Expected Clinical and Patient-Centered Outcomes Associated with Different Rehabilitation Strategies for Severe Maxillary Atrophy: An International Cross-Sectional Survey

Abstract

Background Severe maxillary atrophy remains one of the most challenging conditions in implant dentistry and maxillofacial surgery. Multiple rehabilitation strategies are available, including regenerative procedures, alternative implant-based approaches, and hybrid concepts. Although clinical outcomes have been reported, limited information exists regarding clinician-reported expectations associated with different rehabilitation strategies when evaluating the same clinical scenario. The aim of this study was to investigate clinician-reported expectations associated with different rehabilitation approaches for severe maxillary atrophy. Materials and Methods An international cross-sectional survey was conducted using a standardized anonymized CBCT case classified as Cawood and Howell Class VI. The questionnaire was distributed through professional and academic networks between July and November 2025. Respondents with experience in at least five complex implant-prosthetic rehabilitations per year were included. After selecting their preferred rehabilitation strategy, participants completed a branching questionnaire exploring clinician-reported expectations regarding safety, predictability, immediate loading, implant survival, treatment duration, smile satisfaction, masticatory function, oral hygiene and maintainability, postoperative morbidity, annual maintenance costs, patient satisfaction, and quality-of-life improvement. Descriptive statistics were performed. Results A total of 155 eligible clinicians from 33 countries were included. Alternative implant-based strategies were selected by 83 respondents (53.5%), regenerative approaches by 45 (29.0%), and hybrid approaches by 27 (17.4%). Clinicians selecting alternative implant-based strategies more frequently anticipated immediate loading (81.9%), functional rehabilitation within 72 hours (83.1%), and implant survival exceeding 95% at five years (57.8%). Respondents selecting regenerative approaches more commonly expected treatment durations of approximately one year (64.4%) and reported favorable expectations regarding smile satisfaction (86.7%), patient satisfaction (82.2%), and quality-of-life improvement (97.8%). Across all therapeutic preference groups, clinician-reported expectations regarding masticatory function, patient satisfaction, and quality-of-life improvement were favorable. Most respondents anticipated postoperative discomfort lasting between one and four weeks and treatment abandonment rates below 5%. Conclusions Clinicians selecting different rehabilitation strategies for severe maxillary atrophy reported distinct expectations regarding treatment timing, predictability, implant survival, aesthetics, maintenance requirements, morbidity, and patient-outcomes. Despite these differences, expectations were favorable across all therapeutic preference groups, suggesting that multiple rehabilitation pathways are perceived as viable treatment options. The findings should be interpreted as clinician-reported expectations rather than clinical or patient-reported outcomes.