Salvaging Maxillary Form and Function After Free Tissue Transfer Failures: Successful Use of an IPS ® Custom Subperiosteal Implant

Background: Maxillary defects resulting from tumor resection or trauma can lead to substantial functional and esthetic impairment, including malocclusion, impaired mastication, disordered speech, and loss of midface projection. Free tissue transfer has become the primary method of reconstruction for large maxillary defects, yet flap failure and patient-specific contraindications can limit its use. Custom patient-specific implants have emerged as a potential alternative for patients who are unable to undergo or have previously failed traditional reconstruction. Case Presentation: We present the case of a 23-year-old man who acquired severe maxillary bone loss following childhood fibrous dysplasia treated with hemi-maxillectomy. Over 7 years, he underwent multiple reconstructive attempts at our institution, including 2 fibula free flaps that ultimately failed, prompting consideration for reconstructive alternatives. This patient was selected for custom maxillary reconstruction with a digitally planned, titanium subperiosteal implant using the IPS Implants ® Preprosthetic system. The implant was successfully placed in a single-stage procedure, providing immediate, stable structural support for definitive prosthetic rehabilitation. Conclusions: This case highlights the role of custom patient-specific implants as a viable reconstructive option for patients with extensive maxillary loss who are poor candidates for free tissue transfer. Patient-specific subperiosteal implants may provide durable skeletal support and reliable dental rehabilitation for complex cases in which traditional methods have failed.