George Dimitroulis , Benjamin Gupta, Ian Wilson, Christopher Hart

Full text links: https://pubmed.ncbi.nlm.nih.gov/35119553/

The atrophic edentulous alveolus. A preliminary study on a new generation of subperiosteal implants

1. Scientific Reference

• Study Title: The atrophic edentulous alveolus. A preliminary study on a new generation of subperiosteal implants
• Authors: George Dimitroulis, Benjamin Gupta, Ian Wilson, Christopher Hart
• Journal: Not specified in the provided information.
• Publication Year: 2022
• DOI: 10.1007/s10006-022-01044-3

2. Scientific Background

Managing patients with severely atrophic edentulous jaws remains one of the most demanding challenges in implant dentistry and oral surgery. Limited residual bone volume frequently complicates the placement of conventional endosseous implants and may require extensive reconstructive procedures before fixed implant rehabilitation becomes feasible. As digital technologies continue to transform implant treatment planning, patient-specific implant solutions have attracted growing clinical interest.

This preliminary investigation focuses on a new generation of customized subperiosteal implants manufactured through CAD/CAM design and metal 3D printing technologies. Rather than relying on traditional implant placement within the available bone, these patient-specific devices are designed to adapt to the external surface of the jaw. The study explores whether this digital workflow may provide an alternative restorative option for patients with advanced alveolar atrophy while reducing the need for bone grafting procedures.

3. Study Objective

The primary objective of this study was to evaluate the early clinical performance of a newly developed customized subperiosteal implant system produced using CAD/CAM technologies and metal additive manufacturing. The authors sought to determine whether this personalized bone-supported solution could offer a reliable treatment alternative for edentulous patients with severely atrophic jaws who would otherwise require bone augmentation before receiving conventional implant-supported fixed prostheses.

4. Methodology

This publication reports a cohort case series evaluating the clinical use of customized subperiosteal implants.

A total of 21 patient-specific subperiosteal implant devices were placed during a four-year clinical period. Each implant was digitally designed according to the patient’s anatomy using CAD/CAM technology before being manufactured through metal 3D printing.

The abstract does not provide detailed information regarding the exact number of patients, inclusion or exclusion criteria, follow-up protocol, outcome assessment methods, or statistical analysis. These aspects are therefore not specified in the available information.

5. Main Findings

Initial treatment success was achieved in 14 of the 21 implanted devices, corresponding to a reported success rate of 66.7%. Seven cases experienced complications during the observation period. These included exposure of the metallic framework in five cases, mobility of the implant in one case, and one treatment failure that was reported to be unrelated to the implant device itself.

Importantly, four of these seven complicated cases were successfully managed, resulting in an overall clinical success rate of 85.7%, representing 18 successful cases out of 21.

Based on these findings, the authors suggest that fully customized subperiosteal implants may represent a practical treatment option for selected patients with severe jaw atrophy requiring implant-supported rehabilitation.

6. Clinical Interpretation

This study provides preliminary clinical evidence supporting the feasibility of digitally designed, patient-specific subperiosteal implants for managing advanced edentulous jaw atrophy. Rather than replacing conventional implant therapy, the proposed approach appears to address a specific clinical situation in which available bone volume limits the use of standard endosseous implants.

The reported complications demonstrate that biological and mechanical challenges remain possible, particularly regarding soft tissue coverage over the metallic framework. Nevertheless, the successful management of several complications indicates that unfavorable events do not necessarily result in definitive treatment failure.

From a clinical perspective, these findings highlight the potential role of customized digital implant solutions within highly selected cases where conventional treatment would otherwise require bone grafting procedures. However, because the study represents a case series without a comparison group, its conclusions should not be interpreted as definitive evidence of superiority over established treatment approaches.

Additional research involving larger patient populations and longer follow-up periods will be necessary to better define the long-term clinical performance, safety, and predictability of this technology.

7. Clinical Applications

According to the available data, this customized subperiosteal implant system may be relevant for clinical situations involving:

• severely atrophic edentulous maxillae or mandibles;
• patients who would otherwise require bone grafting before conventional implant placement;
• digitally planned implant rehabilitation using CAD/CAM technologies;
• patient-specific implant-supported prosthetic reconstruction.

The authors also indicate that immediate prosthetic tooth placement may be possible at the time of implantation. No additional clinical indications are described in the provided information.

8. Level of Evidence, Limitations and Transparency

This publication represents a cohort case series, corresponding to a relatively limited level of clinical evidence compared with randomized controlled trials or systematic reviews.

The findings are based on a small clinical experience involving 21 implant devices, and no direct comparison with alternative treatment modalities is reported in the available abstract. Detailed follow-up data, outcome definitions, and statistical methodology are not provided.

The available information does not mention funding sources, conflicts of interest, or relationships between the authors and implant manufacturers.

Consequently, the reported outcomes should be interpreted as preliminary observations that warrant confirmation through more robust prospective clinical investigations.

9. Key Study Highlights

• Study design: Cohort case series.
• Level of evidence: Low to moderate.
• Study population: Not specified in the available information.
• Number of implant devices: 21 customized subperiosteal implants.
• Clinical period: Four years.
• Primary outcome: Clinical success of customized subperiosteal implants.
• Main result: Overall success rate of 85.7% following successful management of several complications.
• Scientific conclusion: Customized CAD/CAM-manufactured subperiosteal implants appear to represent a promising alternative for selected patients with severe jaw atrophy.
• Main limitations: Small case series, absence of a control group, and limited methodological details in the available abstract.

10. Scientific Impact

This preliminary investigation contributes to the growing body of literature exploring digitally manufactured patient-specific implants for complex implant rehabilitation. By combining CAD/CAM planning with metal additive manufacturing, the study illustrates how emerging digital workflows may expand treatment possibilities for patients with severe alveolar atrophy.

Although the evidence remains exploratory, the reported clinical experience suggests that customized subperiosteal implants may reduce the need for extensive reconstructive procedures in carefully selected cases. Equally important, the study identifies complications that should be considered when evaluating this treatment concept, emphasizing the need for careful clinical monitoring.

Rather than establishing a new standard of care, this work provides an early clinical foundation that supports further investigation through larger prospective studies capable of validating long-term safety, effectiveness, and treatment predictability.

11. Editorial Conclusion

This preliminary clinical study presents encouraging early results for a new generation of digitally designed customized subperiosteal implants intended for the rehabilitation of severely atrophic edentulous jaws. While the reported outcomes suggest that this technology may offer an alternative to conventional graft-dependent treatment pathways in selected patients, the current evidence remains limited by the study design. Further well-designed clinical research is required before definitive conclusions regarding long-term performance and broader clinical adoption can be established.