Additively Manufactured Custom-Made Subperiosteal Implant Rehabilitation for a Severely Atrophic Maxillary Molar Region: A Technical Note

Luigi Angelo Vaira, Andrea Biglio, Giovanni Salzano, Jerome R. Lechien, Giacomo De Riu

Full text link: https://pubmed.ncbi.nlm.nih.gov/38866670/

Additively Manufactured Custom-Made Subperiosteal Implant Rehabilitation for a Severely Atrophic Maxillary Molar Region: A Technical Note

1. Scientific Reference

• Study Title: Additively Manufactured Custom-Made Subperiosteal Implant Rehabilitation for a Severely Atrophic Maxillary Molar Region: A Technical Note
• Authors: Luigi Angelo Vaira, Andrea Biglio, Giovanni Salzano, Jerome R. Lechien, Giacomo De Riu
• Journal: Journal of Stomatology, Oral and Maxillofacial Surgery
• Year: 2024
• DOI: 10.1016/j.jormas.2024.101917

2. Scientific Background

Implant rehabilitation of the posterior maxilla remains particularly challenging when severe alveolar bone atrophy limits the placement of conventional dental implants. Traditional treatment pathways often require bone augmentation procedures and staged surgical interventions, resulting in prolonged treatment times before definitive prosthetic rehabilitation can be achieved. These limitations have stimulated interest in graftless approaches designed to simplify the management of advanced maxillary bone loss.

While alternative implant strategies have increasingly been described for extensive maxillary rehabilitation, their application to localized posterior defects is less well documented. At the same time, advances in digital planning, CAD/CAM workflows, and additive manufacturing have renewed interest in patient-specific subperiosteal implants. This technical report explores the feasibility of extending this personalized approach to a sectorial maxillary rehabilitation involving severe posterior atrophy rather than complete arch reconstruction.

3. Study Objective

The purpose of this technical report was to describe the use of a custom-made, additively manufactured subperiosteal implant for the rehabilitation of a patient presenting with severe atrophy of the maxillary molar region. The authors sought to illustrate the technical feasibility of applying this patient-specific solution to a localized posterior edentulous area, an indication that has received limited attention in the existing literature.

4. Methodology

This publication is a technical note describing a single clinical case.

The report presents the rehabilitation of a patient with maxillary molar edentulism associated with severe alveolar bone atrophy using a custom-designed subperiosteal implant manufactured through additive manufacturing technology. The abstract does not provide detailed information regarding the digital design workflow, surgical protocol, prosthetic procedures, follow-up duration, or outcome assessment criteria. Likewise, the exact number of implants placed is not specified in the available information.

5. Main Findings

The report demonstrates the successful technical application of a patient-specific subperiosteal implant for localized rehabilitation of a severely atrophic posterior maxilla.

According to the abstract, this approach illustrates the feasibility of using customized subperiosteal implants beyond full-arch rehabilitation, extending their potential application to sectorial maxillary defects. The authors position this technique as a possible alternative in situations where conventional implant rehabilitation may require multiple surgical procedures and longer treatment timelines.

However, the abstract does not report quantitative clinical outcomes such as implant survival, biological or prosthetic complications, functional performance, marginal bone changes, patient-reported outcomes, or long-term follow-up. Consequently, the available data support technical feasibility only and do not allow conclusions regarding clinical effectiveness or long-term predictability.

6. Clinical Analysis

The principal contribution of this publication lies in expanding the potential indications for custom-made subperiosteal implants rather than demonstrating definitive clinical efficacy. Traditionally, these implants have primarily been described for full-arch rehabilitation of severely atrophic maxillae. This report suggests that advances in digital design and additive manufacturing may also enable their application in localized posterior defects.

From a clinical perspective, patient-specific subperiosteal implants may represent an alternative option in selected cases where conventional implant placement is complicated by severe bone deficiency. Their individualized design reflects the broader evolution of digital implantology, where three-dimensional planning and customized manufacturing aim to improve anatomical adaptation.

Nevertheless, the findings should be interpreted with caution. The publication represents a single technical case without comparative data, standardized outcome measures, or long-term clinical evaluation. As such, it cannot establish superiority or equivalence compared with conventional reconstructive procedures or other graftless implant concepts. Additional clinical studies involving larger patient populations and extended follow-up will be required before broader clinical recommendations can be considered.

7. Clinical Applications

Based on the information available, this technique may be considered for carefully selected patients presenting with severe localized maxillary atrophy affecting the posterior molar region.

The report highlights the potential integration of patient-specific implant design, additive manufacturing, and digital surgical planning into complex implant rehabilitation workflows. Although the publication focuses on a localized clinical application, it does not provide sufficient evidence to define precise clinical indications, patient selection criteria, or long-term treatment outcomes. Therefore, its findings should primarily be viewed as a demonstration of technical feasibility.

8. Level of Evidence, Limitations, and Transparency

This publication is a technical note describing a single clinical case, representing a low level of clinical evidence.

Its methodological limitations include the absence of a control group, quantitative outcome measures, comparative analysis, and long-term follow-up data. These limitations substantially restrict the generalizability of the findings.

The information provided does not mention any declared conflicts of interest or financial relationships with implant manufacturers.

Accordingly, the conclusions should be interpreted as evidence of technical feasibility rather than proof of clinical effectiveness or routine applicability.

9. Key Study Highlights

• Study design: Technical note with a single clinical case.
• Level of evidence: Low.
• Study population: One patient with severe posterior maxillary atrophy and maxillary molar edentulism.
• Number of patients: 1.
• Number of implants: Not specified in the available information.
• Follow-up period: Not specified in the available information.
• Primary outcome: Technical feasibility of a custom-made subperiosteal implant for localized maxillary rehabilitation.
• Main finding: Successful illustration of sectorial rehabilitation using an additively manufactured patient-specific subperiosteal implant.
• Scientific conclusion: The report demonstrates technical feasibility but does not provide sufficient clinical evidence to assess long-term outcomes.
• Main limitations: Single clinical case, absence of quantitative clinical outcomes, no comparative evaluation, and no reported long-term follow-up.

10. Scientific Impact

This technical report contributes to the evolving field of digital implantology by describing a novel application of custom-made subperiosteal implants in localized posterior maxillary rehabilitation. Rather than confirming clinical effectiveness, the publication broadens the conceptual scope of patient-specific implant solutions made possible through additive manufacturing technologies.

Its value lies in introducing a potential treatment concept for sectorial maxillary defects, an indication that has been less frequently explored than full-arch rehabilitation. Although the evidence remains preliminary, the report encourages further investigation into customized implant-supported rehabilitation strategies. Future prospective studies involving larger patient cohorts, standardized clinical outcomes, and long-term follow-up will be necessary to determine the true clinical role of this approach within contemporary implant dentistry.

11. Editorial Conclusion

This technical note presents an innovative application of additively manufactured custom-made subperiosteal implants for the rehabilitation of a severely atrophic posterior maxilla. While it successfully demonstrates the technical feasibility of this personalized approach in a localized clinical setting, the available evidence remains limited to a single case. Consequently, the publication should be regarded as an exploratory contribution that generates hypotheses for future research rather than as evidence supporting routine clinical implementation.