Comparison of Marginal Bone Loss And İmplant Success Between Axial And Tilted Implants in Full Arch Rehabilitations

Year 2025, Volume: 12 Issue: 3, 352 - 356, 29.12.2025

Serhat Can , Sinem Busra Kirac Can , Fatma Öner , Nuri Çelik

https://doi.org/10.15311/selcukdentj.1716989

Abstract

ABSTRACT
Backround: The aim of this study was to investigate the correlation of Marginal Bone Loss and Implant Success between Axial and Tilted implant angulations in full arch rehabilitations.
Methods: A retrospective study was analysed clinical and radiographic data of 256 dental implants between February 2020 and March 2024. A total of 33 patients (17 female and 16 male) received implants according to the All-on-X concept, utilizing the same implant brand. Patients, 17 female and 16 male, were applied with dental implants following the All-on-X concept, utilizing the same brand of implants. Implant angulations and marginal bone loss measurements were assessed using radiographs, while implant success was evaluated based on clinical data.
Results: The mean follow-up period was 23.8±21 months. Similar results were found in implant survival or overall implant success rates. Although marginal bone loss was greater in axial implants compare to tilted implants, the difference was not statistically significant (p:0.309). Similarly, marginal bone loss was higher in the maxilla compare to the mandible, but this difference was also not statistically difference was found (p:0.169)
Conclusions: Patients treated with the All-on-X concept, both axial and tilted implant angulations can be safely used in terms of marginal bone loss and implant success. Therefore, it is a successful procedure for patient rehabilitation.

Keywords

All-on-X , Implant angulation , Marginal Bone Loss

Ethical Statement

The study protocol was approved by the Marmara University Medical Faculty Ethics Committee (No: 09.2024.197, Date: 09/02/2024).

