New-Generation Subperiosteal Implants for Patient-Specific Rehabilitation of Atrophic Dental Arches: A Literature Review and Two Clinical Case Reports

Ernesto Vatteroni, Ugo Covani, Giovanni B. Menchini Fabris

Full text link: https://pubmed.ncbi.nlm.nih.gov/37347616/

New-Generation Subperiosteal Implants for Patient-Specific Rehabilitation of Atrophic Dental Arches: A Literature Review and Two Clinical Case Reports

1. Scientific Reference

• Study Title: New-Generation Subperiosteal Implants for Patient-Specific Rehabilitation of Atrophic Dental Arches: A Literature Review and Two Clinical Case Reports
• Authors: Ernesto Vatteroni, Ugo Covani, Giovanni B. Menchini Fabris
• Journal: The International Journal of Periodontics & Restorative Dentistry (not explicitly provided in the supplied data but identifiable through the DOI)
• Publication Year: 2023
• DOI: 10.11607/prd.6229

2. Scientific Background

Managing severe maxillary and mandibular bone atrophy remains one of the most demanding situations in implant dentistry. Historically, subperiosteal implants were developed as an alternative for completely edentulous patients whose residual bone volume was insufficient for conventional endosseous implants. Although widely adopted for several decades, their use progressively declined because of technical challenges related to implant fabrication, anatomical adaptation, surgical placement, and postoperative complications.

Recent advances in digital implant dentistry have substantially transformed treatment planning and manufacturing processes. High-resolution three-dimensional imaging, computer-assisted design, and additive manufacturing technologies now enable the production of patient-specific titanium frameworks with improved anatomical conformity. These technological developments have renewed scientific interest in subperiosteal implant therapy as a potential option for complex implant-supported rehabilitation in patients with advanced alveolar ridge atrophy.

3. Study Objective

The purpose of this publication was to review the contemporary evolution of subperiosteal implants in the digital era while illustrating their clinical application through two cases treated with new-generation patient-specific subperiosteal implants. The authors also report the corresponding clinical and radiographic observations after one year of follow-up.

4. Methodology

According to the available abstract, this publication combines a literature review with two clinical case reports. The described treatment approach relies on a fully digital workflow incorporating advanced diagnostic imaging, digital implant design, and titanium manufacturing through direct metal laser sintering to produce customized subperiosteal implants.

Two patients underwent rehabilitation using these individualized implant frameworks. Clinical and radiographic evaluations were performed after a one-year follow-up period. The abstract does not provide detailed information regarding the literature review methodology, patient selection criteria, surgical protocol, prosthetic workflow, or predefined outcome measures.

5. Main Findings

The publication highlights how digital technologies have fundamentally changed the design and manufacturing of subperiosteal implants. Modern imaging and computer-assisted production make it possible to fabricate patient-specific titanium frameworks that closely match each individual’s anatomical characteristics, overcoming several technical limitations associated with earlier generations of these implants.

The two reported clinical cases demonstrate the practical application of this digital concept, with clinical and radiographic assessments available after one year. However, the abstract does not report quantitative clinical outcomes, implant survival rates, biological or mechanical complications, prosthetic performance, or patient-reported outcomes. Consequently, the available information should be interpreted as descriptive evidence rather than definitive proof of clinical effectiveness.

6. Clinical Analysis

Rather than presenting a breakthrough clinical outcome study, this publication illustrates the technological evolution of subperiosteal implant therapy. The principal contribution lies in demonstrating how digital planning and additive manufacturing have enabled a modern reinterpretation of a technique that had largely fallen out of routine clinical use because of significant manufacturing and surgical limitations.

From a clinical perspective, patient-specific subperiosteal implants may represent an additional reconstructive option for edentulous individuals with severe jaw atrophy, particularly when conventional implant placement is anatomically challenging. The use of customized titanium frameworks designed through digital workflows has the potential to improve anatomical adaptation compared with historical fabrication techniques.

Nevertheless, these observations should be interpreted cautiously. The clinical evidence presented is limited to two case reports accompanied by a literature review, without a control group or direct comparison with alternative treatment strategies such as bone augmentation or zygomatic implant rehabilitation. Furthermore, the one-year follow-up period does not provide information regarding long-term implant performance or biological stability. Additional prospective clinical studies involving larger patient cohorts will be required to establish the long-term predictability and clinical indications of this approach.

7. Clinical Applications

The findings presented in this publication suggest that digitally designed subperiosteal implants may have potential relevance for the rehabilitation of edentulous patients with advanced maxillary or mandibular atrophy.

This approach integrates contemporary digital implant workflows, including three-dimensional imaging, computer-assisted treatment planning, and CAD/CAM-based titanium manufacturing. The reported cases illustrate how customized implant frameworks can be adapted to individual anatomical conditions in complex implant rehabilitation.

The available data, however, do not allow conclusions regarding the comparative effectiveness of this technique relative to other reconstructive procedures or implant rehabilitation protocols.

8. Level of Evidence, Limitations and Transparency

This publication consists of a literature review combined with two clinical case reports, representing a relatively low level of clinical evidence. Its primary value lies in illustrating an emerging technological approach rather than providing definitive clinical validation.

The principal limitations identifiable from the available information include the very limited number of treated patients and the one-year follow-up period. The methodology of the literature review is not described in the abstract, and no detailed statistical analysis is reported.

No information regarding funding sources, conflicts of interest, or relationships between the authors and implant manufacturers is provided in the supplied material.

9. Key Study Points

• Study type: Literature review with two clinical case reports.
• Level of evidence: Low, based on descriptive clinical evidence.
• Study population: Two patients.
• Number of implants: Not specified in the available information.
• Follow-up period: One year.
• Primary outcome assessed: Clinical and radiographic evaluation of new-generation customized subperiosteal implants.
• Main finding: Digital technologies enable the development and clinical application of patient-specific subperiosteal implants for severely atrophic dental arches.
• Scientific conclusion: Contemporary digital workflows have renewed interest in subperiosteal implant rehabilitation by facilitating anatomically customized implant design.
• Study limitations: Very small clinical sample, limited follow-up, absence of comparative data, and insufficient methodological details in the available abstract.

10. Scientific Impact

This publication contributes to the ongoing reassessment of subperiosteal implant therapy within the context of modern digital implant dentistry. Rather than revisiting historical techniques unchanged, it illustrates how advances in digital imaging, virtual treatment planning, and additive manufacturing have enabled a fundamentally different approach to patient-specific implant fabrication.

Although the clinical evidence remains preliminary, the article highlights a technological direction that may expand treatment possibilities for patients with severe alveolar ridge atrophy. Its principal scientific contribution is demonstrating the feasibility of integrating customized implant design into contemporary implant rehabilitation workflows. At the same time, it emphasizes the need for higher-level clinical research with larger patient populations and longer follow-up periods before definitive conclusions regarding efficacy and long-term predictability can be established.

11. Editorial Conclusion

This study provides an informative overview of the modern evolution of subperiosteal implants through digital technologies and patient-specific manufacturing. The reported clinical cases demonstrate the feasibility of this contemporary approach in the management of severe alveolar atrophy, while the accompanying literature review places these developments within their historical context. Although the findings are encouraging, the limited level of evidence warrants cautious interpretation, and further prospective research is necessary to clarify the long-term clinical role of new-generation subperiosteal implants in complex implant rehabilitation.