Maxillary rehabilitation is an essential field within oral and maxillofacial surgery, especially when dealing with patients who have suffered complications resulting from zygomatic implants. This type of intervention is crucial to restore function and aesthetics, promoting the quality of life of patients. In this context, custom subperiosteal implants stand out as an innovative solution, offering superior results in complex cases, such as maxillary rehabilitation after sequelae of unsuccessful zygomatic implants.
What are Custom Subperiosteal Implants?
Custom subperiosteal implants are fixation devices that adapt perfectly to the patient’s anatomy, providing superior integration with the bone structure. Unlike conventional implants, which require a substantial amount of bone for anchorage, subperiosteal implants are designed to fit the bone surface, making them ideal for patients with significant bone atrophy.
These implants are manufactured based on precise imaging studies, such as CT scans and 3D models, which allow for complete customization of the device. Customization not only improves the stability of the implant, but also reduces the risk of post-operative complications.
Challenges Faced in Patients with Zygomatic Implant Sequelae
Zygomatic implants are often used in patients with severe bone atrophy in the upper jaw. However, in some cases, these implants may fail due to inadequate integration with the zygomatic bone or other complications, such as infections and rejection. When this happens, patients may face significant sequelae, such as loss of the ability to chew properly, difficulty speaking, and obvious aesthetic problems.
Zygomatic implant failure can occur for a variety of reasons, including:
- Lack of adequate fixation in the bone.
- Infections in the tissues surrounding the implant.
- Complications related to inadequate implant design.
- Deficiencies in the surgical technique used.
In these cases, maxillary rehabilitation requires a more sophisticated and careful approach, with the use of customized subperiosteal implants to restore the patient’s functionality and aesthetics.
Advantages of Customized Subperiosteal Implants
The use of customized subperiosteal implants offers several advantages, especially in situations where conventional implants have failed or where there is a large bone deficiency. Among the main benefits, the following stand out:
- Complete Customization: The individualized design of the implants ensures that they adapt perfectly to the unique anatomy of each patient, resulting in a more stable and long-lasting fixation.
- Less Invasiveness: Compared to traditional bone grafting procedures, subperiosteal implants can be placed with less need for bone reconstruction, which reduces the risk of complications.
- Functional and Aesthetic Restoration: These implants not only provide a more secure fixation for dentures, but also help restore the patient’s facial appearance while minimizing the aesthetic impacts of bone atrophy.
- Reduced Recovery Time: The less invasive approach speeds up the healing process, allowing patients to recover more quickly and return to their daily activities in a shorter period.
Clinical Case: Case Study of Maxillary Rehabilitation with Subperiosteal Implants – Patient with Zygomatic Implant Failure
In the case study, a patient had received zygomatic implants in a previous procedure, but these implants failed due to infection and rejection. The patient had severe bone atrophy in the upper jaw, making the placement of new conventional implants impossible. After detailed evaluation and imaging, it was decided to opt for the use of custom subperiosteal implants.
The procedure involved creating a 3D model of the patient’s bone structure based on CT scans and fabricating implants that fit his anatomy exactly. After the implants were placed, the patient was monitored throughout the recovery period, and the results were impressive, with complete restoration of masticatory function and an improved aesthetic appearance.
Planning and Placement Process for Subperiosteal Implants
The placement of custom subperiosteal implants involves a detailed and precise planning process. This process can be divided into several stages:
- Initial Assessment: The first stage consists of a clinical and radiological assessment of the patient, including CT scans and 3D imaging tests, to understand the bone structure and the need for implant customization.
- Creation of 3D Models: Based on the images obtained, a 3D model of the area to be treated is created, which allows for the exact customization of the implants.
- Implant Manufacturing: Using 3D printing technology, the implants are produced with maximum precision, ensuring a perfect adaptation to the patient’s anatomy.
- Surgical Procedure: The surgery to place the subperiosteal implants is performed with the utmost care, using minimally invasive techniques to reduce recovery time and the risk of complications.
- Postoperative Monitoring: After surgery, the patient is monitored regularly to ensure that the implants integrate correctly with the bone and that recovery is occurring as expected.
Conclusion: The Efficiency of Subperiosteal Implants in Maxillary Rehabilitation
The use of customized subperiosteal implants represents a significant advance in maxillary rehabilitation, especially in cases where other types of implants have failed or where bone atrophy is extreme. These implants offer an effective, less invasive, and customized solution that allows patients to recover not only masticatory function but also facial aesthetics.
The success of treatments based on subperiosteal implants depends on careful planning, device customization, and the surgeon’s skill. With the advancement of technologies such as 3D printing and 3D imaging models, the precision and results of treatments only tend to improve, offering patients a faster and more effective recovery.
References
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- Strappa EM, Memé L, Cerea M, et al. Custom-made additively manufactured subperiosteal implant. Minerva Dent Oral Sci. 2022;71(6):353-360.
- Vaira LA, Biglio A, Salzano G, et al. Additively manufactured custom-made subperiosteal implant rehabilitation for severely atrophic maxilla: a multicenter retrospective study. J Craniomaxillofac Surg. 2024;52(9):991-998. doi:10.1016/j.jcms.2024.07.009.
- Mounir M, Atef M, Abou-Elfetouh A, et al. Titanium and PEEK patient-specific sub-periosteal implants: two novel approaches for rehabilitation of the severely atrophic anterior maxillary ridge. Int J Oral Maxillofac Surg. 2018;47(5):658-664. doi:10.1016/j.ijom.2017.11.012.
