After the temporary restoration with a fixed prosthesis, all 10 patients selected a fixed final restoration. These consisted of a cast metal framework with a full ceramic veneering including the replacement of at least the second premolars. They were made after a new impression on the abutment level (Figs. 6 and 7). The neck of the 20 tilted distal implants was positioned in region 4 (n = 5 implants), region 5 (n = 11 implants), and region 6 (n = 4 implants). The length of the distal cantilevers had a mean of 7.5 ± 4.1 mm (range 2.0 to 15.5) and replaced a premolar (n = 5), a molar (n = 5), or two premolars (n = 3). Seven times the distal cantilevers did not exceed the tooth under which the distal implant was positioned, leading to very small cantilevers in a range from 2 to 3.5 mm.

The follow-up was 64 ± 13 months (range 42 to 84 months; seven patients ≥5 years, two patients ≥4 years, one patient = 3.5 years) (Table 2).

Except the three failures after the first 3 months, no more failures were recorded and no technical complications occurred at the final restorations. The overall cumulative implant survival rate is 95% (Table 2).

The mean PT value for osseointegrated implants after 3 months (n = 57) was significantly lower (p < 0.001), and their ISQ significantly higher (p < 0.001) than their means at baseline. Separated into axial (n = 39) and tilted (n = 18) implants, the differences were also significant (p < 0.005) (Tables 3 and 4).

Neither the PT value nor the ISQ differed statistically significantly between the axial and tilted implants neither at the baseline examination or after 3 months.

The AUC of the intraoperative-measured PT values was 0.503, with a 95% confidence interval of 0.130–0.876 (p = 0.986). The ISQ-AUC was 0.506, with a 95% confidence interval of 0.148–0.864 (p = 0.973).

Bone loss was measured at all 57 osseointegrated implants after 1 year (Table 5) with no statistical significance regarding the implant site (mesial/distal) and the implant inclination (axial/tilted). In 51 implants, an additional bone loss was measured. In contrast to the radiological examination after 1 year, the second radiological examination was not obtained at an identical period. These control radiographs were made at a mean of 55 ± 14 months (range 40 to 84 months; one patient after 7 years, two patients after 5.5 years, one patient after 4.5 years, two patients after 4 years, three patients after 3.5 years) after loading with no statistical significance regarding the implant site and the implant inclination.