Severe Mandibular Atrophy Treated with a Subperiosteal Implant and Simultaneous Grafting Using rhBMP-2 and Mineralized Allograft: A Case Report

Cosimo Loperfido, Juan Mesquida, Jaime L. Lozada

Full text link: https://pubmed.ncbi.nlm.nih.gov/23574428/

Severe Mandibular Atrophy Treated with a Subperiosteal Implant and Simultaneous Grafting Using rhBMP-2 and Mineralized Allograft: A Case Report

1. Scientific Reference

• Study Title: Severe Mandibular Atrophy Treated with a Subperiosteal Implant and Simultaneous Grafting Using rhBMP-2 and Mineralized Allograft: A Case Report
• Authors: Cosimo Loperfido, Juan Mesquida, Jaime L. Lozada
• Journal: Journal of Oral Implantology
• Year of Publication: 2013
• DOI: 10.1563/AAID-JOI-D-12-00132

2. Scientific Background

Advanced mandibular atrophy remains one of the most demanding conditions in implant dentistry, particularly when residual bone volume is insufficient to support conventional endosseous implants. Restoring oral function in these patients often requires individualized surgical strategies capable of addressing both implant stability and bone deficiency.

This case report explores a personalized treatment approach combining a patient-specific subperiosteal implant manufactured from a three-dimensional anatomical model with simultaneous bone augmentation. The reconstruction protocol incorporated a mineralized bone allograft together with recombinant human bone morphogenetic protein-2 (rhBMP-2) during the same surgical procedure. The clinical relevance of this report lies in its description of a single-stage reconstructive concept designed to restore mandibular anatomy while providing support for implant-based rehabilitation in a severely resorbed mandible.

3. Study Objective

The purpose of this report was to describe the rehabilitation of a patient presenting with severe mandibular atrophy using a customized hydroxyapatite-coated titanium subperiosteal implant designed from a three-dimensional model. In addition, the authors sought to document the radiographic outcome following simultaneous bone augmentation performed with mineralized allograft and rhBMP-2.

4. Methodology

This publication is a single-patient case report involving a 71-year-old individual with severe mandibular atrophy.

Treatment consisted of placing a custom-made hydroxyapatite-coated titanium subperiosteal mandibular implant specifically engineered to accommodate simultaneous bone augmentation. During the same surgical intervention, the deficient mandibular bone was grafted using a combination of mineralized bone allograft and recombinant human bone morphogenetic protein-2 (rhBMP-2).

Radiographic follow-up included cone beam computed tomography (CBCT) performed 32 months after surgery to assess changes in bone volume beneath the implant framework. Additional methodological details and clinical evaluation criteria are not provided in the available abstract.

5. Main Findings

According to the information provided, the patient underwent successful mandibular rehabilitation using the customized subperiosteal implant and simultaneous grafting protocol.

The 32-month CBCT examination demonstrated vertical bone augmentation beneath the implant framework, indicating bone formation in the reconstructed area during follow-up. This radiographic observation suggests that the combined surgical approach achieved the intended reconstructive outcome in this individual patient.

However, the abstract does not report quantitative measurements of bone gain, implant stability, prosthetic outcomes, biological or mechanical complications, functional performance, or patient-reported outcomes. Consequently, the findings should be interpreted solely within the scope of the information explicitly presented.

6. Clinical Analysis

This case illustrates a highly individualized approach to managing severe mandibular bone atrophy by combining digital implant design with simultaneous regenerative surgery. Rather than separating reconstruction and implant rehabilitation into multiple stages, the described protocol integrates both procedures into a single surgical intervention.

The observation of vertical bone formation beneath the subperiosteal implant framework is clinically noteworthy because it suggests that this customized design may accommodate simultaneous regenerative procedures in carefully selected cases. Nevertheless, the available data do not allow determination of the individual contribution of the customized implant, the mineralized allograft, or rhBMP-2 to the observed outcome.

Because this publication represents a single case report, its findings should be considered exploratory rather than confirmatory. No direct comparison with alternative reconstructive techniques is provided, and the results cannot be generalized to broader patient populations. Additional prospective clinical studies involving larger cohorts would be required to establish the reproducibility, safety, and long-term clinical performance of this treatment strategy.

7. Clinical Applications

The findings reported in this publication may be relevant when considering treatment options for severe mandibular atrophy requiring complex implant rehabilitation.

The case demonstrates the potential application of:

• Customized subperiosteal implants designed from three-dimensional anatomical models.
• Simultaneous bone reconstruction using mineralized allograft and rhBMP-2.
• CBCT imaging for postoperative assessment of bone regeneration beneath implant frameworks.

The available information does not define specific clinical indications, contraindications, or treatment recommendations, and the results should therefore be interpreted within the limitations of a single clinical observation.

8. Level of Evidence, Limitations, and Transparency

This publication is a case report, representing a low level of clinical evidence.

Its principal limitations arise from the study design itself, including the inclusion of only one patient, the absence of a control group, and the lack of statistical analysis. The abstract also provides limited methodological detail and does not report quantitative clinical outcomes, complication rates, or functional assessments.

No information regarding conflicts of interest, financial disclosures, or manufacturer affiliations is provided in the available abstract. Therefore, no conclusions can be drawn regarding potential competing interests.

9. Key Study Highlights

• Study type: Case report.
• Level of evidence: Low.
• Study population: One 71-year-old patient.
• Number of patients: 1.
• Follow-up period: 32 months.
• Primary outcome assessed: Radiographic bone augmentation beneath the subperiosteal implant.
• Main finding: Vertical bone augmentation was observed on CBCT during follow-up.
• Scientific conclusion: Successful rehabilitation was achieved in this patient, with radiographic evidence of bone formation beneath the implant framework.
• Study limitations: Single-patient design, no comparative analysis, limited methodological detail, and absence of quantitative outcome measures.

10. Scientific Impact

This report contributes to the literature by documenting the clinical feasibility of combining a patient-specific subperiosteal implant with simultaneous regenerative bone grafting in the management of advanced mandibular atrophy. It highlights the integration of digital implant design and regenerative biomaterials within a single reconstructive procedure.

From a scientific perspective, the publication should be regarded as hypothesis-generating rather than practice-changing. While the radiographic findings are encouraging, the limited level of evidence precludes definitive conclusions regarding treatment efficacy or superiority over established reconstructive approaches.

The case supports further investigation into customized subperiosteal implant systems and combined regenerative protocols through prospective clinical studies involving larger patient populations and standardized outcome measures.

11. Editorial Conclusion

This case report describes an individualized strategy for treating severe mandibular atrophy using a customized subperiosteal implant combined with simultaneous bone grafting using mineralized allograft and rhBMP-2. The documented vertical bone augmentation observed after 32 months provides an encouraging clinical observation, but the findings should be interpreted cautiously given the inherent limitations of a single-case design. Larger clinical investigations will be necessary to determine the reproducibility and broader clinical applicability of this treatment approach.