The use of prefabricated titanium tissue abutments for the construction of a maxillary subperiosteal implant

The Use of Prefabricated Titanium Tissue Abutments for the Construction of a Maxillary Subperiosteal Implant

1. Scientific Reference

• Study Title: The Use of Prefabricated Titanium Tissue Abutments for the Construction of a Maxillary Subperiosteal Implant
• Authors: Engin Aras, Mehmet Sönmez, Muammer Zora, Meral Basarir, Hüseyin Kurtulmus
• Journal: Journal of Oral Implantology
• Year of Publication: 2005
• DOI: Not specified in the provided material.

2. Scientific Background

The rehabilitation of edentulous patients with severe maxillary bone resorption remains one of the most demanding challenges in implant dentistry. While endosteal dental implants are widely used when sufficient bone volume and density are available, extensive alveolar ridge atrophy may significantly restrict their placement in certain regions of the jaw.

In clinical practice, some patients present with heterogeneous anatomical conditions, where one area of the arch may support conventional implant placement while another exhibits advanced bone loss. Traditionally, these situations often require bone grafting procedures, sinus augmentation, or other reconstructive surgical approaches before implant rehabilitation can be considered.

The study presented by Aras and colleagues explores an alternative treatment strategy for such complex cases. By combining a custom-made maxillary subperiosteal implant with posterior endosteal implants, the authors describe a method intended to provide fixed implant-supported rehabilitation while potentially avoiding additional bone augmentation procedures.

3. Objective of the Study

The purpose of this publication was to describe a combined implant treatment approach involving both endosteal implants and a maxillary subperiosteal implant within the same arch. The authors also aimed to present the laboratory and surgical workflow associated with incorporating prefabricated titanium tissue abutments into the design and fabrication of a custom anterior subperiosteal implant.

4. Methodology

This article represents a clinical case report with a technical description.

The reported case involved a 60-year-old completely edentulous male patient who was dissatisfied with the stability of his maxillary implant-supported removable prosthesis. Clinical evaluation revealed severe anterior maxillary ridge atrophy that prevented placement of conventional endosteal implants in that region.

To address this limitation, the clinicians obtained a direct bone impression after surgical exposure of the maxilla. A custom subperiosteal implant was designed on a laboratory model and fabricated in titanium. Prefabricated titanium tissue abutments were incorporated into the design before casting and served as the implant posts. The completed subperiosteal implant was stabilized using titanium miniscrews and combined with four posterior endosteal implants to support a full-arch fixed prosthetic restoration classified as Misch FP2.

5. Main Findings

The authors report successful fabrication and placement of an anterior maxillary subperiosteal implant incorporating four prosthetic posts created from prefabricated titanium tissue abutments. This implant was used in conjunction with four posterior endosteal implants to support a screw-retained full-arch fixed restoration.

According to the clinical description, prosthetic procedures began two weeks after placement of the subperiosteal implant. Conventional prosthetic steps, including impression taking, framework verification, ceramic evaluation, occlusal adjustment, and final prosthesis delivery, were subsequently completed.

The report highlights two practical observations. First, the combined implant strategy may provide an alternative to more invasive augmentation procedures in selected patients with severe maxillary atrophy. Second, the authors note a relatively short interval between subperiosteal implant placement and prosthetic rehabilitation within the presented protocol.

No quantitative data regarding implant survival rates, complication rates, long-term maintenance, or patient-reported outcomes were provided in the available material.

6. Clinical Analysis

This publication illustrates how different implant modalities may be integrated into a single treatment plan when anatomical conditions vary across the same arch. Rather than applying a uniform approach to all regions of the maxilla, the clinicians selected implant types according to local bone availability.

From a clinical perspective, the report is particularly relevant for the management of advanced maxillary atrophy. The inability to place conventional endosteal implants in the anterior maxilla often leads clinicians toward bone grafting or other reconstructive procedures. The technique described here proposes an alternative pathway based on the use of a custom subperiosteal framework.

Another noteworthy aspect is the incorporation of prefabricated titanium tissue abutments into the implant design. This approach appears intended to simplify the creation of prosthetic emergence points and facilitate restoration delivery.

Nevertheless, the findings must be interpreted cautiously. The article presents only a single patient and does not provide comparative data against grafting procedures, alternative implant designs, or other treatment concepts. Furthermore, the absence of long-term clinical follow-up prevents assessment of biological stability, mechanical reliability, and prosthetic maintenance over time. Consequently, the study should be viewed primarily as a technical demonstration rather than evidence of clinical superiority.

7. Clinical Applications

The technique described in this report may be relevant in selected situations involving:

• Complete maxillary edentulism.
• Severe localized maxillary bone atrophy.
• Anatomical conditions that limit placement of conventional endosteal implants.
• Patients for whom extensive bone grafting procedures may be undesirable or difficult.
• Fixed implant-supported rehabilitation requiring adaptation to variable bone conditions within the same arch.

The publication specifically addresses a combined treatment concept involving both subperiosteal and endosteal implants. The available data do not support extrapolation to other implant protocols or patient populations.

8. Level of Evidence, Limitations, and Transparency

This publication should be classified as a case report with technical documentation, representing a low level of clinical evidence.

Several limitations restrict the strength of the conclusions. The report involves only one patient, lacks a control group, contains no statistical analysis, and does not provide detailed long-term follow-up outcomes. As a result, the findings cannot establish predictability, survival rates, or comparative effectiveness.

The authors mention that laser welding of the titanium tissue abutments to the cast titanium framework could be considered to reduce the risk of future abutment detachment, indicating awareness of potential mechanical considerations associated with the design.

No conflicts of interest, industry sponsorship, or financial relationships with implant manufacturers are reported in the provided material.

9. Key Study Points

• Study Type: Clinical case report with technical description.
• Level of Evidence: Low.
• Population Studied: One completely edentulous patient.
• Number of Patients or Implants: One patient; one anterior subperiosteal implant combined with four posterior endosteal implants.
• Follow-up Duration: Not specified in the provided material.
• Primary Outcome Evaluated: Feasibility of a combined subperiosteal and endosteal implant-supported maxillary rehabilitation.
• Main Finding: Successful delivery of a fixed full-arch prosthesis supported by both implant modalities.
• Scientific Conclusion: The described approach may represent an alternative treatment option in selected cases of severe maxillary bone resorption.
• Potential Limitations: Single-case design, absence of comparative analysis, and lack of long-term outcome data.

10. Scientific Impact

Although limited by its case-report design, this publication contributes to the literature on implant rehabilitation of severely resorbed maxillae by documenting a practical solution for patients with region-specific anatomical deficiencies.

The study is particularly noteworthy because it demonstrates how implant treatment planning can be individualized according to local bone conditions rather than relying exclusively on one implant modality. The integration of prefabricated titanium tissue abutments into the manufacturing process also represents an interesting technical adaptation aimed at improving prosthetic support within a custom subperiosteal framework.

Rather than providing definitive evidence for clinical decision-making, the article expands the range of documented therapeutic options available for complex edentulous cases. It also highlights areas where future research would be valuable, particularly regarding long-term outcomes, complication profiles, and comparisons with reconstructive surgical approaches.

11. Editorial Conclusion

This article presents a technically focused clinical report describing the use of prefabricated titanium tissue abutments in the fabrication of a custom maxillary subperiosteal implant combined with posterior endosteal implants. The report demonstrates the feasibility of achieving fixed implant-supported rehabilitation in a patient with severe anterior maxillary atrophy without relying on additional augmentation procedures. Given the limited level of evidence and the absence of long-term outcome data, the findings should be interpreted as preliminary clinical observations rather than definitive treatment recommendations.