Riabilitazione di arcate dentarie edentule mediante utilizzo di impianti inclinati. Le metodiche all-on-four e all-on-six

The rehabilitation of the edentulous jaws with osseointegrated implants has been proven to be a predictable treatment over time (Adell et al. 1990). However rehabilitation of the edentulous maxilla and mandible is associated with anatomical limitation due to the extremely reduced bone volume. The principle of using six or four implants ( All on 4, All on 6) instead of the maximum possible number of implants for the rehabilitation of fully edentulism is supported by long term studies (Branemark et al. 1995). The technique of tilting implants in order to reduce the need of bone grafting, sinus lift procedures has been recently advocated by many authors (Krekmanov 2000, Krekmanov et al. 2000, Aparicio et al. 2001, 2002, Fortin et al. 2002, Calandriello and Tomatis 2005). Other clinical advantages are 1) the possibility of placement of longer implants which may improve bone anchorage, increase the bone-to-implant contact area and the implant primary stability 2) the distance between implants can be increased, reducing the cantilevers and thus optimizing the load distribution. Using fewer implants to support the prosthesis and the application of the immediate loading protocol can also reduce the treatment costs. The present study data are suggesting that immediate loading associated with tilted implants could be considered viable minimally invasive treatment modality, leading to high patients acceptance.