Rehabilitation of a Severely Atrophic Maxilla Using Le Fort I Advancement Surgery and a Subperiosteal Implant in a Patient with Ectodermal Dysplasia

Mustafa Ayhan, Sabahat Zeynep Yey Özkeskin

Full text link: https://pubmed.ncbi.nlm.nih.gov/38819128/

Rehabilitation of a Severely Atrophic Maxilla Using Le Fort I Advancement Surgery and a Subperiosteal Implant in a Patient with Ectodermal Dysplasia

1. Scientific Reference

• Study Title: Rehabilitation of Severely Atrophic Maxilla with Le Fort I Advancement Surgery and Subperiosteal Implant in a Patient With Ectodermal Dysplasia
• Authors: Mustafa Ayhan, Sabahat Zeynep Yey Özkeskin
• Journal: Journal of Craniofacial Surgery
• Year of Publication: 2024
• DOI:1097/SCS.0000000000010380
• PMID: 38819128

2. Scientific Background

Managing severe maxillary atrophy remains one of the greatest challenges in implant dentistry and maxillofacial reconstruction, particularly when associated with congenital disorders such as ectodermal dysplasia. Patients affected by this condition frequently experience severe tooth agenesis or early tooth loss, often resulting in inadequate bone volume and maxillary skeletal deficiency that complicate conventional implant-supported rehabilitation.

This case report explores a treatment strategy that combines orthognathic surgery with patient-specific implant technology. Rather than approaching skeletal correction and implant rehabilitation as separate procedures, the authors describe an integrated workflow that merges virtual surgical planning, Le Fort I advancement, and placement of a customized subperiosteal implant during the same operation. The report illustrates how digital planning may facilitate complex maxillary reconstruction while simultaneously establishing the foundation for implant-supported prosthetic rehabilitation in anatomically compromised patients.

3. Study Objective

The purpose of this study was to describe the rehabilitation of a patient with ectodermal dysplasia who developed maxillary sagittal deficiency following tooth loss. Specifically, the authors aimed to evaluate the feasibility of combining Le Fort I maxillary advancement with immediate placement of a customized subperiosteal implant capable of both stabilizing the repositioned maxilla and supporting subsequent prosthetic rehabilitation.

4. Methodology

The available information indicates that this publication is a single-patient case report, describing the management of a patient with ectodermal dysplasia and severe maxillary atrophy associated with sagittal maxillary deficiency.

Treatment planning was based on a three-dimensional virtual workflow. A digital model was used to design both a surgical guide for the Le Fort I osteotomy and a patient-specific subperiosteal implant. During surgery, the maxilla was advanced according to the preoperative virtual plan, followed by fixation of the customized subperiosteal implant. Prosthetic rehabilitation was completed one month after surgery.

The abstract does not specify additional methodological details such as clinical evaluation criteria, imaging assessment protocols, functional outcome measures, postoperative assessment methods, or follow-up beyond the timing of prosthetic rehabilitation.

5. Main Findings

The authors report that the postoperative position of the maxilla corresponded to the objectives established during virtual surgical planning, demonstrating successful transfer of the digital treatment plan to the clinical procedure.

The customized subperiosteal implant fulfilled two complementary roles throughout treatment. It provided stabilization of the repositioned maxilla following Le Fort I advancement while simultaneously serving as the definitive support for a full-arch implant-supported prosthesis. According to the reported outcome, stable fixation was achieved, allowing prosthetic rehabilitation to proceed as planned one month after surgery.

No quantitative outcome measures are presented in the available abstract. Likewise, no information is provided regarding implant survival, biological or mechanical complications, patient-reported outcomes, functional performance, esthetic assessment, or long-term stability. Consequently, the reported findings should be interpreted within the limited scope of the immediate clinical outcome described in this individual case.

6. Clinical Analysis

This report illustrates the feasibility of integrating orthognathic surgery, digital planning, and patient-specific implant design into a single treatment strategy for the rehabilitation of severe maxillary atrophy. The principal innovation lies in the dual function assigned to the customized subperiosteal implant, which acts both as a fixation device following Le Fort I advancement and as the definitive support for implant-supported prosthetic rehabilitation.

From a clinical perspective, this integrated approach has the potential to simplify treatment by combining skeletal correction and prosthetic reconstruction within the same surgical protocol. The incorporation of three-dimensional virtual planning may also improve surgical precision by facilitating accurate osteotomy guidance and customized implant adaptation to the patient’s anatomy.

