Journal of Prosthetic Dentistry
Systematic Review|Articles in Press

Impact of tilted implants for implant-supported fixed partial dentures: A systematic review with meta-analysis

Published:December 23, 2022DOI:


      Statement of problem

      The use of tilted implants has been considered a suitable option for completely edentulous patients. However, consensus on their clinical performance is lacking, specifically for partial rehabilitation.


      The purpose of this systematic review and meta-analysis was to evaluate the marginal bone loss and implant survival rate of tilted implants compared with those of axial implants for implant-supported fixed partial dentures (ISFPDs).

      Material and methods

      A systematic search of the MEDLINE/PubMed, Web of Science, Embase, Cochrane, and ProQuest databases and reference lists for articles published until May 2022 was performed by 2 independent reviewers without language or publication date restrictions. A meta-analysis was performed using the RevMan version 5.4 program. Quality assessments were performed using the Newcastle–Ottawa scale.


      Nine studies were included, totaling 258 participants and 604 implants (269 tilted implants and 335 axial implants). No significant differences were found between the tilted and axial implants for the implant survival rate (P=.81; risk ratio: 1.14). However, higher marginal bone loss values were observed for tilted implants (P=.001; mean difference: 0.12 mm). No significant heterogeneity was observed in either analysis.


      No significant relationship was found between tilted and axial implants for ISFPD rehabilitation. However, tilted implants presented greater risks of marginal bone loss than axial implants.
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        • Lemos C.A.A.
        • Nunes R.G.
        • Santiago-Júnior J.F.
        • et al.
        Are implant-supported removable partial dentures a suitable treatment for partially edentulous patients? A systematic review and meta-analysis.
        J Prosthet Dent. 27 July 2021; ([Epub ahead of print])
        • de Souza Batista V.E.
        • Verri F.R.
        • Lemos C.A.A.
        • et al.
        Should the restoration of adjacent implants be splinted or nonsplinted? A systematic review and meta-analysis.
        J Prosthet Dent. 2019; 121: 41-51
        • Carneiro-Campos L.E.
        • Freitas-Fernandes L.B.
        • Fernandes C.P.
        • Zanetta-Barbosa D.
        Evaluation of mandibular implant-supported fixed prosthesis retained by 3 dental implants, 1 straight and 2 angled: a retrospective clinical study.
        J Prosthet Dent. 14 April 2022; ([Epub ahead of print])
        • de Araujo Nobre M.
        • Mano Azul A.
        • Rocha E.
        • Malo P.
        • Salvado F.
        Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology.
        J Prosthodont Res. 2017; 61: 43-53
        • Needleman I.
        • Chin S.
        • O'Brien T.
        • Petrie A.
        • Donos N.
        Systematic review of outcome measurements and reference group(s) to evaluate and compare implant success and failure.
        J Clin Periodontol. 2012; 39: 122-132
        • Del Fabbro M.
        • Ceresoli V.
        The fate of marginal bone around axial vs. tilted implants: a systematic review.
        Eur J Oral Implantol. 2014; 7: S171-S189
        • Apaza Alccayhuaman K.A.
        • Soto-Peñaloza D.
        • Nakajima Y.
        • Papageorgiou S.N.
        • Botticelli D.
        • Lang N.P.
        Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses. A systematic review and meta-analysis.
        Clin Oral Implants Res. 2018; 29: 295-308
        • Lin W.S.
        • Eckert S.E.
        Clinical performance of intentionally tilted implants versus axially positioned implants: a systematic review.
        Clin Oral Implants Res. 2018; 29: 78-105
        • de Faria Almeida D.A.
        • Verri F.R.
        • Lemos C.A.A.
        • et al.
        Effect of splinting of tilted external hexagon implants on 3-unit implant-supported prostheses in the posterior maxilla: a 3D finite element analysis.
        J Prosthodont. 3 December 2021; ([Epub ahead of print])
        • Tribst J.P.
        • Rodrigues V.A.
        • Dal Piva A.O.
        • Borges A.L.
        • Nishioka R.S.
        The importance of correct implants positioning and masticatory load direction on a fixed prosthesis.
        J Clin Exp Dent. 2018; 10: e81-e87
        • de Sousa C.A.
        • Lemos C.A.A.
        • Santiago-Júnior J.F.
        • Faverani L.P.
        • Pellizzer E.P.
