Application of tilted implants in rehabilitation of the edentulous maxilla

doi:10.12337/zgkqzzxzz.2025.06.006

Abstract

Abstract: Edentulous maxillary patients often face the clinical challenge of insufficient residual bone volume during implant rehabilitation. By optimizing the three-dimensional positioning of implants, the tilted implantation technique maximizes the utilization of existing anatomical bone structures while avoiding the risks associated with bone augmentation procedures, thereby achieving favorable primary stability. Compared to traditional bone grafting protocols, this approach significantly reduces surgical trauma and supports immediate loading, effectively shortening the overall treatment duration. With advancements in oral implantology, tilted implantation has demonstrated significant clinical advantages in the rehabilitation of the edentulous maxilla. This article systematically reviewed the application progress of the tilted implantation technique in maxillary edentulous rehabilitation from the perspectives of clinical indications, surgical protocols, and clinical prognosis.

Key words: Edentulism, Tilted implant, Zygomatic implant, Pterygoid implant

Guo Houzuo, Di Ping. Application of tilted implants in rehabilitation of the edentulous maxilla[J]. Chinese Journal of Oral Implantology, 2025, 30(3): 234-242.

References

[1] Raghoebar GM, Onclin P, Boven GC, et al.Long-term effectiveness of maxillary sinus floor augmentation:a systematic review and meta-analysis[J]. 2019,46(Suppl 21):S307-S318.
[2] Pjetursson BE, Tan WC, Zwahlen M, et al.A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation[J]. J Clin Periodontol, 2008,35(Suppl 8):S216-S240. DOI: 10.1111/j.1600-051X.2008.01272.x.
[3] Mattsson T, Köndell PA, Gynther GW, et al.Implant treatment without bone grafting in severely resorbed edentulous maxillae[J]. J Oral Maxillofac Surg, 1999,57(3):281-287. DOI: 10.1016/s0278-2391(99)90673-0.
[4] Krekmanov L, Kahn M, Rangert B, et al.Tilting of posterior mandibular and maxillary implants for improved prosthesis support[J]. Int J Oral Maxillofac Implants, 2000,15(3):405-414.
[5] Maló P, Rangert B, Nobre M."All-on-four" immediate-function concept with Brånemark system implants for completely edentulous mandibles: a retrospective clinical study[J]. Clin Implant Dent Relat Res, 2003,5(Suppl 1):S2-S9. DOI: 10.1111/j.1708-8208.2003.tb00010.x.
[6] Maló P, de Araújo Nobre M, Lopes A, et al. The All-on-4 concept for full-arch rehabilitation of the edentulous maxillae: a longitudinal study with 5-13 years of follow-up[J]. Clin Implant Dent Relat Res, 2019,21(4):538-549. DOI: 10.1111/cid.12771.
[7] Niedermaier R, Stelzle F, Riemann M, et al.Implant-supported immediately loaded fixed full-arch dentures: evaluation of implant survival rates in a case cohort of up to 7 years[J]. Clin Implant Dent Relat Res, 2017,19(1):4-19. DOI: 10.1111/cid.12421.
[8] Lopes A, Maló P, de Araújo Nobre M, et al. The nobelguide^® All-on-4^® treatment concept for rehabilitation of edentulous jaws: a retrospective report on the 7-years clinical and 5-years radiographic outcomes[J]. Clin Implant Dent Relat Res, 2017,19(2):233-244. DOI: 10.1111/cid.12456.
[9] Ren J, Shu L.Pterygoid implant-based "VIV" design for rehabilitation of extreme maxillary atrophy[J].J Craniofac Surg, 2022,33(7):2195-2198. DOI: 10.1097/SCS.0000000000008517.
[10] Maló P, Nobre Mde A, Lopes I.A new approach to rehabilitate the severely atrophic maxilla using extramaxillary anchored implants in immediate function:a pilot study[J]. J Prosthet Dent, 2008,100(5):354-366. DOI: 10.1016/S0022-3913(08)60237-1.
[11] Jensen OT, Cottam J, Ringeman J, et al.Trans-sinus dental implants, bone morphogenetic protein 2, and immediate function for All-on-4 treatment of severe maxillary atrophy[J]. J Oral Maxillofac Surg, 2012,70(1):141-148. DOI: 10.1016/j.joms.2011.03.045.
[12] 黄必行, 张维丹, 潘羽磊, 等. 倾斜种植在骨量不足上颌后牙区的应用研究进展[J].浙江医学,2022,44(2):215-219. DOI: 10.12056/j.issn.1006-2785.2022.44.2.2021-2609.
