Angulated implants
Rehabilitating an atrophic upper jaw with dental implants presents significant challenges due to the pneumatization of the maxillary sinuses, the presence of the nasal cavities, and the centripetal resorption of the maxilla itself—often associated with low-density bone quality. Various techniques have been proposed to overcome these anatomical limitations, including sinus floor elevation, reconstruction using bone autografts, and the placement of implants in anatomical buttresses.
Rehabilitation via grafting requires additional surgery, involves higher morbidity and costs, and carries a greater risk of infection. Furthermore, it results in longer waiting periods from the initial surgery to the placement of the final restoration. The placement of implants in buttresses has evolved significantly in recent years, as it allows for the use of appropriately lengthened implants in atrophic maxillary free ends without invading the maxillary sinus or requiring bone reconstruction.
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Anatomical buttresses are regions of dense bone that form a protective framework around the craniofacial cavities, distributing forces across the facial structure. These areas contain residual bone even in edentulous patients with severe maxillary atrophy. There are several buttresses where implants can be placed: nasopalatine, frontomaxillary, pterygoid, transzygomatic, and palatal approach. To anchor implants into this residual bone in completely edentulous patients, they are typically placed at an angle rather than axially.
Bone atrophy in completely edentulous patients significantly impacts health and affects a substantial number of individuals. We propose a treatment protocol based on varying degrees of maxillary atrophy for full-arch fixed prosthetic rehabilitations. An implant is considered ’tilted’ when it presents an inclination of at least 25-30°.
Our approach focuses on placing implants into the patient’s own pristine bone (residual bone from maxillary buttresses), combining this with bone and soft tissue regeneration. Regarding immediate loading, we offer various treatment possibilities for atrophic jaws.
Placing angulated implants offers both surgical and prosthetic advantages. Combining tilted and axial implants allows for the use of longer implants, thereby increasing the osseointegration surface. It improves primary stability by anchoring into more than one cortical layer and reduces cantilever lengths by placing implants further distal, ensuring better load distribution across the dental arch. Most importantly, it avoids bone grafts and sinus lift procedures, resulting in reduced morbidity. Since marginal bone loss in angulated implants is very similar to that of axial implants, we can conclude that tilted implants perform just as reliably over time.
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At the IDIM Institute of Implantology, led by the Peñarrocha doctors, we don’t just care for your smile—we provide effective solutions, backed by our extensive experience and dedication.
With over 30 years of specialization in dental implantology, we apply advanced techniques and cutting-edge technology to ensure the best results for our patients.
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