Patient Satisfaction and Impact on Oral Health after Maxillary Rehabilitation Using a Personalized Additively Manufactured Subperiosteal Jaw Implant (AMSJI)

Casper Van den Borre, Björn De Neef, Natalie A J Loomans, Marco Rinaldi, Erik Nout, Peter Bouvry, Ignace Naert, Maurice Y Mommaerts

Full text links: https://pubmed.ncbi.nlm.nih.gov/36836531/

Patient Satisfaction and Impact on Oral Health after Maxillary Rehabilitation Using a Personalized Additively Manufactured Subperiosteal Jaw Implant (AMSJI)

1. Scientific Reference

• Study Title: Patient Satisfaction and Impact on Oral Health after Maxillary Rehabilitation Using a Personalized Additively Manufactured Subperiosteal Jaw Implant (AMSJI)
• Authors: Casper Van den Borre, Björn De Neef, Natalie A. J. Loomans, Marco Rinaldi, Erik Nout, Peter Bouvry, Ignace Naert, Maurice Y. Mommaerts
• Scientific Journal: Journal of Personalized Medicine
• Year of Publication: 2023
• DOI: 10.3390/jpm13020297

2. Scientific Background

The management of patients presenting with severe maxillary atrophy remains one of the most complex challenges in implant rehabilitation. When the residual bone volume becomes insufficient to accommodate conventional endosseous implants, advanced reconstructive procedures such as autologous bone grafts or zygomatic implants are often considered.

The evolution of digital technologies, three-dimensional planning, and additive titanium manufacturing has promoted the return of a long-abandoned historical concept: the subperiosteal implant. New-generation customized subperiosteal implants, designed from individual radiological data, now represent a potential alternative for patients suffering from extreme bone atrophy.

In this context, the evaluation of patient-reported outcomes constitutes an essential element. Beyond implant stability or prosthetic success, oral quality of life and functional satisfaction have become major criteria for assessing the clinical value of a therapeutic strategy.

3. Study Objective

The primary objective of this study was to evaluate patient satisfaction and the impact on oral health following rehabilitation of the atrophic maxilla using a customized 3D-printed subperiosteal implant (AMSJI).

The authors sought to measure oral health-related quality of life as well as overall patient satisfaction after treatment, using validated questionnaires and medium-term follow-up.

4. Methodology

This was a retrospective international multicenter study including 40 patients treated for severe maxillary atrophy (Cawood-Howell classification ≥ 5). Participants were recruited from Belgium, Italy, and the Netherlands.

All patients had undergone bilateral AMSJI placement at least one year before inclusion in the study. The mean follow-up period after implant placement was 917 days.

The evaluation was based on two validated instruments:

• the OHIP-14 (Oral Health Impact Profile-14), used to assess oral health-related quality of life;
• the NRS (Numerical Rating Scale), used to measure different aspects of satisfaction such as aesthetics, mastication, comfort, phonation, maintenance, and overall satisfaction.

Statistical analyses were performed using SPSS software.

5. Main Results

All included patients were able to receive functional prosthetic rehabilitation. At the time of evaluation, all were using their fixed or removable restoration.

The mean OHIP-14 score was 4.20 ± 7.09. This low score reflects a favorable oral quality of life, since higher OHIP values correspond to a deterioration in oral health-related quality of life.

Regarding satisfaction, the mean NRS score reached 52.25 ± 4.00 out of a theoretical maximum of 60, suggesting a high level of patient satisfaction.

The highest-rated dimensions were aesthetic benefit (9.03/10), mastication (8.83/10), maintenance (8.73/10), and comfort (8.63/10).

Postoperative complications were nevertheless observed. Twelve patients presented postoperative inflammatory signs. Six required surgical exploration or mechanical debridement. Three patients underwent abutment removal due to persistent infections. Despite these events, implant stability and prosthetic rehabilitation were not compromised. Partial exposure of certain implant extensions was also observed in 26 patients.

