Title Tilted Implants Demonstrate Survival and Marginal Bone Loss That is Comparable to Axial Implants
Clinical Question In a healthy adult patient receiving dental implants, do tilted implants demonstrate survival and marginal bone loss that is comparable to conventionally placed axial implants?
Clinical Bottom Line Tilted implants demonstrate survival and marginal bone loss that is comparable to axial implants. This is supported by two systematic reviews and a meta-analysis that reviewed a large number of implant cases and showed no significant difference overall between failure rates or marginal bone loss of tilted and axial implants.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25239770Chrcanovic/201544 studies with 5029 tilted implants and 5732 axial implantsMeta-Analysis
Key resultsOverall, the implant failure rates were not significantly different between the two procedures with P=0.40 and a RR of 1.14 (95% CI 0.84-1.56). There was a statistically significant difference when only maxillary implants were compared (RR 1.70, 95% CI 1.05-2.74; P=0.03) in favor of axial implants but not for mandibular implants (RR 0.77, 95% CI 0.39-1.52; P=0.45). Tilted implants showed no significant effects on marginal bone loss (MD 0.03, 95% CI -0.03 to 0.08; P=0.32).
24977252Del Fabbro/2014670 patients with a total of 1494 axial and 1338 tilted implantsSystematic review of non-randomized trials
Key resultsAfter 1 year of function, periimplant crestal bone loss for axial implants was 0.43-1.13 mm while tilted implants showed 0.34-1.14 mm of bone loss. There was a trend for lower bone loss around axial implants compared to tilted implants but it was not significant (P = 0.09 and P = 0.30, respectively). There was no significant effect of location, loading mode, restoration type, or study design on marginal bone loss. Within the first year of function, 46 implants (18 axial and 28 tilted) failed in 38 patients. Forty-one of the failures occurred in the maxilla and the survival rate after 12 months of loading was significantly lower in the maxilla (97.4%) than in the mandible (99.6%).
22851285Menini/201211 studies with 1,623 implants (778 tilted, 845 upright) placed in the maxillae of 324 patientsSystematic review of non-randomized trials
Key resultsDuring the first year, there were 17 tilted implant failures (2.19%) and 16 upright implant failures (1.89%). This difference in failure rate between tilted and upright implants was not significant (P = 0.52). Marginal bone loss results (obtained from 6 studies) did not differ significantly between tilted and upright implants (MD = 0.02; 95% CI, -0.05-0.09; p value = 0.58).
Evidence Search (tilted[All Fields] AND implants[All Fields]) AND (Meta-Analysis[ptyp] OR systematic[sb])
Comments on
The Evidence
Validity: Some caution should be exercised when interpreting the results of these articles because there are some uncontrolled confounding factors and the included studies were not randomized. Two articles were systematic reviews and one was a meta-analysis. The three articles combined for review of 7,145 tilted implants and 8,071 axial implants. All three articles appear to have had acceptable search and selection criteria for the literature review. Perspective: The three articles here suggest that tilted implants may demonstrate acceptable survival and marginal bone loss but additional long-term, randomized studies are needed to solidify these results.
Applicability The patients included in these studies are representative of a typical patient population receiving implants and tilted implant placement is feasible for well-trained practitioners. If successful tilted implant placement is an option, patients can potentially avoid additional procedures such as bone grafts and sinus lifts that may otherwise be required to obtain sufficient bone for axial implant placement.
Specialty (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords tilted implant, axial implant, implant angulation, bone graft, sinus lift
ID# 2827
Date of submission 04/08/2015
E-mail ricetd@livemail.uthscsa.edu
Author David Rice
Co-author(s) e-mail
Faculty mentor Richard Finlayson, DDS
Faculty mentor e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available