Immediate Loading of the Edentulous Maxilla with a Definitive Restoration Supported by an Intraorally Welded Titanium Bar and Tilted Implants

Purpose: The aim of this prospective study was to evaluate the concept of intraoral welding as a suitable technique for the fabrication of a restoration for the edentulous atrophic maxilla on the day of placement of axial and tilted implants. Materials and Methods: Thirty patients received three axial and four tilted implants in the edentulous maxilla. Immediately after implant placement, definitive abutments were connected to the implants and then a titanium bar was welded to them using an intraoral welding unit. This framework was used as a support for the definitive restoration, which was attached on the day of implant placement. Mean marginal bone loss and radiographically detectable alteration of the welded framework were assessed using periapical radiographs immediately after surgery and at 6, 12, 24, and 36 months after placement. Results: Sixteen men and 14 women with an average age of 58.1 years (SD 13.6) were consecutively treated with 210 immediately loaded implants. No fractures or radiographically detectable alterations of the welded frameworks were evident. A 100% prosthetic success rate was seen at 36 months. Three (1.4%) implants had serious biologic complications, resulting in success rates of 97.8% for axial implants and 99.2% for tilted implants. The accumulated mean marginal bone loss was 0.92 mm (SD 0.75; n = 90) for axial implants and 1.03 mm (SD 0.69; n = 120) for tilted implants. The average pocket probing depths were 1.87 mm (SD 0.98; n = 90) for the axial implants and 1.95 mm (SD 0.81; n = 120) for the tilted implants. Conclusions: It is possible on the day of implant placement surgery to successfully rehabilitate the edentulous atrophic maxilla with a fixed, definitive restoration supported by an intraorally welded titanium framework attached to axial and tilted implants. Keywords: immediate loading, intraoral welding, tilted implants