Marginal Bone Loss Around Tilted Implants in Comparison to Straight Implants: A Meta-Analysis

Purpose: The primary aim of this systematic review was to compare the amount of marginal bone loss around tilted and straight implants. As the secondary aim, the incidence of biomechanic complications was compared. Materials and Methods: An electronic literature search from five databases, for the years 2000 to 2011, and a hand search in implant-related journals were conducted. Clinical human studies in the English language that had reported marginal bone loss in tilted and straight implants at 12-months followup or longer were included. Mean marginal bone loss and the number of implants that were available for analysis were extracted from original articles for meta-analyses. Results: Eight (six prospective and two retrospective) studies were included. One-year data were available in seven articles, which included 1,015 (451 tilted) implants. Three articles provided 3- to 5-year data from 302 (164 tilted) implants. No significant difference in weighted mean marginal bone loss was found between the tilted and straight implants in the short and medium terms. Three articles reported the incidence of biomechanic complications. There was not enough information to make a comparison. Conclusions: This meta-analysis failed to support the hypothesis that tilted implants that were splinted for the support of fixed prostheses had more marginal bone loss. Additionally, there was not enough evidence to claim a higher incidence of biomechanic complications in tilted implants. However, due to the nature of the study design of the included articles, caution should be exercised when interpreting the results of this review. Keywords: edentulous, immediate dental implant loading, marginal bone loss, nonaxial loading, splinting, tilted implant