title: 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.
abstract: OBJECTIVE
  Posterior 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.
  
  
  METHODS
  Consecutive 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.
  
  
  RESULTS
  Forty-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.
  
  
  CONCLUSIONS
  Within 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.
authors.affiliation: Private Practice, Centre D'Implantologie Dentaire de Quebec, Canada.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Fortin
authors.affiliation: Vice President, Clinical Technologies, Nobel Biocare USA LLC.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sullivan
mesh_terms: D003724:Dental Arch / Q000601:surgery*; D003758:Dental Implantation, Endosseous / Q000379:methods*; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported / Q000379:methods*; D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D005500:Follow-Up Studies; D057893:Immediate Dental Implant Loading; D008437:Maxilla / Q000601:surgery*; D009066:Mouth, Edentulous / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D059546:Sinus Floor Augmentation / Q000379:methods*
keywords: Marius tilted; fixed; implant; maxilla; zygoma