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Soft Tissue Dehiscence and Survival of Customized CAD/CAM Titanium Subperiosteal Implants: A Systematic Review and
Purpose:
This systematic review and meta-analysis aimed to assess the prevalence of soft tissue dehiscence and survival rates of modern customized titanium subperiosteal implants (CSIs). A secondary objective was to determine whether the anatomical site (maxilla vs. mandible) is a significant predictor of these outcomes.
Materials And Methods:
An electronic search was conducted across PubMed, Scopus, and Google Scholar for clinical studies published between January 2010 and April 2026 involving 3D-printed (DMLS) or milled titanium CSIs. Primary outcomes focused on soft tissue dehiscence, while secondary outcomes assessed implant survival. Statistical modeling utilized Kaplan-Meier estimation for time-to-event analysis and Cox Proportional Hazards Regression to evaluate the influence of the surgical site.
Results:
Fourteen clinical studies involving 368 implants (276 maxillary, 92 mandibular) were included. The overall incidence of soft tissue dehiscence was 28.6%. While the maxilla exhibited a higher numerical incidence of dehiscence compared to the mandible (31.9% vs. 18.5%), the hazard ratio (HR 1.518) did not reach statistical significance (p=0.116). The overall implant survival rate was 87.8%. However, the surgical site was a statistically significant predictor of failure, though this association may partly reflect differences in case severity between anatomical cohorts; maxillary implants demonstrated a 3.8-fold higher hazard of failure compared to mandibular implants (HR 3.843; 95% CI: 1.157-12.723; p=0.028).
Conclusions:
Modern titanium CSIs are a viable solution for severe alveolar atrophy, yet they possess a distinct, site-specific risk profile. While the mandible appears more "forgiving" of soft-tissue complications, maxillary dehiscence is significantly more likely to result in total implant loss. Long-term clinical monitoring is essential, as failure hazards exhibit bimodal "step-like" increases at approximately 35 and 70 months postoperatively.
