Uso de implantes subperiosteais personalizados para reabilitação total da maxila após a falha de técnicas convencionais

Jonathas Daniel Paggi Claus
Doutor em Cirurgia Bucomaxilofacial – Instituto Bucomaxilofacial.
ORCID: 0000-0002-7418-045X.

Matheus Spinella Almeida
Doutor em Cirurgia Bucomaxilofacial – Instituto Bucomaxilofacial.
ORCID: 0000-0003-2671-3853.

Hugo Jose Correia Lopes
Doutor em Cirurgia Bucomaxilofacial – Instituto Bucomaxilofacial.
ORCID: 0000-0003-0918-0063.

Diego Klee Vasconcelos
Professor associado do Depto. de Odontologia – Universidade Federal de Santa Catarina.
ORCID: 0000-0002-6927-331X.

DOI:

Jonathas Daniel Paggi Claus
Doutor em Cirurgia Bucomaxilofacial – Instituto Bucomaxilofacial.
ORCID: 0000-0002-7418-045X.

Matheus Spinella Almeida
Doutor em Cirurgia Bucomaxilofacial – Instituto Bucomaxilofacial.
ORCID: 0000-0003-2671-3853.

Hugo Jose Correia Lopes
Doutor em Cirurgia Bucomaxilofacial – Instituto Bucomaxilofacial.
ORCID: 0000-0003-0918-0063.

Diego Klee Vasconcelos
Professor associado do Depto. de Odontologia – Universidade Federal de Santa Catarina.
ORCID: 0000-0002-6927-331X.

DOI: https://doi.org/10.71440/2675-5610.10.3.25.350-356.art

RESUMO
A reabilitação protética da maxila atrófica é um desafio devido à reabsorção óssea e à pneumatização dos seios maxilares, que inviabilizam o uso de implantes convencionais. Historicamente, enxertos ósseos foram utilizados, mas estão associados a altas taxas de morbidade e longos tempos de tratamento. Os implantes zigomáticos surgiram como uma alternativa, no entanto, apresentam complicações, como infecções no seio maxilar. Recentemente, os implantes subperiosteais personalizados (ISPs) destacaram-se como uma solução viável para a reabilitação de maxilas com atrofia severa, especialmente em casos em que técnicas convencionais falharam. Este artigo apresenta o relato de caso de uma paciente de 68 anos que havia passado por múltiplas tentativas fracassadas de reabilitação da maxila severamente atrófica, sendo tratada com sucesso por meio de um ISP. O protocolo incluiu planejamento digital avançado, uso de tecnologias de imagem e impressão 3D, permitindo a instalação precisa do implante com carga imediata. Após um ano e quatro meses de acompanhamento, a paciente apresentou excelente estabilidade do implante e função mastigatória adequada. Embora os ISPs representem uma alternativa promissora, estudos adicionais são necessários para estabelecer suas vantagens e limitações a longo prazo.

Palavras-chave: Reabilitação protética; Maxila edêntula; Implantes subperiosteais personalizados.

Use of customized subperiosteal implants for total maxillary rehabilitation after the failure of conventional techniques – a case report

ABSTRACT

The prosthetic rehabilitation of the atrophic maxilla is a challenge due to bone resorption and maxillary sinus pneumatization, which prevent the use of conventional implants. Historically, bone grafts have been used, but they are associated with high morbidity rates and long treatment times. Zygomatic implants have emerged as an alternative; however, they present complications such as sinus infections. Recently, customized subperiosteal implants (CSIs) have gained prominence as a viable solution for the rehabilitation of severely atrophic maxillae, especially in cases in which conventional techniques have failed. This article presents a case report of a 68-year-old female patient with multiple failed attempts at rehabilitation of a severely atrophic maxilla, successfully treated with a CSI. The protocol included advanced digital planning, the use of imaging technologies, and 3D printing, enabling the precise installation of the implant with immediate loading. After one year and four months of follow-up, the patient exhibited excellent implant stability and adequate masticatory function. Although CSIs represent a promising alternative, further studies are needed to establish their long-term advantages and limitations.

