Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review

Javier Herce-López, Mariano Del Canto Pingarrón, Álvaro Tofé-Povedano, Laura García-Arana, Marc Espino-Segura-Illa, Ramón Sieira-Gil, Carlos Rodado-Alonso, Alba Sánchez-Torres, Rui Figueiredo

Full text link: https://pubmed.ncbi.nlm.nih.gov/38275459/

Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review

1. Scientific Reference

• Study Title: Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review
• Translated Title: Patient-Specific Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: Consensus Report and Literature Review
• Authors: Javier Herce-López, Mariano del Canto Pingarrón, Álvaro Tofé-Povedano, Laura García-Arana, Marc Espino-Segura-Illa, Ramón Sieira-Gil, Carlos Rodado-Alonso, Alba Sánchez-Torres, Rui Figueiredo
• Journal: Biomimetics
• Year of Publication: 2024
• DOI: 10.3390/biomimetics9010061

2. Scientific Background

Managing severe maxillary or mandibular atrophy remains one of the most demanding challenges in implant dentistry and oral rehabilitation. In many edentulous patients, residual bone volume is insufficient for the placement of conventional dental implants, often requiring extensive bone augmentation procedures. While regenerative techniques can expand treatment possibilities, they may increase treatment complexity, morbidity, cost, and overall rehabilitation time.

Recent advances in digital workflows, three-dimensional imaging, computer-aided design, and additive manufacturing have enabled the development of customized subperiosteal implants (CSIs). Unlike conventional endosseous implants, these patient-specific devices are designed according to individual anatomical conditions and can utilize available skeletal support areas that would otherwise be difficult to exploit.

As interest in personalized implant rehabilitation continues to grow, there is a need to critically assess the available evidence supporting these devices. This publication addresses that need by reviewing the current literature and combining it with expert consensus recommendations focused on clinical indications, digital planning, surgical protocols, prosthetic rehabilitation, and maintenance strategies.

3. Study Objective

The primary objective of this study was to review the available scientific literature on customized subperiosteal implants used for the rehabilitation of atrophic jaws.

A secondary objective was to develop clinical guidance based on a structured consensus process involving experts in oral and maxillofacial surgery, prosthodontics, dentistry, biomedical engineering, and research methodology. The authors aimed to identify current indications, technical considerations, surgical and prosthetic protocols, and future research priorities for this emerging treatment modality.

4. Methodology

A literature search was conducted in PubMed/MEDLINE in July 2023 using terms related to customized and personalized subperiosteal implants.

Eligible studies included case series and cohort studies involving partially or totally edentulous patients treated with customized subperiosteal implants and followed for at least six months. Case reports and animal studies were excluded.

The review ultimately included six studies: four case series and two retrospective cohort studies. Reported sample sizes ranged from 4 to 70 patients.

In parallel, a multidisciplinary panel of experts met to discuss six key areas: indications and contraindications, implant design, surgical protocols, prosthetic rehabilitation, peri-implant maintenance, and future perspectives. Recommendations were developed through consensus and subsequently reviewed during a second meeting before final approval.

5. Main Findings

Most studies evaluated laser-sintered titanium customized subperiosteal implants, while one study assessed frameworks manufactured from a cobalt-chromium-molybdenum alloy.

The most common indication was rehabilitation of severely atrophic edentulous maxillae and mandibles. Additional applications included reconstruction after oncologic surgery and treatment of patients unwilling or unable to undergo advanced regenerative procedures.

Reported biological complication rates ranged from 5.7% to 43.8%. These complications included soft tissue dehiscence with implant exposure, peri-implantitis, recurrent infections, and implant failure.

Mechanical complication rates ranged from 6.3% to 20%, with provisional prosthesis fractures representing the most frequently reported issue.

Across the reviewed studies, short-term implant survival appeared favorable. The authors emphasized that accurate digital planning and passive adaptation of the implant framework to the underlying bone are critical factors for clinical success. Poor fit and recurrent infection were identified as potential causes of treatment failure.

6. Clinical Analysis

This review highlights the growing role of personalized implant solutions in the management of severe jaw atrophy. Rather than relying exclusively on extensive bone grafting procedures, customized subperiosteal implants offer an alternative approach that seeks to utilize existing anatomical support structures through advanced digital planning.

