Evaluation of Clinical Success of the 3D-Printed Custom-Made Subperiosteal Implants

Mustafa Ayhan, PhD, DDS, Merve Ozturk Muhtar, DDS,*Abdulsamet Kundakcioglu, PhD, DDS,Osman Kucukcakir, DDS,and Erol Cansiz, MD, PhD, DDS

Full text links: https://pubmed.ncbi.nlm.nih.gov/38709056/

Evaluation of Clinical Success of the 3D-Printed Custom-Made Subperiosteal Implants

1. Scientific Reference

• Study Title: Evaluation of Clinical Success of the 3D-Printed Custom-Made Subperiosteal Implants
• Authors: Mustafa Ayhan, Merve Ozturk Muhtar, Abdulsamet Kundakcioglu, Osman Kucukcakir, Erol Cansiz
• Journal: Journal of Craniofacial Surgery
• Year of Publication: 2024
• DOI: 10.1097/SCS.0000000000010148
• PMID: 38709056

2. Scientific Background

Managing severe alveolar bone atrophy remains one of the most challenging situations in implant dentistry and oral surgery. In advanced cases of bone resorption, conventional endosseous dental implants may not be feasible without extensive reconstructive procedures. As a result, clinicians continue to explore alternative treatment options capable of restoring oral function in patients with limited bone availability.

Recent advances in digital workflows, CAD/CAM technologies, and additive manufacturing have renewed interest in custom-made subperiosteal implants. Unlike traditional endosseous implants, these patient-specific frameworks are designed to fit the external surface of the residual bone, offering a potential solution for complex anatomical situations.

As the clinical use of modern 3D-printed subperiosteal implants expands, it becomes increasingly important to assess their clinical performance, identify potential complications, and determine their role within contemporary implant rehabilitation protocols.

3. Study Objective

The primary objective of this study was to evaluate the clinical outcomes of custom-made 3D-printed subperiosteal implants placed in patients presenting with advanced alveolar bone loss.

The authors also aimed to document intraoperative and postoperative complications associated with these implants and to assess their overall clinical applicability in situations where conventional endosseous implant placement may not be possible.

4. Methodology

This study involved the evaluation of clinical and radiographic records from patients treated with custom-made subperiosteal implants for severe alveolar bone deficiency.

Initially, 32 patients were considered for inclusion. One patient was excluded because of smoking, resulting in a final study population of 31 patients. Among these individuals, 27 were treated for complete edentulism, 3 underwent rehabilitation following maxillectomy, and 1 presented with partial tooth loss.

A total of 60 subperiosteal implants were placed. The reported mean follow-up period was 15 months.

The investigators reviewed surgical events occurring during implant placement as well as biological and prosthetic complications observed during the follow-up period. Detailed success criteria were not specified in the available abstract.

5. Main Findings

Several technical challenges were encountered during surgery. Implant-to-bone adaptation difficulties were reported in 11 patients, while one implant framework fracture occurred intraoperatively. In addition, loss of primary stabilization during mini-screw fixation was observed in two cases.

No early postoperative complications were reported. However, a number of late biological and mechanical complications developed during follow-up.

Soft tissue recession was identified in 12 patients. In six cases, recession was limited to keratinized tissue, whereas in the remaining six cases it extended beyond the keratinized zone. Soft tissue infections occurred in five patients, and one oroantral fistula was reported.

Mechanical complications included mini-screw loosening in three patients.

Despite these events, the authors indicated that the observed complications were manageable and did not necessarily preclude continued clinical use of this treatment modality.

6. Clinical Analysis

This study provides valuable clinical insight into the contemporary application of patient-specific subperiosteal implants manufactured through digital design and 3D-printing technologies. The findings demonstrate that these implants can be used in highly challenging clinical scenarios, including severe jaw atrophy, complete edentulism, and selected post-maxillectomy reconstructions.

