Considering the particularities of rehabilitation treatments with implants, such as patients with the atrophic edentulous maxilla, and particularly rehabilitation using long implants, this study aimed to assess the impact of using a modified long transmaxillary implant, placed horizontally on the OHRQoL of patients with the atrophic maxilla.

The missing teeth impair mastication and swallowing. Additionally, lack of lip support affects esthetics and alters the individual’s speech; moreover, conventional prosthetic rehabilitation using removable prostheses provides feasible stability or lack of retention [5]. Therefore, dental implants are used in edentulous jaws to improve the retention and stability of complete dentures [14]. In addition, implant treatment is an effective method for dental rehabilitation from the perspective of patient-reported outcomes [10].

Patient expectations from implant treatment have also changed over the years, and esthetics plays an important role in defining rehabilitation treatment plans. Two of the many important factors to be considered are the intended implant site and the quantity and quality of bone [16]. Branemark introduced the zygoma implant as an effective method in the management of the atrophic edentulous maxilla [6]. It has been demonstrated that zygomatic implants are a very efficient option in the rehabilitation of atrophic edentulous maxilla [2]. However, as these implants are three to four times longer than conventional implants, they require greater dexterity and skill from the surgeon, as the trajectory of the implant must be locked in the middle or upper third of the face, especially in the body of the zygomatic bone, passing through the interior of the maxillary sinus. Taking into account the length and direction of the implant, precision is essential to minimize the resulting risks, such as deviations from the insertion angle [3, 9].

Long trasmaxillary implants placed horizontally in the maxilla are kept at the limits of the lower third of the face, without invading noble areas in the upper region, unlike the zygomatic implants placed vertically. Transmaxillary implants are anchored from the canine abutment to the maxillary tuberosity for stability. The innovation resulted from the need to advance regarding patient safety and in the other techniques of long implants that have been practiced in recent years. After the installation of the prostheses, the patients continued to be followed up, demonstrating that rehabilitation of the atrophic maxilla was achieved and the treatment was favorable with the viability of the procedure, as well as to the advances regarding the long zygomatic implants.

In this case series, it was possible to conclude that there was an improvement in the perception of OHRQoL between the pre- and postoperative periods in the total OHIP-14 score and in the domains related to functional limitation (D1), physical pain (D2), psychological discomfort (D3), physical disability (D4), psychological disability (D5), social disability (D6), and social disadvantage (D7). All submitted patients had self-perception and improved OHRQoL, which may positively impacts people’s lives, also in the psychological-social aspects.

More patients and longer follow-up periods are necessary for better data evaluation. As the implant model was new, we were unable to compare our results to other similar studies. Based on the results of this study, we concluded that the rehabilitation of severely atrophic jaws with long implants placed horizontally can present a viable and safe treatment alternative and that long-term transmaxillary implant rehabilitation improves OHRQoL. However, further studies with long-term follow-up should be performed.

From the results obtained in this study, we can conclude that the long transmaxillary implant placed horizontally has a qualitative advantage in technical terms, compared to the zygomatic implant placed vertically or inclined, particularly regarding the risks of invasiveness and complications. The transmaxillary implant is a long implant that can be placed horizontally in the maxilla, remaining within the limits of the lower third of the face, without invading noble areas in the upper region.

Moreover, rehabilitation treatment using transmaxillary implants improved the OHRQoL of the patients evaluated in this study.