Frontiers in Oral Health · Published 2026-08-04 · DOI 10.3389/froh.2026.1903798
Giulio Gasparini, Mattia Todaro, Edoardo Papa, Marco Gaetano Amato, Paolo De Angelis, Alessandro Moro, Carlo Lajolo, Gianluca Nicolai, Edoardo Rella, Roberto Boniello, Xavier Moix Gil, Edoardo Staderini, Sofia Gasparini, Federico Perquoti, Gianmarco Spinozzi, Veronica Santoro, Daniele Di Carlo, Giuliano Ascani, Paolo Francesco Manicone, Maurizio Diego Foresti, Maurizio Perugini, Francesca Azzuni, Martinna Bertolini, Cristiano Soares Moreira, Shayan Barootchi, Ryan Andrew Dunlop, Guo-Hao Lin, Vishtasb Broumand, Felipe Kornecki Radzinski, Emine Elif Alaaddinoglu, Alperen Kalyouncu, Sila Cagri Isler, Yiqun Wu, Simon Oh, Ridvan Guler, Onur Şahin, Engin Ozgur, Sascha Heinemann, Michael Marc Bornstein, Emilio Couso-Queiruga, Clemens Raabe, Andrea Roccuzzo, Daniel Thoma, Yi Man, Farah Asa'ad, Mats Sjöström, Jae-Kook Cha, Muhammed Hanif Abram, Nicolai Redko, Alexey Drobyshev, Eduard Kharazyan, Cesare Paoleschi, Sadesh Kumar, Andrey Trokhalin, Ilya Bozo, Zoltán Fábián, Dragan Eliza, Mariu Leretter, Fernando Manuel Pinto Duarte, Adam Aleksnder Nowicki, Ilaria Vitali, Jurjen Schortinghuis, Justin Pijpe, Gerry M Raghoebar, Miljan Micunovic, Viorica Chetrus, Algirdas Puisys, Mohammad Ibrahim Alghraisi, Stefan Cocis, Rocco Borrello, Alessandro Paccagnella, Lisa Catarzi, Giulio Cirignaco, Alessandro Ciolfi, Thomas Starch-Jensen, Hanna Cecilia Aludden, Paolo Ricci, Stefania Romano, Stefano Negrini, Vito del Deo, Giuseppe Consorti, Riccardo Girotto, Roberto Rossi, Igor Kaplasky, Flavio Andrea Govoni, Roberto Pistilli, Gaetano Isola, Andrea Balercia, Edoardo Brauner, Stefano Sivolella, Gianluca Colapinto, Adaia Valls-Ontañón, Adria Jorba-Garcia, Octavi Camps-Font, Ahad Khoshzaban, Aldo Zupi, Alexander Johann Gaggl, Anne-Gaëlle Chaux, Anne-Kathrin Bär, Bilal Al-Nawas
BackgroundSevere maxillary atrophy represents a complex clinical condition requiring individualized implant-prosthetic rehabilitation strategies. Although several therapeutic approaches are available, including graftless implant solutions, regenerative procedures, and hybrid strategies, the decision-making rationale underlying clinicians' preferences remains incompletely defined.ObjectiveThis international cross-sectional survey aimed to investigate clinician-reported decision-making profiles, perceived advantages, and expected outcomes associated with different therapeutic strategies for the rehabilitation of severe maxillary atrophy.Materials and methodsAn international questionnaire-based survey was conducted among clinicians with experience in complex implant-prosthetic rehabilitation. A total of 178 questionnaires were submitted. After exclusion of respondents reporting fewer than five complex rehabilitations per year, 155 eligible responses were included in the final analysis. Participants evaluated a standardized anonymized CBCT clinical case of severe maxillary atrophy classified as Cawood and Howell Class VI and selected their preferred therapeutic strategy. According to this choice, respondents were allocated into three groups: alternative implant strategies, regenerative approach with bone grafting, and hybrid/combined strategy. Descriptive statistics were used to summarize clinician-reported perceptions regarding safety, predictability, immediate loading, expected implant survival, treatment duration, aesthetic and functional outcomes, maintainability, morbidity, maintenance costs, patient satisfaction, and quality-of-life improvement.ResultsAlternative implant strategies were the most frequently selected approach, reported by 83 clinicians (53.5%), followed by regenerative approaches with bone grafting in 45 cases (29.0%) and hybrid/combined strategies in 27 cases (17.4%). Alternative strategies were more frequently associated with immediate loading and shorter treatment duration, whereas regenerative approaches were more commonly perceived as advantageous for aesthetic volume reconstruction and soft-tissue support. Expected five-year implant survival, masticatory function, maintenance burden, and clinician-reported patient satisfaction were generally perceived as favorable across all groups.ConclusionsWithin the limitations of a perception-based survey design and a relatively limited sample size, the findings suggest that therapeutic decision-making in severe maxillary atrophy is not based on a rigid hierarchy of techniques. Instead, clinicians appear to balance treatment timing, surgical morbidity, anatomical reconstruction, prosthetic objectives, aesthetic expectations, maintainability, and patient-related priorities. These results should not be interpreted as evidence of clinical superiority of one approach over another. Further prospective multicenter studies using standardized clinical endpoints and validated patient-reported outcome measures are needed to clarify the comparative effectiveness of these strategies.
Abstract from DOAJ. Public domain (CC0 1.0).
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Gasparini, G., Todaro, M., Papa, E., et al. (2026). Clinician preferences and decision-making patterns in the rehabilitation of severe maxillary atrophy: an international cross-sectional survey using a standardized cawood and howell class VI case. Frontiers in Oral Health. https://doi.org/10.3389/froh.2026.1903798