Maxillary Rehabilitation using subperiosteal implants associated with a Lefort 1 Osteotomy: a technical note

Debortoli, O. Rios, S. Latreche, F. Afota, R. Castro, C. Savoldelli

Full text link: https://pubmed.ncbi.nlm.nih.gov/40675334/

Maxillary Rehabilitation using subperiosteal implants associated with a Lefort 1 Osteotomy: a technical note

1. Scientific Reference

• Study title: Maxillary Rehabilitation using subperiosteal implants associated with a Lefort 1 Osteotomy: a technical note
• Authors: C. Debortoli, O. Rios, S. Latreche, F. Afota, R. Castro, C. Savoldelli
• Journal: Journal of Stomatology, Oral and Maxillofacial Surgery
• Year of publication: 2025
• DOI: 10.1016/j.jormas.2025.102497

2. Scientific Background

Managing patients with severe maxillary atrophy remains one of the greatest challenges in implant dentistry and oral and maxillofacial surgery. Extensive bone resorption often limits the use of conventional implant protocols and requires alternative reconstructive strategies capable of restoring both function and prosthetic support. The renewed development of patient-specific subperiosteal implants, driven by advances in digital planning and manufacturing technologies, has expanded the range of therapeutic options available for these complex clinical situations.

Bone deficiency, however, is not always the only obstacle to successful rehabilitation. In some patients, severe maxillary atrophy is accompanied by a pre-existing sagittal skeletal discrepancy, making prosthetic rehabilitation heavily dependent on restorative compensation rather than anatomical correction. The technical approach presented in this publication addresses both challenges simultaneously by combining patient-specific subperiosteal implants with a Le Fort I osteotomy. Rather than focusing exclusively on implant placement, the proposed protocol seeks to integrate skeletal repositioning into the overall rehabilitation strategy for severely compromised maxillary cases.

3. Study Objective

The purpose of this technical report is to describe a surgical protocol that combines Le Fort I osteotomy with the placement of subperiosteal implants for the rehabilitation of patients presenting severe maxillary atrophy associated with sagittal skeletal discrepancies. According to the authors, this combined approach is intended to reduce the extent of prosthetic compensation required during rehabilitation by correcting the underlying skeletal relationship at the time of implant placement. The publication aims to introduce the technique rather than evaluate its clinical effectiveness or compare it with alternative treatment modalities.

4. Methodology

This publication is presented as a technical note describing a surgical procedure performed under general anesthesia. The protocol combines a Le Fort I osteotomy with the placement of patient-specific subperiosteal implants. Following osteotomy, the implants are secured using osteosynthesis while the repositioned maxilla is maintained in the desired occlusal relationship through guided positioning.

The information available in the abstract is limited to the operative workflow. No details are provided regarding the number of treated patients, inclusion criteria, implant design parameters, follow-up duration, outcome measures, or methods used to assess clinical success. Likewise, no comparative analysis or statistical evaluation is reported within the available data.

5. Main Findings

Rather than reporting clinical outcomes, this publication introduces a combined surgical workflow intended for highly complex maxillary rehabilitation. The authors describe a procedure in which skeletal repositioning and subperiosteal implant fixation are performed during the same operation. According to the technical rationale presented, integrating a Le Fort I osteotomy into the rehabilitation protocol may reduce the prosthetic compensation typically required in patients presenting sagittal skeletal discrepancies.

The report also emphasizes the importance of maintaining accurate occlusal guidance during implant fixation, allowing skeletal correction and implant stabilization to be achieved within a coordinated surgical sequence.

However, the abstract does not provide clinical outcome data. No information is available regarding implant survival, biological or mechanical complications, prosthetic performance, patient-reported outcomes, functional improvement, or long-term stability. Consequently, the available evidence supports the feasibility of the described surgical workflow but does not allow conclusions regarding its clinical effectiveness or predictability.

6. Clinical Analysis

The principal contribution of this publication lies in its conceptual integration of orthognathic surgery and implant rehabilitation for patients with severe maxillary atrophy. In such complex cases, restoring adequate bone support alone may not fully address the underlying skeletal imbalance responsible for compromised occlusion and prosthetic positioning. By combining Le Fort I osteotomy with subperiosteal implant placement, the authors propose a treatment philosophy that seeks to correct skeletal anatomy before relying on prosthetic compensation.

From a clinical perspective, this approach highlights the potential advantages of comprehensive treatment planning supported by digital workflows. Rather than adapting the prosthesis to an unfavorable skeletal relationship, the protocol aims to optimize the anatomical foundation on which implant-supported rehabilitation is ultimately built.

