Subperiosteal Implant
In cases of edentulism where the patient’s bone mass has deteriorated to the extent that endosteal implants are not feasible, custom subperiosteal implants offer a suitable alternative to traditional methods. Previously, iliac grafts and bone grafting were used to create suitable bone tissue for endosteal implants, extending treatment time and incurring significant costs for the patient. With subperiosteal implants, the implant base is designed according to the patient’s bone density and the geometry of the alveolar ridge. The dental abutments are positioned based on input from the specialist surgeon and prosthodontist. A crucial aspect of designing the dental abutments is that their position and orientation are tailored to fit the dental prostheses that will be placed on them.
Mechanical analysis is critical in the design and construction of subperiosteal implants. Initially, dental prostheses are designed using specialized software under the supervision of a prosthodontist. Subsequently, the subperiosteal implant bases are designed accordingly. The orientation of these bases is optimized so that the load transferred from the dental prosthesis to the bases is axial, avoiding the introduction of bending moments to the bases.
Since these implants are placed beneath the gums and sometimes within the oral cavity, their surface quality is of utmost importance. Therefore, the surfaces of these implants are highly polished and anodized after manufacturing.
Advantages of using subperiosteal implants
What Is a Subperiosteal Implant?
A subperiosteal implant is a type of dental implant that, unlike conventional endosseous implants, is not placed inside the jawbone. Instead, it is positioned on top of the jawbone and beneath the gingival tissue. The implant consists of a patient-specific framework designed to closely match the individual anatomy of the patient’s jawbone.
Subperiosteal implants can be an appropriate treatment option for patients who do not have sufficient jawbone volume for conventional implants and who are either unwilling or unable to undergo bone grafting procedures.
Which Patients May Need a Subperiosteal Implant?
Severe Jawbone Resorption:
Patients with advanced bone loss caused by long-term edentulism may not have sufficient bone volume to support conventional endosseous implants.
Patients Unable or Unwilling to Undergo Bone Grafting:
Some patients may not be suitable candidates for extensive bone-grafting procedures because of age, medical conditions, treatment complexity, or personal preference.
Patients with Severely Reduced Bone Height:
In cases where the available bone height is below the level required for conventional endosseous implant placement, a patient-specific subperiosteal implant may provide an alternative implant-supported treatment option.
Digital Subperiosteal Implant Workflow at Farin Roshaan Teb
Farin Roshaan Teb uses a fully digital workflow to design and manufacture patient-specific subperiosteal implants with a high level of anatomical precision.
Step 1: 3D CBCT Imaging and Intraoral Scanning
A high-resolution CBCT scan of the patient’s jawbone is obtained, together with an intraoral scan when required. These datasets provide the anatomical foundation for designing the patient-specific titanium framework, eliminating the need for the exploratory surgical impression procedures used in traditional workflows.
Step 2: Digital Design of the Patient-Specific Framework
Using specialized medical design software, the subperiosteal implant is designed according to the patient’s individual jawbone anatomy. The position, angulation, and height of the prosthetic posts are determined in collaboration with the surgeon.
Step 3: Surgical Simulation
Before manufacturing, the surgeon can review the proposed implant framework on the patient’s three-dimensional anatomical model and approve the final design. This helps minimize the need for intraoperative modification.
Step 4: Three-Dimensional Titanium Manufacturing
The subperiosteal framework is manufactured using high-precision titanium additive manufacturing technology. This patient specific implant is designed to provide an appropriate combination of strength, low weight, and biocompatibility.
Step 5: Quality Control and Delivery
Before delivery to the surgeon, the framework undergoes quality-control procedures to verify dimensional accuracy, anatomical fit, and compliance with the required sterilization protocol.
Why Is Digital Technology Important in Subperiosteal Implant Treatment?
Historically, fabrication of subperiosteal implants often required two separate surgical procedures. During the first procedure, the gingival tissue had to be reflected so that a direct impression of the jawbone surface could be obtained.
This approach subjected the patient to an additional surgical procedure and provided less precise anatomical information than modern digital imaging and design technologies.
Today, Farin Roshaan Teb uses 3D CBCT imaging, intraoral scanning, and specialized digital design software to complete the planning and design process before implant placement. The surgeon can review and approve the final implant on a three-dimensional model of the patient’s anatomy before surgery.
