Rehabilitation of the atrophic posterior maxilla using tilted implants and digital planning: a case report

Background: Rehabilitation of the atrophic posterior maxilla is a complex procedure often requiring invasive bone augmentation techniques, such as sinus floor elevation. Tilted implants have emerged as a minimally invasive alternative to bypass anatomical constraints and utilize residual bone. This case report evaluates the clinical efficacy of combining tilted and axial implants with 3D digital planning for the immediate rehabilitation of a posterior atrophic maxilla. Case Presentation: A 59-year-old female patient presented with a failing fixed prosthesis in the second quadrant and significant bone atrophy. A digital workflow was employed, utilizing CBCT and 3D planning software to design a surgery involving the extraction of compromised teeth and the immediate placement of three implants. To avoid sinus elevation, one axial implant and two implants tilted at 35° were placed, engaging the residual bone anterior and posterior to the maxillary sinus. High primary stability (>30 Ncm) allowed for immediate loading with a screw-retained provisional prosthesis. Results: The use of 3D planning ensured high accuracy in implant positioning and prosthetic emergence. The post-operative course was uneventful, with complete soft tissue healing and successful osseointegration confirmed at follow-up. The definitive rehabilitation was delivered three months post-surgery. Conclusions: The strategic use of tilted implants, supported by rigorous 3D digital planning, represents a safe and predictable treatment option. This approach allows for the bypass of the maxillary sinus and immediate function, significantly reducing treatment time, invasiveness, and patient morbidity compared to traditional regenerative procedures.