Trauma, congenital abnormalities, tumor enucleation, endodontic complications, advanced tooth loss, and severe periodontal disease can create a formidable challenge for the prosthodontist in the rehabilitation of maxillary defects.[1] These defects affect normal mastication, speech, swallowing, and esthetic functions, and negatively impact facial symmetry and psychosocial functioning.[2] Traditional prosthodontic methods have used removable obturator prostheses, complete dentures, which have long been used to restore function, but these methods have poor retention and stability, poor patient comfort, and progressive alveolar bone resorption.[3] Recent developments in prosthodontics have turned attention to more predictable, functionally stable, and esthetically desirable rehabilitation methods with digital technologies, implant-supported prostheses, and multidisciplinary treatment planning.[4]

Edentulism and maxillary defects are still significant public health issues in the world.[5] The Global Burden of Disease (GBD) Study 2021 found that over 350 million people globally suffer from severe tooth loss, which is one of the most common oral diseases.[6] Worldwide, it is estimated that oral diseases impact some 3.5 billion people, and oral health problems not receiving treatment are among the most prevalent non-communicable diseases.[7] In addition, more than 900,000 new cases of head and neck cancers occur worldwide each year, with surgical treatment often leaving a defect in the maxilla, which must be reconstructed with prosthodontic implants.[8] The number of implants used, the expectations of the patients for esthetic outcomes and quality of life, and the ever-increasing life expectancy are all driving factors in the increasing demand for advanced maxillary rehabilitation.[9]

Digital dentistry has revolutionized maxillary prosthodontic reconstruction with high-accuracy diagnosis, virtual treatment planning, computer-guided implant placement, intraoral scanning, computer-aided design/computer-aided manufacturing (CAD/CAM), and three-dimensional (3D) printing.[10] These technologies help to produce personalized prostheses that offer better marginal integrity, biomechanics, fewer clinical visits, and better patient satisfaction.[11] A variety of novel treatment concepts, such as zygomatic implants, patient-specific subperiosteal implants, digitally fabricated obturators, and the hybrid fixed-removable prosthesis, have broadened treatment options for patients with severe defects of the maxilla who were previously considered unsuitable for conventional implant treatment.[12]

Despite all these amazing technological breakthroughs, the rehabilitation of the maxilla is challenging because of the differences in the size of the defect, the quantity of residual bone, the soft tissue support, the occlusal relationships, the esthetic requirements, and the costs. The literature is mainly centered on the use of isolated treatment modalities, and evidence that combines modern digital workflows with innovative reconstructive prosthodontic approaches is still limited. Additionally, long-term functional and patient-reported outcomes of these modern rehabilitation approaches remain poorly reported.

In this regard, new strategies that combine the application of digital planning with innovative concepts in implant design and individualized reconstruction of the prosthesis are required to maximize function and esthetic results in patients who need maxillary rehabilitation. The current study is designed to assess the clinical success of a novel technical approach for the reconstruction of the maxilla in terms of oral function, facial esthetics, stability of the prosthesis, and patient satisfaction, to enable it to become a paradigm shift in modern smile rehabilitation.

