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Clin Implant Dent Relat Res. 2017 Oct;19(5):849-859. doi: 10.1111/cid.12526. Epub 2017 Aug 1.

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.

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Dr. Bernd Quantius & Milena Hopp, Private Practice of Implantology and Periodontology, Giesenkirchener Str. 40, Mönchengladbach 41238, Germany.
Research and Development Department, Maló Clinic, Lisbon, Portugal.
Oral Surgery Department, Maló Clinic, Lisbon, Portugal.



There is need for more scientific and clinical information on longer-term outcomes of tilted implants compared to implants inserted in an axial position.


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.


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).


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.


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.


All-on-4; biological complication; edentulous maxilla; immediate function; longer-term outcome; marginal bone loss; tilted implants

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