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.

Background and Objectives: Stereolithography (SLA) enables the creation of physical replicas of digital models, offering surgeons a realistic representation of patient anatomy. This technology improves diagnostics and surgical planning, facilitates communication within the medical team, and enhances the doctor–patient relationship by promoting compliance. This study aims to place the intervention addressed in a broader context and highlight the utility of SLA models in complex surgical scenarios. Case Presentation: The study presents two cases of patients with severe maxillary atrophy: a 67-year-old healthy male (with well-controlled hypertension) and a 72-year-old female patient (with hypercholesterolemia). Intervention and Outcome: Zygomatic implant procedures with immediate loading were performed to resolve the bone atrophy in both cases. These procedures heavily leveraged preoperative planning using stereolithographic models. Both interventions resulted in a positive outcome, which was confirmed at the 6-month follow-up. Conclusions: The integration of stereolithographic models into the preoperative planning process improved the prognosis of these complex cases, confirming their value in managing severe maxillary atrophy.

Background: Severe jaw atrophy (Cawood and Howell Class V–VI) often renders conventional endosseous implantation unfeasible due to the lack of medullary bone and vascularization. This study presents a digital workflow for customized subperiosteal implants designed to eliminate bone segmentation errors and ensure optimal passive fit. Methods: Two clinical cases of severe atrophy—a full-arch maxillary rehabilitation and a unilateral partial rehabilitation—were treated using a prosthetic-driven CAD/CAM workflow. Key innovations included densitometric mapping using Hounsfield Units (HU) to identify high-mineralization zones (+1200 to +1800 HU) for strategic screw fixation. Intraoperatively, cobalt–chrome osteoplasty guides and PMMA check-templates were utilized to validate bone segmentation accuracy in vivo and regularize the cortical base. Results: The protocol achieved high precision with a monitored alignment deviation of 0.2 mm. At the 2-year follow-up, clinical and radiographic evaluations (CBCT) confirmed the total absence of gaps at the bone–implant interface. No signs of peri-implantitis, osteolysis, or progressive bone loss were observed, and soft tissues remained stable and healthy. Discussion: Success was driven by the rigorous management of the bone–implant interface and the use of preparatory surgical devices to bridge the gap between digital planning and surgical reality. The mechanical stability achieved through divergent fixation vectors prevented stress shielding by converting shear forces into compression, stimulating basal bone density according to Wolff’s Law. Conclusions: The standardized digital workflow and the use of preparatory surgical devices in this preliminary study showed that complex rehabilitations can be performed with favorable short-term outcomes. While this approach reduces surgical time and biological stress, further prospective studies are required to confirm its clinical predictability and define next-generation subperiosteal implants as a valid alternative for the management of severely atrophic cases.