Background/Objectives: Severe maxillary atrophy presents challenges in maxillofacial rehabilitation. This study compares the clinical outcomes of zygomatic and subperiosteal implants, focusing on implant survival, soft tissue management, and postoperative complications over a five-year follow-up. Methods: A retrospective cohort study analyzed 150 patients divided into two groups based on the type of implant. Zygomatic implants were assessed for immediate functional loading, procedural efficiency, and complications such as sinus-related issues and orbital damage. Subperiosteal implants were evaluated for their customized design, keratinized mucosa integration, and adaptation to severe anatomical limitations. Statistical analyses, including Chi-square tests, were used to determine significant differences (p < 0.05). Results: This study demonstrated differences in complication rates (sinus-related complications: 12.4% for zygomatic implants; peri-implantitis: 5.6% for subperiosteal implants). Implant survival rates were comparable (zygomatic: 96.3%, subperiosteal: 97.1%, p = 0.278). Zygomatic implants demonstrated higher incidences of sinus-related complications (12.4%) and risks of orbital damage. Subperiosteal implants exhibited superior soft tissue stability with fewer cases of peri-implantitis (5.6%, p < 0.05). Procedural duration was shorter for zygomatic implants (177 min vs. 123 min); however, subperiosteal implants allowed for re-implantation after failure, providing flexibility that was unavailable with zygomatic implants. Conclusions: Zygomatic implants excel in immediate functional loading and reduced procedural time but require advanced surgical expertise to mitigate anatomical risks. Subperiosteal implants offer a safer, customizable solution, particularly in anatomically complex cases. These findings emphasize the importance of individualized treatment planning and technological advancements in implant design to optimize clinical outcomes for patients with severe maxillary atrophy.

Background: One of the most critical complications that can occur after placing zygomatic implants is the accidental penetration of the patient's eye socket by a drill or implant. This article aims to find some relationships between the anatomical features of the lower orbital wall, different configuration of zygomatic implants, and other factors when planning the placement of zygomatic implants. Methods: A total of 81 patients underwent zygomatic implant procedures, receiving different combinations of implants. These included four zygomatic implants along with one or two conventional implants (Group I), four zygomatic implants alone (Group II), two zygomatic implants paired with four conventional implants (Group III), or three zygomatic implants alongside one or two conventional implants (Group IV). The aim of the study was to describe the complications and clinical outcomes of treatment in 81 patients who received zygomatic implants. Results: The following parameters were statistically significant between all four groups of patients: height and distance of two zygomatic implants in the zygomatic bone; surgery type and duration; the distance between zygomatic implants in the zygomatic bone; and zygomatic orbital floor (ZOF) classification at the left side showed significant differences; intramaxillary insertion of zygomatic implants reduced the rupture of Schneiderian’s membrane; the average of zygomatic implants’ length in all groups was 42.8 mm. Conclusions: Not damaging the ZOF is profoundly important for preventing orbital damage during osteotomy for zygomatic implants and should be measured before every surgery.

Background: Autologous dentin has emerged as a potential grafting material in regenerative oral surgery because of its structural and biological similarities to bone. This technical report describes a modified tooth-shell technique used for horizontal ridge reconstruction with simultaneous implant placement in two clinical cases involving the aesthetic zone. Case Presentation: The first case involved a 29-year-old female patient requiring extraction of a partially impacted, buccally positioned maxillary third molar (tooth 28). The extracted tooth was processed intraoperatively to obtain a dentin shell, which was fixed as a buccal plate during simultaneous implant placement. The remaining defect was filled with sticky bone prepared from biphasic calcium phosphate combined with platelet-rich fibrin. Radiographic evaluations performed at 4 and 6 months demonstrated stable ridge contours, while clinical follow-up continued for 2 years with maintenance of implant function and peri-implant tissue stability. The second case involved a 58-year-old female patient with a previous failure of immediate implantation in the anterior maxilla associated with implant overload, loss of implant stability, and buccal bone deficiency. After soft- and hard-tissue healing, ridge reconstruction was performed using a dentin shell prepared from tooth 18 together with simultaneous implant placement and immediate provisional restoration. Follow-up after 6 months revealed stable peri-implant tissues, a satisfactory aesthetic outcome, and successful prosthetic rehabilitation. Conclusions: The modified tooth-shell technique using autologous dentin provided satisfactory preliminary clinical and radiographic outcomes in both cases. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies with longer follow-up periods.

Peri-implantitis is a plaque-associated inflammatory condition characterized by progressive loss of supporting peri-implant bone and remains one of the most challenging biological complications in implant dentistry. Although reconstructive procedures are increasingly used, the relative effectiveness of different regenerative biomaterials and biologically enhanced strategies remains uncertain. This structured narrative review critically evaluates current clinical evidence for regenerative biomaterials used in peri-implantitis treatment and places emerging biological and cell-based approaches within their appropriate translational context. A structured literature search was conducted in PubMed/MEDLINE. Particular emphasis was placed on direct human evidence concerning enamel matrix derivative, porous titanium granules, deproteinized bovine bone mineral (DBBM), hydroxyapatite, biphasic calcium phosphate, and platelet-rich fibrin, while periodontal, endodontic, and preclinical studies were considered indirect or translational evidence where relevant. Available clinical studies indicate that reconstructive procedures can improve radiographic defect fill and selected peri-implant clinical parameters; however, radiographic improvement does not necessarily correspond to complete disease resolution or true re-osseointegration. Among currently evaluated grafting materials, DBBM, porous titanium granules, and hydroxyapatite are supported by direct human clinical evidence, although heterogeneity in HA formulations and accompanying treatment protocols limits material-specific conclusions. BCP-containing reconstructive protocols have also been evaluated clinically, but the independent contribution of BCP remains difficult to isolate. Enamel matrix derivative and platelet-rich fibrin may provide biologically active adjunctive effects, although their independent contribution within multimodal regenerative protocols remains difficult to determine. Emerging cell-based and cell-derived strategies offer additional regenerative potential but remain predominantly supported by preclinical or translational evidence. No single biomaterial has demonstrated universal superiority. Future studies require standardized disease definitions, defect classifications, outcome measures, adequately powered multicentre trials, long-term follow-up, and improved patient and defect stratification to determine which regenerative strategies provide clinically meaningful and durable benefits.