Alternative treatment methods using conventional and cortical implants in partially edentulous arches

Rehabilitation of the mandible with dental implants presents distinct biomechanical and biological challenges in posterior and anterior regions. In the posterior mandible, conventional implant-supported restorations are typically retained by cement or screws. Cement-retained crowns offer favorable esthetics but are associated with biological complications due to residual subgingival cement, which has been implicated in peri-implant mucositis, peri-implantitis, and crestal bone loss. Screw-retained prostheses eliminate cement-related pathology but frequently result in compromised esthetics due to occlusal access openings and are prone to mechanical complications such as screw loosening, screw fracture, and porcelain chipping over time. To address these limitations, cementless screwless prosthetic systems utilizing Morse-taper friction-fit connections have been introduced. These systems provide bacterial sealing at the implant-abutment interface, frictional retention, and retrievability without luting agents. In the anterior mandible, treatment is complicated by ridge atrophy, limited alveolar width, poor cancellous bone quality, and proximity to the mental foramen and inferior alveolar nerve. Conventional implant protocols often require bone grafting procedures, increasing treatment duration, cost, and patient morbidity. Cortical basal implants offer an alternative by achieving primary stability through engagement of dense basal cortical bone rather than cancellous bone. Their disk-type or bicortical design permits flapless placement and immediate loading, thereby reducing surgical invasiveness and treatment time.
This clinical report presents two different clinical scenarios:
1. Rehabilitation of a missing mandibular molar using a cementless screwless crown over a conventional endosseous implant.
2. Rehabilitation of missing mandibular anterior teeth using cortical basal implants. Both approaches aim to minimize biological and surgical complications.
Conclusions: Cementless screwless conventional implant crown offer a biologically safe and esthetic option for posterior rehabilitation by eliminating cement-related inflammation and screw-related mechanical failures, both well documented in implantology. Cortical basal implants enable immediate, graftless rehabilitation in atrophic anterior mandibles with high primary stability. Both techniques demonstrate promising short-term clinical and radiographic outcomes and expand treatment options for anatomically challenging mandibular sites. Long-term prospective studies are required to evaluate prosthetic survival, wear of the taper interface, and marginal bone stability.