Virtual surgical planning and customized subperiosteal implants: a systematic review

This systematic review was performed to evaluate the use of subperiosteal implants (SPIs) manufactured using digital workflows, focusing on their indications, performance, osseointegration, and safety by categorizing early and late biological and mechanical complications. The PubMed and Embase databases were searched, covering the years 2018-2023. The PRISMA guidelines were followed. Quality was assessed using JBI and NIH tools. Twenty-four articles (six cohort studies, six case series, 12 case reports) reporting 246 implants were analysed. After a mean follow-up of 17 months, 97.6% of implants were functional, with well-fitting results. Implants were primarily used for full-arch dentures in the maxilla and bridge prostheses in both jaws, with high survival rates (94.1-100%). Early complications included pain (25%) and swelling (24%), while late complications requiring SPI removal were infrequent (five reported failures). Partial exposure occurred in 37% of implants. Success rates, patient satisfaction, and aesthetics were reported positively, although rarely. Methods to enhance osseointegration included additively manufactured titanium, acid-etching, grit-blasting, and polyether ether ketone, but no clear superiority was found. Study heterogeneity precluded meta-analysis. The results indicate that digitally manufactured SPIs are a viable option for severely atrophic jaws, especially in elderly or compromised patients. More research with larger cohorts and longer follow-ups is needed to confirm their long-term safety and effectiveness.