Comparison of marginal bone loss and implant success between axial and tilted implants in maxillary All‐on‐4 treatment concept rehabilitations after 5 years of follow‐up

BACKGROUND There is need for more scientific and clinical information on longer-term outcomes of tilted implants compared to implants inserted in an axial position. PURPOSE Comparison of marginal bone loss and implant success after a 5-year follow-up between axial and tilted implants inserted for full-arch maxillary rehabilitation. MATERIAL AND METHODS The retrospective clinical study included 891 patients with 3564 maxillary implants rehabilitated according to the All-on-4 treatment concept. The follow-up time was 5 years. Linear mixed-effect models were performed to analyze the influence of implant orientation (axial/tilted) on marginal bone loss and binary logistic regression to assess the effect of patient characteristics on occurrence of marginal bone loss >2.8 mm. Only those patients with measurements of at least one axial and one tilted implant available were analyzed. This resulted in a data set of 2379 implants (1201 axial, 1178 tilted) in 626 patients (=reduced data set). RESULTS Axial and tilted implants showed comparable mean marginal bone losses of 1.14 ± 0.71 and 1.19 ± 0.82 mm, respectively. Mixed model analysis indicated that marginal bone loss levels at 5 years follow up was not significantly affected by the orientation (axial/tilted) of the implants in the maxillary bone. Smoking and female gender were associated with marginal bone loss >2.8 mm in a logistic regression analysis. Five-year implant success rates were 96%. The occurrence of implant failure showed to be statistically independent from orientation. CONCLUSIONS Within the limitations of this study and considering a follow-up time of 5 years, it can be concluded that tilted implants behave similarly with regards to marginal bone loss and implant success in comparison to axial implants in full-arch rehabilitation of the maxilla. Longer-term outcomes (10 years +) are needed to verify this result.

[1]  F. Ogutlu.  All‐on‐4 immediate function concept , 2019, Clinical Oral Implants Research.

[2]  Yingliang Song,et al.  Immediate loading for implant restoration compared with early or conventional loading: A meta-analysis. , 2017, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[3]  F. Stelzle,et al.  Implant‐Supported Immediately Loaded Fixed Full‐Arch Dentures: Evaluation of Implant Survival Rates in a Case Cohort of up to 7 Years , 2017, Clinical implant dentistry and related research.

[4]  E. Rocha,et al.  Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. , 2017, Journal of prosthodontic research.

[5]  P. Maló,et al.  Dental implants in diabetic patients: retrospective cohort study reporting on implant survival and risk indicators for excessive marginal bone loss at 5 years. , 2016, Journal of oral rehabilitation.

[6]  S. Matalon,et al.  Effect of implant insertion and loading protocol on long-term stability and crestal bone loss: A comparative study. , 2016, The Journal of prosthetic dentistry.

[7]  A. Catena,et al.  Impact of Maintenance Therapy for the Prevention of Peri-implant Diseases , 2016, Journal of dental research.

[8]  E. Baltacıoğlu,et al.  Immediate implant placement in fresh sockets versus implant placement in healed bone for full-arch fixed prostheses with conventional loading. , 2016, International journal of oral and maxillofacial surgery.

[9]  P. Rompré,et al.  Patients' expectations, satisfaction, and quality of life with immediate loading protocol. , 2016, Clinical oral implants research.

[10]  V. Moraschini,et al.  Immediate versus conventional loaded single implants in the posterior mandible: a meta-analysis of randomized controlled trials. , 2016, International journal of oral and maxillofacial surgery.

[11]  H. De Bruyn,et al.  Ongoing Crestal Bone Loss around Implants Subjected to Computer-Guided Flapless Surgery and Immediate Loading Using the All-on-4® Concept. , 2015, Clinical implant dentistry and related research.

[12]  T. Albrektsson,et al.  Tilted versus axially placed dental implants: a meta-analysis. , 2015, Journal of dentistry.

[13]  H. De Bruyn,et al.  A multifactorial analysis to identify predictors of implant failure and peri-implant bone loss. , 2015, Clinical implant dentistry and related research.

[14]  N. Gupta,et al.  Tilted and short implants supporting fixed prosthesis in an atrophic maxilla: a 3D-FEA biomechanical evaluation. , 2015, Clinical implant dentistry and related research.

[15]  J. Strub,et al.  The all-on-four treatment concept: a systematic review. , 2014, Clinical implant dentistry and related research.

[16]  L. Canullo,et al.  Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis. , 2014, International journal of oral and maxillofacial surgery.

[17]  S. Balshi,et al.  A retrospective analysis of 800 Brånemark System implants following the All-on-Four™ protocol. , 2014, Journal of prosthodontics : official journal of the American College of Prosthodontists.

[18]  J. Smith-Palmer,et al.  Evaluating the health economic implications and cost-effectiveness of dental implants: a literature review. , 2013, The International journal of oral & maxillofacial implants.