This prospective interventional clinical study was conducted to evaluate the clinical effectiveness of a novel approach to maxillary prosthodontic reconstruction for smile rehabilitation. The study was carried out in in the Department of Prosthodontics. This study was carried out for six months from November, 2025 to April, 2026. The sample size was determined through the use of the OpenEpi version 3.01 sample size calculator for estimating a single population proportion. The frequency (p) was assumed to be 80% based on the study conducted by Ben Youssef et al. (2025), which reported an expected patient satisfaction rate of 80% after maxillary implant-supported prosthodontic rehabilitation.[13] The sample size of 62 participants was determined using a 95% confidence level, absolute precision of 10%, and a design effect of 1.0. This resulted in the recruitment of 68 patients for the study, as there was a possibility of dropouts and incomplete follow-up. A consecutive non-probability sampling method was used. All prosthodontics attendees who met the inclusion criteria in the Department during the study period were invited to participate until the required number of patients was reached. The study was designed to include patients 18 years or older who had had either a partial or complete maxillary defect that necessitated prosthodontic reconstruction. Patients who were considered at medical risk to undergo a prosthodontics rehabilitation, who gave written informed consent, and agreed to return for follow-up visits were included. Medical risk patients, who gave written informed consent and agreed to attend follow-up visits as scheduled, were included. Individuals with good oral hygiene and good clinical records for planning and evaluating treatment outcomes were also included. Uncontrolled systemic diseases that might affect healing, active oral infections, untreated periodontal disease, severe parafunctional habits (bruxism), previous failed maxillary reconstruction that would require revision surgery, pregnancy, and inability to attend follow-up visits were excluded. Those who refused to participate or those with incomplete clinical records were also excluded. All participants gave informed consent, and the Institutional Review Board approved the study, which was conducted prospectively. Eligible patients were examined thoroughly clinically and radiographically with cone-beam computed tomography (CBCT) and digitally intraorally for treatment planning. A detailed proforma was used to record baseline demographic and clinical data, including age, sex, and etiology of the maxillary defect, classification of the defect, oral hygiene status, and relevant medical history. A digital workflow was used to plan the novel prosthodontic reconstruction, and all prostheses were fabricated and delivered following clinical standards of care by experienced prosthodontists. Patients were followed up at the time of prosthesis delivery, 1 week, 1 month, 3 months, and 6 months. Assessment of clinical outcomes such as prosthesis retention, stability, masticatory efficiency, speech function, esthetic outcome, prosthetic complications, and implant/prosthesis survival (where applicable) was conducted at each visit. The validated Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to assess patient satisfaction and oral health-related quality of life.[14] Data collection forms (DCF) were used to standardize all clinical findings, and questionnaires were completed by calibrated investigators. The data obtained were entered and analyzed by IBM Statistical Package for the Social Sciences (SPSS) version 27.0. Data of continuous variables were normally distributed by the Shapiro-Wilk test and were displayed as mean ± standard deviation or median and interquartile range (IQR). Frequencies and percentages were obtained for the categorical variables. The paired t-test was used to compare the pre- and post-treatment continuous outcomes. The Chi-square test and Fisher's exact test were used to test associations between categorical variables. The factors associated with successful prosthodontic rehabilitation and high patient satisfaction were analyzed using binary logistic regression, the results of which are quoted as ORs (95% CI). The p-value of <0.05 was regarded as statistically significant.

A total of 68 patients completed the study. The mean age was 49.8 ± 11.6 years, with 50% of the patients between 41 and 60 years of age. There were 58.8% males in the study population. Most cases of maxillary defects (35.3%) were post-tumorous, followed by trauma, and 69.1% had partial maxillary defects. The majority of participants were non-smokers (75.0%), and 29.4% had systemic disease. (Table 1).

All functional and patient-reported outcomes improved considerably after prosthodontic reconstruction. There was a significant improvement in OHIP-14 from 34.9 ± 6.4 to 13.5 ± 4.7 (p < 0.001). Likewise, masticatory efficiency, speech function, esthetic satisfaction and overall patient satisfaction significantly improved after treatment (all p < 0.001). (Table 2).

Prosthesis retention and stability were excellent in 82.4% and 85.3% of the patients, respectively. Overall, the novel reconstructive approach had good short-term clinical efficacy (98.5% implant prosthesis survival and 94.1% of successful rehabilitation). (Table 3).

There were few post treatment complications. There were no complications in most patients (82.4%) in six months follow-up. The most frequent adverse event (7.4%) was minor mucosal irritation while the most frequent prosthesis adjustment requirement was (5.9%). Screw loosening (2.9%) and a fracture of the prosthesis (1.5%) were rare occurrences. (Table 4).

Bivariate analysis showed that the rate of successful prosthodontic rehabilitation was significantly higher for patients with partial maxillary defects and non-smokers (p = 0.033) and for non-smokers (p = 0.020) compared to patients with complete defects who smoke. There were no significant differences found between age and gender. (Table 5).

Partial maxillary defects (p=0.025) and non-smoking status (p=0.020) were independent predictors of successful prosthodontic rehabilitation. There were no significant associations between treatment success and age, gender, or systemic disease, after adjustment for potential confounders. (Table 6).

Table 1. Baseline Demographic and Clinical Characteristics of the Participants (n = 68)

Table 2. Comparison of Functional and Patient-Reported Outcomes Before and Six Months After Prosthodontic Reconstruction (n = 68)

Table 3. Clinical Outcomes Following Maxillary Prosthodontic Reconstruction (n = 68)

Table 4. Postoperative Complications During Six-Month Follow-up (n = 68)

Table 5. Association Between Selected Variables and Successful Prosthodontic Rehabilitation

Table 6. Binary Logistic Regression Analysis for Predictors of Successful Prosthodontic Rehabilitation

