subperiosteal implants
Soft Tissue Response and Determination of Underlying Risk Drivers for Recession and Mucositis after AMSJI Implantation in the Maxilla
Full text link: https://pubmed.ncbi.nlm.nih.gov/37910836/
Soft Tissue Response and Determination of Underlying Risk Drivers for Recession and Mucositis after AMSJI Implantation in the Maxilla
1. Scientific Reference
- Study Title: Soft Tissue Response and Determination of Underlying Risk Drivers for Recession and Mucositis after AMSJI Implantation in the Maxilla
- Authors: Casper Van den Borre, Björn De Neef, Natalie A. J. Loomans, Marco Rinaldi, Erik Nout, Peter Bouvry, Ignace Naert, Karlijn J. Van Stralen, Maurice Y. Mommaerts
- Journal: Not specified in the provided data.
- Year of Publication: 2023
- DOI: 10.11607/jomi.10490
2. Scientific Background
The rehabilitation of patients with severe maxillary atrophy remains one of the most demanding challenges in implant dentistry and oral surgery. When conventional endosseous implants cannot be placed because of insufficient bone volume, patient-specific additively manufactured subperiosteal jaw implants (AMSJIs) have emerged as a digital alternative for restoring function without relying on extensive bone augmentation procedures.
While the mechanical performance of these customized implants has received increasing attention, less information is available regarding the biological response of the surrounding soft tissues. Soft tissue recession and peri-implant mucosal inflammation may compromise long-term treatment stability by exposing portions of the implant framework and increasing the complexity of postoperative maintenance. Against this background, the present study focuses on the biological behavior of peri-implant soft tissues and explores the patient-related factors associated with soft tissue complications following maxillary rehabilitation with AMSJIs.
3. Study Objective
The primary objective of this investigation was to evaluate soft tissue healing and long-term soft tissue response following bilateral placement of additively manufactured subperiosteal jaw implants in patients with severe maxillary atrophy. The authors also sought to identify clinical variables associated with an increased risk of mucosal recession and peri-implant mucositis.
4. Methodology
This international multicenter observational study included 40 patients presenting with advanced maxillary resorption corresponding to Cawood and Howell Class V or higher. All participants had undergone bilateral AMSJI placement in the maxilla at least one year before clinical evaluation.
Patient demographic information was collected, followed by comprehensive clinical examinations assessing implant stability and the condition of the peri-implant soft tissues. Particular attention was given to the occurrence of mucosal recession and mucositis. The mean follow-up period was 917 days. Additional details regarding clinical assessment protocols or statistical methodology are not specified in the available abstract.
5. Main Findings
Primary implant stability was successfully achieved in every patient, and all implants were restored with definitive prostheses. At the time of follow-up, implant mobility exceeding 1 mm was observed in only one patient with bilateral AMSJIs, indicating a high level of mechanical stability throughout the cohort.
Biological complications affecting the soft tissues were considerably more common than implant instability. Mucosal recession resulting in exposure of the implant framework was identified in 26 of the 40 patients (65%), with the highest frequency occurring in the right and left mid-lateral regions.
Statistical analysis demonstrated that a thin soft tissue biotype and the presence of mucositis were significantly associated with the occurrence of recession (P < .05). Smoking also appeared to increase the likelihood of recession, with an odds ratio of 6.88 compared with non-smokers; however, this association did not reach statistical significance (P = .08).
6. Clinical Analysis
Rather than questioning the mechanical reliability of customized subperiosteal implants, this study emphasizes the importance of peri-implant soft tissue management in determining clinical outcomes. The observation that nearly all implants remained stable while soft tissue complications occurred frequently suggests that biological maintenance deserves particular attention after prosthetic loading.
The association between a thin mucosal biotype and recession indicates that soft tissue phenotype may influence the long-term coverage of the implant framework. Likewise, the relationship between mucositis and recession reinforces the importance of controlling peri-implant inflammation throughout maintenance therapy.
For clinicians managing patients with severe maxillary atrophy, these findings highlight the value of careful preoperative assessment of soft tissue quality, together with regular postoperative monitoring aimed at detecting early inflammatory changes. Nevertheless, these observations should not be interpreted as evidence of causality. Because the investigation was observational and lacked a comparison group, the reported associations should be considered hypothesis-generating rather than definitive proof of risk.
7. Clinical Applications
The findings are particularly relevant for clinicians involved in the rehabilitation of severely atrophic maxillae using patient-specific subperiosteal implants. They support careful evaluation of peri-implant soft tissue characteristics before treatment planning and emphasize the importance of structured maintenance protocols after implant placement.
Patients presenting with a thin mucosal phenotype or signs of peri-implant mucosal inflammation may warrant closer clinical surveillance during follow-up. However, the available data do not support specific preventive or therapeutic recommendations beyond identifying these factors as being associated with an increased likelihood of soft tissue recession.
8. Level of Evidence, Limitations and Transparency
This publication represents an international multicenter observational study evaluating clinical outcomes following AMSJI rehabilitation. As an observational cohort without a control group, its level of evidence is lower than that of randomized controlled clinical trials but provides valuable real-world clinical data regarding a relatively recent implant concept.
The absence of a comparison group constitutes a methodological limitation that can reasonably be inferred from the study design. Additional limitations are not detailed in the available abstract. Likewise, no information regarding funding sources or conflicts of interest is provided in the supplied material and therefore cannot be assessed.
9. Key Study Points
- Study design: International multicenter observational study.
- Level of evidence: Observational clinical study.
- Study population: Patients with severe maxillary atrophy (Cawood and Howell Class V or greater).
- Number of patients: 40.
- Mean follow-up: 917 ± 307 days.
- Primary outcome: Soft tissue response and identification of factors associated with mucosal recession following AMSJI placement.
- Main finding: Framework exposure due to mucosal recession occurred in 65% of patients.
- Significant risk factors: Thin soft tissue biotype and peri-implant mucositis.
- Scientific conclusion: Soft tissue complications represent an important component of long-term follow-up after AMSJI rehabilitation, with identifiable clinical factors associated with recession.
- Limitations: No control group; additional methodological limitations are not specified in the available data.
10. Scientific Impact
This study contributes clinically relevant evidence regarding the biological performance of patient-specific additively manufactured subperiosteal jaw implants in individuals with advanced maxillary atrophy. Rather than focusing solely on implant stability, it expands current knowledge by addressing the behavior of peri-implant soft tissues, an aspect that remains insufficiently documented in the literature.
By identifying soft tissue phenotype and mucositis as factors associated with recession, the investigation encourages greater emphasis on biological monitoring alongside mechanical success. These findings provide a foundation for future prospective and comparative studies designed to clarify the mechanisms underlying soft tissue breakdown and to determine whether targeted preventive strategies may improve long-term outcomes in patients rehabilitated with customized subperiosteal implants.
11. Editorial Conclusion
This observational study provides valuable insight into the soft tissue response surrounding customized AMSJIs placed in severely atrophic maxillae. Although implant stability remained consistently high, mucosal recession emerged as a frequent biological complication associated with thin soft tissue phenotype and peri-implant mucositis. Given the observational nature of the evidence, these findings should be interpreted cautiously but underscore the importance of meticulous soft tissue assessment and long-term biological follow-up when managing complex implant-supported rehabilitations.
