Two-Stage Management of Severe Maxillary Atrophy With Maxillary Advancement, Bone Reconstruction, and Custom Subperiosteal Implant

Severe maxillary atrophy is a significant challenge for implant-supported rehabilitation, often requiring complex reconstructive or adaptive procedures. Contemporary patient-specific subperiosteal implants, designed through digital planning and fabricated using titanium additive manufacturing technology, have re-emerged as a viable alternative in patients for whom conventional implants are not feasible. This report describes the management of a 45-year-old patient with a class III facial deformity and severe maxillary atrophy. An initial diagnostic phase was performed to achieve anterior and inferior repositioning of the edentulous maxilla through a Le Fort I osteotomy and reconstruction using an iliac crest graft to reestablish vertical dimension. This was followed by the use of a stabilization splint with an esthetic anterior reference and a transitional prosthetic rehabilitation to achieve balanced bilateral occlusion. On the basis of this prosthetic setup, digital planning and design of a patient-specific subperiosteal implant were performed, optimizing bone support areas and prosthetic emergence. Surgery was carried out using a lateral approach independent from the prosthetic access, with fixation of the structure using osteosynthesis screws to achieve primary mechanical stability. Immediate splinting was performed using a fixed prosthesis anchored to the 4 connections of the subperiosteal implants. After an initial stabilization period, follow-up demonstrated complete system stability, efficient occlusion, and adequate 3-dimensional support for oral and facial rehabilitation, achieving satisfactory functional and esthetic outcomes.