One of the most clinically relevant observations is that these devices may allow fixed implant-supported rehabilitation in patients who would otherwise face complex regenerative surgery. This could be particularly valuable in situations where treatment morbidity, surgical complexity, or patient acceptance limit the feasibility of traditional augmentation procedures.

However, the study also illustrates the current limitations of the evidence base. Most available data originate from retrospective studies and case series with relatively short follow-up periods. Consequently, important questions remain unanswered, including long-term biological behavior, peri-implant disease progression, prosthetic durability, and comparative performance against alternative treatment strategies such as zygomatic implants or advanced bone reconstruction techniques.

The consensus recommendations presented by the expert panel provide practical guidance, but they should not be interpreted as definitive clinical standards. Instead, they reflect the best available knowledge in a field that remains under active development and requires further scientific validation.

7. Clinical Applications

Based on the evidence reviewed, customized subperiosteal implants may be considered in several clinical scenarios:

• Rehabilitation of severely atrophic maxillae and mandibles where conventional implants cannot be placed.
• Management of fully edentulous patients requiring fixed implant-supported prostheses.
• Cases in which extensive bone grafting procedures are contraindicated or declined by the patient.
• Reconstruction following maxillofacial oncologic surgery resulting in major bone defects.
• Digitally planned implant rehabilitation workflows incorporating CAD/CAM design and additive manufacturing technologies.
• Selected situations where alternative approaches, such as zygomatic implants, may not be ideal.

These applications should be considered within the context of careful case selection and thorough preoperative planning.

8. Level of Evidence, Limitations, and Transparency

The overall level of evidence remains limited.

The literature reviewed consisted primarily of retrospective cohort studies and case series, with no randomized controlled trials identified. Most studies involved relatively small patient populations and short observation periods, frequently two years or less.

The authors explicitly acknowledge several limitations, including the scarcity of available studies, limited follow-up duration, potential sources of bias, and the absence of direct comparisons with alternative treatment modalities.

Conflict-of-interest disclosures were reported. Several authors declared research funding, consulting activities, honoraria, or non-financial support from companies operating in the dental and implant industry. The manuscript states that the study sponsors had no role in study design, data interpretation, manuscript preparation, or publication decisions.

9. Key Study Points

• Study Type: Literature review combined with expert consensus report
• Level of Evidence: Low to moderate
• Studies Included: 6 clinical studies
• Patient Population: Partially and totally edentulous patients
• Number of Patients: Between 4 and 70 patients per included study
• Minimum Follow-Up: 6 months
• Primary Outcome Evaluated: Clinical performance and application of customized subperiosteal implants
• Main Biological Complications: Soft tissue dehiscence, peri-implantitis, implant exposure, infection
• Main Mechanical Complications: Fracture of provisional prostheses
• Principal Finding: Favorable short-term survival with a relatively low incidence of major complications
• Scientific Conclusion: A promising treatment option that currently lacks robust long-term evidence
• Major Limitations: Limited number of studies, retrospective designs, short follow-up, absence of randomized trials

10. Scientific Impact

This publication represents an important contribution to the evolving field of patient-specific implant rehabilitation. Rather than introducing a new clinical trial, its value lies in consolidating existing evidence and translating expert clinical experience into structured recommendations.

The review highlights the growing integration of digital technologies, including three-dimensional imaging, virtual treatment planning, and additive manufacturing, into contemporary implant dentistry and oral surgery. It also reinforces the concept that customized devices may provide new therapeutic opportunities for patients with severe bone deficiency who have traditionally been considered difficult to rehabilitate.

Equally important, the article clearly identifies the current gaps in knowledge. By emphasizing the need for randomized clinical trials, long-term cohort studies, biomechanical investigations, and comparative analyses, the authors establish a roadmap for future research. As such, this work serves both as a summary of current practice and as a foundation for the next phase of scientific development in customized subperiosteal implantology.

11. Editorial Conclusion

Patient-specific subperiosteal implants represent an innovative approach to the rehabilitation of severely atrophic jaws and may expand treatment possibilities for patients who are not ideal candidates for conventional implant placement or complex bone grafting procedures. The available evidence suggests encouraging short-term outcomes and acceptable complication rates. Nevertheless, the current scientific foundation remains limited, and the recommendations presented should be interpreted within the context of relatively low-level evidence. Well-designed comparative studies and long-term clinical data will be essential to define the precise role of customized subperiosteal implants in modern implant dentistry and oral rehabilitation.