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

PurposePosterior maxillary tilted implants are gaining prevalence as an alternative to sinus grafts supporting fixed maxillary restorations. This paper reports long-term results after loading using this technique. Materials and MethodsConsecutive patients presenting for either routine hygiene maintenance or unplanned emergency care who had received tilted implants as a sinus graft alternative to support fixed fully implant-supported restoration of an edentulous maxilla and were followed for a minimum of 10 years from initial implant placement were included in this evaluation. ResultsForty-four patients were identified: 40 with bilateral tilted implants and 4 with one tilted and one axial posterior implant. Eight patients received one-piece fixed porcelain-to-gold screw-retained restorations, and thirty-six patients received a fully implant-supported patient-removable Marius Bridge. Seventy-nine out of 84 originally loaded posterior tilted implants survived a minimum of 10 years loading; one tilted implant was lost at 10 years. Eight additional posterior implants were placed for either these lost tilted posterior implants or as proactive supplemental support; one of these replacement tilted implants survived for at least 10 years and is included in the data. All patients have maintained continuous fixed function throughout the follow-up period. Forty-one out of 44 patients continue with the original restoration, 33 without modification or removal of the fixed restoration or implant-connecting bar. One porcelain-to-gold and seven Marius Bridges had framework modifications to accommodate additional implants; 3 Marius Bridge restorations were replaced with a newer generation. ConclusionWithin the limits of this retrospective study, the results show that continuous fixed function of fully implant-supported maxillary restorations using posterior tilted implants in terminal positions of support as a sinus graft alternative combined with axial anterior implants is possible over a prolonged period. Loss of a posterior tilted implant after loading is treatable with another tilted, zygomatic or axial implant, typically requiring only modification of the fixed restoration.