Keywords: Prosthetic rehabilitation; Edentulous maxilla; Customized subperiosteal implants.

Referências

1. Alotaibi FF, Rocchietta I, Buti J, D’Aiuto F. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: a systematic review and network meta-analysis. J Clin Periodontol. 2023;50(11):1487-519.
2. McKenna GJ, Gjengedal H, Harkin J, Holland N, Moore C, Srinivasan M. Effect of autogenous bone graft site on dental implant survival and donor site complications: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022;22(3):101731.
3. Costa FO, Costa AM, Ferreira SD, Lima RPE, Pereira GHM, Cyrino RM et al. Long-term impact of patients’ compliance to peri-implant maintenance therapy on the incidence of peri-implant diseases: an 11-year prospective follow-up clinical study. Clin Implant Dent Relat Res. 2023;25(2):303-12.
4. Cercadillo-Ibarguren I, Sánchez-Torres A, Figueiredo R, Valmaseda-Castellón E. Early complications of immediate loading in edentulous full-arch restorations: a retrospective analysis of 88 cases. Int J Oral Maxillofac Implants. 2017;32(5):1116-22.
5. Korn P, Gellrich N-C, Spalthoff S, Jehn P, Eckstein F, Lentge F et al. Managing the severely atrophic maxilla: farewell to zygomatic implants and extensive augmentations? J Stomatol Oral Maxillofac Surg. 2022;123(5):562-5.
6. Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and complications of zygomatic implants: an updated systematic review. J Oral Maxillofac Surg. 2016;74(10):1949-64.
7. Kämmerer PW, Fan S, Aparicio C, Bedrossian E, Davó R, Morton D et al. Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review. Int J Implant Dent. 2023;9(1):11.
8. Angelo DF, Ferreira JR. The role of custom-made subperiosteal implants for rehabilitation of atrophic jaws – a case report. Ann Maxillofac Surg. 2020;10(2):507-11.
9. Vaira LA et al. Implant-prosthetic rehabilitation of the atrophic posterior mandible with additively manufactured custom-made subperiosteal implants: a cohort study. Int J Oral Maxillofac Surg. 2024;53(6):533-40.
10. Marconcini S, Giammarinaro E, Covani U. The rehabilitation of the atrophic posterior maxilla with a custom-made subperiosteal implant in a patient with a history of medications related to osteonecrosis of the jaws: one-year case report. Oral Maxillofac Surg Cases. 2023;9:100292.
11. Tofé-Povedano A, Parras-Hernández J, Herce-López J, Matute-García D, González-Moguena VA, Rollón-Mayordomo A. Design modifications in subperiosteal implants to avoid complications. Presentation of a case series study and literature review. Rev Esp Cir Oral Maxillofac. 2023;45:57-63.
12. Mangano C, Bianchi A, Mangano FG, Dana J, Colombo M, Solop I et al. Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series. 3D Print Med. 2020;6(1):1.
13. Borre CVD, Rinaldi M, De Neef B, Loomans NAJ, Nout E, Van Doorne L et al. Radiographic evaluation of bone remodeling after additively manufactured subperiosteal jaw implantation (Amsji) in the maxilla: a one-year follow-up study. J Clin Med. 2021;10(16):3542.
14. Borre CVD, Rinaldi M, De Neef B, Loomans NAJ, Nout E, Van Doorne L et al. Patient- and clinician-reported outcomes for the additively manufactured sub-periosteal jaw implant (AMSJI) in the maxilla: a prospective multicentre one-year follow-up study. Int J Oral Maxillofac Surg. 2022;51(2):243-50.
15. Korn P, Gellrich NC, Jehn P, Spalthoff S, Rahlf B. A new strategy for patient-specific implant-borne dental rehabilitation in patients with extended maxillary defects. Front Oncol. 2021;11:718872.
16. Mommaerts MY. Additively manufactured sub-periosteal jaw implants. Int J Oral Maxillofac Surg. 2017;46(7):938-40.
17. Mommaerts MY. Evolutionary steps in the design and biofunctionalization of the additively manufactured sub-periosteal jaw implant ‘AMSJI’ for the maxilla. Int J Oral Maxillofac Surg. 2019;48(1):108-14.
18. Gellrich NC, Zimmerer RM, Spalthoff S, Jehn P, Pott PC, Rana M et al. A customised digitally engineered solution for fixed dental rehabilitation in severe bone deficiency: a new innovative line extension in implant dentistry. J Craniomaxillofac Surg. 2017;45(10):1632-8.
19. Gellrich NC, Korn P, Jehn P, Neuhaus M, Lentge F, Rahlf B. Exceptional cases demand exceptional personalized solutions: the next level in dental rehabilitation. J Pers Med. 2024;14(3):294.
20. Dantas TA, Vaz P, Samuel FS. Subperiosteal dental implants: past or future? A critical review on clinical trials/case reports and future directions. J Dent Implant. 2023;13:35-48.
21. Ângelo DF, Ferreira JRV. The role of custom made subperiosteal implants for rehabilitation of atrophic jaws – a case report. Ann Maxillofac Surg. 2020;10(2):507-11.
22. Herce-López J, Pingarrón MDC, Tofé-Povedano A, García-Arana L, Espino-Segura-Illa M, Sieira-Gil R et al. Customized subperiosteal implants for the rehabilitation of atrophic jaws: a consensus report and literature review. Biomimetics. 2024;9(1):61.
23. Carretero JLC, Vera JLDCP, García NM, Martínez PG, Martínez MMP, Niño IA et al. Virtual surgical planning and customized subperiosteal titanium maxillary implant (CSTMI) for three-dimensional reconstruction and dental implants of maxillary defects after oncological resection: case series. J Clin Med. 2022;11(15):4594.
24. Dimitroulis G, Gupta B, Wilson I, Hart C. The atrophic edentulous alveolus. A preliminary study on a new generation of subperiosteal implants. Oral Maxillofac Surg. 2023;27(1):69-78.
25. Vatteroni E, Covani U, Menchini Fabris GB. The new generation of subperiosteal implants for patient-specific treatment of atrophic jawbone: literature review and a two-case report. Int J Periodontics Restorative Dent. 2023;43(6):735-41.
26. Santos LMM, Figueiredo JLT, Coelho RPLM. Integração musculoesquelética em implantes individualizados. Soluções clínicas para reabilitações totais sobre implantes sem enxertos ósseos (vol. 2). São Paulo: Santos Publicações, 2022.
27. Medeiros AC, Dantas-Filho AM. Intervenções fundamentais em cirurgia: diérese, hemostasia e síntese. J Surg Clin Res. 2018;9(2):54-74.
28. Tazima MFGS, Vicente YAMVA, Moriya T. Biologia da ferida e cicatrização. Medicina Ribeirão Preto 2008;41(3):259-64.

