(53) The Resurrection of Subperiosteal Implants: A Case Series

Abstract: Statement of the problem:Rehabilitation of the atrophic edentulous maxilla/mandible is a challenging feat for a myriad of reasons. This can be further complicated by unique defects resulting from trauma or pathology. In such cases, the use of traditional endosteal implants is not feasible, yet patients desire rehabilitation of their dentition for improved quality of life. Subperiosteal implants, a once abandoned technology, may now offer a solution to these complex cases. First described by Dahl in 1943 [1] subperiosteal implants have a complicated history marked by a time of success followed by failure. They gained a less than favorable reputation, however with advances in technology, they have been revamped and offer a promising alternative to traditional endosteal implants. Today, custom-made, additively manufactured subperiosteal implants enable one-time surgery, immediate loading, better fit, and surgical time reduction over former subperiosteal implants. [2] Materials and methods: This is a case series of four patients. All of the patients were from University of Florida Health in Jacksonville, Florida. Inclusion criteria were that patients had to have undergone subperiosteal implant placed between August 2023 and December 2023. There were no exclusion criteria. The history of presenting illness, virtual surgical planning, surgical procedure, and postoperative course for 4 patients were reviewed. The duration of postoperative period ranges from 6-12 months. There will be no statistical analysis. However, outcomes will be subjectively analyzed in terms of surgical outcome, biologic and mechanical complications, and patient satisfaction.Results/outcomes of investigation:Virtual surgical plans were used to create patient-specific implants for a single-stage surgery with immediate loading with a temporary prosthesis. The patients of this study have had satisfactory results, but some minor complications did arise along the way. In one case, a patient who underwent resection of the right posterior maxilla due to chronic osteomyelitis at the time of subperiosteal implant placement developed an oroantral communication requiring a secondary surgical procedure. Most notably, all 4 patients had incidences of the temporary prosthesis becoming loose, requiring occlusal adjustments and retightening of their screws. There was no incidence of postoperative infection. All the patients are able to function utilizing their prosthesis, tolerate a normal diet, and are pleased with their outcomes. All patients reported an increased quality of life due to their dental rehabilitation. Conclusions relevant to the problem:We have experienced that patient-specific, selective laser-melded subperiosteal implants present satisfactory implant survival with minor complications thus far. Although there was no incidence of postoperative infection or loss of hardware, there were difficulties with the temporary prosthesis becoming loose with function. In one case of chronic osteomyelitis, there was an oroantral communication that was likely related to the limitations in soft-tissue reconstruction at the time of maxillary resection, where a buccal fat pad advancement was used. It is the hope of the authors that this study may help to guide future research to improve the prosthesis/implant interface to prevent further issues with loosening, which will ultimately improve patients’ outcomes. References1. Dahl, S.G.A. Om möjligheten för implantation i käken av metallskelett som bas eller retention för fasta eller avtagbara protester Särtryck ur Odontologisk Tidskrift häfte. Odontol. Tidskr. 1943, 52, 440–446.2. Anitua E, Eguia A, Staudigl C, Alkhraisat MH. Clinical performance of additively manufactured subperiosteal implants: a systematic review. Int J Implant Dent. 2024 Feb 5;10(1):4. doi: 10.1186/s40729-024-00521-6. PMID: 38315326; PMCID: PMC10844163.

Preop CBCT
Subperiosteal VSP
Subperiosteal Intraoperative Photo