Angled or tilted distal implants used to support edentulous full-arch restorations have become a standard in implant dentistry. Early concerns regarding off-axis loading producing detrimental forces have been addressed, with more recent publications presenting sound evidence as to the efficacy of this approach. As a result, treatment plans can now eliminate the need for grafting, shorten overall treatment time, and allow for immediate loading in a much broader spectrum of patient presentations. Tilting of distal implants to avoid anatomical structures can also have the beneficial effect of improving anterior-posterior spread, enhancing cross-arch stability, and allowing placement of longer implants in higher-stress areas. The ultimate result can be a reduction in the number of implants needed (as few as four in the edentulous arch) for support in many cases. With the use of CBCT scans for accurate diagnosis of osseous anatomy and for determining the capability of existing bone to allow immediate loading, this approach is now even more controlled and precise. This resentation will focus on literature-based experience using available bone receptor sites to place diverging implants for maximum desired effect with immediate loading. Additionally, a new treatment-planning protocol to avoid complications based on data from this experience will also be presented.
Stephen M. Parel, DDS, is a professor and director of the Division of Maxillofacial Prosthetics in the Department of Oral and Maxillofacial Surgery and Pharmacology at the Baylor College of Dentistry, Texas A&M University Health Science Center in Dallas. A Diplomate of the American Board of Prosthodontics and the American College of Dentists, he is the co-founder of Osseointegration Seminars, Inc, and a past president of the American Academy of Maxillofacial Prosthetics and the Academy of Osseointegration. He has authored many articles and textbook chapters as well as three books. Dr Parel also serves as a consultant for the International Journal of Periodontics and Restorative Dentistry.
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