Huang BX, Zhang WD, Pan YL, et al.Application research progress of tilted implantation in the maxillary posterior region with insufficient bone mass[J]. Zhejiang Med, 2022,44(2):215-219. DOI: 10.12056/j.issn.1006-2785.2022.44.2.2021-2609.
[13] 段文君, 王柏翔. 倾斜种植体修复骨量不足上颌后牙区牙列缺损的研究进展[J].口腔医学,2025,45(2):139-145. DOI: 10.13591/j.cnki.kqyx.2025.02.011.
Duan WJ, Wang BX.Research progress of inclined implant in repairing dentition defect in maxillary posterior region with insufficient bone mass[J]. Stomatology, 2025,45(2):139-145. DOI: 10.13591/j.cnki.kqyx.2025.02.011.
[14] Cortés-Bretón Brinkmann J, García-Gil I, Pedregal P, et al. Long-term clinical behavior and complications of intentionally tilted dental implants compared with straight implants supporting fixed restorations: a systematic review and meta-analysis[J]. Biology (Basel), 2021,10(6):509. DOI: 10.3390/biology10060509.
[15] 范震, 刘月, 王佐林. 牙列缺失倾斜种植设计[J].华西口腔医学杂志, 2021,39(4):377-385. DOI: 10.7518/hxkq.2021.04.002.
Fan Z, Liu Y, Wang ZL.Tilted implantation technique for edentulous patients[J].West Chin J Stomatol, 2021,39(4):377-385. DOI: 10.7518/hxkq.2021.04.002.
[16] Avila-Ortiz G, Vegh D, Mukaddam K, et al.Treatment alternatives for the rehabilitation of the posterior edentulous maxilla[J]. Periodontol 2000, 2023,93(1):183-204. DOI: 10.1111/prd.12507.
[17] Karimov M, Timarcioglu G, Candirli C.Evaluation of buccolingual and linguobuccal implants in the atrophic posterior mandible: a finite element analysis study[J]. J Oral Biol Craniofac Res, 2024,14(6):793-801. DOI: 10.1016/j.jobcr.2024.10.009.
[18] Fortin Y, Sullivan RM.Terminal posterior tilted implants planned as a sinus graft alternative for fixed full-arch implant-supported maxillary restoration: a case series with 10- to 19-year results on 44 consecutive patients presenting for routine maintenance[J]. Clin Implant Dent Relat Res, 2017,19(1):56-68. DOI: 10.1111/cid.12433.
[19] Calandriello R, Tomatis M.Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: a prospective 1-year clinical study[J]. Clin Implant Dent Relat Res, 2005,7(Suppl 1):S1-S12. DOI: 10.1111/j.1708-8208.2005.tb00069.x.
[20] Bellini CM, Romeo D, Galbusera F, et al.A finite element analysis of tilted versus nontilted implant configurations in the edentulous maxilla[J]. Int J Prosthodont, 2009,22(2):155-157.
[21] Tezerişener HA, Özalp Ö, Altay MA, et al.Comparison of stress distribution around All-on-four implants of different angulations and zygoma implants: a 7-model finite element analysis[J]. BMC Oral Health, 2024,24(1):176. DOI: 10.1186/s12903-023-03761-x.
[22] Turp I, Turp V, Tuncel İ, et al.Stress distribution of four implant supported overdentures with tilted standard-sized implants and mini implants[J]. Eur Oral Res, 2024,58(2):95-101. DOI: 10.26650/eor.20241272144.
[23] Ibrahim C, Sameh A, Askar O.A finite element analysis study on different angle correction designs for inclined implants in All-on-four protocol[J]. BMC Oral Health, 2024,24(1):331. DOI: 10.1186/s12903-024-04091-2.
[24] Rito-Macedo F, Barroso-Oliveira M, Paranhos LR, et al.Implant insertion angle and depth: peri-implant bone stress analysis by the finite element method[J]. J Clin Exp Dent, 2021,13(12):e1167-e1173. DOI: 10.4317/jced.58930.
[25] Brum JR, Macedo FR, Oliveira MB, et al.Assessment of the stresses produced on the bone implant/tissue interface to the different insertion angulations of the implant - a three-dimensional analysis by the finite elements method[J].J Clin Exp Dent, 2020,12(10):e930-e937. DOI: 10.4317/jced.57387.