        Bone augmentation using autogenous bone versus biomaterial in the posterior region of atrophic mandibles: a systematic review and meta-analysis.
        J Dent. 2018; 76: 1-8
        • Cruz R.S.
        • Lemos C.A.A.
        • Batista V.E.S.
        • et al.
        Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis.
        Braz Oral Res. 2018; 32: e86
        • Rathod M.
        • Kshirsagar R.A.
        • Joshi S.
        • et al.
        Evaluation of neurosensory function following inferior alveolar nerve lateralization for implant placement.
        J Maxillofac Oral Surg. 2019; 18: 273-279
        • Maló P.
        • Rangert B.
        • 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: 2-9
        • Maló P.
        • Rangert B.
        • 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: S88-S94
        • Maló P.
        • de Araújo Nobre M.
        • Lopes A.
        • Ferro A.
        • Nunes M.
        The All-on-4 concept for full-arch rehabilitation of the edentulous maxillae: a longitudinal study with 5-13 years of follow-up.
        Clin Implant Dent Relat Res. 2019; 21: 538-549
        • Hopp M.
        • de Araújo Nobre M.
        • Maló P.
        Comparison of marginal bone loss and implant success between axial and tilted implants in maxillary All-on-4 treatment concept rehabilitations after 5 years of follow-up.
        Clin Implant Dent Relat Res. 2017; 19: 849-859
        • Ferrini F.
        • Capparé P.
        • Vinci R.
        • Gherlone E.F.
        • Sannino G.
        Digital versus traditional workflow for posterior maxillary rehabilitations supported by one straight and one tilted implant: a 3-year prospective comparative study.
        Biomed Res Int. 2018; 2018: 4149107
        • Queridinha B.M.
        • Almeida R.F.
        • Felino A.
        • de Araújo Nobre M.
        • Maló P.
        Partial rehabilitation with distally tilted and straight implants in the posterior maxilla with immediate loading protocol: a retrospective cohort study with 5-year follow-up.
        Int J Oral Maxillofac Implants. 2016; 31: 891-899
        • Barnea E.
        • Tal H.
        • Nissan J.
        • Tarrasch R.
        • Peleg M.
        • Kolerman R.
        The use of tilted implant for posterior atrophic maxilla.
        Clin Implant Dent Relat Res. 2016; 18: 788-800
        • Agliardi E.L.
        • Tetè S.
        • Romeo D.
        • Malchiodi L.
        • Gherlone E.
        Immediate function of partial fixed rehabilitation with axial and tilted implants having intrasinus insertion.
        J Craniofac Surg. 2014; 25: 851-855
        • Peñarrocha Diago M.
        • Maestre Ferrín L.
        • Peñarrocha Oltra D.
        • Canullo L.
        • Calvo Guirado J.L.
        • Peñarrocha Diago M.
        Tilted implants for the restoration of posterior mandibles with horizontal atrophy: an alternative treatment.
        J Oral Maxillofac Surg. 2013; 71: 856-864
        • Pozzi A.
        • Sannino G.
        • Barlattani A.
        Minimally invasive treatment of the atrophic posterior maxilla: a proof-of-concept prospective study with a follow-up of between 36 and 54 months.
        J Prosthet Dent. 2012; 108: 286-297
        • Balleri P.
        • Ferrari M.
        • Veltri M.
        One-year outcome of implants strategically placed in the retrocanine bone triangle.
        Clin Implant Dent Relat Res. 2010; 12: 324-330
        • Koutouzis T.
        • Wennström J.L.
        Bone level changes at axial- and non-axial-positioned implants supporting fixed partial dentures. A 5-year retrospective longitudinal study.
        Clin Oral Implants Res. 2007; 18: 585-590
        • Aparicio C.
        • Perales P.
        • Rangert B.
        Tilted implants as an alternative to maxillary sinus grafting: a clinical, radiologic, and periotest study.
        Clin Implant Dent Relat Res. 2001; 3: 39-49
        • Higgins J.P.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Ouzzani M.
        • Hammady H.
        • Fedorowicz Z.
        • Elmagarmid A.
        Rayyan-a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Wells G.A.
        • Shea B.
        • O’Connell D.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
        Ottawa Hospital Research Institute, Ottawa2009 (Available at: Accessed May 28, 2022.)
        • Egger M.
        • Smith G.D.
        Principles of and procedures for systematic reviews.
        in: Egger M. Smith G. Altman Douglas G. Systematic reviews in health care, evidence-based health Care. 2017: 23-42
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174