All-on-4 and Tilting of Implants // Dr. Alessandro Palumbo

All-on-4 and

Tilting of Implants

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  • All-on-4 and Tilting of Implants

  • All-on-4 was developed to provide edentulous patients with a fast, cost-effective fixed restoration using only 4 implants to support a full-arch prosthesis. Two of these implants are tilted posteriorly. An acrylic prosthesis is immediately loaded on the four implants.

    When used in the mandible, tilting of the posterior implants makes it possible to use longer implants and, thereby, achieve good bone anchorage without interfering with the mental foramina. In severely resorbed maxillae the tilted implants are an alternative to sinus floor augmentation. Tilting of the posterior implants results in a better spread of the implants along the alveolar crest which is beneficial for the load distribution and allows the final prostheses to hold as many as 12 teeth with only short cantilevers.

    Published data on the All-on-4 concept shows cumulative survival rates between 92.2 and 100% [1-5]. Tilting of implants has been applied in clinical practice for over a decade and shows good results [5-16]. Biomechanical measurements show that tilted implants, when part of a prosthetic support, do not have a negative effect on the load distribution[8].


    1. Maló P, Rangert B, de Araújo Nobre M. “All-on-Four” immediate-function concept with Brånemark System implants for completely edentulous mandibles: A retrospective clinical study. Clin Implant Dent Relat Res 2003; 5 (Suppl 1): 2-9.
    2. Maló P, Rangert B, de Araújo Nobre M. All-on-4 immediate-function concept with Brånemark System implants for completely edentulous maxillae: A 1-year retrospective clinical study. Clin Implant Dent Relat Res 2005; 7 (Suppl 1): S88-94.
    3. Maló P, de Araújo Nobre M, Petersson U, Wigren S. A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: Case series. Clin Implant Dent Relat Res 2006; 8:223-232
    4. Maló P, de Araújo Nobre M, Lopes A. The use of computer-guided flapless implant surgery and 4 implants placed in immediate function to support a fixed denture: Preliminary results after a mean follow-up period of 13 months. J Prosthet Dent 2007; 97(suppl):S26-S34.
    5. Davo Rodriguez R, Malevez C and Rojas J. Immediate function in atrophic upper jaw using Zygoma implants: A preliminary study. J Prosthet Dent 2007; 97(suppl):S44-S51.
    6. Tulasne J F. Osseointegrated fixtures in the pterygoid region. in: Advanced osseointegration surgery. Applications in the maxillofacial region. Worthington P; Brånemark PI.- Chicago, USA: Quintessence Publ. Co, Inc. 1992.- p. 182-188.
    7. Graves SL. The pterygoid plate implant: a solution for restoring the posterior maxilla. Int J Periodontics Restorative Dent, 1994; 4: 512-523.
    8. Parel S, Brånemark PI, Ohrnell LO, Svensson B. Remote implant anchorage for the rehabilitation of maxillary defects. J Prosthet Dent 2001; 86: 377-381.
    9. Vrielinck L, Politis C, Schepers S, Pauwels M, Naert I. Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides. Preliminary results from a prospective clinical follow-up study. Int. J Oral Maxillofac Surg 2003; 32:7-14.
    10. Hirsch J-M, Henry P, Andreasson L et al. A clinical Evaluation of the Zygoma Fixture. One-year follow-up at 16 clinics. J Oral Maxillofac Surg 2004; 9 (Suppl): 22-29.
    11. Krekmanov L, Kahn M, Rangert B, Lindström H. Tilting of posterior mandibular and maxillary implants of improved prosthesis support. Int J Oral Maxillofac Implants 2000; 15: 405-414
    12. Aparicio C, Perales P, Rangert B. Tilted implants as an alternative to maxillary sinus grafting: A clincal, radiologic, and periotest study. Clin Implant Dent Relat Res 2001; 3: 39-49.
    13. Fortin Y, Sullivan R, Rangert B. The Marius implant bridge: surgical and prosthetic rehabilitation for the completely edentulous upper jaw with moderate to severe resorption: A 5-year retrospective clinical study. Clin Implant Dent Relat Res 2002; 4: 69-77.
    14. Aparicio C, Arevalo X, Ouzzani W, Granados C. A retrospective clinical and radiographic evaluation of tilted implants used in the treatment of severely resorbed edentulous maxilla. Appl Osseointegrat Res 2003; 1: 17-21.
    15. Calandriello R, Tomatis M, Rangert N, Gottlow J. Immediate function of tilted implants in the atrophic posterior maxilla. Clin Oral Impl Res 2004; 15: 1xxi
    16. Calandriello R, Tomatis M. Simplified Treatment of the Atrophic Posterior Maxilla via Immediate/ Early Function and Tilted Implants: A Prospective 1-Year Clinical Study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S1-12

  • Pubblicazione
    Aprile 2007
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