Virtual Surgical Planning and Customized Subperiosteal Implant for Reconstruction of Maxillary Defect After Oncological Resection

Abdulsamet Kundakçioğlu, Eda Bilazeroğlu, Yusuf Emes, Büket Aybar

Full text link: https://pubmed.ncbi.nlm.nih.gov/39171794/

Virtual Surgical Planning and Customized Subperiosteal Implant for Reconstruction of Maxillary Defect After Oncological Resection

1. Scientific Reference

• Study Title: Virtual Surgical Planning and Customized Subperiosteal Implant for Reconstruction of Maxillary Defect After Oncological Resection
• Authors: Abdulsamet Kundakçioğlu, Eda Bilazeroğlu, Yusuf Emes, Büket Aybar
• Journal: Journal of Craniofacial Surgery
• Publication Year: 2024
• DOI: 10.1097/SCS.0000000000010525

2. Scientific Background

Restoring maxillary defects following oncologic resection remains one of the greatest challenges in oral and maxillofacial surgery. Beyond replacing missing bone, reconstruction must restore facial symmetry, oral function, and provide a stable foundation for prosthetic rehabilitation. Conventional reconstructive techniques, including iliac crest and free fibula grafts, remain widely used but often require extensive surgery, prolonged treatment, and additional donor-site morbidity.

The increasing integration of digital technologies into reconstructive surgery has expanded the possibilities for patient-specific treatment planning. Virtual surgical planning, computer-aided design (CAD), and additive manufacturing now allow surgeons to create customized implants that closely match individual anatomy. Within this evolving digital workflow, patient-specific subperiosteal implants have emerged as a potential alternative for selected complex maxillary defects. This publication illustrates the clinical application of these technologies in the reconstruction of a maxillary defect following tumor resection while incorporating implant-supported prosthetic rehabilitation into the overall treatment strategy.

3. Study Objective

The primary objective of this publication was to demonstrate the clinical feasibility of reconstructing a maxillary defect using a customized subperiosteal titanium implant designed through virtual surgical planning and computer-aided design. Through a single clinical case, the authors sought to illustrate how a fully digital workflow could support both maxillofacial reconstruction and subsequent implant-supported prosthetic rehabilitation after oncologic surgery. No secondary objectives are specified in the available abstract.

4. Methodology

This publication is presented as a clinical case report. The authors describe the treatment of a 28-year-old female patient who underwent maxillectomy for the management of a maxillary myxoma. Reconstruction was performed using a patient-specific titanium subperiosteal implant manufactured through three-dimensional printing following virtual surgical planning and computer-aided design.

The digital workflow was used to optimize implant adaptation to the patient’s anatomy while minimizing pressure on the surrounding soft tissues. Definitive prosthetic rehabilitation was subsequently completed.

The available abstract does not provide information regarding follow-up duration, clinical evaluation criteria, implant manufacturing details beyond the digital workflow, or objective outcome measures.

5. Main Findings

According to the authors, the customized subperiosteal implant successfully supported reconstruction of the maxillary defect and enabled definitive dental rehabilitation. Digital planning facilitated the development of an implant specifically adapted to the patient’s anatomy, with the intention of reducing mechanical stress on the overlying soft tissues.

The reported postoperative course was favorable, with definitive prosthetic treatment completed and only a limited number of complications observed. The authors further suggest that this digitally planned approach may shorten the overall treatment pathway compared with traditional reconstructive techniques. They also indicate that, in patients presenting with adequate soft tissue thickness, customized titanium implants may improve aesthetic outcomes while reducing the need for additional reconstructive procedures.

The abstract does not report quantitative outcomes such as implant survival, functional assessment, complication rates, patient-reported outcomes, or long-term follow-up data.

6. Clinical Analysis

This case report highlights the potential role of virtual surgical planning combined with patient-specific subperiosteal implants in the management of complex maxillary defects following oncologic resection. Rather than introducing a new reconstructive concept, the study demonstrates how an entirely digital workflow can be integrated into surgical and prosthetic rehabilitation for highly individualized treatment.

A key aspect of this approach is the ability to design an implant that closely matches the patient’s remaining anatomy. According to the authors, optimizing implant geometry through computer-aided design may reduce pressure on the surrounding soft tissues, potentially contributing to a more favorable postoperative course. The report also illustrates how digital planning can simultaneously address reconstructive and prosthetic objectives, emphasizing the growing integration of CAD/CAM technologies within oral and maxillofacial surgery.