[26] Bedrossian E, Sullivan RM, Fortin Y, et al.Fixed-prosthetic implant restoration of the edentulous maxilla: a systematic pretreatment evaluation method[J]. J Oral Maxillofac Surg, 2008,66(1):112-122. DOI: 10.1016/j.joms.2007.06.687.
[27] Chan MH, Holmes C.Contemporary "All-on-4" concept[J]. Dent Clin North Am, 2015,59(2):421-470. DOI: 10.1016/j.cden.2014.12.001.
[28] Carpentieri J, Greenstein G, Cavallaro J.Hierarchy of restorative space required for different types of dental implant prostheses[J]. J Am Dent Assoc, 2019,150(8):695-706. DOI: 10.1016/j.adaj.2019.04.015.
[29] Salama MA, Pozzi A, Clark WA, et al.The "scalloped guide": a proof-of-concept technique for a digitally streamlined, pink-free full-arch implant protocol[J]. Int J Periodontics Restorative Dent, 2018,38(6):791-798. DOI: 10.11607/prd.3778.
[30] Block MS.Maxillary fixed prosthesis design based on the preoperative physical examination[J]. J Oral Maxillofac Surg, 2015,73(5):851-860. DOI: 10.1016/j.joms.2014.12.027.
[31] Bidra AS, Agar JR. A classification system of patients for esthetic fixed implant-supported prostheses in the edentulous maxilla[J]. Compend Contin Educ Dent, 2010,31(5):366-368, 370, 372-374 passim.
[32] Bidra AS.A technique for transferring a patient's smile line to a cone beam computed tomography (CBCT) image[J]. J Prosthet Dent, 2014,112(2):108-111. DOI: 10.1016/j.prosdent.2013.10.021.
[33] Demurashvili G, Davarpanah K, Szmukler-Moncler S, et al.Technique to obtain a predictable aesthetic result through appropriate placement of the prosthesis/soft tissue junction in the edentulous patient with a gingival smile[J]. Clin Implant Dent Relat Res, 2015,17(5):923-931. DOI: 10.1111/cid.12192.
[34] Chan MH, Nudell YA.All-on-4 concept update[J]. Dent Clin North Am, 2021,65(1):211-227. DOI: 10.1016/j.cden.2020.09.014.
[35] Walter L, Greenstein G.Utility of measuring anterior-posterior spread to determine distal cantilever length off a fixed implant-supported full-arch prosthesis: a review of the literature[J]. J Am Dent Assoc, 2020,151(10):790-795. DOI: 10.1016/j.adaj.2020.06.016.
[36] Agliardi EL, Romeo D, Wenger A, et al.Immediate rehabilitation of the posterior maxilla with extensive sinus pneumatization with one axial and one trans-sinus tilted implant: a 3-year clinical report and a classification[J]. J Prosthet Dent, 2015,113(3):163-168. DOI: 10.1016/j.prosdent.2014.07.017.
[37] Drago C.Ratios of cantilever lengths and anterior-posterior spreads of definitive hybrid full-arch, screw-retained prostheses: results of a clinical study[J]. J Prosthodont, 2018,27(5):402-408. DOI: 10.1111/jopr.12519.
[38] Kumari A, Malhotra P, Phogat S, et al.A finite element analysis to study the stress distribution on distal implants in an All-on-four situation in atrophic maxilla as affected by the tilt of the implants and varying cantilever lengths[J].J Indian Prosthodont Soc, 2020,20(4):409-416. DOI: 10.4103/jips.jips_70_20.
[39] Maló P, de Araújo Nobre M, Lopes A, et al. "All-on-4" immediate-function concept for completely edentulous maxillae: a clinical report on the medium (3 years) and long-term (5 years) outcomes[J]. Clin Implant Dent Relat Res, 2012,14(Suppl 1):e139-e150. DOI: 10.1111/j.1708-8208.2011.00395.x.
[40] Babbush CA, Kanawati A, Kotsakis GA.Marginal bone stability around tapered, platform-shifted implants placed with an immediately loaded four-implant-supported fixed prosthetic concept: a cohort study[J]. Int J Oral Maxillofac Implants, 2016,31(3):643-650. DOI: 10.11607/jomi.4354.
[41] Francetti L, Romeo D, Corbella S, et al.Bone level changes around axial and tilted implants in full-arch fixed immediate restorations. Interim results of a prospective study[J]. Clin Implant Dent Relat Res, 2012,14(5):646-654. DOI: 10.1111/j.1708-8208.2010.00304.x.
