One-Stage Digital Rehabilitation of a Severely Atrophic Posterior Maxilla Using a Customized Zirconia Mesh, Lateral Sinus Floor Elevation, and Simultaneous Implant Placement: A Clinical Case Report

Background: Rehabilitation of the posterior atrophic maxilla remains one of the greatest challenges in implant dentistry because of limited residual bone volume and maxillary sinus pneumatization. Digital technologies have recently expanded the possibilities for guided bone regeneration (GBR) through the design of customized patient-specific devices. This case report describes the clinical management of a severe three-dimensional posterior maxillary defect using a fully digital workflow.

Case Presentation: A 57-year-old healthy female presented with a long-standing posterior maxillary edentulism associated with severe vertical and horizontal ridge deficiency and marked maxillary sinus pneumatization. Preoperative planning combined cone-beam computed tomography (CBCT), intraoral optical scanning, three-dimensional segmentation, and CAD/CAM design to fabricate a customized zirconia mesh and a fully guided surgical template. A one-stage surgical approach was performed, including lateral sinus floor elevation using the LAS Kit, simultaneous implant placement, vertical guided bone regeneration with xenogeneic bone substitute, stabilization of the customized zirconia mesh, and coverage with a resorbable collagen membrane. After six months of healing, the zirconia mesh was removed, revealing satisfactory bone regeneration that allowed successful prosthetic rehabilitation with a three-unit implant-supported fixed prosthesis.

Discussion: This digital workflow enabled precise surgical planning, accurate adaptation of the customized zirconia mesh, and predictable implant positioning while reducing intraoperative adjustments. Combining simultaneous sinus augmentation, vertical GBR, and implant placement shortened the overall treatment time and avoided multiple surgical interventions. Customized zirconia meshes may represent a promising alternative to conventional titanium meshes because of their excellent biocompatibility, anatomical precision, and favorable soft-tissue behavior.

Conclusions: Within the limitations of a single clinical case, the combination of digital planning, customized zirconia mesh, simultaneous lateral sinus floor elevation, and immediate implant placement demonstrated encouraging clinical outcomes. Further prospective clinical studies are required to confirm the long-term predictability of this innovative treatment strategy.