A treatment approach using intentionally tilted implants has been recommended to both reduce prosthetic cantilevers and additional surgical interventions. This review was undertaken to determine the clinical performance of dental implants that are intentionally tilted when compared to implants that are placed following the long axis of the residual alveolar ridge, when used to support full- arch fixed prostheses. Primary outcomes evaluated were implant and prosthesis survival rates. Secondary outcomes included peri- implant marginal bone loss, soft and hard tissue complications, prosthetic complications and subjective patient- centred outcomes.
- There is no statistically significant difference in primary outcomes (survival rates for implant and prosthesis) or secondary outcomes (peri-implant marginal bone loss, soft and hard tissue complications, prosthetic complications and patient- centred outcomes) for implants placed in an axial or in a tilted configuration when used to support full-arch FDPs. This statement is based on 20 studies (2 RCTs, 1 CT and 17 Prospective Cohort).
- The most common complications associated with an interim full-arch fixed acrylic resin prosthesis were prosthesis fracture, screw loosening and fracture of the veneering material. This statement is based on 20 studies (2 RCTs, 1 CT and 17 Prospective Cohort).
- For definitive prostheses, metal framework fracture was uncommon. More commonly encountered complications included wear or fracture of the veneering material or artificial teeth, need for re-adaptation of prostheses to tissue to compensate for continuing resorption, abutment or prosthetic screw loosening, prosthetic screw fracture and loss of screw access restoration. This statement is based on 21 studies (2 RCTs, 1 CT and 18 Prospective Cohort).
- The studies report satisfactory patient-reported outcomes measures. These include aesthetics, phonetics, ease of maintenance and functional efficiency. This statement is based on nine studies (1 RCT, 8 Prospective Cohort).
- The anterior posterior implant distribution should be maximized for full-arch FDPs. When conditions allow implants should be positioned axially. If anatomic limitations or prosthetic indications exist, the posterior implants can be intentionally tilted.