Nevertheless, the clinical implications remain limited by the study design. As this publication reports only a single clinical case, it does not provide sufficient evidence to determine the reproducibility, safety, or long-term effectiveness of the proposed technique. Furthermore, the absence of comparative data prevents any assessment of whether this approach offers advantages over alternative reconstructive strategies. Additional clinical studies involving larger patient cohorts and extended follow-up periods will be necessary before broader conclusions regarding its clinical value can be established.

7. Clinical Applications

The treatment protocol described in this report may be relevant for highly selected patients presenting with severe maxillary atrophy combined with sagittal maxillary deficiency, particularly when associated with ectodermal dysplasia. It also demonstrates the potential contribution of digital surgical planning and customized subperiosteal implants in managing anatomically complex cases requiring advanced maxillofacial reconstruction.

Based on the available evidence, this approach should be considered an individualized treatment strategy rather than a standard therapeutic protocol. While the reported case demonstrates technical feasibility, the limited level of evidence means that its broader clinical application cannot be established without additional studies evaluating long-term outcomes, complication rates, and reproducibility in larger patient populations.

8. Level of Evidence, Limitations, and Transparency

This publication is a single-patient case report, representing a low level of clinical evidence. Its primary contribution is the description of a technically feasible treatment strategy rather than the validation of a therapeutic protocol.

Several methodological limitations should be considered when interpreting the findings. The report includes only one patient and does not incorporate a control group or comparison with alternative treatment approaches. Although prosthetic rehabilitation was completed one month after surgery, the abstract does not provide information regarding longer-term clinical follow-up, implant survival, biological or mechanical complications, functional outcomes, or patient-reported satisfaction. Consequently, the durability and predictability of the proposed technique cannot be assessed from the available data.

No conflicts of interest, industry affiliations, funding sources, or financial disclosures are reported in the information provided. The findings should therefore be interpreted as an illustration of clinical feasibility rather than evidence supporting routine clinical implementation.

9. Key Study Highlights

• Study design: Single-patient case report.
• Level of evidence:
• Study population: One patient with ectodermal dysplasia presenting with severe maxillary atrophy and sagittal maxillary deficiency.
• Number of patients:
• Number of implants: One customized subperiosteal implant.
• Follow-up: Prosthetic rehabilitation performed one month after surgery; longer-term follow-up was not reported.
• Primary outcome assessed: Feasibility of combining Le Fort I maxillary advancement with immediate placement of a customized subperiosteal implant.
• Main finding: Virtual surgical planning was successfully translated into clinical treatment, with satisfactory maxillary stabilization and completion of full-arch implant-supported rehabilitation.
• Scientific conclusion: The combined surgical approach may allow simultaneous correction of sagittal maxillary deficiency and prosthetic rehabilitation while reducing the overall treatment timeline in selected patients.
• Study limitations: Single case, absence of a control group, lack of quantitative clinical outcomes, and no long-term follow-up data.

10. Scientific Impact

This case report contributes to the growing body of literature exploring patient-specific solutions for complex maxillary reconstruction. Rather than introducing definitive clinical evidence, it demonstrates how digital surgical planning, orthognathic surgery, and customized subperiosteal implant technology can be integrated into a single treatment workflow for patients with severe anatomical deficiencies.

The report highlights the potential role of personalized implant design in situations where conventional implant rehabilitation may be particularly challenging. By combining skeletal repositioning and prosthetic support within the same surgical intervention, the described technique offers an alternative concept for managing highly complex maxillary deformities.

However, the scientific significance of this publication should be interpreted within the context of its study design. Additional clinical investigations involving larger patient populations, standardized outcome measures, and extended follow-up are required to determine the reproducibility, safety, and long-term clinical performance of this treatment approach.

11. Editorial Conclusion

This case report presents an innovative combination of Le Fort I maxillary advancement, digital surgical planning, and a customized subperiosteal implant for the rehabilitation of severe maxillary atrophy in a patient with ectodermal dysplasia. The reported outcome demonstrates the technical feasibility of integrating skeletal correction and implant-supported rehabilitation into a single surgical procedure. Given the limited level of evidence and the absence of long-term clinical data, these findings should be regarded as preliminary and hypothesis-generating rather than as confirmation of an established therapeutic protocol.