RESUMO
A reabilitação protética da maxila atrófica é um desafio devido à reabsorção óssea
e à pneumatização dos seios maxilares, que inviabilizam o uso de implantes
convencionais. Historicamente, enxertos ósseos foram utilizados, mas estão
associados a altas taxas de morbidade e longos tempos de tratamento. Os implantes
zigomáticos surgiram como uma alternativa, no entanto, apresentam complicações,
como infecções no seio maxilar. Recentemente, os implantes subperiosteais
personalizados (ISPs) destacaram-se como uma solução viável para a reabilitação
de maxilas com atrofia severa, especialmente em casos em que técnicas
convencionais falharam. Este artigo apresenta o relato de caso de uma paciente
de 68 anos que havia passado por múltiplas tentativas fracassadas de reabilitação
da maxila severamente atrófica, sendo tratada com sucesso por meio de um ISP.
O protocolo incluiu planejamento digital avançado, uso de tecnologias de imagem
e impressão 3D, permitindo a instalação precisa do implante com carga imediata.
Após um ano e quatro meses de acompanhamento, a paciente apresentou
excelente estabilidade do implante e função mastigatória adequada. Embora
os ISPs representem uma alternativa promissora, estudos adicionais
são necessários para estabelecer suas vantagens e limitações a longo prazo.

