First Global Consensus for Clinical Guidelines: Structured Recommendations (S2k-Level Guideline Framework) for the...

Rehabilitation of the edentulous maxilla poses major clinical and patient-centered challenges. While implant survival and marginal bone level changes dominate the literature, patient-reported outcomes (PROs) such as aesthetic satisfaction, comfort, and quality of life remain underrepresented. The Global Consensus for Clinical Guidelines (GCCG) aimed to develop an international, consensus-based guideline for maxillary rehabilitation that integrates PROs and clinician-reported outcomes (ClinROs) within a structured treatment workflow and to identify future research priorities.

This S2k-level guideline was developed through a multi-phase process involving clinical experts, a methodologist, patients, and interdisciplinary contributors. Evidence synthesis included eight systematic reviews and six structured surveys. A Core Outcome Set (COS) of 34 critically important outcomes (10 PROs, 22 objective and 2 subjective ClinROs) was established via a three-round Delphi process with 105 experts. Consensus recommendations were generated and voted upon by 105 delegates from 26 countries using nominal group technique and anonymous plenary voting.

The guideline defines 36 consensus-based recommendations mapped to 34 COS outcomes, covering all phases of care, patient selection, diagnostics, surgical and prosthetic treatment, complication management, and maintenance. It emphasizes shared decision-making, prosthetically driven planning, immediate protocols when feasible, and risk-based maintenance to prevent surgical, biological, and technical complications. A clinical workflow checklist and decision trees support practical implementation.

This is the first global guideline for edentulous maxilla rehabilitation integrating a COS across all treatment phases, fostering evidence-based, outcome-driven, and patient-centered implant care worldwide.