Supporting Institution

none

Thanks

none

References

• 1. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants. 1990;5(4):347-59.
• 2. Lambrecht JT, Filippi A, Künzel AR, Schiel HJ. Long-term evaluation of submerged and nonsubmerged ITI solid-screw titanium implants: a 10-year life table analysis of 468 implants. Int J Oral Maxillofac Implants. 2003;18(6):826-34.
• 3. Ravald N, Dahlgren S, Teiwik A, Gröndahl K. Long-term evaluation of Astra Tech and Brånemark implants in patients treated with full-arch bridges. Results after 12-15 years. Clin Oral Implants Res. 2013;24(10):1144-51.
• 4. Cochran DL, Nummikoski P V., Schoolfield JD, Jones AA, Oates TW. A Prospective Multicenter 5‐Year Radiographic Evaluation of Crestal Bone Levels Over Time in 596 Dental Implants Placed in 192 Patients. J Periodontol. 2009;80(5):725-33.
• 5. Barnea E, Tal H, Nissan J, Tarrasch R, Peleg M, Kolerman R. The Use of Tilted Implant for Posterior Atrophic Maxilla. Clin Implant Dent Relat Res. 2016;18(4):788-800.
• 6. Maló P, Nobre M de A, Lopes A. Immediate loading of ‘All-on-4’ maxillary prostheses using trans-sinus tilted implants without sinus bone grafting: A retrospective study reporting the 3-year outcome. Eur J Oral Implantol. 2013;6(3):273-83.
• 7. Barone A, Varanini P, Orlando B, Tonelli P, Covani U. Deep-Frozen Allogeneic Onlay Bone Grafts for Reconstruction of Atrophic Maxillary Alveolar Ridges: A Preliminary Study. J Oral Maxillofac Surg. 2009;67(6):1300-6.
• 8. Nissan J, Ghelfan O, Mardinger O, Calderon S, Chaushu G. Efficacy of cancellous block allograft augmentation prior to implant placement in the posterior atrophic mandible. Clin Implant Dent Relat Res. 2011;13(4):279-85.
• 9. Weinstein R, Agliardi E, Fabbro MD, Romeo D, Francetti L. Immediate Rehabilitation of the Extremely Atrophic Mandible with Fixed Full-Prosthesis Supported by Four Implants. Clin Implant Dent Relat Res. 2012;14(3):434-41.
• 10. Van Weehaeghe M, De Bruyn H, Vandeweghe S. A prospective, split-mouth study comparing tilted implants with angulated connection versus conventional implants with angulated abutment. Clin Implant Dent Relat Res. 2017;19(6):989-996.
• 11. Salyut DDS A, Sinem Akdeniz DDS S, Ergezen DDS E, Çetinşahin C. Evaluation of the Relationship Between Marginal Bone Loss and Implant Angulation in All-on-Four System. EurAsian Journal of Oral and Maxillofacial Surgery. 2024;3(1):22-31.
• 12. Fortin Y, Sullivan RM. Terminal Posterior Tilted Implants Planned as a Sinus Graft Alternative for Fixed Full-Arch Implant-Supported Maxillary Restoration: A Case Series with 10- to 19-Year Results on 44 Consecutive Patients Presenting for Routine Maintenance. Clin Implant Dent Relat Res. 2017;19(1):56-68.
• 13. Calandriello R, Tomatis M. Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: A prospective 1-year clinical study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S1-12.
• 14. Del Fabbro M, Bellini CM, Romeo D, Francetti L. Tilted Implants for the Rehabilitation of Edentulous Jaws: A Systematic Review. Clin Implant Dent Relat Res. 2012;14(4):612-21.
• 15. Albrektsson T, Zarb GA. Determinants of correct clinical reporting. Ont Dent. 1999;76(4):29-33.
• 16. Cortés-Bretón Brinkmann J, García-Gil I, Pedregal P, Peláez J, Prados-Frutos JC, Suárez MJ. Long-term clinical behavior and complications of intentionally tilted dental implants compared with straight implants supporting fixed restorations: A systematic review and meta-analysis. Biology (Basel). 2021;10(6):509.
• 17. Browaeys H, Dierens M, Ruyffelaert C, Matthijs C, De Bruyn H, Vandeweghe S. Ongoing Crestal Bone Loss around Implants Subjected to Computer-Guided Flapless Surgery and Immediate Loading Using the All-on-4® Concept. Clin Implant Dent Relat Res. 2015;17(5):831-43.
• 18. Del Fabbro M, Ceresoli V. The fate of marginal bone around axial vs. tilted implants: A systematic review. Eur J Oral Implantol. 2014;7 Suppl 2:S171-89.
• 19. Lin WS, Eckert SE. Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review. Clin Oral Implants Res. 2018;29 Suppl 16:78-105.
• 20. Monje A, Catalunya UI De, Chan H, Galindo-moreno P. Marginal Bone Loss Around Tilted Implants in. Int J Oral Maxillofac Implants. 2012;27(6):1576-83.
• 23. Ata-Ali J, Peñarrocha-Oltra D, Candel-Marti E, Peñarrocha-Diago M. Oral rehabilitation with tilted dental implants: A metaanalysis. Med Oral Patol Oral Cir Bucal. 2012;17(4):e582-7.
• 24. Apaza Alccayhuaman KA, Soto-Peñaloza D, Nakajima Y, Papageorgiou SN, Botticelli D, Lang NP. Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses. A systematic review and meta-analysis. Clin Oral Implants Res. 2018;29 Suppl 18:295-308.
• 25. Pjetursson BE, Heimisdottir K. Dental implants – are they better than natural teeth? Eur J Oral Sci. 2018;126 Suppl 1:81-87.
• 26. Niedermaier R, Stelzle F, Riemann M, Bolz W, Schuh P, Wachtel H. Implant-Supported Immediately Loaded Fixed Full-Arch Dentures: Evaluation of Implant Survival Rates in a Case Cohort of up to 7 Years. Clin Implant Dent Relat Res. 2017;19(1):4-19.
• 27. Maló P, De Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M. ‘All-on-4’ Immediate-Function Concept for Completely Edentulous Maxillae: A Clinical Report on the Medium (3 Years) and Long-Term (5 Years) Outcomes. Clin Implant Dent Relat Res. 2012;14 Suppl 1:e139-50.
• 28. Vervaeke S, Collaert B, Cosyn J, Deschepper E, De Bruyn H. A multifactorial analysis to identify predictors of implant failure and peri-implant bone loss. Clin Implant Dent Relat Res. 2015;17 Suppl 1:e298-307.
• 29. Patzelt SBM, Bahat O, Reynolds MA, Strub JR. The all-on-four treatment concept: A systematic review. Clin Implant Dent Relat Res. 2014;16(6):836-55.
• 30. Balshi TJ, Wolfinger GJ, Slauch RW, Balshi SF. A Retrospective analysis of 800 brånemark system implants following the all-on-fourTM protocol. J Prosthodont. 2014;23(2):83-8.