The present study has proved that the innovative strategy used for the maxillary prosthodontic reconstruction achieved results of excellent clinical and patient-reported outcomes. A significant increase in oral health-related quality of life, masticatory efficiency, speech, esthetic satisfaction, and overall patient satisfaction was achieved after the rehabilitation. In addition, the high prosthesis survival rate (98.5%) and the low complication rate after the surgery showed that the present prosthodontic reconstruction is predictable and effective for reestablishing function and esthetics in patients with defects in the maxillary. The marked reduction in OHIP-14 scores in our study is supported by the systematic review by Sáez-Alcaide et al. (2022), which showed that zygomatic implant-supported prostheses were effective in improving OHQOL following rehabilitation. They found that patient satisfaction, esthetic appearance, and chewing ability improved significantly, which is in line with our observations that modern reconstructive techniques significantly improve patients' quality of life.[15] Our study further showed that there was a significant increase in the masticatory efficiency after the treatment. This has been confirmed by Ye et al. (2026) who compared zygomatic and conventional implant supported fixed restorations, and reported excellent functional outcomes in both groups with similar chewing efficiency between both rehabilitation methods. They have concluded that implant-supported maxillary reconstruction is effective in restoring oral function, which is consistent with previously published results.[16] In the present study, speech function was significantly improved following prosthodontic rehabilitation. The anatomy of the maxillary area is restored by creating individual prostheses, which contribute to the clarity of speech, as well as a more comfortable palate contour. These results are in line with the conclusions of the 2026 Global Consensus for Rehabilitation of the Edentulous Maxilla, which recommended that speech and phonetic improvement are critical patient-reported outcomes following implant-supported maxillary rehabilitation.[17] Rehabilitation resulted in a significant improvement in esthetic satisfaction, with postoperative VAS scores more than 9 out of 10. A similar finding was reported by Aparicio et al. (2021), who found significantly higher patient satisfaction and better quality of life outcomes in patients rehabilitated with zygomatic implant-supported prostheses than in patients rehabilitated with the All-on-Four concept.[18] The implant/prosthesis survival rate of 98.5% in our study is similar to that found in the literature. Advanced implant-supported rehabilitation is long-term predictable, as reported by Sáez-Alcaide et al. (2022), who reported an overall implant survival rate of 98.3% after a mean follow-up period of around four years.[15] Similarly, Gellrich et al. (2025) conducted a systematic review of zygomatic and CAD/CAM subperiosteal implants, with survival rates of more than 96% for each type of implant, highlighting the excellent clinical outcomes in this study.[19] Favorable outcomes in this study may have been due to the use of a digital workflow, which included CBCT imaging, intraoral scanning, and CAD/CAM fabrication of the prosthesis. Consequently, with recent developments in digital dentistry, the accuracy of implant position, the production of customised prostheses and the time spent on treatment has improved, leading to more accurate prostheses fit and patient satisfaction.[20] Such technological advances have revolutionized the surgical management of challenging maxillary defects and are still broadening the range of prosthodontic rehabilitation. A recent systematic evidence in 2026 also highlights the need for maximum use of validated patient-reported outcome measures, such as OHIP-14, esthetic satisfaction, speech, chewing efficiency, prosthesis stability and treatment satisfaction should be routinely used in future studies evaluating maxillary rehabilitation.[21] All these clinically relevant outcome measures were included in our study, which resulted in the results being very similar to the current international guidelines. In summary, the results of this study support the published evidence, showing that MDAPR results in a predictable functional rehabilitation, excellent esthetic results, very high prosthesis survival, and significant improvement in ORQOL. The results of these studies support the use of the more advanced reconstructive protocols in routine prosthodontics for suitable patients. This study had a number of limitations. First, it was carried out in a single tertiary care center with a relatively small group of patients, which could restrict the generalizability of the results. Second, the follow-up period of 6 months was relatively brief and the long-term implant survival, prosthesis longevity, and late biological and mechanical complications could not be evaluated. Third, no comparison group was used for direct comparison of the novel reconstructive approach with the conventional prosthodontic approach. Lastly, patient-reported outcomes were obtained by a validated questionnaire, but individual expectations and subjective perceptions could have influenced their results.

The novel approach to maxillary prosthodontic reconstruction yielded excellent clinical performance and played a crucial role in enhancing oral health-related quality of life, masticatory efficiency, speech, esthetic outcomes, and patient satisfaction. High prosthesis survival and a low complication rate further support the effectiveness and predictability of this rehabilitation strategy. The results indicated a successful treatment outcome for the patients with maxillary defects in terms of function and facial esthetics, with the introduction of advanced prosthodontic principles and digital treatment planning. These positive results suggest that larger, multicenter studies with longer follow-up periods and with a comparative design should be conducted to confirm them and determine the long-term clinical effectiveness.

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