subperiosteal implants
Maxillary rehabilitation after zygomatic implant sequelae using custom subperiosteal implants: A case study
Full text link : https://pubmed.ncbi.nlm.nih.gov/39551184/
Maxillary Rehabilitation After Zygomatic Implant Sequelae Using Custom Subperiosteal Implants: A Case Study
1. Scientific Reference
- Study Title: Maxillary Rehabilitation After Zygomatic Implant Sequelae Using Custom Subperiosteal Implants: A Case Study
- Authors: Frederico Rodger Gomes Rodrigues Cardoso, Ricardo Grillo
- Scientific Journal: Journal of Stomatology, Oral and Maxillofacial Surgery
- Year of Publication: 2024
- DOI: 10.1016/j.jormas.2024.102154
2. Scientific Background
The management of severely atrophic maxillae remains one of the most complex challenges in dental implantology and oral surgery. When residual bone volume becomes insufficient to accommodate conventional implants, several therapeutic strategies may be considered, including bone grafts, zygomatic implants, or certain customized approaches based on digital technologies.
The emergence of digital workflows, three-dimensional virtual planning, and additive manufacturing has profoundly changed the possibilities for implant rehabilitation. These innovations now allow the design of customized implants adapted to the specific anatomy of each patient.
The article is situated within this particular technological and clinical context. It addresses a particularly difficult rehabilitation situation, characterized by the previous failure of zygomatic implants associated with chronic inflammatory complications. This type of situation represents an important challenge for practitioners confronted with the sequelae of complex implant failures.
3. Study Objective
The objective of the authors was to present the clinical case of a patient who had undergone multiple unsuccessful attempts at maxillary rehabilitation before being treated with a customized subperiosteal implant manufactured using an additive process.
The study also aims to illustrate the potential value of this approach in the management of severe maxillary atrophy and in the treatment of sequelae related to failed zygomatic implants.
4. Methodology
This is a clinical case report conducted according to the CARE guidelines. The study concerns a single 62-year-old female patient who was a smoker and had no reported comorbidities.
The patient presented with severe maxillary atrophy as well as a history of multiple prosthetic rehabilitations. Four zygomatic implants had been placed several years earlier but had progressed to chronic inflammation, recurrent infections, and implant instability.
Computed tomography was used to perform CAD/CAM digital planning with the 3-matic® (Materialise) software. A customized subperiosteal implant was then manufactured in titanium using an additive manufacturing process. During a single surgical procedure, the zygomatic implants were removed and replaced by the customized implant, which was fixed to the maxilla using titanium screws.
The reported follow-up reached 18 months.
5. Main Results
The previously placed zygomatic implants showed significant clinical exposure associated with persistent peri-implantitis and marked bone resorption. Despite the hygiene measures implemented, the clinical situation could not be stabilized, leading to their removal.
After placement of the customized subperiosteal implant, a complication was observed approximately two weeks after surgery: partial exposure of the implant in a limited area of the maxilla. A second surgical procedure was performed to cover the exposed area using a flap incorporating the buccal fat pad combined with a connective tissue graft.
According to the authors, healing subsequently allowed completion of the prosthetic rehabilitation. After 18 months of follow-up, no further implant exposure or other complications were reported. The patient reported a significant improvement in function and quality of life.
6. Clinical Analysis
This work provides an interesting perspective on a relatively recent indication for customized subperiosteal implants: the management of sequelae resulting from failed zygomatic implants.
The main clinical interest lies in the possibility of providing a rehabilitation solution without resorting to extensive bone reconstruction protocols. In this particular case, bone atrophy was associated with significant resorption and peri-implant complications that greatly limited conventional therapeutic alternatives.
The study also highlights the importance of digital implant planning. Virtual design, combined with additive titanium manufacturing, made it possible to create a structure adapted to the patient’s residual anatomy. This approach appears to have facilitated mechanical stabilization of the rehabilitation despite an unfavorable anatomical context.
However, the results must be interpreted with caution. This is a single case, and the conclusions cannot be generalized to all patients presenting with severe maxillary atrophy. Furthermore, a postoperative complication requiring an additional surgical intervention was observed, reminding clinicians that this approach is not free from biological risks.
The article also highlights the current lack of robust clinical data regarding customized subperiosteal implants and the need for multicenter studies including a larger number of patients.
7. Clinical Applications
The presented results may be particularly relevant in the following situations:
- Severe maxillary atrophy with insufficient bone volume for conventional implants.
- Sequelae of failed zygomatic implants.
- Patients requiring complex implant rehabilitation.
- Cases in which CAD/CAM digital planning can be utilized.
- Situations requiring extensive customization of implant treatment.
- Implant-supported rehabilitation of maxillae presenting extensive bone defects.
The article suggests that customized subperiosteal implants may represent a salvage option in certain complex cases, without establishing their superiority over other available therapeutic strategies.
8. Level of Evidence, Limitations and Transparency
The level of evidence of this publication is low because it is a clinical case report involving a single patient. The results describe an individual experience and do not allow conclusions that can be generalized to a broader population.
The main identifiable methodological limitations are:
- absence of a control group;
- sample limited to a single patient;
- inability to evaluate reproducibility of the results;
- absence of direct comparison with other rehabilitation techniques.
The reported follow-up was 18 months, providing intermediate clinical data but not allowing assessment of the very long-term behavior of the implant.
Regarding transparency, the authors declare that they have no conflicts of interest.
9. Key Points of the Study
- Study Type: Clinical Case Report (CARE Case Report)
- Level of Evidence: Low
- Population or Number of Studies Analyzed: 1 patient
- Number of Patients or Implants: 1 patient; customized subperiosteal implant placed after removal of four zygomatic implants
- Follow-up Duration: 18 months
- Primary Outcome Evaluated: Maxillary rehabilitation after failure of zygomatic implants
- Main Result: Functional rehabilitation achieved with maintenance of the customized implant at the end of the reported follow-up
- Scientific Conclusion: Customized subperiosteal implants appear to be a potential option in certain complex cases of severe maxillary atrophy
- Potential Limitations: Single case, absence of control, absence of comparative data
10. Scientific Impact
This publication contributes to a still limited body of literature dedicated to next-generation customized subperiosteal implants. Its interest lies less in demonstrating generalizable effectiveness than in illustrating an implant salvage strategy within a particularly complex clinical context.
The article highlights the integration of several technologies that have become central to modern oral surgery: computed tomography acquisition, CAD/CAM design, virtual simulation, and metallic additive manufacturing. These tools make it possible to develop individualized solutions for patients whose therapeutic options may be restricted.
The authors themselves emphasize the need to generate additional clinical data, particularly through multicenter studies and larger cohorts.
This publication therefore contributes to the gradual development of knowledge regarding the indications and limitations of customized subperiosteal implants in the rehabilitation of severely atrophic maxillae.
11. Editorial Conclusion
This case report describes a complex maxillary rehabilitation performed using a customized subperiosteal implant manufactured through additive technology following the failure of zygomatic implants. Despite the occurrence of implant exposure requiring a secondary surgical procedure, the 18-month follow-up reported satisfactory clinical stability and functional improvement perceived by the patient. Given the low level of evidence associated with a single case, these results should be considered exploratory but illustrate the potential of customized digital approaches in the management of severe maxillary atrophy.
