subperiosteal implants
Unilateral Additive Manufactured Subperiosteal Jaw Implant for Complex Oral Rehabilitation: Case Report
Joel Joshi Otero, Manuel Fernandez Dominguez
Unilateral Additive Manufactured Subperiosteal Jaw Implant for Complex Oral Rehabilitation: Case Report
1. Scientific Reference
- Study Title: Unilateral Additive Manufactured Subperiosteal Jaw Implant for Complex Oral Rehabilitation: Case Report
- Authors: Dr. Joel Joshi Otero, Dr. Manuel Fernandez Dominguez
- Scientific Journal: Current Trends in Medical and Clinical Case Reports
- Year of Publication: 2020
- DOI: 10.47690/CTMCCR.2020.2201
2. Scientific Background
The management of patients presenting advanced maxillary and mandibular bone atrophy remains one of the major challenges in implantology and oral surgery. When residual bone volume is insufficient, conventional protocols often rely on bone reconstruction procedures, grafting techniques, or specific implant approaches requiring multiple surgical stages before achieving fixed prosthetic rehabilitation.
The evolution of digital technologies, particularly computer-aided design and manufacturing (CAD/CAM), metal 3D printing, and virtual biomechanical analyses, has promoted the development of customized subperiosteal implants. These devices are designed to adapt to the patient’s anatomy and may represent an alternative in certain situations where conventional endosseous implants are difficult to consider.
This article is situated within this context of innovation by presenting a clinical case of complex oral rehabilitation using a unilateral mandibular subperiosteal implant manufactured through additive technology.
3. Study Objective
The objective of this case report was to describe the clinical use of a customized unilateral mandibular subperiosteal implant manufactured by 3D printing in a patient presenting severe post-traumatic mandibular atrophy and a history of failed bone reconstruction.
The authors sought to illustrate the feasibility of this approach in a complex clinical situation where conventional options were limited and where the patient refused further bone grafting procedures.
4. Methodology
This is a clinical case report.
The patient was a 35-year-old man presenting severe post-traumatic mandibular atrophy classified as level V according to the Cawood and Howell classification. His medical history included a previous failure of an autologous bone graft harvested from the iliac crest, as well as recurrent episodes of mandibular fistulas.
Planning was based on a high-resolution maxillomandibular CT scan. DICOM data were converted into STL models in order to design a customized implant. A Finite Element Analysis (FEA) was performed with a load of 100 N applied to the implant abutments. The implant was manufactured from Ti6Al4V titanium alloy using laser melting technology.
The follow-up reported in the article was one year. No control group was used, which is consistent with the descriptive nature of a case report.
5. Main Results
The customized subperiosteal implant was placed without the need for intraoperative modification, suggesting a good correspondence between digital planning and the actual clinical situation.
Three prosthetic abutments were integrated into the implant design, and fixation was achieved using four self-tapping osteosynthesis screws. After eight weeks, a definitive screw-retained hybrid prosthesis was delivered.
During postoperative follow-up, localized swelling of the left parasymphyseal region was observed during the third week. According to the authors, the CT scan performed did not reveal any significant abnormality. Antibiotic therapy with clindamycin was prescribed, and the outcome was favorable.
The patient was followed for a period of one year, with maintenance of the fixed prosthetic rehabilitation described in the clinical case. No other major clinical events were reported in the available data.
6. Clinical Analysis
This publication illustrates the potential interest of customized subperiosteal implants in particularly complex implant rehabilitation situations. The presented case concerns a patient combining several unfavorable factors: previous trauma, severe bone atrophy, prior bone graft failure, and refusal of further reconstructive procedures.
The originality of the approach lies in the combined use of digital workflow, CAD/CAM planning, finite element analysis, and additive titanium manufacturing. These tools theoretically allow precise anatomical adaptation of the implant while reducing certain constraints associated with conventional reconstructive techniques.
From a clinical perspective, this report highlights the possibility of achieving a fixed implant-supported restoration without resorting to additional bone augmentation in a selected case. However, it does not allow determination of the long-term performance of this solution or comparison with conventional endosseous implants, zygomatic implants, or bone grafting procedures.
The conclusions must therefore be interpreted with caution. The success observed in a single patient does not constitute sufficient evidence to generalize this approach to all patients affected by severe bone atrophy. Studies involving a greater number of patients and longer follow-up periods would be necessary to better evaluate the biological and prosthetic stability of this technology.
7. Clinical Applications
The presented data suggest a potential interest in this approach in certain complex oral rehabilitation situations:
- Severe mandibular atrophy (Cawood and Howell Class V).
- Patients with a history of failed bone reconstruction.
- Cases in which additional bone grafting procedures are not desired or are refused.
- Implant rehabilitation requiring advanced digital planning.
- Use of CAD/CAM workflows and additive manufacturing in oral surgery.
- Fabrication of implant-supported hybrid prostheses on customized subperiosteal implants.
However, the article does not provide general clinical recommendations and does not allow precise definition of the optimal indications for this technique.
8. Level of Evidence, Limitations and Transparency
This publication corresponds to a clinical case report, which represents a low level of evidence within the hierarchy of scientific data.
The main methodological limitation is the inclusion of a single patient without a comparison group. The observed results therefore do not allow assessment of the reproducibility of the technique or its potential superiority compared with other implant rehabilitation strategies.
The reported follow-up was one year, which remains insufficient to fully assess the long-term behavior of the implant, particularly regarding biological or mechanical complications.
No conflict of interest is explicitly declared in the provided material. The authors mention the involvement of a company specialized in digital implant design, but no financial relationship is detailed in the available document.
9. Key Points of the Study
- Study Type: Clinical Case Report
- Level of Evidence: Low
- Population or Number of Studies Analyzed: 1 patient
- Number of Patients or Implants: 1 patient; unilateral mandibular subperiosteal implant
- Follow-up Duration: 1 year
- Primary Outcome Evaluated: Clinical feasibility of implant rehabilitation using a customized subperiosteal implant
- Main Result: Successful placement of the implant and delivery of a fixed hybrid prosthesis with one-year reported follow-up
- Scientific Conclusion: The technique appears feasible in this complex clinical case
- Potential Limitations: Single case, absence of control group, absence of long-term data
10. Scientific Impact
This publication contributes to the emerging literature dedicated to customized subperiosteal implants manufactured through 3D printing. It provides a practical illustration of the integration of digital workflow into implant rehabilitation for patients presenting advanced bone atrophy.
The scientific interest of this work does not lie in demonstrating generalized clinical effectiveness but rather in the detailed description of a protocol combining three-dimensional imaging, computer-aided design, biomechanical analysis, and additive manufacturing.
The presented case supports the idea that certain clinical situations historically associated with complex reconstructive procedures may benefit from customized approaches. However, the available data remain limited and do not allow conclusions regarding long-term implant survival, complication rates, or the exact place of this technique within the therapeutic arsenal of modern implantology.
11. Editorial Conclusion
This case report highlights the use of a customized mandibular subperiosteal implant produced through additive manufacturing in a context of complex oral rehabilitation associated with severe bone atrophy. The reported results suggest the feasibility of this approach in a selected patient presenting unfavorable surgical history. Nevertheless, due to the low level of evidence and the isolated nature of the presented case, these observations should be considered exploratory and require confirmation through more robust clinical studies before any large-scale extrapolation.
