Treatment of Severe Atrophy with Juxta-Osseous Implants: A Systematic Review and Case Report

Background: Severe jaw atrophy limits traditional endosseous implantation, often necessitating complex regenerative procedures. Advances in digital planning and 3D printing have reintroduced custom-made subperiosteal (juxta-osseous) implants as a viable alternative. This study evaluates the clinical reliability and advantages of next-generation juxta-osseous implants. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines across the PubMed, Scopus, and Web of Science databases. The search focused on English-language studies reporting on custom-made titanium juxta-osseous implants in patients with severe maxillary or mandibular atrophy. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Additionally, a representative clinical case of a 60-year-old female treated via a fully digital workflow is presented to illustrate the protocol. Results: Twenty-six articles were included, accounting for 147 clinical cases. Most patients exhibited Cawood and Howell Class V-VI atrophy. All identified treatments utilized integrated digital workflows, including CBCT imaging, CAD/CAM design, and additive manufacturing (SLM/DMLS) of medical-grade titanium alloy. Reported success rates exceeded 90%, with high primary stability enabling immediate or early loading protocols and high patient satisfaction. Complications were primarily limited to manageable soft-tissue dehiscence. Conclusions: Modern juxta-osseous implants represent a promising, minimally invasive alternative to bone grafting for severe atrophy, enabling rapid functional restoration in the short-to-medium-term. However, because current evidence is limited to clinical studies, these findings should be interpreted with caution. Long-term prospective trials are essential to establish definitive clinical predictability and standardized protocols.