[19]  S. Froum,et al.  Long-term bone stability assessment around 1,187 immediately placed implants with 1- to 22-year follow-up. , 2013, The International journal of oral & maxillofacial implants.

[20]  P. Galindo-Moreno,et al.  Marginal bone loss around tilted implants in comparison to straight implants: a meta-analysis. , 2012, The International journal of oral & maxillofacial implants.

[21]  S. Taschieri,et al.  Bone level changes around axial and tilted implants in full-arch fixed immediate restorations. Interim results of a prospective study. , 2012, Clinical implant dentistry and related research.

[22]  E. Valmaseda-Castellón,et al.  Long-term marginal bone loss in 217 machined-surface implants placed in 68 patients with 5 to 9 years of follow-up: a retrospective study. , 2012, The International journal of oral & maxillofacial implants.

[23]  Massimo Del Fabbro,et al.  Tilted implants for the rehabilitation of edentulous jaws: a systematic review. , 2012, Clinical implant dentistry and related research.

[24]  Luca Francetti,et al.  Immediate rehabilitation of the extremely atrophic mandible with fixed full-prosthesis supported by four implants. , 2012, Clinical implant dentistry and related research.

[25]  C. Francischone,et al.  "All-on-4" immediate-function concept for completely edentulous maxillae: a clinical report on the medium (3 years) and long-term (5 years) outcomes. , 2012, Clinical implant dentistry and related research.

[26]  J. Ata-Ali,et al.  Oral rehabilitation with tilted dental implants: A metaanalysis , 2012, Medicina oral, patologia oral y cirugia bucal.

[27]  F. Pera,et al.  Implants in the Immediate Loading rehabilitation of the Maxilla : A systematic review , 2012 .

[28]  C. Babbush,et al.  The all-on-four immediate function treatment concept with NobelActive implants: a retrospective study. , 2011, The Journal of oral implantology.

[29]  P. Maló,et al.  A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. , 2011, Journal of the American Dental Association.

[30]  P. Maló,et al.  The rehabilitation of completely edentulous maxillae with different degrees of resorption with four or more immediately loaded implants: a 5-year retrospective study and a new classification. , 2011, European journal of oral implantology.

[31]  M. Esposito,et al.  Timing of implant placement after tooth extraction: immediate, immediate-delayed or delayed implants? A Cochrane systematic review. , 2010, European journal of oral implantology.

[32]  M. Peñarrocha-Diago,et al.  Comparative study of wide-diameter implants placed after dental extraction and implants positioned in mature bone for molar replacement. , 2008, The International journal of oral & maxillofacial implants.

[33]  P. Fugazzotto.  Implant Placement at the Time of Mandibular Molar Extraction: Description of Technique and Preliminary Results of 341 Cases , 2008 .

[34]  J. Wennström,et al.  Bone level changes at axial- and non-axial-positioned implants supporting fixed partial dentures. A 5-year retrospective longitudinal study. , 2007, Clinical oral implants research.

[35]  Gustavo Avila,et al.  Immediate Implant Loading: Current Status From Available Literature , 2007, Implant dentistry.

[36]  Massimo Del Fabbro,et al.  Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study. , 2007, The International journal of oral & maxillofacial implants.

[37]  P. Reichart,et al.  Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. , 2007, Journal of clinical periodontology.

[38]  A. Rosén,et al.  Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[39]  D. Hinode,et al.  Influence of smoking on osseointegrated implant failure: a meta-analysis. , 2006, Clinical oral implants research.

[40]  Miguel Nobre,et al.  All-on-4 immediate-function concept with Brånemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. , 2005, Clinical implant dentistry and related research.

[41]  C. Hämmerle,et al.  Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. , 2004, The International journal of oral & maxillofacial implants.

[42]  Hiroshi Fukuda,et al.  Finite element analysis of the influence of implant inclination, loading position, and load direction on stress distribution , 2003, Odontology.

[43]  Miguel Nobre,et al.  "All-on-Four" immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. , 2003, Clinical implant dentistry and related research.

[44]  U. Grunder.  Immediate functional loading of immediate implants in edentulous arches: two-year results. , 2001, The International journal of periodontics & restorative dentistry.

[45]  B. Rangert,et al.  Tilted implants as an alternative to maxillary sinus grafting: a clinical, radiologic, and periotest study. , 2001, Clinical implant dentistry and related research.

[46]  B. Rangert,et al.  Immediate function of Brånemark implants in the esthetic zone: a retrospective clinical study with 6 months to 4 years of follow-up. , 2000, Clinical implant dentistry and related research.

[47]  B Rangert,et al.  Tilting of posterior mandibular and maxillary implants for improved prosthesis support. , 2000, The International journal of oral & maxillofacial implants.

[48]  T. Albrektsson,et al.  Determinants of correct clinical reporting. , 1998, The International journal of prosthodontics.

[49]  A. Gilat,et al.  A photoelastic and strain gauge analysis of angled abutments for an implant system. , 1993, The International journal of oral & maxillofacial implants.