The Subperiosteal Implant as a Viable Long-Term Treatment Modality in the Severely Atrophied Mandible: A Patient’s 40-Year Case History

M. Kurtzman, K. Schwartz

Full text link: https://pubmed.ncbi.nlm.nih.gov/7473869/

The Subperiosteal Implant as a Viable Long-Term Treatment Modality in the Severely Atrophied Mandible: A Patient’s 40-Year Case History

1. Scientific Reference

• Study title: The subperiosteal implant as a viable long-term treatment modality in the severely atrophied mandible: a patient’s 40-year case history
• Authors: M. Kurtzman, K. Schwartz
• Scientific journal: Not specified in the information provided.
• Year of publication: Not specified in the information provided.
• DOI: Not specified in the information provided.
• PMID: 7473869

2. Scientific Background

Rehabilitation of a severely atrophied, fully edentulous mandible can become particularly challenging when advanced ridge resorption compromises the stability and function of a conventional complete denture. Limited available bone may also restrict the placement of certain endosseous implant designs.

Kurtzman and Schwartz examine the role of the subperiosteal implant in this demanding clinical setting. At the time described by the authors, subperiosteal implants had already been used for almost 50 years as a treatment modality for atrophied edentulous mandibles.

The particular scientific interest of this report lies in its unusually long observation period. The authors document the clinical history of a patient over 40 years following rehabilitation of a severely atrophied, completely edentulous mandible with a subperiosteal implant supporting a removable prosthesis. The report therefore provides a rare individual perspective on the potential long-term durability of this form of implant-supported rehabilitation.

3. Study Objective

The purpose of this publication was to document the 40-year clinical history of a patient with a severely atrophied and fully edentulous mandible treated using a subperiosteal implant combined with a removable implant-borne prosthesis.

Through this individual case, the authors sought to illustrate the long-term viability of the subperiosteal implant in a clinical situation characterized by severe ridge resorption and inadequate bone for the endosseous implant designs discussed in the abstract.

4. Methodology

This publication is best classified as an individual clinical case report with long-term longitudinal follow-up, rather than a controlled or comparative clinical study.

The report follows one patient with a severely atrophied, fully edentulous mandible who underwent rehabilitation using a subperiosteal implant and a removable implant-borne prosthesis. The reported observation period extends over 40 years.

The available abstract does not provide detailed information regarding the surgical protocol, implant design, prosthetic procedures over time, or standardized criteria used to evaluate treatment outcomes. Similarly, specific biological, radiographic, functional, or mechanical parameters are not described in the information provided.

5. Main Results

The central finding is the documented long-term persistence of a subperiosteal implant-supported rehabilitation in a patient with severe mandibular atrophy. The 40-year clinical history represents the key temporal outcome reported by the authors.

Based on this individual experience, the authors considered the subperiosteal implant to represent a potential long-term treatment option for selected patients who are unable to function adequately with a mandibular complete denture because of ridge resorption and who present osseous deficiencies that do not provide sufficient bone for the blade- or root-form endosseous implants referenced in the abstract.

No implant survival rate, complication rate, quantitative functional assessment, or other statistical outcome is reported in the information provided. Such outcomes therefore cannot be inferred from this single case.

6. Clinical Analysis

The principal clinical value of this publication is not evidence of general therapeutic effectiveness, but rather the documentation of exceptional longevity in one individual clinical situation. A 40-year history demonstrates that a subperiosteal implant-supported rehabilitation can remain a viable solution over several decades under certain circumstances.

This distinction is important when interpreting the study. A single case cannot establish an expected survival rate, quantify the probability of biological or mechanical complications, or determine whether the same outcome would be reproducible in a broader patient population. Nor does the report provide comparative evidence demonstrating superiority over other treatment modalities.

Nevertheless, the case is clinically relevant to the management of the severely resorbed edentulous mandible. The patient described presented a situation in which ridge resorption interfered with the use of a mandibular complete denture and the available bone was considered inadequate for the endosseous implant designs mentioned by the authors.

The findings should therefore be interpreted as evidence of clinical feasibility and individual long-term durability, rather than as proof of predictable outcomes across different patient populations. The report contributes a longitudinal perspective on implant-prosthetic rehabilitation in a particularly compromised anatomical situation while remaining limited by the nature of a single-patient observation.

7. Clinical Applications

The findings are primarily relevant to the consideration of treatment strategies for the severely atrophied, fully edentulous mandible.

In the reported case, the subperiosteal implant was used in conjunction with a removable implant-borne prosthesis in a patient whose advanced ridge resorption compromised the use of a conventional mandibular complete denture and whose osseous anatomy was considered inadequate for the endosseous implants referenced in the abstract.

The publication may therefore contribute to the scientific discussion surrounding implant-supported rehabilitation in cases of extreme mandibular atrophy. However, the information provided does not support extending its conclusions to bone grafting procedures, zygomatic implants, guided surgery, digital implant planning, or contemporary CAD/CAM protocols.

8. Level of Evidence, Limitations, and Transparency

The level of evidence is low, as the publication describes the clinical history of a single patient. Although the 40-year follow-up provides notable longitudinal information, an extended observation period does not overcome the methodological limitations inherent to an individual case report.

The absence of a control group and the single-patient design prevent estimates of treatment predictability, complication frequency, or comparative effectiveness.

In addition, the available abstract does not provide detailed outcome criteria or information regarding biological, mechanical, or radiographic complications. These aspects therefore cannot be assessed from the material provided.

Author conflicts of interest or industry relationships: Not specified in the information provided.

9. Key Study Points

• Study type: Individual clinical case report with longitudinal follow-up.
• Level of evidence: Low, due to the single-patient observational design.
• Population or studies analyzed: One clinical case.
• Number of patients or implants: 1 patient; exact number of implants not specified in the information provided.
• Follow-up duration: 40 years.
• Primary outcome assessed: Long-term clinical course of a subperiosteal implant-supported mandibular rehabilitation.
• Main result: The case documents long-term viability of the subperiosteal implant rehabilitation in this individual patient.
• Scientific conclusion: The authors consider the subperiosteal implant a potential long-term treatment option for selected patients with severe mandibular ridge resorption under the clinical circumstances described.
• Main limitations: Single-patient observation, absence of a comparator group, and limited methodological and outcome information in the available abstract.

10. Scientific Impact

The principal contribution of this publication is its very long-term clinical documentation. A 40-year history of a subperiosteal implant-supported rehabilitation in a patient with severe mandibular atrophy provides an uncommon longitudinal perspective on this treatment modality.

Its scientific significance should nevertheless be interpreted within the boundaries of a case report. The observation establishes that prolonged clinical viability was possible in this particular patient, but it does not determine how frequently similar outcomes may be achieved in a larger population.

Accordingly, the article is more appropriately viewed as descriptive long-term clinical evidence than as validation of a broadly applicable treatment protocol. Its value lies in documenting the durability of one implant-prosthetic rehabilitation in a challenging anatomical setting.

More extensive patient populations, standardized outcome measures, and detailed reporting of biological and mechanical complications would be necessary to establish broader conclusions regarding treatment predictability. This represents a methodological interpretation of the available level of evidence rather than an additional finding reported by the authors.

11. Editorial Conclusion

The case reported by Kurtzman and Schwartz is notable for its 40-year clinical history in a patient with a severely atrophied, fully edentulous mandible. It demonstrates that a subperiosteal implant-supported removable prosthetic rehabilitation can achieve remarkable longevity in an individual case. Its implications should nevertheless remain appropriately limited: a single clinical observation cannot establish predictable outcomes for other patients or demonstrate superiority over alternative implant rehabilitation strategies.