[42] Toljanic JA, Ekstrand K, Baer RA, et al.Immediate loading of tilted and axial posterior implants in the edentulous maxillary arch: a retrospective comparison of 5-year outcomes[J]. Int J Oral Maxillofac Implants, 2018,33(2):433-438. DOI: 10.11607/jomi.6107.
[43] Gherlone EF, Sannino G, Rapanelli A, et al.Prefabricated bar system for immediate loading in edentulous patients:a 5-year follow-up prospective longitudinal study[J]. Biomed Res Int, 2018,2018:7352125. DOI: 10.1155/2018/7352125.
[44] Ayna M, Gülses A, Açil Y.Comprehensive comparison of the 5-year results of All-on-4 mandibular implant systems with acrylic and ceramic suprastructures[J].J Oral Implantol, 2015,41(6):675-683. DOI: 10.1563/aaid-joi-D-14-00016.
[45] 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[J]. Clin Implant Dent Relat Res, 2017,19(5):849-859. DOI: 10.1111/cid.12526.
[46] Uchida Y, Goto M, Katsuki T, et al.Measurement of the maxilla and zygoma as an aid in installing zygomatic implants[J]. J Oral Maxillofac Surg, 2001,59(10):1193-1198. DOI: 10.1053/joms.2001.26725.
[47] Brånemark PI.Surgery and fixture installation: zygomaticus fixture clinical procedures[M]. Gothenburg, Sweden: Nobel Biocare AB, 1998.
[48] Stevenson AR, Austin BW.Zygomatic fixtures--the sydney experience[J]. Ann R Australas Coll Dent Surg, 2000,15:337-339.
[49] Malevez C, Daelemans P, Adriaenssens P, et al.Use of zygomatic implants to deal with resorbed posterior maxillae[J]. Periodontol 2000, 2003,33:82-89. DOI: 10.1046/j.0906-6713.2002.03307.x.
[50] Al-Nawas B, Aghaloo T, Aparicio C, et al.ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes[J]. Int J Implant Dent, 2023,9(1):28. DOI: 10.1186/s40729-023-00489-9.
[51] Hung K, Huang W, Wang F, et al.Real-time surgical navigation system for the placement of zygomatic implants with severe bone deficiency[J]. Int J Oral Maxillofac Implants, 2016,31(6):1444-1449. DOI: 10.11607/jomi.5526.
[52] Polido WD, Machado-Fernandez A, Lin WS, et al.Indications for zygomatic implants: a systematic review[J]. Int J Implant Dent, 2023,9(1):17. DOI: 10.1186/s40729-023-00480-4.
[53] Bedrossian E.Zygomatic implants operative consideration to minimize technical errors, complications, and their management[J]. Atlas Oral Maxillofac Surg Clin North Am, 2021,29(2):277-289. DOI: 10.1016/j.cxom.2021.04.005.
[54] Van Camp P, Vrielinck L, Gemels B, et al.Intraorbital hemorrhage following a secondary intervention at integrated zygomatic implants: a case report[J]. Int J Surg Case Rep, 2018,43:21-24. DOI: 10.1016/j.ijscr.2018.01.007.
[55] Topilow N, Chen Y, Capo H, et al.Extraocular muscle injury in zygomatic implant placement: a case report, review of the literature, and simple maneuver for avoidance[J]. J Oral Maxillofac Surg, 2020,78(8):1328-1333. DOI: 10.1016/j.joms.2020.04.027.
[56] Dawood A, Kalavresos N.Management of extraoral complications in a patient treated with four zygomatic implants[J]. Int J Oral Maxillofac Implants, 2017,32(4):893-896. DOI: 10.11607/jomi.5484.
[57] Abouzeid O, Gaber RM, Maergy HA, et al.A modified protocol merging two published techniques for computer guided zygomatic implants surgery: a technical note[J]. BMC Oral Health, 2024,24(1):1273. DOI: 10.1186/s12903-024-05010-1.
[58] Bolzoni AR, Zingari F, Gallo F, et al.Zygomatic implant guided rehabilitation based on inverted support technique: a pilot study[J]. Eur Rev Med Pharmacol Sci, 2023,27(Suppl 3):S77-S91. DOI: 10.26355/eurrev_202304_31324.
[59] Wu Y, Tao B, Lan K, et al.Reliability and accuracy of dynamic navigation for zygomatic implant placement[J]. Clin Oral Implants Res, 2022,33(4):362-376. DOI: 10.1111/clr.13897.
