Management of adverse effects following additively manufactured subperiosteal jaw implantation in the maxilla.

Abstract

Objective: This expert opinion presents provisional guidelines for addressing complications associated with Additively Manufactured Subperiosteal Jaw Implants (AMSJI®) in patients with severe maxillary atrophy. AMSJI®'s custom design, supported by finite element analysis (FEA), allows precise placement that avoids critical anatomical structures and minimizes complications relative to alternative solutions.

Materials and methods: Data were gathered through firsthand experiences, direct communications, two structured surveys and insights from international workgroup meetings.

Results: Minor complications, such as soft tissue recession with inflammation, can be managed through thorough patient selection and early intervention. Severe complications, such as ascending infections and mechanical issues (e.g., fractures of implant components), have been rare. Compared to zygomatic implants and bone grafting, AMSJI® demonstrates a favorable safety profile. Zygomatic implants may lead to severe issues like orbital cellulitis and diplopia, while bone grafting risks include graft resorption, loss, and donor site complications. To mitigate risks, selecting patients carefully and ensuring diligent follow-up are critical, especially in those with risk factors like smoking or bruxism. Improved imaging, planning, and FEA have further contributed to minimizing complications, reinforcing AMSJI®'s role in complex maxillary reconstructions and implant-supported prosthetics.

Conclusions: AMSJI® demonstrates high success rates but requires meticulous risk management. Key strategies involve carefully candidates by excluding those who are smokers, immunocompromised, or non-compliant, or diabetics with a history of infectious complications. Additionally, strict adherence to oral hygiene protocols is essential to optimize outcomes and minimize risks.Proactive management in these areas is crucial to optimize outcomes, ensure implant longevity, and support successful prosthetic rehabilitation.