Rehabilitation of Partially Edentulous Posterior Mandible with Bilateral Impacted Second Premolars Using TTPHIL- ALL TILT® Implant Technique: A 3-years Follow-up Case Report

Loss of teeth in the posterior mandible leads to progressive alveolar bone resorption, superficial location of the inferior alveolar nerve (IAN), thereby diminishing the amount of hard and soft tissue available for implant placement. This biological process is compounded by the presence of impacted teeth. The presence of impacted mandibular premolars, though asymptomatic, might be discovered when a patient presents for replacement of missing teeth or a cystic lesion in an adjacent tooth. Placement of dental implants in such cases may require multiple surgeries, including bone augmentations or vestibuloplasty or nerve lateralization surgeries. These extensive surgical procedures are seldom used in clinical practice due to their complexity and potential damage to IAN. This article demonstrates TTPHIL-ALL-TILT® protocol for placement of tilted implants utilizing available bone, lingual and buccal cortical plate engagement, bypassing IAN and the impacted premolar, in the posterior partially edentulous mandible in an anxious patient.