[60] Li C, Wang M, Deng H, et al.Autonomous robotic surgery for zygomatic implant placement and immediately loaded implant-supported full-arch prosthesis: a preliminary research[J]. Int J Implant Dent, 2023,9(1):12. DOI: 10.1186/s40729-023-00474-2.
[61] Fan S, Sáenz-Ravello G, Diaz L, et al.The accuracy of zygomatic implant placement assisted by dynamic computer-aided surgery: a systematic review and meta-analysis[J]. J Clin Med, 2023,12(16):5418. DOI: 10.3390/jcm12165418.
[62] Wang W, Yu X, Wang F, et al. Clinical efficacy of computer-assisted zygomatic implant surgery: a systematic scoping review[J]. J Prosthet Dent, 2023:S0022-3913(23)00717-5. DOI: 10.1016/j.prosdent.2023.10.032.[published online ahead of print].
[63] Aparicio C, López-Piriz R, Albrektsson T.ORIS criteria of success for the zygoma-related rehabilitation: the (revisited) zygoma success code[J]. Int J Oral Maxillofac Implants, 2020,35(2):366-378. DOI: 10.11607/jomi.7488.
[64] Li H, Fan X, Tao B, et al.Zygoplanner: a three-stage graphics-based framework for optimal preoperative planning of zygomatic implant placement[J]. Med Image Anal, 2025,101:103401. DOI: 10.1016/j.media.2024.103401.
[65] Aparicio C.A proposed classification for zygomatic implant patient based on the zygoma anatomy guided approach (ZAGA): a cross-sectional survey[J]. Eur J Oral Implantol, 2011,4(3):269-275.
[66] Stella JP, Warner MR.Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note[J]. Int J Oral Maxillofac Implants, 2000,15(6):889-893.
[67] Migliorança RM, Coppedê A, Dias Rezende RC, et al.Restoration of the edentulous maxilla using extrasinus zygomatic implants combined with anterior conventional implants: a retrospective study[J]. Int J Oral Maxillofac Implants, 2011,26(3):665-672.
[68] Brennand Roper M, Vissink A, Dudding T, et al.Long-term treatment outcomes with zygomatic implants:a systematic review and meta-analysis[J]. Int J Implant Dent, 2023,9(1):21. DOI: 10.1186/s40729-023-00479-x.
[69] Gaur V, Doshi AG, Palka LR.Multiple pterygoid approach: a novel technique with single-piece implants[J]. Natl J Maxillofac Surg, 2022,13(Suppl 1):S228-S236. DOI: 10.4103/njms.NJMS_137_20.
[70] Tulasne JF.Osseointegrated fixtures in the pterygoid region[C]. Advanced Osseointegration Surgery: Applications in the maxillofacial region. Chicago: Quintessence, 1992:182-188.
[71] Cea-Arestín P, Bilbao-Alonso A, Hernández-DeOliveira M. Retrospective study of a serie of pterygoid implants[J]. Med Oral Patol Oral Cir Bucal, 2024,29(5):e650-e654. DOI: 10.4317/medoral.26633.
[72] Testori T, Clauser T, Rapani A, et al.Indications for implant-supported rehabilitation of the posterior atrophic maxilla: a multidisciplinary consensus among experts in the field utilising the modified delphi method[J]. Int J Oral Implantol (Berl), 2024,17(1):89-100.
[73] Aalam AA, Krivitsky-Aalam A, Kurtzman GM, et al.The severely atrophic maxilla: decision making with zygomatic and pterygoid dental implants[J]. J Oral Biol Craniofac Res, 2023,13(2):202-206. DOI: 10.1016/j.jobcr.2023.01.008.
[74] Peñarrocha M, Carrillo C, Boronat A, et al.Retrospective study of 68 implants placed in the pterygomaxillary region using drills and osteotomes[J]. Int J Oral Maxillofac Implants, 2009,24(4):720-726.
[75] Araujo RZ, Santiago Júnior JF, Cardoso CL, et al.Clinical outcomes of pterygoid implants: systematic review and meta-analysis[J]. J Craniomaxillofac Surg, 2019,47(4):651-660. DOI: 10.1016/j.jcms.2019.01.030.
[76] Bidra AS, Huynh-Ba G.Implants in the pterygoid region: a systematic review of the literature[J]. Int J Oral Maxillofac Surg, 2011,40(8):773-781. DOI: 10.1016/j.ijom.2011.04.007.
