Immediate Loading of Four Interforaminal Implants Supporting Cantilevered Fixed Detachable Restoration with Either Axial or Tilted Distal Inclination Opposing Maxillary Complete Denture: Two-Year Prospective Study.

Objectives: To assess the radiographic and clinical outcomes of immediately loaded 4 axial implants versus 2 axial anterior and 2 tilted posterior implants placed in the mandibular interforaminal area to support fixed detachable restorations.
Methods: : Adopting 80% power of the study in calculating sample size, 32 edentulous participants were randomly allocated to 2 equal groups. The control group received 2 anterior axial and 2 distal tilted implants while the test group received 4 axial implants in the mandibular interforaminal area. On the same day of surgery conversion technique for immediate loading was accomplished. Three months later, all participants received a screw- retained metal resin cantilevered mandibular restoration. A follow-up protocol of 12, and 24 months was scheduled to evaluate marginal bone level changes, modified gingival index, modified plaque index, peri-implant probing depth, and clinical attachment level.
Results: Implants were evaluated throughout 2 years. The clinical results revealed no statistically significant difference (P>.05) between the studied groups regarding the marginal bone level changes, modified gingival index, modified plaque index scores, peri-implant probing depth, and clinical attachment level over the follow-up period.
Conclusions: Flapless guided surgery together with immediate loading of 4 implants, supporting a full-arch cantilevered screw-retained prosthesis in the edentulous mandible is a feasible treatment option, whether the distal implants are inclined or axially placed.