A Digitally Planned "Dental-Implant-First" Protocol for Surgical Advancement and Prosthetic Restoration of Edentulous Maxilla With Skeletal Class III Deficiency: A Surgical Innovation.

In edentulous patients with skeletal Class III maxillary deficiency, Le Fort I osteotomy followed by delayed implant placement faces maxillary segment instability during healing. This article describes a reversed "dental-implant-first" protocol that alters the traditional sequence by placing implants prior to osteotomy within a 24-hour interval. On day 1, 4 implants were placed with a minimum insertion torque of 35 Ncm, maintaining a 3.0 mm safety distance from the planned osteotomy plane. On day 2, Le Fort I osteotomy was performed. The CAD-CAM milled temporary prosthesis was screwed in situ, serving as a rigid guide for maxillary repositioning and providing immediate cross-arch splinting. At 3 months, the maxilla was stable with a three-dimensional deviation root-mean-square value of 1.25 mm. This hybrid workflow offers a preliminary alternative to traditional staged protocols under strict safety boundaries. This represents the first-in-human application.