Another noteworthy observation is the possibility of streamlining treatment. The authors suggest that customized titanium implants may reduce the need for additional reconstructive procedures typically associated with conventional bone grafting techniques. If confirmed in larger studies, this could simplify treatment pathways for selected patients requiring complex maxillary reconstruction.

However, the clinical implications should be interpreted with caution. As a single case report, this publication provides only preliminary evidence of feasibility. The absence of comparative data, objective functional outcomes, implant survival analysis, and long-term follow-up prevents any conclusions regarding superiority, predictability, or long-term performance. Consequently, the findings should be viewed as an encouraging proof of concept rather than definitive clinical evidence supporting widespread adoption of customized subperiosteal implants after oncologic maxillary resection.

7. Clinical Applications

The findings presented in this report suggest that patient-specific subperiosteal implants may represent a valuable reconstructive option for carefully selected patients undergoing maxillary resection for benign or malignant tumors. The integration of virtual surgical planning, CAD/CAM technology, and three-dimensional printing enables reconstruction to be tailored to the patient’s anatomical defect while facilitating implant-supported prosthetic rehabilitation.

This digital workflow may be particularly relevant in complex maxillofacial reconstruction where individualized implant design is desirable and where adequate soft tissue coverage can be achieved. According to the authors, this approach may also reduce the need for additional reconstructive procedures in selected cases.

Given the limited level of evidence, these applications should be considered exploratory. Further clinical investigations involving larger patient cohorts and longer follow-up periods are required before broader clinical recommendations can be established.

8. Level of Evidence, Limitations and Transparency

This publication is a single clinical case report, representing a low level of scientific evidence. The reported findings demonstrate the technical feasibility of combining virtual surgical planning with a customized titanium subperiosteal implant for reconstruction following maxillary tumor resection.

The available information does not allow assessment of treatment reproducibility, long-term implant stability, functional performance, or comparison with established reconstructive techniques. Furthermore, the abstract does not specify follow-up duration, objective clinical outcome measures, or standardized evaluation criteria.

The principal methodological limitations arise from the descriptive nature of a single-patient report and the absence of a control group. No disclosures regarding conflicts of interest, financial relationships, or manufacturer affiliations are mentioned in the information provided. Consequently, the reported outcomes should be interpreted as preliminary clinical observations rather than evidence supporting definitive therapeutic recommendations.

9. Key Study Highlights

• Study design: Clinical case report.
• Level of evidence: Low.
• Study population: One 28-year-old female patient with a maxillary myxoma requiring maxillectomy.
• Number of patients: 1.
• Number of implants: Not specified in the available information.
• Follow-up duration: Not specified in the available information.
• Primary outcome assessed: Clinical feasibility of reconstructing a maxillary defect using virtual surgical planning and a customized subperiosteal implant with subsequent prosthetic rehabilitation.
• Main finding: Successful reconstruction and definitive prosthetic rehabilitation with a favorable postoperative course and few reported complications.
• Scientific conclusion: The authors suggest that patient-specific digitally designed titanium implants may shorten treatment time, improve aesthetic outcomes in appropriately selected patients, and reduce the need for additional reconstructive procedures.
• Main limitations: Single-patient case report, absence of quantitative outcome measures, no comparative analysis, and no long-term follow-up reported.

10. Scientific Impact

This publication contributes to the growing body of literature exploring digital workflows for complex maxillofacial reconstruction. Although limited to a single clinical case, it illustrates how virtual surgical planning, CAD/CAM technology, and additive manufacturing can be integrated into a personalized reconstructive strategy following oncologic maxillary surgery.

Its principal scientific value lies in demonstrating the technical feasibility of combining patient-specific implant design with implant-supported prosthetic rehabilitation within a unified digital treatment pathway. The report supports the ongoing evolution toward individualized reconstructive solutions while highlighting the potential role of customized subperiosteal implants in carefully selected clinical scenarios.

Because of its descriptive design, the study cannot establish clinical effectiveness or long-term predictability. Instead, it provides preliminary evidence that may encourage future prospective studies evaluating implant survival, functional outcomes, patient satisfaction, biological and mechanical complications, and comparative performance against conventional reconstructive approaches.

11. Editorial Conclusion

This case report illustrates the potential of virtual surgical planning and customized titanium subperiosteal implants as part of a fully digital approach to maxillary reconstruction following oncologic resection. The favorable clinical outcome described suggests that individualized implant design may facilitate both anatomical reconstruction and implant-supported prosthetic rehabilitation in selected patients. Nevertheless, the evidence remains preliminary owing to the single-case design and the absence of long-term clinical data. Larger prospective studies are required before this technique can be considered an established reconstructive option in oral and maxillofacial surgery.