Five-Year Survival Outcomes of Angulated Dental Implants Placed Tangentially to the Inferior Alveolar Nerve in the Posterior Mandible

Background:This retrospective study evaluates the effect of tilted dental implants on marginal bone loss and prosthetic complications in patients with severe posterior mandibular atrophy, in which implant placement bypasses the inferior alveolar nerve (IAN). Material/Methods:A total of 37 patients with mandibular posterior atrophy and residual bone height less than 4 mm received tilted dental implants.A total of 63 implants were placed at angles ranging from 15 to 25, avoiding interference with the IAN.Marginal bone loss was assessed over a 5-year follow-up period using 2-dimensional radiographic views.Survival rates, prosthetic complications, and bone loss were analyzed. Results:A total of 63 implants placed in 37 patients were followed for 5 years, with a 100% implant survival rate and no recorded failures.Implant angulation (15 vs 25) showed no significant effect on marginal bone loss.Mean marginal bone loss across all implants was minimal (0.0160.13 mm), with clinically relevant bone loss observed in only 1 implant.Increasing age and male sex were significantly associated with greater marginal bone loss. Conclusions:Tilted dental implants placed to bypass the IAN may serve as a minimally invasive alternative for the rehabilitation of posterior mandibular atrophy.By potentially reducing the need for augmentation procedures, they are associated with favorable survival rates and clinically acceptable marginal bone levels in anatomically challenging cases.