Palavras-chave: Reabilitação protética; Maxila edêntula; Implantes subperiosteais personalizados.

Use of customized subperiosteal implants for total maxillary rehabilitation after
the failure of conventional techniques – a case report

ABSTRACT
The prosthetic rehabilitation of the atrophic maxilla is a challenge due to bone
resorption and maxillary sinus pneumatization, which prevent the use of conventional
implants. Historically, bone grafts have been used, but they are associated with
high morbidity rates and long treatment times. Zygomatic implants have emerged
as an alternative; however, they present complications such as sinus infections.
Recently, customized subperiosteal implants (CSIs) have gained prominence as a
viable solution for the rehabilitation of severely atrophic maxillae, especially in cases
in which conventional techniques have failed. This article presents a case report
of a 68-year-old female patient with multiple failed attempts at rehabilitation
of a severely atrophic maxilla, successfully treated with a CSI. The protocol included
advanced digital planning, the use of imaging technologies, and 3D printing,
enabling the precise installation of the implant with immediate loading. After
one year and four months of follow-up, the patient exhibited excellent implant stability
and adequate masticatory function. Although CSIs represent a promising alternative,
further studies are needed to establish their long-term advantages and limitations.

Keywords: Prosthetic rehabilitation; Edentulous maxilla; Customized subperiosteal implants.

