Search Results (48)

Background: Severe maxillary atrophy remains a major challenge for implant-supported rehabilitation, often requiring complex grafting procedures or zygomatic implants associated with increased surgical morbidity. Advances in digital planning and additive manufacturing have enabled the development of patient-specific subperiosteal implants supported by cortical bone anchorage. Materials and Methods: This study presents a fully digital workflow combining customized subperiosteal implants (SP3D) with guided pterygoid fixation (PT3D) to achieve stable distal support and allow immediate loading in severely atrophic maxillae. Results: Nine patients presenting with advanced maxillary atrophy were treated using computer-assisted design, guided surgery, and immediate prosthetic rehabilitation. All implants were successfully placed according to the digital plan, achieving stable fixation through bilateral pterygoid engagement. No major intraoperative or postoperative complications were observed. Immediate loading was performed in all cases with stable prosthetic outcomes during the follow-up period (average follow-up period was 12.7 months). Conclusions: The combined SP3D–PT3D approach represents a minimally invasive alternative for full-arch rehabilitation in extreme maxillary atrophy, potentially reducing the need for bone grafting while improving surgical predictability and biomechanical stability. Full article

Background/Objectives: Contemporary patient-specific subperiosteal implants have re-emerged as graftless solutions for oral and maxillofacial rehabilitation, driven by advances in digital planning, CAD/CAM workflows, additive manufacturing, and biomaterial engineering. Their indications have progressively expanded from severely atrophic edentulous jaws to segmental defects, single-tooth replacement, congenital craniofacial anomalies, salvage situations, and oncologic reconstruction. This scoping review aimed to map the current evidence on modern patient-specific subperiosteal implants, focusing on indications, workflow, design principles, materials, outcomes, complications, and maintenance. Methods: A scoping review was conducted according to PRISMA-ScR principles to identify clinical studies, case series, case reports, systematic and scoping reviews, technical notes, finite element analyses, in vitro studies, and relevant translational investigations dealing with contemporary custom-made or CAD/CAM subperiosteal implants. The evidence was narratively synthesized according to clinical indication and thematic domains, including full-arch rehabilitation, sectional and single-tooth applications, congenital and post-oncologic defects, rescue indications, biomechanics, material selection, surface response, prosthetic protocols, and complication management. No quantitative meta-analysis was performed because of the scoping design and the substantial heterogeneity of study types, indications, implant systems, outcome definitions, and follow-up durations. Results: The final evidence map included 116 records, of which 56 were unique human clinical records with extractable denominators and 60 were biomechanical, in vitro, surface-biology, review, consensus, historical, or conceptual records. Of the 56 unique clinical records, 49 were mapped within the six indication-level clinical sections, while seven were retained as cross-cutting clinical evidence addressing patient-reported outcomes, design-related complications, bone apposition, anchorage strategy, comparative graftless rehabilitation, or reconstructive/prosthetic principles. The six indication-level sections included 52 clinical-record assignments: 15 for full-arch rehabilitation, 13 for segmental or sectional rehabilitation, one for single-tooth rehabilitation, four for congenital or craniofacial indications, 13 for post-oncologic or post-ablative reconstruction, and six for rescue or salvage indications. Because three records addressed more than one indication, these counts represent indication-level assignments rather than mutually exclusive clinical records. Reported survival in most short- to mid-term clinical series was generally high, commonly ranging from 90% to 100%, although lower values of 70–80% were reported in selected longer-term cohorts and survival clearly overestimated clinical success in some studies. Expanding applications include posterior mandibular and maxillary defects, lateral incisor agenesis, cleft-related or syndromic deformities, maxillectomy reconstruction, obturator support, and hybrid rehabilitation with endosseous implants; however, evidence for the indications at the extremes of this spectrum—single-tooth replacement and primary oncologic reconstruction—remains limited to small, largely single-group case series and reports. Soft-tissue events, including dehiscence, mucositis, recession, and framework exposure, were the dominant complications and showed wide variability, with reported recession/exposure rates ranging from approximately 10% in some sectional and full-arch series to as high as 65% in bilateral maxillary cohorts; their clinical significance varied from asymptomatic stable findings to progressive inflammatory complications requiring revision. Conclusions: Patient-specific subperiosteal implants represent a promising and increasingly versatile reconstructive option; however, the present findings should be interpreted as evidence mapping rather than as definitive comparative evidence. Their clinical use should remain highly selective, prosthetically driven, and supported by meticulous planning, rigid fixation, soft-tissue management, and structured maintenance. Standardized success criteria, longer follow-up, and comparative prospective studies are required. Full article

