Tilted Implants: A Review of Rationale, Biomechanics and Applications

Rehabilitation of partial or complete edentulism with dental implants is a well-documented treatment plan with a predictable outcome up to date. The use of tilted implants for rehabilitation of full or partial edentulous patients has been suggested by many authors with several advantages, including immediate loading, avoiding the anatomic limitations (maxillary sinus and mental foramen), and as an alternative for complex surgical procedures (sinus augmentation, and repositioning of inferior dental canal, and others). Other advantages of this approach include increasing implant length, engaging more cortical bone, increasing bone- implant contact, and thus increasing primary stability; in total arch cases, this technique reduces the size of the anteroposterior spread of the prosthesis and, therefore, better load distribution. The use of tilted implants has gained popularity recently, so this review aims to clarify the rationale, biomechanics, and applications of tilted implants. In conclusion, in this review article, the application of tilted implants in rehabilitation of partial or complete edentulism provides a viable alternative to more complex procedures, with the advantage of immediate loading and a better survival rate, with no difference in bone loss, compared to axial implants. Although the biomechanics of tilted implants are different from that of axial implants in that there will be greater stress concentration on the bone around implants; there is more excellent distribution of the loads to the peri-implant bone with tilted implants compared with vertical ones because of increased implant length and thus "making the best use of available bone".