Nevertheless, these considerations should be interpreted cautiously. As a technical note, this publication is designed to describe a surgical technique rather than demonstrate superior clinical outcomes. The proposed benefits remain theoretical within the context of the available evidence because no quantitative clinical data are reported.

The authors also acknowledge that the procedure requires substantial surgical expertise, underscoring that its application is likely restricted to highly experienced multidisciplinary teams familiar with advanced implant surgery, orthognathic procedures, and digital surgical planning. Additional prospective clinical studies will be necessary before the broader clinical value of this combined approach can be established.

7. Clinical Applications

Based on the information provided, this technical note is primarily relevant to patients with severe maxillary atrophy associated with a sagittal skeletal discrepancy. In these challenging cases, the combined use of a Le Fort I osteotomy and patient-specific subperiosteal implants is intended to address skeletal alignment while simultaneously preparing the maxilla for implant-supported prosthetic rehabilitation.

The described protocol may be considered in situations where conventional prosthetic rehabilitation would otherwise require substantial compensation because of the underlying skeletal relationship. The report also illustrates the role of digital workflows in planning and executing complex implant-supported reconstructions involving customized subperiosteal implants.

However, the available data do not define specific patient selection criteria, indications, contraindications, or comparative advantages over alternative reconstructive approaches. Consequently, this publication should be viewed as the presentation of a surgical technique rather than as evidence supporting its routine clinical adoption.

8. Level of Evidence, Limitations and Transparency

This publication is classified as a technical note, representing a low level of scientific evidence. Its primary objective is to describe an operative protocol rather than to evaluate clinical outcomes through a structured research design.

The abstract does not specify the number of patients treated, duration of follow-up, outcome assessment methods, or quantitative measures of success. Likewise, no information is provided regarding implant survival, complication rates, functional outcomes, or prosthetic performance. These limitations prevent any assessment of the clinical effectiveness, reproducibility, or long-term reliability of the proposed technique.

No conflicts of interest, industry affiliations, or sources of financial support are reported in the information provided. Therefore, no conclusions can be drawn regarding potential conflicts of interest. Overall, the findings should be interpreted within the context of a descriptive technical publication rather than as evidence supporting clinical recommendations.

9. Key Study Points

• Study type: Technical note.
• Level of evidence: Low; descriptive technical report.
• Study population: Not specified in the available information.
• Number of patients or implants: Not specified in the available information.
• Follow-up duration: Not specified in the available information.
• Primary objective: To describe a surgical protocol combining Le Fort I osteotomy with patient-specific subperiosteal implants for rehabilitation of severely atrophic maxillae associated with sagittal skeletal discrepancies.
• Main finding: The proposed technique is intended to reduce prosthetic compensation by incorporating skeletal correction into the implant rehabilitation procedure.
• Scientific conclusion: The authors describe a technically demanding surgical workflow designed for complex maxillary rehabilitation. Clinical effectiveness cannot be assessed from the available data.
• Main limitations: Absence of quantitative clinical outcomes, follow-up data, comparative analysis, and information regarding implant survival or complications.

10. Scientific Impact

This publication contributes to the evolving field of advanced implant rehabilitation by describing a surgical concept that combines orthognathic surgery with patient-specific subperiosteal implant placement. Its scientific value lies primarily in introducing an integrated operative strategy for managing severe maxillary atrophy complicated by sagittal skeletal discrepancies, rather than in providing clinical validation of the approach.

The report also reflects the growing influence of digital planning and customized implant manufacturing in the management of anatomically challenging cases. By integrating skeletal correction and implant rehabilitation into a single surgical protocol, the authors propose an alternative treatment concept that may stimulate further discussion and investigation within oral and maxillofacial surgery.

Because the publication does not include outcome data, its impact should be regarded as conceptual rather than confirmatory. Future clinical studies involving clearly defined patient cohorts, standardized outcome measures, and long-term follow-up will be required to determine whether this combined approach offers measurable advantages in terms of functional rehabilitation, implant survival, prosthetic outcomes, and patient satisfaction.

11. Editorial Conclusion

This technical note introduces a novel surgical strategy combining Le Fort I osteotomy with patient-specific subperiosteal implants for the rehabilitation of severely atrophic maxillae associated with sagittal skeletal discrepancies. Its principal contribution is the description of an integrated workflow designed to reduce prosthetic compensation by addressing skeletal alignment during implant placement. Although the concept is technically compelling, the absence of clinical outcome data means that its effectiveness, safety, and long-term predictability remain to be established through appropriately designed clinical research.