Revisiting Subperiosteal Implants: A Narrative Review of the Contemporary Literature ^†

Subperiosteal implants, once a historical footnote in implant dentistry, are experiencing a revival in the digital era. This study provides an overview of modern CAD/CAM-designed subperiosteal implants for patients with severe jaw atrophy. Severe atrophic jaws often cannot retain conventional screw implants without extensive bone grafting. Subperiosteal implants offer a graft-less solution by resting a custom-fitted framework on the bone surface under the periosteum [1,2].

Our review of recent literature (2019–2025) shows that digitally fabricated subperiosteal implants achieve high short-term success rates. In studies totaling over 200 patients, the implant survival within ~2 years exceeded 95–98% [1,2,3,4,5]. Avoiding bone graft surgery is a key advantage, particularly for elderly or medically compromised patients.

The main concern with subperiosteal implants remains soft-tissue health. Unlike an internal implant post, a subperiosteal frame spans a large area under the gums. About one-quarter of cases in short-term studies experienced some gum dehiscence or exposure of the metal framework. These exposures were usually small and manageable, but they signal that the gum integration is not always ideal. Infection around the implant occurred in a smaller percentage of patients (~5%) [4,5], often linked to those exposure sites. Long-term data (5–6 years) are only beginning to emerge. One 6-year follow-up reported that while almost all implants were still physically present (high survival), only 25% of cases remained completely free of complications over that time. This indicates that gradual bone resorption or tissue thinning can lead to late issues, even if the implant initially succeeds. Therefore, long-term maintenance and perhaps periodic soft tissue grafting might be necessary to sustain these implants over a decade or more [1,3].

Compared to zygomatic implants, subperiosteal implants had similar 5-year survival rates (97.1% vs. 96.3%), with complications limited to the soft tissue as the sinus was avoided entirely (12% sinus-related complications in zygomatic implants). Patient satisfaction improved in terms of function and esthetics [4].

In conclusion, modern subperiosteal implants show great promise as a custom-tailored remedy for extreme jaw atrophy. They achieve functional rehabilitation with high short-term success, rivaling alternative techniques. However, careful patient selection and diligent follow-up are essential, given the soft-tissue-related challenges. As technology and techniques improve, subperiosteal implants could firmly re-establish themselves as a valuable option in implant dentistry, offering hope to patients who were once deemed untreatable with fixed restorations.