[77] 罗翠芬, 彭国光, 夏炜, 等. 上颌结节倾斜种植体联冠桥修复在上颌后牙区骨量不足中的应用效果评价[J].上海口腔医学,2018,27(2):170-175. DOI: 10.19439/j.sjos.2018.02.011.
Luo CF, Peng GG, Xia W, et al.Clinical study on united crowns or bridges for restoration of posterior teeth with insufficient maxillary bone by means of maxillary tuberosity dental implants[J]. Shanghai J Stomatol, 2018,27(2):170-175. DOI: 10.19439/j.sjos.2018.02.011.
[78] Rodríguez X, Méndez V, Vela X, et al.Modified surgical protocol for placing implants in the pterygomaxillary region: clinical and radiologic study of 454 implants[J]. Int J Oral Maxillofac Implants, 2012,27(6):1547-1553.
[79] Vrielinck L, Politis C, Schepers S, et al.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[J]. Int J Oral Maxillofac Surg, 2003,32(1):7-14. DOI: 10.1054/ijom.2002.0337.
[80] 浦益萍, 高振华, 赵正宜, 等. 上颌翼板区种植技术的临床应用及操作规范[J].中国口腔种植学杂志, 2021,26(3): 143-151. DOI: 10.12337/zgkqzzxzz.2021.06.001.
Pu YP, Gao ZH, Zhao ZY, et al.Clinical application of implant technique in the pterygoid plate area-standard operational practice[J]. Chin J Oral Implantol, 2021, 26(3):143-151. DOI: 10.12337/zgkqzzxzz.2021.06.001.
[81] Franchina A, Stefanelli LV, Gorini S, et al.Digital approach for the rehabilitation of the edentulous maxilla with pterygoid and standard implants: the static and dynamic computer-aided protocols[J]. Methods Protoc, 2020,3(4):84. DOI: 10.3390/mps3040084.
[82] Grecchi F, Stefanelli LV, Grivetto F, et al.A novel guided zygomatic and pterygoid implant surgery system: a human cadaver study on accuracy[J]. Int J Environ Res Public Health, 2021,18(11):6142. DOI: 10.3390/ijerph18116142.
[83] Stefanelli LV, Graziani U, Pranno N, et al.Accuracy of dynamic navigation surgery in the placement of pterygoid implants[J]. Int J Periodontics Restorative Dent, 2020,40(6):825-834. DOI: 10.11607/prd.4605.
[84] Tao B, Wang N, Ling X, et al.Comparison of the accuracy of dynamic navigation and the free hand approaches in the placement of pterygoid implants in the completely edentulous maxilla: an in vitro study[J]. J Dent Sci, 2024,19(4):2341-2347. DOI: 10.1016/j.jds.2024.01.024.
[85] Lv H, Wu H, Hu L, et al.Pterygoid implant-based maxillary full-arch rehabilitation using an autonomous robot system: a case report[J]. J Prosthodont, 2025,34(3):232-239. DOI: 10.1111/jopr.13979.
[86] Aalam AA, Krivitsky-Aalam A, Zelig D, et al.Trans-sinus dental implants, for immediate placement when insufficient alveolar height is present: an alternative to zygomatic implants - surgical case series[J]. Ann Med Surg (Lond), 2023,85(1):51-56. DOI: 10.1097/MS9.0000000000000201.
[87] Grandi T, Faustini F, Casotto F, et al.Immediate fixed rehabilitation of severe maxillary atrophies using trans-sinus tilted implants with or without sinus bone grafting: one-year results from a randomised controlled trial[J]. Int J Oral Implantol (Berl), 2019,12(2):141-152.
[88] Maló P, Md N, Lopes A.Immediate loading of 'All-on-4' maxillary prostheses using trans-sinus tilted implants without sinus bone grafting: a retrospective study reporting the 3-year outcome[J]. Eur J Oral Implantol, 2013,6(3):273-283.
[89] Testori T, Mandelli F, Mantovani M, et al.Tilted trans-sinus implants for the treatment of maxillary atrophy: case series of 35 consecutive patients[J]. J Oral Maxillofac Surg, 2013,71(7):1187-1194. DOI: 10.1016/j.joms.2013.02.013.
[90] Zaninovich M.Immediate rehabilitation of the severely atrophic maxilla using trans-sinus nasal protocol and extended length subcrestal angulated implants. case series with 1-year follow-up[J]. J Oral Implantol, 2022,48(2):117-124. DOI: 10.1563/aaid-joi-D-19-00307.