The use of laser technology (Er;Cr:YSGG) and stereolithography to aid in the placement of a subperiosteal implant: case study

The Use of Laser Technology (Er,Cr:YSGG) and Stereolithography to Aid in the Placement of a Subperiosteal Implant: Case Study

1. Scientific Reference

• Study Title: The Use of Laser Technology (Er,Cr:YSGG) and Stereolithography to Aid in the Placement of a Subperiosteal Implant: Case Study
• Author: Edward R. Kusek
• Journal: Journal of Oral Implantology
• Year of Publication: 2009
• DOI: Not specified in the provided material.

2. Scientific Background

Managing patients with severe mandibular atrophy remains one of the most demanding situations in implant dentistry. In cases where residual bone volume is insufficient, conventional endosseous implants may require extensive bone augmentation procedures or may carry an increased risk of mandibular fracture. Under these circumstances, custom-made subperiosteal implants continue to represent a potential treatment option for selected patients who are not ideal candidates for conventional implant rehabilitation.

This case report reflects the evolution of digital technologies in oral and maxillofacial surgery. By combining computed tomography (CT), computer-aided design and manufacturing (CAD/CAM), and stereolithography, patient-specific implant frameworks can be designed with greater anatomical precision while eliminating the need for the preliminary surgical impression traditionally required for subperiosteal implants. The study also explores the integration of the Er,Cr:YSGG laser throughout the surgical workflow with the aim of minimizing tissue trauma and supporting postoperative healing.

3. Study Objective

The primary objective of this publication was to describe a clinical protocol combining stereolithography and Er,Cr:YSGG laser technology for the placement of a CAD/CAM-fabricated custom mandibular subperiosteal implant in a patient with severe mandibular atrophy. The author also sought to illustrate the potential clinical advantages of incorporating laser technology into different stages of the surgical procedure, including soft tissue management, bone preparation, and postoperative biostimulation.

4. Methodology

This publication is a single-patient case report, representing a low level of clinical evidence while providing a detailed description of an innovative surgical technique.

The report describes the treatment of a 70-year-old female with advanced mandibular bone resorption, complete mandibular edentulism, and multiple systemic comorbidities. Three-dimensional CT imaging was used to generate a stereolithographic model of the mandible, which served as the basis for designing a patient-specific titanium subperiosteal implant manufactured using CAD/CAM technology. Surgery was performed under general anesthesia. The Er,Cr:YSGG laser was used for soft tissue incision, cortical decortication, initial preparation for fixation screws, and postoperative low-level laser biostimulation. Beta-tricalcium phosphate mixed with the patient’s blood was grafted around the implant framework before membrane placement and primary wound closure. The duration of follow-up was not specified in the article.

5. Main Findings

The customized subperiosteal implant demonstrated an excellent intraoperative fit according to the author. The digital workflow, based on stereolithographic modeling, eliminated the need for a preliminary surgical procedure traditionally required to fabricate mandibular models for subperiosteal implant construction.

Following rehabilitation, the patient reported substantial improvement in oral function. Headaches, temporomandibular discomfort, mucosal irritation, and chewing limitations described before treatment were no longer present. The overdenture remained stable, allowing the patient to resume a more varied diet and improving overall masticatory function. Postoperative pain was rated by the patient as 3 on a 0–10 pain scale. The author further suggests that the laser-assisted protocol contributed to reduced postoperative pain and swelling, faster healing, and enhanced bone-to-implant contact compared with conventional techniques. However, these observations were based solely on this individual clinical case and were not supported by comparative clinical data.

6. Clinical Analysis

Rather than attempting to establish the superiority of a new treatment modality, this case report demonstrates the feasibility of integrating several advanced technologies into the rehabilitation of patients with severe mandibular atrophy. The combination of digital imaging, CAD/CAM manufacturing, and stereolithography enabled the fabrication of a highly customized implant framework while avoiding an additional surgical stage that had historically been necessary during conventional subperiosteal implant fabrication.

