Management of adverse effects following additively manufactured subperiosteal jaw implantation in the maxilla

Maurice Y Mommaerts 

Full text link : https://pubmed.ncbi.nlm.nih.gov/39709145/

Management of adverse effects following additively manufactured subperiosteal jaw implantation in the maxilla

1. Scientific Reference

• Study Title: Management of adverse effects following additively manufactured subperiosteal jaw implantation in the maxilla
• Author: Maurice Y. Mommaerts
• Scientific Journal: Journal of Stomatology, Oral and Maxillofacial Surgery
• Year of Publication: 2024 (article available online in 2025)
• DOI: 10.1016/j.jormas.2024.102206

2. Scientific Background

The management of severe maxillary atrophy remains one of the major challenges in advanced implantology. In some patients, bone resorption compromises the use of conventional endosseous implants and leads clinicians to consider more complex protocols such as bone grafting, zygomatic implants, or customized subperiosteal solutions.

Additively Manufactured Subperiosteal Jaw Implants (AMSJI®) were developed to address these challenging clinical situations through an individualized design based on three-dimensional imaging and digital planning. This approach aims to overcome anatomical constraints while providing fixed prosthetic support.

However, like any maxillofacial reconstruction procedure involving a complex implantable device, this technology may be associated with biological or mechanical complications. The value of this article lies in its intention to propose a structured approach to identify, prevent, and manage these adverse events in a real clinical setting.

3. Study Objective

The primary objective of this publication was to provide practical recommendations regarding the management of complications observed after placement of customized AMSJI® subperiosteal implants in the maxilla.

The author seeks to provide a framework for prevention, early diagnosis, and management of adverse effects that may occur following this form of implant rehabilitation intended for patients with advanced maxillary atrophy.

4. Methodology

This publication corresponds to an expert opinion based on several sources of clinical information. The author compiled data collected during eight years of clinical experience, discussions with practitioners using AMSJI®, international working group meetings, and two surveys conducted in November and December 2024.

The surveys involved 132 surgeons who had collectively treated 552 patients. However, only nine respondents provided detailed data concerning 92 clinical cases. Complications were classified according to an adaptation of the Clavien-Dindo classification applied to AMSJI® surgery.

The study is not presented as prospective or longitudinal research but rather as a synthesis of clinical experience intended to guide clinical practice.

5. Main Results

The reported complications were grouped according to their clinical severity.

The most moderate events included soft tissue recessions around transmucosal abutments, localized peri-implant inflammation, and certain defects of osseointegration. These situations could generally be monitored or treated through reinforced oral hygiene measures, antiseptic protocols, and, in some cases, mucogingival surgical interventions.

More severe complications remained uncommon. The author describes ascending cheek infections, cellulitis, cutaneous fistulas, fractures of implant components, oroantral communications, sinusitis related to screw penetration into the maxillary sinus, and loss of osseointegration associated with behavioral or medical factors.

The article also highlights the role of digital planning, improved three-dimensional imaging, and Finite Element Analysis (FEA) in reducing mechanical and anatomical risks.

6. Clinical Analysis

This publication primarily provides a pragmatic perspective on the management of complications associated with customized subperiosteal implants intended for cases of extreme maxillary atrophy.

Beyond the description of complications, one of the central messages concerns the importance of patient selection. The most frequently cited risk factors include smoking, bruxism, difficulties in glycemic control among diabetic patients, and poor compliance with postoperative instructions. These factors appear to be major determinants in the occurrence of biological and mechanical complications.

The article also highlights the growing role of the digital workflow in complex implant surgery. The quality of preoperative imaging, customized CAD/CAM design, and the use of finite element analysis are presented as tools that help anticipate areas of mechanical stress and optimize implant positioning.

From a clinical standpoint, the author suggests that some complications traditionally associated with bone grafting procedures or zygomatic implants could potentially be avoided through this approach. Nevertheless, no robust direct comparison is performed in this publication, and any extrapolation should remain cautious.

7. Clinical Applications

The findings of this study may be of interest to practitioners involved in:

• Implant rehabilitation of severely atrophied maxillae;
• Personalized maxillofacial reconstruction protocols;
• Digital implant planning;
• CAD/CAM workflows applied to implantology;
• Situations in which extensive bone grafting is difficult to consider;
• Long-term follow-up of customized subperiosteal implants;
• Prevention of biological and mechanical complications associated with implant-supported prostheses.

The article particularly emphasizes the necessity of rigorous follow-up and regular peri-implant maintenance to optimize the stability of treatment outcomes.

8. Level of Evidence, Limitations and Transparency

This publication corresponds to an expert opinion based on a compilation of clinical experiences, field observations, and survey data. Its level of evidence is therefore lower than that of a controlled prospective study, randomized clinical trial, or systematic review.

Several limitations are explicitly mentioned. The study is not longitudinal and does not allow assessment of the temporal evolution of complications. The survey response rate appears limited, since only nine practitioners reported detailed data. Furthermore, the author acknowledges that the proposed recommendations do not constitute definitive solutions supported by high-level evidence.

Regarding transparency, the author declares being Innovation Manager and Clinical Lead at CADskills BV, a company involved in the development of AMSJI®. This conflict of interest is explicitly disclosed in the article.

9. Key Points of the Study

• Study Type: Expert Opinion
• Level of Evidence: Low to Moderate
• Population or Number of Studies Analyzed: Not applicable
• Number of Patients or Implants: Survey involving 552 patients; detailed data reported for 92 cases
• Follow-up Duration: From 3 months to 6 years depending on the reported cases
• Primary Outcome Evaluated: Management of complications associated with maxillary AMSJI®
• Main Result: Severe complications appear to be uncommon and require management tailored to their severity
• Scientific Conclusion: Patient selection, oral hygiene, and postoperative follow-up are central elements in limiting complications
• Potential Limitations: Expert opinion, absence of direct comparative study, low survey response rate, absence of structured longitudinal follow-up

10. Scientific Impact

This publication contributes to a still relatively recent body of literature concerning additively manufactured subperiosteal implants. Its primary value does not lie in demonstrating a new clinical efficacy but rather in formalizing a framework for managing complications associated with this technology.

The article highlights the specific challenges related to implant rehabilitation in patients with advanced maxillary atrophy and emphasizes the role of digital technologies in reducing surgical risks. It also provides practical information on complications observed under real-world conditions, an aspect that is often less documented than implant survival outcomes.

Finally, this work contributes to the clinical maturation of AMSJI® by identifying risk factors and preventive strategies that may serve as a foundation for future, more robust prospective studies.

11. Editorial Conclusion

This expert opinion provides a useful synthesis of complications that may be encountered following placement of AMSJI® subperiosteal implants in the maxilla. The presented data suggest that prevention relies primarily on careful patient selection, precise digital planning, and attentive postoperative follow-up. Given the available level of evidence and the declared conflict of interest, these conclusions should be interpreted with caution; nevertheless, they represent a relevant contribution to clinical reflection regarding implant solutions intended for severe maxillary atrophy.