Psychosocial Impact of Maxilla-For-All® Treatment Using Standard and Long Implants (Pterygoid, Trans-Sinus and Zygomatic) on Patients with Severe Maxillary Atrophies: A 1-Year Prospective Study with PIDAQ-23 and OHIP-14

Abstract

Background/Objectives: The satisfaction of patients following maxillary full-arch rehabilitation is crucial in assessing treatment effectiveness. This one-year study evaluated patients' satisfaction, quality of life, and aesthetic perception after receiving the Maxilla-for-All^®/All-On-X treatments, which combine standard, pterygoid, trans-sinus, and zygomatic implants to support a fixed prosthesis and offer a graftless solution that reduces morbidity and treatment time. Methods: A prospective cohort study using convenience sampling of subjects treated for severe maxillary atrophies was conducted on patients receiving immediate implant-supported full-arch fixed prostheses. The Oral Health Impact Profile (OHIP-14) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ-23) were administered preoperatively and one year post-treatment. Patients were grouped based on the presence or absence of complications (surgical, technical, and mechanical) and Wilcoxon tests were used for comparison (significance level = 0.05). Results: A total of 56 patients (29 female, 27 male) participated, with no implant or prosthesis failures. Eleven patients reported unilateral sinus membrane perforation, and seven had technical or mechanical complications. Preoperatively, 69% of patients rated their oral condition as unfavorable according to the OHIP-14; this dropped significantly to 21.8% post-treatment (p-value < 0.0001). After one year, the average PIDAQ-23 score improved significantly from 44.7 ± 16.6 to 6.8 ± 5.3 (p-value < 0.0001). No significant differences were observed between patients with or without complications (p-values ranging from 0.5270 to 0.8920). Conclusions: Full-arch rehabilitation using Maxilla-for-All^®/All-On-X treatments significantly improved both aesthetic perception and chewing function in patients with severe maxillary atrophies. They reported a substantial reduction in oral health-related discomfort, as shown by a significant decrease in OHIP-14 scores one year post-treatment. Clinical or technical complications did not significantly impact patients' quality-of-life outcomes or satisfaction, supporting the reliability of this treatment protocol.

Keywords: OHIP; PIDAQ; aesthetics; implant-supported full-arch prosthesis; patient satisfaction; quality of life; severe maxillary atrophies.

Figure 1

(A) Preoperative clinical view. (B) Intraoperative view after flap elevation and placement of implants. (C) Postoperative CT scans with 3D reconstruction showing the trajectory and position of zygomatic implants with A—Anterior; P—Posterior; R—Right; L—Left; H—Head; F—Foot. (D) Preoperative orthopantomogram. (E,F) Postoperative orthopantomograms showing the implants in place (E) and the final prosthetic rehabilitation (F). The abutments were attached following flap closure with non-resorbable sutures (4/0). The following post-surgical instructions were given: (1) ibuprofen 400 mg (or paracetamol 1 g for patients allergic to NSAIDs) to be taken 2–4 times a day, during meals if needed; (2) 0.2% chlorhexidine mouthwash for 1 min twice a day for 2 weeks. A soft diet was recommended for 3 weeks.

Figure 2

Box and whisker plot of the PIDA-23 (with 4 components) and OHIP-14 at baseline (preoperative or PREOP) and at 12 months (postoperative or POSTOP). Pair-wise statistical comparisons: Wilcoxon signed-rank test assessed changes in time: significant (° with 0.001 ≤ p-values < 0.01), very significant (°° with 0.0001 ≤ p-values < 0.001), extremely significant (°°° with p-values < 0.0001). ◯: no complications; +: outliers lying in both extremes of data; ☐: medical complications; : mechanical complications.