A notable aspect of the study is the relatively frequent occurrence of complications. The reported adaptation issues emphasize the importance of accurate digital planning and precise manufacturing processes. Likewise, the incidence of soft tissue complications highlights the critical role of long-term biological integration and peri-implant tissue management.

From a clinical perspective, the study suggests that custom-made subperiosteal implants may offer a viable treatment alternative for patients who are not candidates for conventional endosseous implant therapy. However, the results also underscore the need for careful patient selection, meticulous surgical execution, and ongoing postoperative monitoring.

Because the follow-up period was limited to a mean of 15 months, the long-term predictability of this approach remains uncertain. Therefore, the findings should be interpreted cautiously and not be considered definitive evidence of long-term success.

7. Clinical Applications

The findings of this study may be relevant in several complex implant rehabilitation scenarios, including:

• Severe maxillary or mandibular bone atrophy.
• Complete edentulism requiring extensive implant-supported rehabilitation.
• Selected post-maxillectomy reconstructions.
• Cases where conventional endosseous implant placement is not feasible.
• Digitally planned patient-specific implant reconstructions using CAD/CAM and additive manufacturing technologies.

The study supports consideration of custom-made subperiosteal implants as a potential treatment option in carefully selected patients with limited reconstructive alternatives.

8. Level of Evidence, Limitations and Transparency

Based on the available information, this publication should be considered an observational case series reflecting the clinical experience of a single treatment center.

Consequently, the level of evidence is lower than that provided by randomized clinical trials, controlled prospective studies, or systematic reviews.

Several limitations can be identified from the information provided. These include the relatively small sample size, the absence of a control group, the lack of direct comparison with alternative treatment approaches, and a mean follow-up period limited to 15 months.

Furthermore, the specific criteria used to define clinical success were not detailed in the abstract.

No conflicts of interest, industry affiliations, or financial disclosures were reported within the information provided. Therefore, no conclusions can be drawn regarding potential author-related biases.

9. Key Study Highlights

• Study Type: Observational case series.
• Level of Evidence: Low to moderate.
• Population: 31 patients.
• Number of Implants: 60 custom-made subperiosteal implants.
• Follow-up Duration: Mean follow-up of 15 months.
• Primary Outcome Evaluated: Clinical performance and complications of 3D-printed custom-made subperiosteal implants.
• Main Finding: Both intraoperative and postoperative complications were observed but were considered manageable by the authors.
• Scientific Conclusion: Custom-made subperiosteal implants may represent a treatment alternative for severely atrophic jaws where conventional endosseous implants cannot be placed.
• Potential Limitations: Small sample size, absence of a control group, and limited follow-up duration.

10. Scientific Impact

This study contributes to the growing body of evidence surrounding modern subperiosteal implant rehabilitation supported by digital technologies and additive manufacturing. By reporting real-world clinical outcomes from a cohort of patients with advanced bone deficiency, it provides useful information regarding both the opportunities and challenges associated with this treatment approach.

An important contribution of the study is its documentation of biological and mechanical complications. Rather than focusing exclusively on feasibility, the authors offer insight into the practical issues clinicians may encounter during treatment and follow-up.

Although the study does not establish definitive long-term effectiveness, it adds meaningful clinical data to an area where published evidence remains relatively limited. The findings support continued investigation into patient-specific subperiosteal implant systems and highlight the need for larger studies with longer observation periods to better define their long-term role in implant dentistry and maxillofacial rehabilitation.

11. Editorial Conclusion

This study provides early clinical evidence regarding the use of 3D-printed custom-made subperiosteal implants in patients with severe alveolar bone loss. The reported outcomes suggest that these implants may offer a practical alternative when conventional implant therapy is not possible. However, the occurrence of biological and mechanical complications, combined with the limited follow-up period and observational design, warrants cautious interpretation. Further research with stronger study designs and longer-term evaluation will be necessary to clarify the predictability and durability of this treatment approach.