Background and Objectives: Zygomatic implants have progressively become a widely adopted graft-free treatment option for the rehabilitation of severe maxillary atrophy. However, the expansion of their clinical indications has generated debate regarding patient selection, treatment hierarchy, and potential overtreatment. This review aimed to critically analyze current evidence regarding the use of zygomatic implants in the rehabilitation of the atrophic maxilla. Methods: A comprehensive narrative review of the literature was conducted through searches of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Relevant clinical studies, systematic and narrative reviews, and consensus statements published in English up to 27 March 2026 were critically analyzed to provide a comprehensive narrative synthesis focusing on treatment indications, surgical protocols, complications, patient-reported outcomes, and evidence gaps. Results: The reviewed literature consistently reported high implant survival rates and highlighted the role of zygomatic implants in reducing the need for extensive grafting procedures in selected patients with severe maxillary atrophy. The most frequently reported complications included sinus-related disorders, soft-tissue complications, prosthetic problems, and challenges associated with the management of implant failure. Different surgical approaches, including intra-sinus, sinus-slot, and extra-sinus techniques, were described. However, substantial heterogeneity emerged regarding treatment algorithms, complication reporting, success criteria, and patient-reported outcome assessment. Conclusions: Zygomatic implants represent an established treatment option associated with high reported implant survival in selected patients with severe maxillary atrophy, particularly when conventional implant placement would require extensive reconstructive procedures. However, in borderline clinical situations characterized by partial residual bone availability, treatment planning should also consider less invasive alternatives, including short implants, tilted implants, regenerative procedures, or customized subperiosteal implants, according to individual anatomical, prosthetic, and patient-related factors. Greater standardization of indications, complication reporting, and patient-reported outcome assessment is needed to better define the role of zygomatic implants within evidence-based treatment planning for the atrophic maxilla. Full article

Background/Objectives: Patient-specific subperiosteal implants are increasingly used to treat severely atrophic ridges due to advances in digital planning and additive manufacturing. This study aimed to evaluate the effects of material type and implant configuration on stress distribution in subperiosteal implant systems and to compare their overall biomechanical performance using a multi-criteria decision framework. Methods: A three-dimensional model of a severely atrophic maxilla was reconstructed to simulate four clinical scenarios combining two configurations (one-piece and two-piece) and two materials (titanium and 60% carbon fiber-reinforced polyetheretherketone). Finite element analysis was conducted to assess stress distribution within the implant body, fixation screws, prosthetic framework, and surrounding bone under vertical and oblique loading conditions. Maximum and minimum principal stresses were evaluated in bone, whereas von Mises stresses were calculated for implant components. The resulting biomechanical indicators were subsequently integrated using an entropy weight–TOPSIS multi-criteria decision analysis. Results: Principal stresses in the surrounding bone showed minimal variation between titanium and 60% carbon fiber-reinforced polyetheretherketone across all configurations. Implant configuration had a more pronounced effect on implant body stress. Under oblique loading, the two-piece configuration demonstrated substantially higher implant stresses than the one-piece design, whereas under vertical loading, lower implant stresses were observed in the two-piece configuration. The multi-criteria analysis ranked the one-piece titanium model highest under oblique loading and the two-piece titanium model highest under vertical loading. Conclusions: Implant configuration and loading direction influenced biomechanical behavior more than material selection in patient-specific subperiosteal implants. Full article

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. Full article

Background: Custom-made subperiosteal implants have re-emerged as a valuable option for the rehabilitation of patients with severe maxillofacial atrophy and post-oncological defects. Despite advances in digital workflows and implant design, their unique anatomical, biological, and prosthetic characteristics pose specific challenges for long-term maintenance, and no dedicated standardized guidelines are currently available. Methods: This narrative review critically appraises the available literature on implant maintenance and related fields. A comprehensive search was conducted across PubMed, Scopus, and Web of Science, including studies on peri-implant maintenance, supportive periodontal therapy, full-arch and zygomatic implant rehabilitations, and subperiosteal implants. Due to the lack of direct evidence, a qualitative narrative synthesis was adopted to develop preliminary clinical considerations for maintenance of custom-made subperiosteal implants. These considerations should be interpreted as an expert-informed perspective rather than validated clinical guidelines. Results: Conventional maintenance protocols developed for endosseous implants are not directly transferable to subperiosteal implants due to differences in the implant–tissue interface, biomechanics, diagnostic parameters, and hygiene accessibility. Key challenges include the absence of a conventional peri-implant sulcus, possible implant exposure, complex prosthetic geometries, and potential susceptibility to biofilm accumulation in areas with limited access. Evidence from related fields highlights the importance of structured maintenance, individualized risk-based follow-up, effective biofilm control, and patient-specific home-care strategies. Conclusions: Preliminary evidence-informed clinical considerations for the maintenance of subperiosteal implants are proposed, with emphasis on plaque control, individualized follow-up, descriptive clinical monitoring, and hygiene-oriented prosthetic and surgical planning. These considerations are not intended as validated guidelines, but as a practical starting point for clinical reasoning in an area where dedicated evidence remains limited. Full article

