Clinical performance of additively manufactured subperiosteal implants: a systematic review

Abstract

Purpose The aim of this study was to assess implant survival and complications rate of modern subperiosteal implants (CAD designed and additively manufactured). Methods A systematic review was conducted using three electronic databases; Medline (Pubmed), Cochrane library, and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: “In patients with bone atrophy (P), do additively manufactured subperiosteal implants (I), compared to subperiosteal implants manufactured following traditional approaches (c), present satisfactory implant survival and complication rates (O)? The study was pre-registered in PROSPERO (CRD42023424211). Included articles quality was assessed using the “NIH quality assessment tools”. Results Thirteen articles were finally selected (5 cohort studies and 8 case series), including 227 patients (121 female / 106 male; weighted mean age 62.4 years) and 227 implants. After a weighted mean follow-up time of 21.4 months, 97.8% of implants were in function (5 failures reported), 58 implants (25.6%) presented partial exposure, 12 patients (5.3%) suffered soft tissue or persistent infection. Fracture of the interim prosthesis was reported in 8 of the155 patients (5.2%) in which the use of a provisional prosthesis was reported. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Conclusions Within the limitations of this study, modern additively manufactured subperiosteal implants presented a good survival in the short-time, but a noticeable number of soft-tissue related complications were reported. Further studies are needed to assess the clinical behavior in the medium- and long-term. Graphical Abstract

Long-Term Clinical Outcomes of 3D-Printed Subperiosteal Titanium Implants: A 6-Year Follow-Up

“…The purpose of this publication was to convey our 6-year clinical observations with a novel, digitally custom-designed subperiosteal jaw implant. This technique was mainly addressed to patients with severe bone resorption in which bone grafting would be highly unpredictable due to the decreased osteogenic capacity of the recipient site, especially those with Cawood and Howell Class IV to VI edentulous ridges [2,7,18,19].…”

“…However, a certain quantity and quality of bone are needed for its installation [5]. Bone grafts, jaw osteotomies, sinus lifts, distractions of the alveolar ridge, zygomatic implants, and barrier membranes are traditionally used in complex reconstructive surgery for dental rehabilitation of atrophic edentulous jaws and alveoli, which is necessary for patients undergoing oncology or post-traumatic treatment [2,6,7]. The main drawbacks, without a doubt, are the long times between treatment initiation and final prosthesis delivery, the high morbidity rate, and the complex and time-consuming procedure [8][9][10].…”