibles with horizontal atrophy: an alternative treatment. J Oral Maxillofac Surg. 71:856–64. https://doi.org/10.1016/j.joms.2012.12.016. DOI: 10.1016/j.joms.2012.12.016. PMID: 23415467.

12. Krekmanov L, Kahn M, Rangert B, Lindström H. 2000; Tilting of posterior mandibular and maxillary implants for improved prosthesis support. Int J Oral Maxillofac Implants. 15:405–14. PMID: 10874806.

13. Capelli M, Zuffetti F, Del Fabbro M, Testori T. 2007; Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study. Int J Oral Maxillofac Implants. 22:639–44. PMID: 17929526.

14. Maló P, Rangert B, Nobre M. 2003; "All-on-four" immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 5 Suppl 1:2–9. https://doi.org/10.1111/j.1708-8208.2003.tb00010.x. DOI: 10.1111/j.1708-8208.2003.tb00010.x. PMID: 12691645.

15. Maló P, de Araújo Nobre M, Lopes A, Ferro A, Nunes M. 2019; The all-on-4 concept for full-arch rehabilitation of the edentulous maxillae: a longitudinal study with 5-13 years of follow-up. Clin Implant Dent Relat Res. 21:538–49. https://doi.org/10.1111/cid.12771. DOI: 10.1111/cid.12771. PMID: 30924250.

16. Liu X, Pang F, Li Y, Jia H, Cui X, Yue Y, et al. 2019; Effects of different positions and angles of implants in maxillary edentulous jaw on surrounding bone stress under dynamic loading: a three-dimensional finite element analysis. Comput Math Methods Med. 2019:8074096. https://doi.org/10.1155/2019/8074096. DOI: 10.1155/2019/8074096. PMID: 31933678. PMCID: PMC6942770.

17. Behnaz E, Ramin M, Abbasi S, Pouya MA, Mahmood F. 2015; The effect of implant angulation and splinting on stress distribution in implant body and supporting bone: a finite element analysis. Eur J Dent. 9:311–8. https://doi.org/10.4103/1305-7456.163235. DOI: 10.4103/1305-7456.163235. PMID: 26430356. PMCID: PMC4569979.

18. Clementini M, Morlupi A, Agrestini C, Barlattani A. 2013; Immediate versus delayed positioning of dental implants in guided bone regeneration or onlay graft regenerated areas: a systematic review. Int J Oral Maxillofac Surg. 42:643–50. https://doi.org/10.1016/j.ijom.2013.01.018. DOI: 10.1016/j.ijom.2013.01.018. PMID: 23481543.

19. Peñarrocha-Diago M, Aloy-Prósper A, Peñarrocha-Oltra D, Calvo-Guirado JL, Peñarrocha-Diago M. 2013; Localized lateral alveolar ridge augmentation with block bone grafts: simultaneous versus delayed implant placement: a clinical and radiographic retrospective study. Int J Oral Maxillofac Implants. 28:846–53. https://doi.org/10.11607/jomi.2964. DOI: 10.11607/jomi.2964. PMID: 23748318.

20. Glauser R, Sennerby L, Meredith N, Rée A, Lundgren A, Gottlow J, et al. 2004; Resonance frequency analysis of implants subjected to immediate or early functional occlusal loading. Successful vs. failing implants. Clin Oral Implants Res. 15:428–34. https://doi.org/10.1111/j.1600-0501.2004.01036.x. DOI: 10.1111/j.1600-0501.2004.01036.x. PMID: 15248877.

21. Huang H, Wu G, Hunziker E. 2020; The clinical significance of implant stability quotient (ISQ) measurements: a literature review. J Oral Biol Craniofac Res. 10:629–38. https://doi.org/10.1016/j.jobcr.2020.07.004. DOI: 10.1016/j.jobcr.2020.07.004. PMID: 32983857. PMCID: PMC7494467.

22. Benn DK. 1990; A review of the reliability of radiographic measurements in estimating alveolar bone changes. J Clin Periodontol. 17:14–21. https://doi.org/10.1111/j.1600-051x.1990.tb01041.x. DOI: 10.1111/j.1600-051X.1990.tb01041.x. PMID: 2404031.