Bone Regeneration Over Subperiosteal Implants Using 3D-Printed Polycaprolactone Scaffolds

Ryan Goh, Cedryck Vaquette, Danilo Carluccio, Saso Ivanovski, Yohaann Ghosh, Omar Breik, Martin Batstone 

Full text link: https://pubmed.ncbi.nlm.nih.gov/42166886/

Bone Regeneration Over Subperiosteal Implants Using 3D-Printed Polycaprolactone Scaffolds

1. Scientific Reference

• Study Title: Bone Regeneration Over Subperiosteal Implants Using 3D-Printed Polycaprolactone Scaffolds
• Authors: Ryan Goh, Cedryck Vaquette, Danilo Carluccio, Saso Ivanovski, Yohaann Ghosh, Omar Breik, Martin Batstone
• Journal: Journal of Cranio-Maxillofacial Surgery
• Publication Year: 2026
• DOI: 10.1016/j.jcms.2026.104590

2. Scientific Background

Subperiosteal implants have re-emerged as a treatment option for patients with severe alveolar bone deficiency who are not suitable candidates for conventional endosseous implant placement. Recent advances in digital planning, CAD/CAM manufacturing, and patient-specific implant design have renewed interest in this approach. Nevertheless, biological complications remain a major concern. Peri-implant mucositis, peri-implantitis, and bacterial colonization of exposed implant components continue to compromise long-term treatment outcomes.

One proposed strategy to improve the biological integration of subperiosteal implants is to promote bone formation over the implant framework, thereby reducing its direct exposure to surrounding soft tissues. In this context, three-dimensional polycaprolactone (PCL) scaffolds have emerged as a promising regenerative platform because they provide a temporary architecture capable of supporting new bone formation. This preclinical investigation evaluates whether different scaffold designs can enhance osseous coverage of titanium subperiosteal implants and potentially improve their biological performance.

3. Study Objective

The primary objective of this study was to investigate whether three-dimensional printed polycaprolactone scaffolds could promote bone regeneration over titanium subperiosteal implants. The authors also sought to compare several scaffold architectures to determine which design most effectively enhanced bone formation relative to titanium implants without scaffold coverage.

4. Methodology

This was a preclinical animal study conducted using a large animal model. Four experimental groups were evaluated: a titanium-only control group and three groups receiving different 3D-printed polycaprolactone scaffold configurations (PCL Open, PCL Closed, and Nano PCL).

Radiographic assessment of bone formation was performed using computed tomography at 3 months and 6 months. Histological analysis was additionally carried out at 6 months to evaluate the quality and extent of newly formed bone surrounding the implants. The abstract does not specify the number of animals included in each experimental group.

5. Main Findings

The study demonstrated that polycaprolactone scaffolds consistently supported bone deposition over subperiosteal titanium implants, whereas the titanium-only control group showed less favorable outcomes.

Mixed Model Analysis identified statistically significant differences between the titanium-only control group and the PCL Closed scaffold group in both radiographic and histological evaluations. These differences were particularly evident in regenerated bone volume as well as maximum and mean bone height measurements surrounding the implants.

Among the tested scaffold designs, PCL Closed produced the most favorable regenerative response, while the PCL Open configuration also outperformed the titanium-only control. According to the authors, these findings suggest that functionalized PCL scaffolds may facilitate bone coverage of subperiosteal implants, potentially allowing their biological integration to resemble that of endosseous implants.

6. Clinical Analysis

This study provides important preclinical evidence supporting a regenerative approach to improving the biological integration of custom subperiosteal implants. Rather than leaving the titanium framework permanently covered only by soft tissue, the investigated strategy aims to encourage progressive bone formation over the implant surface through the use of biodegradable 3D-printed scaffolds.

From a clinical perspective, this concept is particularly relevant for modern implant dentistry, where patient-specific subperiosteal implants have regained interest for managing severe maxillary or mandibular atrophy. If similar biological responses can be reproduced in humans, enhanced osseous coverage could potentially reduce the biological challenges historically associated with these implants, including bacterial colonization and peri-implant inflammatory complications.

However, the findings should be interpreted cautiously. The investigation represents a pilot study conducted in an animal model and therefore cannot be directly translated into clinical recommendations for human patients. Furthermore, the available abstract does not provide information regarding implant survival, long-term functional performance, or complication rates. Consequently, the results should be regarded primarily as proof of biological feasibility that supports the development of future human clinical trials rather than definitive evidence of clinical effectiveness.

7. Clinical Applications

The findings suggest potential applications for customized subperiosteal implant rehabilitation in patients with significant bone deficiency where conventional implant placement may be challenging.

Combining additive manufacturing technologies with biodegradable polycaprolactone scaffolds could become part of digitally planned implant rehabilitation workflows aimed at improving biological integration. This approach may also contribute to future developments in bone regeneration strategies associated with patient-specific implant reconstruction. Nevertheless, these potential applications remain investigational and require confirmation through well-designed clinical studies before routine implementation.

8. Level of Evidence, Limitations, and Transparency

This publication represents a preclinical animal study, corresponding to a relatively low level of clinical evidence compared with human clinical trials.

As a pilot investigation, its primary strength lies in demonstrating biological feasibility rather than establishing clinical efficacy. The abstract does not report sample size, statistical power calculations, long-term outcomes, or functional clinical endpoints.

Methodological limitations are not explicitly discussed in the information provided. Likewise, no conflicts of interest or financial relationships with implant manufacturers are disclosed within the available abstract.

9. Key Study Highlights

• Study design: Preclinical large animal study.
• Level of evidence: Preclinical.
• Study population: Sheep animal model.
• Sample size: Not specified in the available information.
• Follow-up: 6 months.
• Primary outcome: Bone regeneration over titanium subperiosteal implants assessed by computed tomography and histological analysis.
• Main finding: Three-dimensional polycaprolactone scaffolds promoted bone deposition over subperiosteal implants, with the PCL Closed design demonstrating the strongest regenerative performance.
• Scientific conclusion: Functionalized PCL scaffolds show promise for enhancing bone formation over customized subperiosteal implants and provide a rationale for future clinical investigations.
• Study limitations: Pilot preclinical design; sample size not reported; absence of human clinical outcomes in the available abstract.

10. Scientific Impact

This study contributes meaningful preclinical evidence to the evolving field of digitally manufactured subperiosteal implants. By demonstrating that biodegradable polycaprolactone scaffolds can support bone regeneration over titanium implant frameworks, the authors introduce a regenerative concept that may help overcome some of the biological limitations historically associated with this implant design.

Another important contribution lies in the comparison of multiple scaffold architectures, highlighting that scaffold geometry appears to influence regenerative outcomes. These findings provide a scientific foundation for future optimization of scaffold design and support continued investigation into biomaterial-assisted bone regeneration for complex implant rehabilitation. As emphasized by the authors, clinical trials will be required to determine whether these encouraging experimental observations translate into improved patient outcomes.

11. Editorial Conclusion

This preclinical study suggests that three-dimensional printed polycaprolactone scaffolds may enhance bone regeneration over customized subperiosteal implants, with the PCL Closed configuration demonstrating the most favorable regenerative response among the tested designs. Although these findings remain limited to an animal model, they represent an important step toward improving the biological integration of subperiosteal implants. Future human clinical studies will be essential to confirm the clinical relevance, long-term safety, and therapeutic value of this regenerative strategy in implant dentistry.