Current Implant Treatment Modalities for the Atrophic Maxilla: A Comprehensive Narrative Review

Rehabilitation of the atrophic maxilla presents a significant clinical challenge due to severe alveolar bone resorption, poor bone quality, and anatomical limitations such as sinus pneumatization. While traditional bone grafting procedures are effective, they are often invasive and unsuitable for medically compromised patients. This narrative review evaluates current implant-based treatment modalities, with a focus on graftless techniques including short, tilted, pterygoid, zygomatic, and patient-specific subperiosteal implants. A comprehensive literature search was conducted across multiple databases (PubMed, Google Scholar, EBSCO, Web of Science, and Cochrane Library) for studies published between January 1998 and December 2024. A total of 40 relevant articles were selected, highlighting that graftless solutions demonstrate high survival rates and reduced morbidity. Reported survival rates include up to 96% for short implants, 98.6% for tilted implants, approximately 97% for zygomatic implants, and 91% for pterygoid implants. Implants in sinus-augmented areas show variable success, with rough-surfaced implants outperforming machined ones. Key biomechanical considerations, such as implant diameter, splinting, and angulation, significantly influence load distribution and implant longevity. Overall, advancements in digital planning, implant technology, and biomaterials have established graftless implant approaches as effective and predictable alternatives for restoring function and esthetics in patients with atrophic maxillae, while minimizing surgical invasiveness.