Custom-Made Direct Metal Laser Sintering Titanium Subperiosteal Implants: A Retrospective Clinical Study on 70 Patients

Abstract

Purpose To present a digital technique for the fabrication of custom-made subperiosteal implants and to report on the survival and complication rates encountered when using these fixtures. Methods The data used for this retrospective clinical study were derived from the medical records of five different private dental practices. Inclusion criteria were patients over the age of 60, treated with custom-made direct metal laser sintering (DMLS) titanium subperiosteal implants (Eagle-Grid®, BTK, Dueville, Vicenza) during a two-year period (2014-2015) and restored with fixed restorations; all enrolled patients needed to have complete pre- and postoperative clinical and radiographic documentation, with at least 2 years of follow-up. Exclusion criteria were smoking and bruxism. The main outcomes looked at were implant survival and complications. Results Seventy patients (39 males and 31 females, aged 62-79 years) who had been treated with custom-made DMLS titanium subperiosteal implants were enrolled in this study. After 2 years of follow-up, three implants were lost due to recurrent, untreatable infections; the survival rate was therefore 95.8% (67/70 implants). Four patients reported pain/discomfort/swelling after implant placement; the incidence of immediate postoperative complications was therefore 5.7% (4/70 implants). During the follow-up period, one patient suffered from recurrent infections classified as a biologic complication; the incidence of biologic complications was therefore 1.4% (1/67 surviving implants). Finally, four patients experienced prosthetic problems with their implant-supported restorations during the provisional phase (fracture of the acrylic restoration) and two patients had ceramic chipping of the definitive restoration; the incidence of prosthetic complications was therefore 8.9% (6/67 surviving implants). Conclusions Within the limits of the present study (limited follow-up time and low number of patients treated, retrospective design), the application of custom-made DMLS titanium subperiosteal implants showed satisfactory implant survival (95.8%) and low complication rates. Further studies are needed to confirm the positive outcomes found in this research.

Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series

“…For all these patients, and in all these situations, subperiosteal implants may be an alternative, due to the digital revolution and the advent of modern digital technologies in dentistry [34][35][36][37]46]. CBCT allows acquisition of 3D data of the patient's residual bone volume, with considerable accuracy, and a low dose of radiation directed exclusively at the area of interest [27,47].…”

“…CBCT allows acquisition of 3D data of the patient's residual bone volume, with considerable accuracy, and a low dose of radiation directed exclusively at the area of interest [27,47]. The data acquired with the CBCT is then re-elaborated with appropriate reconstruction software, which allows generation of a virtual bone model of the area of interest [34][35][36][37]. Capturing an optical impression of the dentate arches allows modelling of a virtual diagnostic wax-up.…”

“…Capturing an optical impression of the dentate arches allows modelling of a virtual diagnostic wax-up. Finally, the superimposition of bone and dental models, together with the virtual wax-up, makes it possible to design and model custom-made subperiosteal implants, designed and conceived specifically for the patient's needs, both as a bone-supported structure and as a prosthetic emergency [34][35][36][37]. These 3D-printed implants represent a possible alternative solution for the rehabilitation of the atrophic posterior mandible of elderly patients who do not want or cannot undergo traditional regenerative techniques, preparatory to insertion of classical endosseous implants [34][35][36][37].…”

“…a Buccal view of the framework; b the zirconia structure, buccal view; c the zirconia structure, lingual view as porous, hollow objects with interconnections, tunnels and crevices. It is possible to manufacture titanium or titanium alloy implants, whether standard endosseous [29] or custom-made subperiosteal [34][35][36][37].…”

“…This allows the opportunity to revisit some old concepts, such as the placement of subperiosteal implants, and reinterpret them in a new technological context based on consolidated anatomical and physiological principles [34][35][36]. The reduction of treatment to a single surgical session, lower costs for the patient and, above all, the precision that makes the method more predictable and safer in the short term have brought the attention of clinicians back to the use of subperiosteal implants, particularly for the management of complex atrophies such as in the posterior mandible of elderly patients [36,37].…”