Rehabilitation of the severely atrophic maxilla using LeFort I maxillary advancement and simultaneous zygoma implant placement: Proof of concept

Purpose: To illustrate the workflow for simultaneous LeFort I maxillary advancement and zygomatic implant (ZI) placement. Materials and methods: Three consecutive patients referred for the rehabilitation of the severely atrophic maxilla were treated with simultaneous LeFort I maxillary advancement and ZI placement. An evaluation of the treatment protocol was carried out to validate the proposed workflow: indications, treatment planning, surgical splint manufacturing, surgical procedure and prosthetic loading. Results: Maxillary reposition was carried out according to the previous virtual planning. Consequently, in all cases extrasinusal or sinus slot paths were used, proper emergence of the implant platform fully surrounded by alveolar bone was ensured, and full-arch rehabilitation supported by ZI was performed. A straight facial profile was achieved postoperatively in all cases and no surgical complications were noted. No resorption of maxillary distal bone was evident at the end of the first year of follow-up. However, a mean relapse of -4.3 mm (-10.06%) was evidenced for maxillary downward movement, and conversely, an extra-forward maxillary movement was observed (mean +1.4 mm, +82.8%) in all cases. Conclusions: Besides restoring oral function and aesthetics, this technique avoids donor site morbidity, decreases surgical time, and shortens the overall rehabilitation period.