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PURPOSE: There are few treatment options for oral rehabilitation in patients with advanced maxillary resorption (Cawood-Howell Class V or more). Patient-specific, 3D-printed titanium subperiosteal implants have been described as a potentially valuable alternative solution. Surgeon and patient mediated functional outcomes have been studied and the results are promising. The surrounding soft tissue health has been much less researched. This study aims to evaluate the soft tissue response to the placement of additively manufactured subperiosteal jaw implants (AMSJI®) in the severely atrophic maxilla and to identify possible risk factors for soft tissue breakdown. MATERIALS AND METHODS: An international multicenter study was conducted and fifteen men (mean age 64.62 years, SD ± 6.75) and twenty-five women (mean age 65.24 years, SD ± 6.77) with advanced maxillary jaw resorption (Cawood-Howell Class V or more) were included in this study. General patient data were collected and all subjects were clinically examined. Inclusion criteria were patients who underwent bilateral AMSJI placement® in the maxilla at least a year before and whose surgeon and themselves agreed to participate in the study before their inclusion. RESULTS: A total of forty patients were enrolled with a mean follow-up period of 917 days (SD ± 306.89 days). Primary stability of the implant was achieved postoperatively in all cases, and all implants were loaded with a final prosthesis. At the time of study, only one patient showed mobility of the bilateral AMSJI (more than 1 mm). Exposure of the framework, due to mucosal recession, was seen in 26 patients (65%) and was mainly in the left (21.43%) and right (18.57%) mid-lateral region. Thin biotype and the presence of mucositis were found to be risk factors (p-value < 0.05). Although not significant, smokers had a nearly seven times (Odds ratio 6.88, p=0.08) more risk of developing a recession compared to nonsmokers. CONCLUSION: Twenty-six (65%) patients presented with a recession in one or (more) of the seven regions after oral rehabilitation with bilateral AMSJI installation. Several risk drivers were evaluated. The collapse of soft tissues around the AMSJI that led to caudal exposure of the arms was correlated with a thin biotype and the presence of mucositis.
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Subperiosteal implants (SIs) were first developed by Dahl in 1941 for oral rehabilitation in case of severe jaw atrophy. Over time, this technique was abandoned due to the high success rate of endosseous implants. The emergence of patient-specific implants and modern dentistry allowed a revisitation of this 80-year-old concept resulting in a novel "high-tech" SI implant. This study evaluates the clinical outcomes in forty patients after maxillary rehabilitation with an additively manufactured subperiosteal jaw implant (AMSJI®). The oral health impact profile-14 (OHIP-14) and numerical rating (NRS) scale were used to assess patient satisfaction and evaluate oral health. In total, fifteen men (mean age: 64.62 years, SD ± 6.75 years) and twenty-five women (mean age: 65.24 years, SD ± 6.77 years) were included, with a mean follow-up time of 917 days (SD ± 306.89 days) after AMSJI installation. Patients reported a mean OHIP-14 of 4.20 (SD ± 7.10) and a mean overall satisfaction based on the NRS of 52.25 (SD ± 4.00). Prosthetic rehabilitation was achieved in all patients. AMSJI is a valuable treatment option for patients with extreme jaw atrophy. Patients enjoy treatment benefits resulting in high patient satisfaction rates and impact on oral health.
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Additively manufactured subperiosteal jaw implants (AMSJI) are patient-specific, 3D-printed, titanium implants that provide an alternative solution for patients with severe maxillary bone atrophy. The aim of this study was to evaluate the bony remodeling of the maxillary crest and supporting bone using AMSJI. Fifteen patients with a Cawood-Howell Class V or greater degree of maxillary atrophy were evaluated using (cone beam) computed tomography scans at set intervals: one month (T1) and twelve months (T2) after definitive masticatory loading of bilateral AMSJI implants in the maxilla. The postoperative images were segmented and superimposed on the preoperative images. Fixed evaluation points were determined in advance, and surface comparison was carried out to calculate and visualize the effects of AMSJITM on the surrounding bone. A total mean negative bone remodeling of 0.26 mm (SD 0.65 mm) was seen over six reference points on the crest. Minor bone loss (mean 0.088 mm resorption, SD 0.29 mm) was seen at the supporting bone at the wings and basal frame. We conclude that reconstruction of the severely atrophic maxilla with the AMSJI results in minimal effect on supporting bone. Reduced stress shielding with a biomechanically tuned subperiosteal implant does not induce radiographically significant crestal bone atrophy.
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INTRODUCTION: We described our rationale and experiences with the use of cutting jigs for vertical ostectomy in cases of terminal maxillary dentition when edentulation and an additively manufactured subperiosteal jaw implant (AMSJI®) are planned. MATERIAL AND METHODS: Our experience covers 15 patients treated by four clinicians. We tabulated our criteria for planning and manufacturing vertical and horizontal ostectomy guides. RESULTS: In order to guarantee accurate osteotomy, titanium guides are preferable to guides made of polymer. The most important consideration is to avoid acute angles in the buccal arms of the AMSJI®. It is up to the surgeon whether to screw-fix the ostectomy guides or to use handles to maintain their position. DISCUSSION: Guided ostectomy has the potential to extend the use of AMSJI® to cases where teeth have yet to be removed or where the contours of the residual bone are not favorable. The use of guided ostectomy in such cases lessens the time between edentulation and implantation and improves the design of the implants.