The Er,Cr:YSGG laser represents another important component of the described workflow. In this case, it was used not only for soft tissue incision but also for cortical bone decortication, osteotomy initiation, and postoperative biostimulation. According to the author, these applications may contribute to improved soft tissue elasticity, easier primary wound closure, reduced surgical trauma, and enhanced postoperative recovery.

Nevertheless, the findings should be interpreted with considerable caution. Because the publication consists of a single clinical observation without a control group, standardized outcome measurements, or long-term follow-up, it cannot establish clinical superiority or determine the reproducibility of the reported outcomes. Instead, it should be viewed as a technical demonstration highlighting potential applications of digital planning and laser-assisted surgery in carefully selected cases requiring complex implant rehabilitation.

7. Clinical Applications

The protocol described in this report may be relevant for selected patients presenting with severe mandibular atrophy, particularly when conventional endosseous implant placement would require extensive reconstructive procedures or may not be clinically appropriate.

The study also illustrates how digital implant planning, CAD/CAM manufacturing, stereolithography, and laser-assisted oral surgery can be integrated into a personalized treatment workflow for implant-supported overdentures. Although encouraging, these observations should not be interpreted as evidence supporting routine clinical adoption without confirmation from larger prospective clinical studies.

8. Level of Evidence, Limitations and Transparency

This publication is a case report, corresponding to a low level of scientific evidence.

The conclusions are based on the treatment of a single patient. No control group, statistical analysis, or direct comparison with conventional surgical techniques was included. In addition, the duration of follow-up was not reported, preventing assessment of long-term implant performance or biological stability.

The author discloses serving as a lecturer for Biolase, the manufacturer of the Er,Cr:YSGG laser used in this report, while stating that no research funding or financial remuneration was received in connection with this publication. This disclosure should be considered when interpreting the reported outcomes.

9. Key Study Highlights

• Study design: Case report
• Level of evidence: Low
• Study population: One patient
• Number of patients: 1
• Number of implants: One custom mandibular subperiosteal implant
• Follow-up duration: Not specified in the provided article
• Primary outcome: Clinical feasibility of combining stereolithography, CAD/CAM fabrication, and Er,Cr:YSGG laser technology for subperiosteal implant placement
• Main finding: Successful functional rehabilitation with reported improvement in postoperative comfort and overdenture stability
• Scientific conclusion: The described protocol was feasible in this clinical case and may reduce surgical trauma according to the author’s observations.
• Limitations: Single case, no control group, no statistical analysis, no long-term follow-up.

10. Scientific Impact

This publication illustrates the early integration of digital workflow technologies into implant dentistry, demonstrating how CT-based planning, stereolithography, and CAD/CAM manufacturing can be combined to produce patient-specific subperiosteal implants. At the time of publication, these technologies represented an important step toward individualized implant rehabilitation for patients with severe alveolar bone resorption.

The report also contributes to the evolving discussion regarding the role of Er,Cr:YSGG laser technology in implant surgery. By describing its application throughout multiple surgical stages—including soft tissue management, cortical bone preparation, and postoperative biostimulation—the article proposes a comprehensive laser-assisted surgical protocol. Although the evidence remains limited to a single clinical case, the publication helped highlight potential avenues for future research evaluating digital workflows and laser-assisted implant surgery in more robust clinical trials.

11. Editorial Conclusion

This case report presents an innovative combination of stereolithography, CAD/CAM technology, and Er,Cr:YSGG laser-assisted surgery for the placement of a customized mandibular subperiosteal implant. The reported clinical outcome suggests improved postoperative comfort and successful functional rehabilitation in a patient with severe mandibular atrophy. However, because the evidence is limited to a single clinical observation, the findings should be interpreted cautiously. The publication is best regarded as a proof of concept demonstrating the feasibility of integrating digital technologies and laser-assisted surgery into complex implant rehabilitation rather than as definitive evidence supporting widespread clinical implementation.