Tilted Endosseous Dental Implants in Atrophic Maxilla: A Clinical Prospective Study

Background Atrophic edentulous maxillary arches present a significant surgical challenge for conventional implant placement owing to inadequate bone height, pneumatization of the maxillary sinus, and compromised bone quality in the posterior region. Traditional solutions, including sinus floor elevation, ridge augmentation, and bone grafting, carry inherent morbidity and procedural complexity. Objective This study aimed to evaluate the clinical and radiographic outcomes of tilted endosseous dental implants placed in atrophic maxillae, with specific assessment of osseointegration quality, crestal bone loss, periodontal parameters, and pain scores at three and six months post-operatively. Methods Thirty tilted endosseous implants were placed in atrophic maxillae of adult patients. Pre-surgical evaluation included cone-beam computed tomography (CBCT) and orthopantomography (OPG). Modified plaque index, gingival index, probing depth, crestal bone loss, osseointegration quality (Hounsfield units), and pain (McGill Pain Questionnaire and visual analog scale (VAS)) were assessed immediately post-operatively and at three and six months. Results Mean crestal bone loss at three and six months was 1.46 ± 0.53 mm and 1.75 ± 0.37 mm, respectively, for anterior implants and 1.25 ± 0.31 mm and 1.65 ± 0.35 mm, respectively, for posterior implants. A statistically significant difference (p < 0.05) was observed between anterior and posterior implants for crestal bone loss at both time points. Conclusion Tilted endosseous implants achieved a six-month survival rate of 93.3% (28 of 30 implants) in this cohort and represent a promising treatment option for the atrophic maxilla without requiring sinus augmentation. Larger, long-term prospective studies with a control group are warranted before broader claims of predictability can be made.