CHALLENGES IN THE REHABILITATION OF ATROPHIC MAXILLAE

Abstract

The rehabilitation of atrophic maxillae represents one of the greatest challenges in modern implant dentistry due to severe bone resorption, which often prevents the placement of conventional implants without prior interventions. Traditionally, complex reconstructive procedures, such as autogenous bone grafts, were the main approach, despite being associated with high complication rates, donor site morbidity, and longer treatment time. Therefore, this study, a narrative literature review, aimed to discuss and compare the main rehabilitative strategies for atrophic maxillae and mandibles, seeking criteria for individualized clinical decision-making. The analyzed data point to a paradigm shift in the management of atrophic arches, prioritizing techniques that utilize residual native bone. The innovative and less invasive approaches highlighted are: Short Implants, which offer success rates comparable to conventional implants after grafting, with lower cost and surgical morbidity; Zygomatic implants, which show high survival rates (90.3%–100%) in severe atrophy and favor immediate loading protocols; and customized subperiosteal implants (CAD-CAM), a valid alternative for extreme atrophy or after grafting failures, providing primary stability and rapid loading. In conclusion, there is no single gold standard approach, and the therapeutic choice should be individualized, integrating the digital workflow and considering the severity of the atrophy and the patient's systemic profile.