Background/Objectives: Contemporary implant dentistry is increasingly oriented toward minimally invasive regenerative strategies designed to reduce surgical morbidity while preserving or improving clinical outcomes. Conventional bone augmentation procedures remain effective and biologically well established, but they may be associated with greater patient burden, increased risk of complications, and higher technical demands in selected clinical scenarios. This narrative review critically examines minimally invasive bone regeneration approaches in implant dentistry, with particular focus on the Bone Core Technique, the Sub-Periosteal Peri-implant Augmented Layer (SPAL) technique, and Immediate Dentoalveolar Restoration (IDR), emphasizing their biological rationale, clinical indications, surgical workflows, limitations, and reported outcomes. Methods: A structured, non-systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify publications relevant to minimally invasive bone regeneration in implant dentistry. Priority was given to clinical studies, prospective cohorts, case series, technical descriptions, and biologically oriented conceptual papers addressing vascular preservation, flap limitation, donor-site morbidity, and peri-implant hard- and soft-tissue integration. Results: Available evidence suggests that minimally invasive regenerative protocols may offer favorable clinical and patient-centered outcomes only in carefully selected indications and when performed by experienced operators. The strength of support is uneven across techniques: the Bone Core Technique currently has the strongest dedicated prospective follow-up for localized peri-implant defects, SPAL is supported by limited retrospective and emerging histologic evidence, and IDR remains largely based on case reports, technique-driven descriptions, and broader immediate implant literature. Conclusions: Minimally invasive bone regeneration reflects a shift toward biologically guided and patient-centered treatment concepts in implant dentistry, but it should not be interpreted as a universal substitute for conventional augmentation. Its successful application depends on careful case selection, sound knowledge of wound healing and defect morphology, and advanced surgical and prosthetic expertise. Further research should prioritize standardized outcome measures, longer follow-up, and comparative prospective studies. Full article

Background: Rehabilitation of edentulous mandibles in a post-oncologic setting remains a major clinical challenge. In such situations, placement of conventional endosseous implants may be compromised by severe bone deficiency, a history of peri-implant infection, and constraints related to reconstructive soft tissues. Customized titanium subperiosteal implants, made possible by three-dimensional imaging, computer-aided design, and additive manufacturing, represent a potential alternative when conventional options are unfavorable. This case report describes a full-arch fixed rehabilitation of an edentulous mandible in a patient previously treated for squamous cell carcinoma of the floor of the mouth. Methods: A patient-specific titanium additively manufactured subperiosteal jaw implant (AMSJI) made of biocompatible titanium was designed using a digital planning workflow. Implant placement was performed in a single surgical session under general anesthesia, with fixation using osteosynthesis screws. A screw-retained full-arch provisional prosthesis was delivered intraoperatively, allowing immediate loading with adjustments aimed at avoiding compression of the healing soft tissues. Results: The patient achieved satisfactory functional and esthetic rehabilitation. Postoperative follow-up showed overall favorable mucosal tolerance; an early, limited peri-abutment mucosal dehiscence was observed and managed with suturing under local anesthesia, without compromising implant stability. Conclusions: This case highlights the clinical interest of patient-specific titanium subperiosteal implants as a fixed rehabilitation option in post-oncologic patients with major osseous and mucosal constraints and a history of reconstructive procedures. The combination of accurate digital planning and custom-made manufacturing may avoid the need for extensive bone grafting. However, these findings should be interpreted with caution due to the short-term follow-up and the inherent limitations of a single-case report, which limit the level of evidence and generalizability. Full article

