Patient-Specific Subperiosteal Implant for Dental Rehabilitation of Severe Atrophic Maxilla: A Single Institution Series

Nikita Chintalapudi, Andriy Yuzvyak, Arvin Kadempour, Andrea Torroni

Full text link: https://pubmed.ncbi.nlm.nih.gov/41524259/

Patient-Specific Subperiosteal Implant for Dental Rehabilitation of Severe Atrophic Maxilla: A Single Institution Series

1. Scientific Reference

• Study Title: Patient-Specific Subperiosteal Implant for Dental Rehabilitation of Severe Atrophic Maxilla: A Single Institution Series
• Authors: Nikita Chintalapudi, Andriy Yuzvyak, Arvin Kadempour, Andrea Torroni
• Journal: Not specified in the information provided.
• Year of Publication: 2025
• DOI: 10.1097/SCS.0000000000012321

2. Scientific Background

Managing patients with severe maxillary atrophy remains one of the most demanding challenges in implant dentistry and oral and maxillofacial surgery. Extensive bone resorption often limits the use of conventional endosseous implants and may require complex reconstructive procedures before implant placement. Recent advances in digital dentistry, including virtual surgical planning, CAD/CAM design, and additive manufacturing, have expanded the possibilities for patient-specific treatment approaches.

This study focuses on customized subperiosteal implants (IPS) developed for patients with Cawood and Howell Class VI maxillary atrophy. Rather than relying on bone augmentation, the authors investigated a fully digital workflow to fabricate individualized titanium implants tailored to each patient’s anatomy. The report contributes preliminary clinical evidence regarding the feasibility and short-term performance of this personalized approach in the rehabilitation of severely resorbed maxillae.

3. Study Objective

The primary objective of this retrospective investigation was to assess the clinical performance of patient-specific subperiosteal implants for the rehabilitation of severely atrophic maxillae. The authors aimed to evaluate surgical feasibility, postoperative outcomes, and early complications associated with this customized implant approach while documenting the initial prosthetic rehabilitation process.

4. Methodology

This investigation was designed as a retrospective single-center case series. Eight patients diagnosed with Cawood and Howell Class VI maxillary atrophy underwent treatment between 2021 and 2025.

Treatment planning was performed collaboratively by prosthodontists and bioengineers using virtual surgical planning. Patient-specific titanium subperiosteal implants were designed with CAD/CAM technology and manufactured through selective laser melting.

Clinical follow-up ranged from 2 to 20 months, with a mean follow-up of 8.6 months. The abstract does not specify detailed outcome measures, although it reports surgical success, postoperative complications, and the progress of prosthetic rehabilitation.

5. Main Findings

All customized subperiosteal implants were successfully placed without major intraoperative or postoperative complications. Throughout the reported follow-up period, no implant mobility, postoperative infection, or inflammatory complications were observed.

By the time of analysis, four patients had completed their definitive prosthetic rehabilitation, while treatment remained ongoing for the remaining four individuals.

Reported adverse events were limited. One patient experienced minor gingival recession, while several patients developed transient maxillary hypoesthesia that resolved completely or improved substantially within five weeks following surgery.

Based on these preliminary clinical observations, the authors suggest that patient-specific subperiosteal implants may represent a viable graft-free option for managing severe maxillary atrophy. However, they emphasize that larger clinical studies are required to validate long-term outcomes and optimize patient selection.

6. Clinical Analysis

This study provides early clinical evidence supporting the feasibility of patient-specific subperiosteal implants in one of the most challenging indications encountered in implant dentistry. The combination of digital treatment planning, CAD/CAM design, and additive manufacturing demonstrates how personalized implant reconstruction can be integrated into contemporary workflows for patients with advanced maxillary bone loss.

The absence of implant mobility, infection, and inflammatory complications during the reported follow-up is encouraging and suggests that this customized approach can achieve satisfactory short-term clinical stability. Equally important, the reported complications were relatively minor and either resolved spontaneously or improved within a short period.

Nevertheless, the findings should be interpreted with appropriate caution. The study includes only eight patients, has a retrospective design, and lacks a comparison group. Furthermore, the follow-up period remains relatively limited and does not provide information regarding long-term implant survival, prosthetic longevity, or biological stability over time.

Rather than establishing definitive clinical recommendations, this case series should be viewed as preliminary evidence supporting the technical feasibility of individualized subperiosteal implants while highlighting the need for prospective studies with larger patient cohorts and longer observation periods.

7. Clinical Applications

The findings may be relevant for clinicians treating patients with severe maxillary atrophy in whom conventional implant placement is difficult because of extensive bone resorption. The study illustrates the application of a fully digital workflow incorporating virtual surgical planning, CAD/CAM technology, and selective laser melting to manufacture customized titanium subperiosteal implants.

Within the limitations of the available data, this graft-free approach may represent a potential treatment option for selected patients requiring complex implant rehabilitation. However, the present study does not provide comparative evidence against alternative reconstructive strategies, and no conclusions can be drawn regarding superiority over other treatment modalities.

8. Level of Evidence, Limitations, and Transparency

This publication represents a retrospective single-center case series, corresponding to a relatively low level of clinical evidence.

Its principal methodological limitations include the small sample size, the absence of a control group, and the relatively short follow-up period. These factors limit the generalizability of the findings and preclude conclusions regarding long-term implant survival or comparative clinical effectiveness.

The authors explicitly acknowledge that larger studies are necessary to confirm long-term success and improve patient selection criteria.

No conflicts of interest or financial relationships with implant manufacturers are reported in the information provided.

9. Key Study Highlights

• Study design: Retrospective single-center case series
• Level of evidence: Low (observational case series)
• Study population: Eight patients with Cawood and Howell Class VI maxillary atrophy
• Number of implants: Not specified in the available information (at least one customized implant per patient)
• Follow-up: 2–20 months (mean: 8.6 months)
• Primary outcome assessed: Clinical performance of patient-specific subperiosteal implants
• Main finding: Successful implant placement in all patients without infection, implant mobility, or inflammatory complications during follow-up
• Scientific conclusion: Patient-specific subperiosteal implants appear to be a promising graft-free option for severe maxillary atrophy, although larger studies are required for validation.
• Main limitations: Small sample size, retrospective design, single-center experience, absence of a control group, and limited follow-up.

10. Scientific Impact

This study contributes additional clinical evidence supporting the emerging role of patient-specific subperiosteal implants in the management of severe maxillary atrophy. Its principal contribution lies in demonstrating the integration of digital treatment planning and advanced manufacturing technologies into a personalized implant rehabilitation workflow.

Although the study does not establish definitive evidence of long-term clinical effectiveness, it provides valuable proof-of-concept data showing that customized subperiosteal implants can be successfully implemented with a low incidence of early complications in this small patient cohort.

The findings also reinforce the growing interest in digitally designed implant solutions for anatomically complex cases where conventional treatment options may be challenging. Future prospective investigations involving larger populations and extended follow-up periods will be essential to determine the durability, long-term biological performance, and optimal indications for this treatment approach.

11. Editorial Conclusion

This retrospective case series offers encouraging preliminary evidence for the use of patient-specific subperiosteal implants in the rehabilitation of severely atrophic maxillae. By combining virtual surgical planning, CAD/CAM technology, and additive manufacturing, the proposed workflow demonstrates the feasibility of a highly individualized treatment strategy without bone grafting. However, given the limited sample size and relatively short follow-up, these findings should be interpreted cautiously. Robust prospective studies with longer-term evaluation are required before the technique can be considered an established therapeutic option.