The Role of Custom-made Subperiosteal Implants for Rehabilitation of Atrophic Jaws: A Case Report

David Faustino Ângelo, José Ricardo Vieira Ferreira

Full text link: https://pubmed.ncbi.nlm.nih.gov/33708606/

The Role of Custom-made Subperiosteal Implants for Rehabilitation of Atrophic Jaws: A Case Report

1. Scientific Reference

• Study Title: The Role of Custom-made Subperiosteal Implants for Rehabilitation of Atrophic Jaws: A Case Report
• Authors: David Faustino Ângelo, José Ricardo Vieira Ferreira
• Journal: Annals of Maxillofacial Surgery
• Publication Year: 2021
• DOI: 10.4103/ams.ams_263_20

2. Scientific Background

Managing severely atrophic jaws remains one of the most demanding challenges in implant dentistry and oral rehabilitation. Conventional treatment strategies based on endosseous dental implants often require bone augmentation procedures when residual bone volume is inadequate, increasing both surgical complexity and treatment duration. Although immediate loading protocols have improved rehabilitation outcomes in many patients, extensive bone loss or previous implant failure may limit their applicability.

Advances in digital planning and patient-specific implant manufacturing have renewed interest in custom-made subperiosteal implants as a potential alternative for selected complex cases. Rather than relying solely on residual alveolar bone for fixation, these customized frameworks are designed to adapt to each patient’s anatomy. This case report explores the clinical application of such an approach in a patient with severe maxillary and mandibular atrophy following failure of a previous implant-supported rehabilitation, contributing to the ongoing discussion regarding alternative treatment options for challenging anatomical situations.

3. Study Objective

The purpose of this case report was to describe the clinical management of a patient with severe jaw atrophy using custom-made subperiosteal implants featuring an innovative design that combines subperiosteal and endosseous support. Through this clinical presentation, the authors aimed to illustrate the potential role of this treatment concept as an alternative for carefully selected patients in whom conventional endosseous implant rehabilitation may be difficult or has previously failed. The study does not investigate secondary objectives beyond this clinical illustration.

4. Methodology

This publication is a single-patient case report, representing an observational design with a limited level of clinical evidence.

The report describes the treatment of a 44-year-old male with congenital dental agenesis who had previously undergone mandibular rehabilitation using an All-on-6 implant-supported fixed prosthesis, which subsequently failed because of peri-implantitis. The therapeutic approach consisted of bimaxillary rehabilitation using patient-specific subperiosteal implants manufactured with an original design integrating both subperiosteal and endosseous support.

According to the abstract, immediate loading was performed after implant placement. However, the available information does not provide detailed descriptions of the digital workflow, surgical protocol, manufacturing process, follow-up duration, evaluation criteria, or postoperative assessment methods. These methodological details are not specified in the information provided.

5. Main Findings

The authors report successful rehabilitation of both jaws using customized subperiosteal implants in the presented patient. Based on this clinical outcome, they suggest that this treatment strategy may offer several potential advantages for carefully selected cases.

According to their interpretation, custom-made subperiosteal implants may enable a single-stage surgical procedure with immediate loading in severely atrophic jaws. They also propose that this approach could simplify treatment compared with conventional protocols involving bone grafting followed by endosseous implant placement. In addition, the technique is presented as a possible rescue option after failure of conventional implant therapy.

The authors remain appropriately cautious regarding these observations. They emphasize that their conclusions are derived from a single clinical case and explicitly state that larger studies with long-term follow-up are required before these preliminary assumptions can be confirmed. The abstract does not report quantitative clinical outcomes, implant survival rates, complication rates, or follow-up duration.

6. Clinical Analysis

This case report highlights a potential treatment alternative for patients with advanced jaw atrophy in whom conventional implant rehabilitation is particularly challenging. The patient presented a combination of complex clinical conditions, including congenital dental agenesis, severe maxillary and mandibular atrophy, and failure of a previous mandibular implant-supported rehabilitation due to peri-implantitis. Within this context, the use of patient-specific subperiosteal implants was intended to provide a personalized solution adapted to compromised bone anatomy.

The principal value of this publication lies in demonstrating the feasibility of an emerging therapeutic concept rather than establishing its clinical superiority. The implant design described by the authors combines subperiosteal support with endosseous anchorage, illustrating how contemporary digital technologies have transformed a historical implant concept into a modern, customized treatment option. Although the abstract does not describe the digital workflow in detail, the study reflects the growing integration of personalized implant design into complex oral rehabilitation.