Background and Objectives: Severe alveolar atrophy may pose significant challenges for dental rehabilitation. Recent advances in digital planning and CAD/CAM technology have renewed the interest in patient-specific subperiosteal implants as a treatment option for anatomically challenging cases. This cohort study evaluated changes in oral health-related quality of life and patient satisfaction following rehabilitation with customized subperiosteal implants in severe alveolar atrophy. Materials and Methods: This cohort study included all consecutive adult patients with severe alveolar atrophy who underwent reconstruction with patient-specific subperiosteal implants at the Department of Oral and Maxillofacial Surgery of “Evangelismos” General Hospital, Athens, Greece, in 2025. Oral health-related quality of life was assessed using the validated OHIP-14 questionnaire preoperatively and 12 months postoperatively. Patient satisfaction was evaluated using a numerical rating scale (NRS). Secondary outcomes included postoperative complications, implant exposure, implant stability, and need for reoperation. Comparisons between baseline and 12-month scores were performed using the Wilcoxon signed-rank test. Results: Nine patients who had completed 12-month follow-up were included. Five were male, and all implants were placed in the maxilla. Significant improvement was observed in oral health-related quality of life, with the median OHIP-14 total score decreasing from 41 preoperatively to 1 at the 12-month follow-up. Patient satisfaction also improved significantly, with the median NRS total score increasing from 17 to 58. Improvements were consistent across all OHIP-14 domains and all NRS items. No major complications were recorded. One patient developed early wound dehiscence, and one patient presented with implant exposure at the anterior palate. At the final follow-up twelve months postoperatively, all implants remained clinically and radiographically stable. Conclusions: These preliminary short-term findings suggest that customized subperiosteal implants may be a promising option for selected patients with severe alveolar atrophy in whom placement of conventional endosseous implants is not feasible; however, the results should be interpreted cautiously given the very small sample size and observational design. Full article

In a previous study, we demonstrated that a novel surface treatment applied to laser-melted Ti6Al4V substrates supports osteoblast-like cell adhesion, proliferation, and the activation of early osteogenic pathways. Building on these preliminary findings, the present work aimed to further investigate the ability of the same surface to promote extracellular matrix (ECM) deposition, organization, and osteogenic maturation, which are critical events for the establishment of a stable bone–implant interface in subperiosteal dental implants. Human osteoblast-like MG-63 cells were cultured on Ti6Al4V discs subjected to different surface treatments, including a proprietary surface modification (ATcs) specifically designed for subperiosteal applications. ECM formation and maturation were evaluated through scanning electron microscopy coupled with energy-dispersive spectroscopy, immunofluorescence, and semiquantitative analyses of osteogenic markers type I collagen (COL1A1), secreted protein acidic and rich in cysteine (SPARC), and dentin matrix protein 1 (DMP1) through Western blotting. The results showed that, while all tested surfaces supported cell adhesion, the ATcs surface promoted a distinct osteogenic profile characterized by enhanced DMP1 expression, organized collagen deposition, and the formation of calcium–phosphate–rich mineralized structures. Compared to surfaces that primarily stimulated cell proliferation or early matrix production, ATcs appeared to favour progression toward late-stage osteogenic maturation and matrix mineralization. Taken together, these findings extend our previous observations and indicate that this novel surface treatment not only supports osteoblast viability and early differentiation but also promotes extracellular matrix maturation, a key prerequisite for effective osseointegration. Although further in vivo studies are required, the present data provide additional biological rationale for the use of ATcs-treated Ti6Al4V surfaces in next-generation custom-made subperiosteal implant designs. Full article

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. Full article

Background/Obectives: Alveolar bone resorption after tooth extraction compromises esthetics and implant placement. Conventional alveolar ridge preservation (ARP) relies on grafting. This randomized controlled study evaluated a graft-free, lamina-based approach aimed at preserving ridge morphology by protecting the buccal cortical plate. Methods: Forty alveoli were randomly assigned to Guided Alveolar Ridge Preservation (G-ARP) with a subperiosteally positioned cortical lamina (test) or unassisted healing (control; CTRL). Cone-beam computed tomography (CBCT) was performed before extraction and after five months. Vertical and horizontal dimensional changes were statistically compared. Results: Healing was uneventful. At five months, the G-ARP group showed a vertical gain of 0.5 mm and a horizontal reduction of 0.2 mm, whereas the CTRL group exhibited a vertical loss of 1.7 mm (p < 0.01) and a horizontal loss of 2.7 mm (p < 0.001). Effect sizes were large for vertical change and very large for horizontal change (Hedges’ g = 0.95 and 2.19, respectively). Regeneration occurred through native bone formation without grafts. Conclusions: Subperiosteal placement of a cortical lamina effectively preserved ridge dimensions after extraction. This graft-free approach may offer technical and biological advantages while supporting new bone regeneration. Full article