Referências

1. Alotaibi FF, Rocchietta I, Buti J, D’Aiuto F. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: a systematic review and network meta-analysis. J Clin Periodontol. 2023;50(11):1487-519.
2. McKenna GJ, Gjengedal H, Harkin J, Holland N, Moore C, Srinivasan M. Effect of autogenous bone graft site on dental implant survival and donor site complications: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022;22(3):101731.
3. Costa FO, Costa AM, Ferreira SD, Lima RPE, Pereira GHM, Cyrino RM et al. Long-term impact of patients’ compliance to peri-implant maintenance therapy on the incidence of peri-implant diseases: an 11-year prospective follow-up clinical study. Clin Implant Dent Relat Res. 2023;25(2):303-12.
4. Cercadillo-Ibarguren I, Sánchez-Torres A, Figueiredo R, Valmaseda-Castellón E. Early complications of immediate loading in edentulous full-arch restorations: a retrospective analysis of 88 cases. Int J Oral Maxillofac Implants. 2017;32(5):1116-22.
5. Korn P, Gellrich N-C, Spalthoff S, Jehn P, Eckstein F, Lentge F et al. Managing the severely atrophic maxilla: farewell to zygomatic implants and extensive augmentations? J Stomatol Oral Maxillofac Surg. 2022;123(5):562-5.
6. Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and complications of zygomatic implants: an updated systematic review. J Oral Maxillofac Surg. 2016;74(10):1949-64.
7. Kämmerer PW, Fan S, Aparicio C, Bedrossian E, Davó R, Morton D et al. Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review. Int J Implant Dent. 2023;9(1):11.
8. Angelo DF, Ferreira JR. The role of custom-made subperiosteal implants for rehabilitation of atrophic jaws – a case report. Ann Maxillofac Surg. 2020;10(2):507-11.
9. Vaira LA et al. Implant-prosthetic rehabilitation of the atrophic posterior mandible with additively manufactured custom-made subperiosteal implants: a cohort study. Int J Oral Maxillofac Surg. 2024;53(6):533-40.
10. Marconcini S, Giammarinaro E, Covani U. The rehabilitation of the atrophic posterior maxilla with a custom-made subperiosteal implant in a patient with a history of medications related to osteonecrosis of the jaws: one-year case report. Oral Maxillofac Surg Cases. 2023;9:100292.
11. Tofé-Povedano A, Parras-Hernández J, Herce-López J, Matute-García D, González-Moguena VA, Rollón-Mayordomo A. Design modifications in subperiosteal implants to avoid complications. Presentation of a case series study and literature review. Rev Esp Cir Oral Maxillofac. 2023;45:57-63.
12. Mangano C, Bianchi A, Mangano FG, Dana J, Colombo M, Solop I et al. Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series. 3D Print Med. 2020;6(1):1.
13. Borre CVD, Rinaldi M, De Neef B, Loomans NAJ, Nout E, Van Doorne L et al. Radiographic evaluation of bone remodeling after additively manufactured subperiosteal jaw implantation (Amsji) in the maxilla: a one-year follow-up study. J Clin Med. 2021;10(16):3542.
14. Borre CVD, Rinaldi M, De Neef B, Loomans NAJ, Nout E, Van Doorne L et al. Patient- and clinician-reported outcomes for the additively manufactured sub-periosteal jaw implant (AMSJI) in the maxilla: a prospective multicentre one-year follow-up study. Int J Oral Maxillofac Surg. 2022;51(2):243-50.
15. Korn P, Gellrich NC, Jehn P, Spalthoff S, Rahlf B. A new strategy for patient-specific implant-borne dental rehabilitation in patients with extended maxillary defects. Front Oncol. 2021;11:718872.
16. Mommaerts MY. Additively manufactured sub-periosteal jaw implants. Int J Oral Maxillofac Surg. 2017;46(7):938-40.
17. Mommaerts MY. Evolutionary steps in the design and biofunctionalization of the additively manufactured sub-periosteal jaw implant ‘AMSJI’ for the maxilla. Int J Oral Maxillofac Surg. 2019;48(1):108-14.
18. Gellrich NC, Zimmerer RM, Spalthoff S, Jehn P, Pott PC, Rana M et al. A customised digitally engineered solution for fixed dental rehabilitation in severe bone deficiency: a new innovative line extension in implant dentistry. J Craniomaxillofac Surg. 2017;45(10):1632-8.
19. Gellrich NC, Korn P, Jehn P, Neuhaus M, Lentge F, Rahlf B. Exceptional cases demand exceptional personalized solutions: the next level in dental rehabilitation. J Pers Med. 2024;14(3):294.
20. Dantas TA, Vaz P, Samuel FS. Subperiosteal dental implants: past or future? A critical review on clinical trials/case reports and future directions. J Dent Implant. 2023;13:35-48.
21. Ângelo DF, Ferreira JRV. The role of custom made subperiosteal implants for rehabilitation of atrophic jaws – a case report. Ann Maxillofac Surg. 2020;10(2):507-11.
22. Herce-López J, Pingarrón MDC, Tofé-Povedano A, García-Arana L, Espino-Segura-Illa M, Sieira-Gil R et al. Customized subperiosteal implants for the rehabilitation of atrophic jaws: a consensus report and literature review. Biomimetics. 2024;9(1):61.
23. Carretero JLC, Vera JLDCP, García NM, Martínez PG, Martínez MMP, Niño IA et al. Virtual surgical planning and customized subperiosteal titanium maxillary implant (CSTMI) for three-dimensional reconstruction and dental implants of maxillary defects after oncological resection: case series. J Clin Med. 2022;11(15):4594.
24. Dimitroulis G, Gupta B, Wilson I, Hart C. The atrophic edentulous alveolus. A preliminary study on a new generation of subperiosteal implants. Oral Maxillofac Surg. 2023;27(1):69-78.
25. Vatteroni E, Covani U, Menchini Fabris GB. The new generation of subperiosteal implants for patient-specific treatment of atrophic jawbone: literature review and a two-case report. Int J Periodontics Restorative Dent. 2023;43(6):735-41.
26. Santos LMM, Figueiredo JLT, Coelho RPLM. Integração musculoesquelética em implantes individualizados. Soluções clínicas para reabilitações totais sobre implantes sem enxertos ósseos (vol. 2). São Paulo: Santos Publicações, 2022.
27. Medeiros AC, Dantas-Filho AM. Intervenções fundamentais em cirurgia: diérese, hemostasia e síntese. J Surg Clin Res. 2018;9(2):54-74.
28. Tazima MFGS, Vicente YAMVA, Moriya T. Biologia da ferida e cicatrização. Medicina Ribeirão Preto 2008;41(3):259-64.