The authors propose that this approach may reduce the need for extensive bone grafting procedures while allowing immediate loading in selected patients. They also suggest that customized subperiosteal implants could represent a valuable salvage option following failure of conventional endosseous implants. However, these considerations should be interpreted cautiously, as they are based exclusively on the outcome of a single clinical case.

The absence of comparative data, quantitative clinical outcomes, and long-term follow-up substantially limits the generalizability of the findings. Consequently, this report should be viewed as an exploratory clinical contribution that supports further investigation rather than as evidence validating a new standard of care. The authors themselves acknowledge that larger prospective studies with extended follow-up are required before firm conclusions can be drawn.

7. Clinical Applications

Based on the information provided, custom-made subperiosteal implants may represent a potential treatment option for carefully selected patients with severe maxillary or mandibular atrophy, particularly when conventional endosseous implant placement is difficult or when previous implant-supported rehabilitation has failed.

The authors also suggest that this approach may facilitate a single-stage surgical procedure combined with immediate loading, potentially reducing the complexity of treatment in specific clinical situations. Nevertheless, these potential applications should be interpreted within the context of a single case report. The available evidence does not establish definitive clinical indications, patient selection criteria, or superiority over conventional reconstructive approaches. Further clinical research will be necessary to determine the appropriate role of this treatment modality in implant dentistry and oral rehabilitation.

8. Level of Evidence, Limitations and Transparency

This publication is a single-patient case report, representing a low level of clinical evidence. While it demonstrates the feasibility of an innovative therapeutic approach, it does not provide sufficient evidence to establish clinical effectiveness, predictability, or long-term performance.

Several limitations should be considered when interpreting the findings. The report describes only one patient, without a control group or comparison with alternative treatment strategies. Furthermore, the abstract does not provide information regarding follow-up duration, objective clinical outcome measures, complication rates, implant survival, or prosthetic performance over time. The authors explicitly recognize these limitations by emphasizing the need for larger patient cohorts and long-term clinical studies.

No conflicts of interest, industry sponsorship, or financial relationships involving implant manufacturers are reported in the information provided. Likewise, no declaration regarding funding or competing interests is included in the available abstract.

9. Key Study Highlights

• Study design: Single-patient case report.
• Level of evidence: Low (descriptive clinical evidence).
• Study population: One patient with congenital dental agenesis and severe bimaxillary atrophy.
• Number of patients: 1.
• Number of implants: Not specified in the available information.
• Follow-up period: Not specified in the available information.
• Primary outcome assessed: Clinical feasibility of bimaxillary rehabilitation using custom-made subperiosteal implants with immediate loading.
• Main finding: Successful rehabilitation was achieved in the reported patient using a customized implant design combining subperiosteal and endosseous support.
• Scientific conclusion: The authors suggest that custom-made subperiosteal implants may represent a valuable treatment alternative for carefully selected patients with severe jaw atrophy or after failure of conventional endosseous implants. They emphasize that larger studies with long-term follow-up are necessary to validate these preliminary observations.
• Main limitations: Single clinical case, absence of comparative data, lack of quantitative outcome measures, and no long-term follow-up reported in the available abstract.

10. Scientific Impact

This publication contributes to the renewed interest in subperiosteal implants within the context of contemporary digital implant dentistry. Rather than introducing definitive clinical evidence, it illustrates how patient-specific implant design may expand therapeutic possibilities for complex cases of severe jaw atrophy where conventional implant rehabilitation is limited.

An important aspect of this report is the presentation of a customized implant concept that combines subperiosteal and endosseous support. This hybrid design reflects ongoing developments in personalized implant manufacturing and demonstrates how modern technologies may revisit historical treatment concepts through improved anatomical adaptation.

Although the evidence remains limited to a single clinical observation, the study encourages further investigation into the role of customized subperiosteal implants as an alternative treatment strategy. By explicitly calling for larger patient cohorts and long-term clinical evaluation, the authors position their work as an exploratory contribution that may help guide future prospective research rather than establish new clinical recommendations.

11. Editorial Conclusion

This case report provides a thoughtful illustration of how custom-made subperiosteal implants may offer an additional treatment option for selected patients with severe jaw atrophy and previous implant rehabilitation failure. While the reported outcome is encouraging, the findings should be interpreted within the limitations of a single clinical case. The publication primarily highlights the feasibility of an innovative personalized implant concept and underscores the need for well-designed clinical studies to determine its long-term safety, predictability, and place within contemporary implant rehabilitation protocols.