Personalized Subperiosteal Implants for Oral Rehabilitation Following Maxillofacial Tumor Resection: A Systematic Review of Case Reports and Case Series

Nathan Estevão de Oliveira, Murilo Navarro de Oliveira, Cristiano Elias Figueiredo

Full text link: https://pubmed.ncbi.nlm.nih.gov/40707332/

Personalized Subperiosteal Implants for Oral Rehabilitation Following Maxillofacial Tumor Resection: A Systematic Review of Case Reports and Case Series

1. Scientific Reference

• Study title: Personalized Subperiosteal Implants for Oral Rehabilitation Following Maxillofacial Tumor Resection: A Systematic Review of Case Reports and Case Series
• Authors: Nathan Estevão de Oliveira, Murilo Navarro de Oliveira, Cristiano Elias Figueiredo
• Journal: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
• Year of publication: 2025
• DOI: 10.1016/j.oooo.2025.06.009

2. Scientific Background

Restoring oral function after maxillofacial tumor resection remains one of the greatest challenges in oral and maxillofacial surgery. Extensive bone loss following ablative procedures frequently limits the use of conventional dental implants, making prosthetic rehabilitation considerably more complex. In this setting, patient-specific subperiosteal implants, designed through digital planning and custom manufacturing technologies, have re-emerged as a potential reconstructive solution for patients with severe anatomical deficiencies.

This systematic review focuses specifically on the published evidence regarding the use of customized subperiosteal implants in patients undergoing maxillofacial resection. Rather than introducing a new surgical protocol, the study consolidates the currently available clinical literature to assess reported outcomes and evaluate the methodological quality of existing evidence. Such an overview is valuable for clinicians involved in implant dentistry, oral surgery, and maxillofacial reconstruction who manage complex post-oncologic rehabilitation cases.

3. Study Objective

The purpose of this systematic review was to evaluate the available scientific evidence regarding the placement of personalized subperiosteal implants in patients who had undergone maxillofacial tumor resection. The authors sought to identify relevant clinical studies, critically assess their methodological quality, and summarize the reported clinical outcomes associated with this reconstructive approach.

4. Methodology

This investigation was conducted as a systematic review following a protocol registered in PROSPERO (CRD42023468928). A comprehensive literature search included six electronic databases—Embase, LILACS, PubMed, SciELO, Scopus, and the Cochrane Library—as well as two sources of gray literature (Mednar and ProQuest).

Eligible studies involved patients receiving subperiosteal implants after maxillofacial resection, with no restrictions on publication year, language, or publication status. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Among the 3,851 records initially identified, six studies fulfilled the inclusion criteria, representing a total of 31 patients. The abstract does not specify implant numbers, follow-up duration, or detailed clinical evaluation parameters.

5. Main Findings

Only six studies, published between 2017 and 2022, met the eligibility criteria from the initial pool of 3,851 records. Together, these reports included 31 patients, comprising 17 men and 14 women.

Quality assessment demonstrated that five studies presented a low risk of bias, whereas one study was considered to have a moderate risk of bias. Although methodological differences among the included publications prevented quantitative data synthesis through meta-analysis, every study reported clinical outcomes considered satisfactory according to their respective evaluation criteria.

The available abstract does not provide implant survival rates, complication frequencies, prosthetic outcomes, or long-term follow-up data. Consequently, the conclusions are based on the collective clinical observations reported within the included case reports and case series.

6. Clinical Analysis

This systematic review highlights an emerging reconstructive strategy for patients who require oral rehabilitation following extensive maxillofacial tumor surgery. Personalized subperiosteal implants are intended to address situations in which conventional implant placement may be limited by severe bone deficiency resulting from surgical resection.

The overall findings suggest that this treatment approach is technically feasible and has produced encouraging clinical outcomes in the published reports reviewed by the authors. Nevertheless, these observations should be interpreted cautiously. Despite the systematic methodology used to identify and evaluate the literature, the available evidence is derived exclusively from case reports and case series involving a relatively small patient population.

The inability to perform a meta-analysis further illustrates the variability in study design and clinical protocols across the included publications. Consequently, the review supports the potential reliability of customized subperiosteal implants in complex reconstructive scenarios but does not establish definitive evidence regarding their long-term effectiveness or superiority over alternative reconstructive strategies. Instead, it provides a structured overview of the current evidence base while emphasizing the need for more robust clinical investigations.

7. Clinical Applications

The findings of this review are primarily relevant to clinicians managing patients requiring oral rehabilitation after maxillofacial tumor resection, particularly in cases where residual bone volume may not support conventional implant therapy.

Personalized subperiosteal implants may represent a reconstructive option within digitally planned treatment workflows for selected patients with significant post-resection anatomical defects. Based on the available evidence, this technique appears applicable in complex implant-supported rehabilitation; however, the abstract does not provide sufficient information regarding specific surgical protocols, prosthetic procedures, or long-term maintenance outcomes.

8. Level of Evidence, Limitations, and Transparency

This publication is a systematic review, but its conclusions are based exclusively on case reports and case series, resulting in an overall limited level of clinical evidence despite the rigorous literature search methodology.

The principal limitations include the relatively small sample size (31 patients) and the heterogeneity of the included studies, which prevented quantitative meta-analysis. The abstract does not report long-term follow-up data, detailed complication rates, or comparative analyses with alternative reconstructive approaches.

No information regarding conflicts of interest, financial disclosures, or industry affiliations is provided in the available abstract.

9. Key Study Highlights

• Study design: Systematic review
• Level of evidence: Systematic review of case reports and case series
• Studies included: 6
• Number of patients: 31
• Number of implants: Not specified in the available information.
• Follow-up period: Not specified in the available information.
• Primary outcome assessed: Clinical outcomes of personalized subperiosteal implants following maxillofacial resection.
• Main finding: All included studies reported satisfactory clinical outcomes and supported the use of personalized subperiosteal implants in post-resection patients.
• Scientific conclusion: The currently available evidence is encouraging but remains limited by the nature and heterogeneity of the included studies.
• Potential limitations: Small patient population, heterogeneous methodologies, inability to perform meta-analysis, and lack of detailed long-term outcome data.

10. Scientific Impact

This systematic review provides one of the first structured summaries of the published clinical evidence regarding customized subperiosteal implants for oral rehabilitation after maxillofacial tumor resection. By critically evaluating the available literature, it helps define the current state of knowledge in an area where clinical evidence remains relatively limited.

Rather than establishing definitive clinical recommendations, the review demonstrates that the existing published reports consistently describe favorable clinical experiences while simultaneously highlighting important methodological limitations. As such, it contributes to the growing body of literature supporting patient-specific implant technologies in complex maxillofacial reconstruction and underscores the need for prospective studies with standardized protocols, larger patient cohorts, and longer follow-up periods to strengthen future evidence.

11. Editorial Conclusion

This systematic review offers a balanced overview of the current evidence supporting personalized subperiosteal implants for oral rehabilitation following maxillofacial tumor resection. Although the published clinical experiences are consistently favorable, the available evidence remains limited to small case-based studies. Consequently, these findings support the clinical potential of this reconstructive approach while reinforcing the importance of higher-quality clinical research before broader conclusions regarding long-term efficacy and predictability can be established.