Management of Severely Resorbed Jaws Using Custom Subperiosteal Implants Restored with Implant-Retained Overdentures: A Case Report

Marjan Rashidi, Negin Aminianpour, Zeinab Gholami, Zahra Jandaghian

Full text link: https://pubmed.ncbi.nlm.nih.gov/40702913/

Management of Severely Resorbed Jaws Using Custom Subperiosteal Implants Restored with Implant-Retained Overdentures: A Case Report

1. Scientific Reference

• Study Title: Management of Severely Resorbed Jaws Using Subperiosteal Implants Restored with Implant-Retained Overdentures – A Case Report
• Authors: Marjan Rashidi, Negin Aminianpour, Zeinab Gholami, Zahra Jandaghian
• Journal: Indian Journal of Dental Research
• Publication Year: 2025
• DOI: 10.4103/ijdr.ijdr_779_24

2. Scientific Background

Managing patients with advanced maxillary or mandibular bone atrophy remains one of the greatest challenges in implant dentistry and oral rehabilitation. Extensive alveolar bone resorption frequently limits the placement of conventional endosseous dental implants, often requiring complex reconstructive procedures before implant-supported prosthetic treatment can be considered. Although bone augmentation techniques have become well established, they are associated with additional surgical morbidity, longer treatment times, and increased patient burden.

Recent advances in digital dentistry have renewed interest in custom-made subperiosteal implants. Modern workflows combining cone-beam computed tomography (CBCT), computer-aided design (CAD), and additive manufacturing allow patient-specific titanium implants to be fabricated with high anatomical precision. This case report contributes to the growing clinical experience with digitally designed subperiosteal implants by describing their use in the rehabilitation of a patient presenting with severe jaw atrophy, together with the subsequent prosthetic restoration using implant-retained overdentures.

3. Study Objective

The primary objective of this case report was to describe the clinical management of a completely edentulous patient with severe maxillary and mandibular bone resorption using customized subperiosteal implants produced through digital manufacturing technologies. The authors sought to illustrate a treatment approach capable of supporting implant-retained overdentures without extensive bone grafting procedures.

4. Methodology

This publication is a single-patient case report.

A 64-year-old edentulous woman with advanced maxillary and mandibular bone atrophy underwent clinical examination and CBCT imaging, which demonstrated insufficient bone volume for conventional implant therapy. Following multidisciplinary treatment planning, patient-specific subperiosteal implants were digitally designed and manufactured from Grade V titanium using laser melting technology.

The implants were surgically placed under general anesthesia. After a six-month healing period, prosthetic rehabilitation was completed with implant-retained overdentures. Clinical follow-up continued for two years after prosthesis delivery. The article does not report standardized outcome measures beyond the clinical observations described in the case.

5. Main Findings

According to the authors, the customized subperiosteal implants were successfully positioned and subsequently supported prosthetic rehabilitation after confirmation of satisfactory clinical integration.

The definitive treatment consisted of implant-retained overdentures, including a palateless maxillary design. Throughout the reported two-year follow-up, no complications were observed. The patient maintained satisfactory prosthetic function, while the rehabilitation also achieved favorable esthetic outcomes, including improved lip support.

The authors additionally discuss how modern manufacturing techniques, particularly selective laser melting and finite element-based design optimization, may have contributed to improving the clinical performance of contemporary subperiosteal implants compared with earlier generations. These comments provide contextual information rather than direct findings from the reported clinical case.

6. Clinical Analysis

This report illustrates the practical application of customized subperiosteal implants in a patient with advanced jaw atrophy where conventional endosseous implant placement was not considered feasible. Rather than attempting to demonstrate superiority over alternative treatment strategies, the publication documents the clinical feasibility of a digitally planned patient-specific implant approach.

One of the most valuable aspects of the report is its integration of contemporary digital technologies, including CBCT-based planning, CAD/CAM design, and additive titanium manufacturing. These technologies allow implants to be adapted to the patient’s residual bone anatomy, potentially reducing the need for extensive reconstructive surgery in selected clinical situations.

The favorable clinical course observed during the two-year follow-up is encouraging. However, the findings should be interpreted within the limitations inherent to a single case report. Individual clinical success cannot be generalized to broader patient populations or interpreted as evidence of comparative effectiveness.

Consequently, this publication should primarily be viewed as a demonstration of a technically feasible treatment workflow rather than definitive clinical evidence supporting routine use of customized subperiosteal implants. Larger prospective studies with longer follow-up periods will be necessary to better define their long-term role in implant rehabilitation of severely atrophic jaws.

7. Clinical Applications

The clinical observations presented in this report may be relevant for practitioners involved in managing patients with severe alveolar ridge atrophy who are not suitable candidates for conventional implant placement.

Potential applications described in the article include:

• rehabilitation of severely atrophic maxillae and mandibles;
• digitally planned custom subperiosteal implant therapy;
• CAD/CAM-based implant design and manufacturing;
• implant-retained overdenture rehabilitation;
• prosthetic treatment supported by patient-specific titanium implants.

The study does not establish formal clinical indications or demonstrate superiority over alternative reconstructive approaches, and its findings should therefore be interpreted cautiously.

8. Level of Evidence, Limitations and Transparency

This publication represents a case report, corresponding to a low level of clinical evidence.

Its principal methodological limitation is the inclusion of only one patient without a control group or comparative treatment arm. Although the reported follow-up extends to two years, the findings remain descriptive and cannot establish treatment efficacy or predict long-term outcomes across larger populations.

The authors report no conflicts of interest and indicate that no external financial support was received for the study. These disclosures contribute to the transparency of the publication.

9. Key Study Points

• Study type: Case report
• Level of evidence: Low
• Study population: One edentulous patient
• Number of patients: 1
• Number of implants: Four customized subperiosteal implants described in the surgical procedure
• Follow-up duration: 2 years
• Primary outcome assessed: Clinical feasibility of implant-supported rehabilitation
• Main finding: Functional and esthetic rehabilitation was maintained without reported complications during follow-up.
• Scientific conclusion: Customized subperiosteal implants may represent a treatment option for selected patients with severe jaw atrophy.
• Main limitations: Single-patient design, absence of comparative analysis, and limited level of evidence.

10. Scientific Impact

This report contributes to the evolving body of literature exploring digitally manufactured custom subperiosteal implants for complex implant rehabilitation. Although limited by its design, it demonstrates how modern digital workflows—including three-dimensional imaging, computer-assisted implant design, and additive manufacturing—can be integrated into the management of severe alveolar bone resorption.

Rather than establishing definitive clinical recommendations, the publication expands the available clinical documentation supporting patient-specific implant concepts. It also reflects the ongoing transition from historically manufactured subperiosteal implants toward digitally engineered devices with improved precision and individualized adaptation.

Future clinical research involving larger cohorts, comparative studies, and longer observation periods will be necessary to determine the predictability, complication profile, and long-term survival of these customized implant systems.

11. Editorial Conclusion

This case report describes the successful rehabilitation of a patient with severe maxillary and mandibular atrophy using digitally designed customized subperiosteal implants supporting implant-retained overdentures. While the favorable two-year clinical outcome is encouraging, the evidence remains limited by the single-case design. The study nevertheless illustrates the growing potential of personalized digital implant technologies as an alternative approach for carefully selected patients presenting with complex anatomical conditions.