Custom-made subperiosteal implants are increasingly used in clinical cases where significant bone loss due to trauma or disease renders conventional endosseous implant placement unfeasible. This study investigated how different internal structural designs affect the deformation and stress distribution in mandibular subperiosteal implants under clinically relevant loading conditions. An idealized implant geometry was defined based on average human mandibular dimensions, and four configurations with identical outer shape and connection features were created, differing only in sidewall architecture (solid, top-relieved, top-relieved with lateral perforations, and top-relieved lattice framework). All specimens were manufactured by metal additive manufacturing and evaluated using cone-beam computed tomography (CBCT). Mechanical testing was performed in two stages: (i) cyclic loading consisting of 500 bite cycles at an overall force of ~326–350 N and (ii) a single static high-load event of 2000 N, applied parallel to the fixation pin axes. CT datasets acquired before and after each stage were compared to detect permanent deformation. No measurable residual deformation was identified in any configuration; the only observed macroscopic change was an adhesive-bond limitation in one case, rather than structural yielding of the implant. Finite element analysis further supported these findings by identifying localized stress concentrations mainly at the implant–prosthetic interface and by revealing the load-transfer zones that govern the mechanical response. Overall, the results indicate that lightweight, perforated, and lattice-based internal designs can preserve global structural integrity across physiological and supra-physiological load ranges while enabling design optimization to improve stress distribution. Full article

Background: Rehabilitation of the severely atrophic maxilla remains a major challenge in implant dentistry, particularly when conventional endosseous implants and regenerative procedures are contraindicated due to extensive bone loss, sinus pathology, or patient-related factors. Advances in digital planning and additive manufacturing have enabled the reintroduction of juxta-osseous subperiosteal implants as a graftless, patient-specific treatment option. This case report aimed to describe the complete digital workflow, surgical placement, and immediate prosthetic rehabilitation of a customized juxta-osseous subperiosteal implant in a patient with severe posterior maxillary atrophy and a history of failed sinus augmentation procedures. Case Presentation: A 75-year-old male patient presenting with left severe posterior maxillary atrophy and previous unsuccessful sinus lift surgeries was rehabilitated using a digitally designed, additively manufactured titanium subperiosteal implant. Cone-beam computed tomography–based planning and CAD–CAM technology were used to design a patient-specific framework, which was rigidly fixed to stable maxillofacial support and immediately loaded with a screw-retained provisional prosthesis. Results: Clinical and radiographic follow-up demonstrated stable implant fixation, soft tissue healing, absence of biological or mechanical complications, and satisfactory functional and aesthetic outcomes. The patient reported high levels of comfort and satisfaction throughout the treatment period. Conclusions: Digitally manufactured juxta-osseous subperiosteal implants may represent a predictable and minimally invasive graftless alternative for selected patients with severe maxillary atrophy, particularly when conventional implant placement or extensive bone augmentation is not feasible. Accurate digital planning, rigid fixation, and appropriate patient selection appear to be key factors for clinical success. Full article

Background: Several minimally invasive techniques have been introduced to augment horizontal ridge volume for prosthetically driven implant placement, utilizing different biomaterials to enhance regenerative outcomes. This article presents two clinical cases illustrating a tunneling approach for horizontal alveolar ridge augmentation using a combination of xenogeneic bone graft, hyaluronic acid, and an acellular dermal matrix. Methods: A single vertical incision was made mesial to the bone defect and a dermal matrix was suitably shaped and positioned into the subperiosteal tunnel. Subsequently, the bone graft was inserted between the dermal matrix and the buccal bone plate. Primary wound closure was achieved. After six months, implants were placed. For each patient, an optical scan was performed at baseline (T₀), at six months post-operative ridge augmentation surgery (T₁) and at two months post-implant insertion (T₂). A digital measurement of the horizontal ridge thickness was performed at each inserted implant site. Clinical parameters and patient postoperative morbidity were recorded. Results: The procedure was well tolerated by the patients. No postoperative clinical complications were observed. The mean tissue thickness achieved at T1 was recorded to be 13.3 mm. The same value was recorded at T2. Conclusions: This technique allowed the placement of prosthetically guided implants, with minimal morbidity and no observed complications. Further studies analyzing the histology of newly formed bone and performing three-dimensional radiological examinations to confirm the effectiveness of the surgical technique are warranted to validate these preliminary findings. Clinical Trial Number (NIH): NCT06424223 Full article