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

Venkat Ratna Nag *

Meenakshi Ammal Dental College, Chennai, India and Institute for Dental Implantology, Hyderabad, India and Department of Prosthodontics and Implantology, Panineeya Dental College, Hyderabad, India.

Sarika V Puppala

Institute for Dental Implantology, Hyderabad, India.

Bhavna V Lokwani

Institute for Dental Implantology, Hyderabad, India.

Manikandhan R

Meenakshi Ammal Dental College, Chennai, India.

*Author to whom correspondence should be addressed.


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.

Keywords: Bicuspid, dental implants, immediate dental implant loading, implant-supported dental prosthesis, dental implantation, mandibular nerve

How to Cite

Nag, Venkat Ratna, Sarika V Puppala, Bhavna V Lokwani, and Manikandhan R. 2024. “Rehabilitation of Partially Edentulous Posterior Mandible With Bilateral Impacted Second Premolars Using TTPHIL- ALL TILT® Implant Technique: A 3-Years Follow-up Case Report”. International Journal of Research and Reports in Dentistry 7 (1):44-51.


Download data is not yet available.


Felice P, Pellegrino G, Chechhi L, Pistilli, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs 7mm long implants in posterior mandibles: 1-year results of a randomised clinical trial. Clin Oral Implants Res. 2010;21:1394-1403. Availa

Nishimaki F, Kurita H, Tozawa S, Teramoto Y, Nishizawa R. Subjective and qualitative assessment of neural disturbance after inferior alveolar nerve transposition for dental implant placement. Int J Implant Dent. 2016;2:14. Available:

Krekmanov L. Placement of posterior mandibular and maxillary implants in patients with severe bone deficiency: a clinical report of procedure. Int J Oral Maxillofac Implants. 2000;15(5):722–30.

Pistilli R, Zucchelli G, Barausse C, Bonifazi L, Karaban M, Gasparro R et al. Minimally invasive fixed rehabilitation of an extremely atrophic posterior mandible using 4-mm ultrashort implants: A case report with a 7year follow-up. Int.J.Periodontics Restor.Dent. 2020;40(6):e235-e240 DOI:10.11607/prd.4157

Pistilli R, Barausse C, Checchi L, Felice P. Rehabilitation of the atrophic posterior mandible with short (4-mm) implants: A case report. Int.J.PeriodonticsRestor.Dent. 2014;34(5):713-718.


Filipov L, Chirila L, Cristache MC. Rehabilitation of extremely atrophic edentulous mandible in elderly patients with associated comorbidities: A case report and proof of concept. Head & Face Medicine. 2021;17:22 DOI:10.1186/s13005-021-00274-2

Papaspyridakos P, De Souza A, Vazouras K, Gholami H, Pagni S, Weber H-P. Survival rates of short dental implants (≤6 mm) compared with implants longer than 6 mm in posterior jaw areas: A meta-analysis. Clinical Oral Implants Research. 2018;29:8–20 Available:

Chu FCS, Li TKL, Lui VKB, Newsome PRH, Chow RLK, Cheung LK. Prevalence of impacted teeth and associated pathologies-A radiographic study of Hong Kong Chinese population. Hong Kong Med J. 2003;9:158-163.

Ferguson JW, Pitt SK. Management of unerupted maxillary canines where no orthodontic treatment is planned; A survey of UK consultant opinion. J Orthod. 2004;31:28-33 Available:

Becker A, Chaushu S. Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2003;124:509-514. DOI:10.1016/s0889-5406(03)00578-x.

Romanos GE, Cionei G, Jucan A, Malmstrom H, Gupta B. In vitro assessment of primary stability of Straumann® implant designs. Clin Implant Dent Relat Res 2014;16:89-95 DOI:10.1111/j.1708-8208.2012.00464.x.

Koh RU, Oh T-J, Rudek I, Neiva GF, Misch CE, Rothman ED, Wang H-L. Hard and soft tissue changes after crestal and subcrestal immediate implant placement. Journal of Periodontology. 2011;82(8): 1112–1120. DOI:10.1902/jop.2011.100541

R Bettach, S Taschieri, G Boukhris, M Del Fabbro. “Implant survival after preparation of the implant site using a single bur: A case series.” Clinical Implant Dentistry and Related Research. 2015;17(1)13–21.

Aimetti M, Ferrarotti F, Mariani GM, Ghelardoni C, Romano F. Soft tissue and crestal bone changes around implants with platform-switched abutments placed nonsubmerged at subcrestal position: a 2-year clinical and radiographic evaluation. Int J Oral Maxillofac Implants. 2015, Nov-Dec;30(6):1369-77. DOI:10.11607/jomi.4017