Tilted implants for the restoration of posterior mandibles with horizontal atrophy: An alternative treatment

Purpose: Horizontal atrophy in the posterior mandible presents serious limitations on conventionalimplant placement. The purpose of this study was to evaluate the use of tilted implants angled in a buccolingual direction for restoring atrophic posterior mandibular sectors.Materials and Methods: A cohort study was performed of 25 patients who had partial prostheses supported by more than 1 implant ($1 tilted and 1 axial implant) to restore molar areas in the mandible. Whenthe bone thickness was at least 5 mm, axial implants were placed; when the alveolar ridge was narrower,the implant was placed with tilted angulation. The beds for these tilted implants were prepared using a lingual approach, tipping the implant apex toward the vestibule. Twelve months after loading, bone loss wasevaluated and the success rates of the tilted and axial implants were calculated.Results: The study included 20 women and 5 men (mean age, 54.8 yr) who received 67 implants in theposterior mandibular sectors. Thirty-nine implants were placed with a buccal angulation and 28 implantswere placed vertically. Mean bone losses of 0.59 0.26 mm among the tilted implants and 0.48 0.34 mmamong the axial implants were observed 1 year after loading. The success rate of the tilted implants was94.9%, and that of the axial implants was 100%. No significant differences in success rates or in bone lossbetween the tilted and axial implants were found at 12 months after loading.Conclusions: Twelve months after loading, tilted implants provided good results for the restoration ofposterior mandibles with horizontal atrophy and no significant differences in success rates or marginalbone loss between tilted and axial implants were observed.