15/03/2026
Digital Design of Juxta-Osseous Subperiosteal Implant
Rehabilitation for Severe Maxillary Atrophy
Agron Meto 1 , Emanuele Morella 2, Algen Isufi 3,4 and Aida Meto 1,5,6,*
Academic Editor: Antonio Scarano
Received: 19 January 2026
Revised: 10 February 2026
Accepted: 12 February 2026
Published: 26 February 2026
Copyright: © 2026 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license.
1 Department of Dentistry, Faculty of Dental Sciences, University of Aldent, 1007 Tirana, Albania;
agron.meto@ual.edu.al
2 Private Practice, 20099 Sesto San Giovanni, Italy; info@studiodrmorella.com
3 Department of Oro-Maxillofacial Surgery, Faculty of Dental Sciences, Aldent University, 1005 Tirana, Albania;
algenisufi@gmail.com
4 Oral & Maxillofacial (OMF) Surgery Service, “Mother Theresa” University Hospital Centre,
372 Tirana, Albania
5 Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant,
Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
6 Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth,
Pimpri, Pune 411018, India
* Correspondence: aida.meto@ual.edu.al
Abstract
Background: Rehabilitation of the severely atrophic maxilla remains a major challenge in
implant dentistry, particularly when conventional endosseous implants and regenerative
procedures are contraindicated due to extensive bone loss, sinus pathology, or patient-
related factors. Advances in digital planning and additive manufacturing have enabled
the reintroduction of juxta-osseous subperiosteal implants as a graftless, patient-specific
treatment option. This case report aimed to describe the complete digital workflow, sur-
gical placement, and immediate prosthetic rehabilitation of a customized juxta-osseous
subperiosteal implant in a patient with severe posterior maxillary atrophy and a history
of failed sinus augmentation procedures. Case Presentation: A 75-year-old male patient
presenting with left severe posterior maxillary atrophy and previous unsuccessful sinus lift
surgeries was rehabilitated using a digitally designed, additively manufactured titanium
subperiosteal implant. Cone-beam computed tomography–based planning and CAD–CAM
technology were used to design a patient-specific framework, which was rigidly fixed to
stable maxillofacial support and immediately loaded with a screw-retained provisional
prosthesis. Results: Clinical and radiographic follow-up demonstrated stable implant
fixation, soft tissue healing, absence of biological or mechanical complications, and sat-
isfactory functional and aesthetic outcomes. The patient reported high levels of comfort
and satisfaction throughout the treatment period. Conclusions: Digitally manufactured
juxta-osseous subperiosteal implants may represent a predictable and minimally invasive
graftless alternative for selected patients with severe maxillary atrophy, particularly when
conventional implant placement or extensive bone augmentation is not feasible. Accurate
digital planning, rigid fixation, and appropriate patient selection appear to be key factors
for clinical success.
Keywords: additive manufacturing; AMSJI; CAD–CAM; digital workflow; graftless
rehabilitation; immediate loading; juxta-osseous implant; patient-specific implant; severe
maxillary atrophy; subperiosteal implant
Appl. Sci. 2026, 16, 2228 https://doi.or
