Managing the severely atrophic maxilla: Farewell to zygomatic implants and extensive augmentations?

Managing the severely atrophic maxilla: Farewell to zygomatic implants and extensive augmentations?

1. Scientific Reference

• Study Title: Managing the severely atrophic maxilla: Farewell to zygomatic implants and extensive augmentations?
• Authors: Philippe Korn, Nils-Claudius Gellrich, Simon Spalthoff, Philipp Jehn, Fabian Eckstein, Fritjof Lentge, Alexander-Nicolai Zeller, Björn Rahlf
• Journal: Journal of Stomatology, Oral and Maxillofacial Surgery
• Year of Publication: 2021
• DOI: 10.1016/j.jormas.2021.12.007

2. Scientific Background

Severe maxillary atrophy remains one of the most demanding conditions in implant dentistry and oral rehabilitation. Limited residual bone volume frequently complicates the placement of conventional dental implants, often requiring advanced reconstructive procedures or the use of zygomatic implants. Although these treatment strategies have expanded therapeutic possibilities, they are not suitable for every patient and may present additional surgical complexity, particularly in individuals with previous implant failures.

The emergence of patient-specific subperiosteal implants represents a modern digital approach to managing advanced maxillary bone loss. By combining individualized design with rigid multivector bone fixation, these customized devices seek to provide prosthetic support without relying on extensive bone augmentation. This study explores the early clinical performance of such implants in patients with severe maxillary atrophy.

3. Study Objective

The primary objective of this retrospective investigation was to assess the short-term clinical performance of patient-specific subperiosteal implants (IPS Implant® Preprosthetic) in the rehabilitation of severely atrophic maxillae. The authors focused on implant stability, successful prosthetic rehabilitation, and the occurrence of biological or mechanical complications during follow-up.

4. Methodology

This was a single-center retrospective study conducted at Hannover Medical School. The investigators reviewed all patients treated with patient-specific IPS Implant® devices for severe maxillary atrophy. Individuals with a history of malignancy, cleft lip or palate, or traumatic defects were excluded from the analysis.

Among 58 implanted devices, 13 implants placed in 10 patients met the inclusion criteria for this study. Patients were followed for a mean period of 8.2 months, with observation periods ranging from 1 to 29 months. Clinical assessment focused on implant stability, prosthetic rehabilitation, and postoperative complications.

5. Main Findings

Throughout the reported follow-up period, every evaluated implant remained clinically stable. Patients who completed more than two months of follow-up successfully received their definitive prosthetic rehabilitation.

The authors reported several postoperative events, including screw fractures, localized infections, and exposure of the implant framework. Importantly, none of these complications resulted in implant loss during the observation period.

Although the findings demonstrate encouraging short-term outcomes, they are derived from a limited number of cases and should therefore be interpreted as preliminary clinical evidence rather than definitive proof of long-term effectiveness.

6. Clinical Analysis

This study highlights the potential role of customized subperiosteal implants as an alternative treatment option for patients with advanced maxillary atrophy, particularly when conventional implant placement is not feasible. The reported clinical stability and successful prosthetic rehabilitation suggest that this technology may provide a viable solution in carefully selected cases.

One notable aspect of the study is its focus on patients who may have experienced previous implant failures, a population that often presents considerable reconstructive challenges. The findings indicate that individualized implant design may broaden therapeutic possibilities without necessarily relying on extensive augmentation procedures.

However, these results should not be interpreted as evidence that patient-specific implants are superior to zygomatic implants or traditional bone grafting techniques. The study did not include a comparative design, and its observational nature limits the strength of any clinical conclusions.

Furthermore, the relatively short follow-up period and modest sample size prevent any reliable assessment of long-term implant survival, biological stability, or prosthetic durability. Additional prospective studies involving larger patient populations and extended observation periods will be necessary before broader clinical recommendations can be established.

7. Clinical Applications

The findings may be relevant for clinicians managing severe maxillary atrophy requiring complex implant-supported rehabilitation. Patient-specific subperiosteal implants could represent an alternative for carefully selected individuals in whom conventional implant placement is difficult or when previous implant therapy has failed.

The study also illustrates the growing role of customized implant solutions supported by digital planning and personalized manufacturing. Nevertheless, the available evidence does not define precise clinical indications or establish superiority over other treatment modalities, including zygomatic implants or augmentation procedures.

8. Level of Evidence, Limitations and Transparency

This publication represents a retrospective observational single-center study, corresponding to a relatively limited level of clinical evidence.

Several methodological limitations should be considered, including the small patient cohort, the absence of a control group, and the relatively short follow-up period. These factors restrict the generalizability of the findings and limit conclusions regarding long-term clinical performance.

The authors themselves acknowledge that larger studies with extended follow-up are required to validate these preliminary observations.

No conflicts of interest or relationships with the implant manufacturer are reported within the information provided.

9. Key Study Highlights

• Study design: Single-center retrospective observational study
• Level of evidence: Retrospective clinical study
• Study population: 10 patients with severe maxillary atrophy
• Number of implants: 13 implants analyzed (58 implants placed overall)
• Mean follow-up: 8.2 months (range: 1–29 months)
• Primary outcome: Implant stability, prosthetic rehabilitation, and complications
• Main finding: All evaluated implants remained clinically stable during follow-up despite reported complications
• Scientific conclusion: Patient-specific subperiosteal implants appear to be a promising treatment alternative requiring further clinical validation
• Main limitations: Small sample size, retrospective design, lack of control group, and limited follow-up

10. Scientific Impact

This study contributes early clinical evidence supporting the use of patient-specific subperiosteal implants for the rehabilitation of severely atrophic maxillae. Rather than providing definitive proof of effectiveness, it offers preliminary data suggesting that individualized implant solutions may expand therapeutic options for patients facing challenging anatomical conditions.

The investigation also reflects the ongoing evolution of digitally planned, customized implant technologies within contemporary oral and maxillofacial surgery. While the reported outcomes are encouraging, the authors appropriately emphasize the need for larger cohorts and longer-term evaluation before firm conclusions regarding routine clinical implementation can be drawn.

As an initial clinical experience, this work provides a valuable foundation for future prospective research aimed at defining the long-term role of customized subperiosteal implants in advanced implant rehabilitation.

11. Editorial Conclusion

This retrospective study presents encouraging preliminary outcomes for patient-specific subperiosteal implants used in the management of severe maxillary atrophy. The reported short-term clinical stability and successful prosthetic rehabilitation suggest that this technology may become an additional treatment option in selected complex cases. Nevertheless, the limited sample size and short observation period warrant cautious interpretation, and further well-designed clinical studies remain essential to confirm these early findings.