6. Clinical Analysis

This study provides particularly valuable insight into a dimension that is often insufficiently documented in the literature: patients’ own perception of treatment.

The results suggest that patients with advanced maxillary atrophy may achieve significant improvement in oral comfort and satisfaction following rehabilitation with AMSJI. It should be remembered that this population is often confronted with major difficulties when using conventional prostheses, particularly regarding stability, mastication, and retention.

The potential clinical interest of this approach also lies in its personalized nature. Digital design and additive manufacturing allow individualized anatomical adaptation that may avoid certain limitations of historical subperiosteal implants.

The authors also emphasize that this strategy constitutes an alternative to major bone grafting procedures or zygomatic implants. However, the study does not allow the establishment of clinical superiority among these different therapeutic options. The comparisons discussed are mainly based on data from other publications.

The observed complications remind us that this technique remains a complex surgical intervention requiring careful monitoring. The reported infectious events demonstrate that high patient satisfaction should not be interpreted as an absence of biological risk.

7. Clinical Applications

The results of this study may be of particular interest in the following situations:

• severe maxillary atrophy preventing the placement of conventional implants;
• edentulous patients presenting advanced bone resorption;
• complex implant rehabilitation requiring a personalized approach;
• situations in which extensive bone grafting procedures are difficult or not desired;
• rehabilitation protocols using digital planning and CAD/CAM technologies;
• management of patients who have previously experienced bone reconstruction failures.

The available data exclusively concern the severely atrophic maxilla and do not allow the results to be extrapolated to other indications.

8. Level of Evidence, Limitations, and Transparency

This publication corresponds to a retrospective multicenter observational study based on patient-reported outcomes.

The level of evidence should therefore be considered moderate to low compared with prospective or randomized controlled trials.

Several limitations can be identified:

• retrospective nature of the study;
• absence of a control group;
• absence of preoperative measurements allowing comparison before and after treatment;
• sample size limited to 40 patients;
• voluntary participation of patients and practitioners, which may introduce selection bias.

Regarding transparency, the authors declare the absence of specific funding. Nevertheless, a conflict of interest is reported: Maurice Mommaerts states that he serves as an innovation consultant for CADskills BV. The other authors report no conflicts of interest.

9. Key Points of the Study

• Study Type: Retrospective multicenter study
• Level of Evidence: Observational study
• Population Analyzed: Patients with severe maxillary atrophy
• Number of Patients: 40
• Number of Implants: Not specified in the information provided
• Follow-up Duration: Mean of 917 days
• Primary Outcome Evaluated: Patient satisfaction and oral quality of life
• Main Result: Mean OHIP-14 score of 4.20 and mean NRS score of 52.25/60
• Scientific Conclusion: Patients report a high level of satisfaction following maxillary rehabilitation with AMSJI
• Potential Limitations: Retrospective study, absence of a control group, and absence of preoperative data

10. Scientific Impact

This study contributes to expanding a field that remains relatively poorly documented: the evaluation of patient-reported outcomes following the use of customized 3D-printed subperiosteal implants.

While the literature often focuses on implant survival or surgical complications, this publication provides data centered on quality of life and patient experience. It therefore contributes to a more comprehensive approach to implant rehabilitation in cases of severe bone atrophy.

The results support the potential clinical interest of digital subperiosteal implants in complex indications where conventional alternatives may be burdensome or technically demanding. They also contribute to documenting the contemporary evolution of a historical technique revisited through additive manufacturing technologies.

Nevertheless, controlled prospective studies will be required to confirm these observations and to clarify the role of AMSJI within the therapeutic armamentarium of advanced implantology.

11. Editorial Conclusion

This multicenter study highlights a high level of satisfaction and favorable oral quality of life among patients treated with AMSJI for severe maxillary atrophy. Although biological complications were observed, prosthetic rehabilitation was successfully completed in all participants.

These results reinforce the interest in customized subperiosteal implants as an implant rehabilitation option in particularly complex anatomical situations, while also emphasizing the need for comparative prospective data with longer-term follow-up.