For the patient, this digital workflow may mean fewer surgical stages, reduced treatment burden, and a more predictable treatment process. For the surgeon, it provides greater control over implant design, reduces intraoperative variables, and improves the ability to transfer the preoperative plan to the surgical field.
Each Farin Roshaan Teb titanium subperiosteal implant is designed according to the individual geometry of the patient’s jawbone rather than relying on a standardized implant shape.
Advantages of Farin Roshaan Teb Digital Subperiosteal Implants
No Exploratory Impression Surgery:
The digital workflow eliminates the need for an initial surgical procedure solely to obtain a direct impression of the bone surface. CBCT imaging provides the anatomical data required for implant design.
Fewer Surgical Stages:
Compared with traditional workflows that may require separate procedures for bone impression and implant placement, the digital approach can reduce the number of surgical stages.
Patient-Specific Anatomical Fit:
The framework is designed according to the three-dimensional geometry of the patient’s jawbone, allowing close adaptation between the implant and the underlying bone surface.
Optimized Force Distribution:
Digital design allows the implant geometry, fixation points, and prosthetic support structures to be planned with the goal of achieving appropriate distribution of functional loads across the jawbone.
Suitable for Both the Maxilla and Mandible:
Farin Roshaan Teb designs patient-specific subperiosteal implants for both the upper and lower jaws.
Frequently Asked Questions About Subperiosteal Implants
A subperiosteal implant is a patient-specific metallic framework that, unlike conventional endosseous dental implants placed within the jawbone, is positioned on the surface of the jawbone beneath the periosteum and gingival tissues. It is primarily designed for patients with severe jawbone resorption who may not have sufficient bone volume for conventional implants.
The longevity of a subperiosteal implant depends on several factors, including oral hygiene, patient-related factors, prosthetic loading, regular follow-up, and appropriate surgical planning. Modern digitally designed subperiosteal implants use CT-based imaging and CAD/CAM technologies to achieve a more accurate anatomical fit than traditional manually fabricated frameworks, which may contribute to improved long-term stability.
The cost of a subperiosteal implant varies from patient to patient and depends on factors such as the extent of jawbone resorption, imaging requirements, the complexity and dimensions of the patient-specific framework, the material and manufacturing process, and the overall surgical treatment plan. An accurate estimate requires individual evaluation based on the patient’s clinical condition and CT imaging.
Conventional endosseous implants are inserted directly into the jawbone and require sufficient bone volume for stable placement. A subperiosteal implant is positioned on the surface of the jawbone and is individually designed for patients with severe bone loss who may not be suitable candidates for conventional implants or extensive bone-grafting procedures.
No. Although both treatment approaches may be considered in patients with reduced jawbone volume, they use different biomechanical and surgical concepts. Basal implants obtain fixation from deeper or denser basal cortical bone, whereas a subperiosteal implant consists of a patient-specific framework designed to adapt to the surface geometry of the jawbone rather than relying on deep intraosseous placement.
Bleeding risk is managed through appropriate preoperative assessment, detailed anatomical planning, careful surgical technique, and intraoperative hemostasis. Digital planning based on CT imaging can help the surgical team understand the patient’s anatomy and optimize the design and positioning of the framework; however, the management of bleeding ultimately depends on the surgeon’s clinical assessment and surgical technique.
Subperiosteal implants may be considered for patients with severe jawbone resorption who do not have sufficient bone height or width for conventional endosseous implants and who are unable or unwilling to undergo extensive bone augmentation procedures. Final candidacy must be determined by an oral and maxillofacial surgeon or appropriately qualified clinician after reviewing the patient’s clinical condition and imaging.
The surgeon provides the patient’s CT or CBCT imaging data and relevant treatment information to the Farin Roshaan Teb medical engineering team. A patient-specific framework is then digitally designed using CAD software according to the patient’s jaw anatomy. After review and approval by the surgeon, the implant is manufactured from medical-grade titanium using metal additive manufacturing technology.
Farin Roshaan Teb is an Iranian knowledge-based company active in digital maxillofacial surgery since 2016. The company designs and manufactures patient-specific subperiosteal implants using patient CT or CBCT data, digital CAD-based planning, and advanced manufacturing technologies, providing these solutions in collaboration with oral and maxillofacial surgeons.
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Opinions of users of this service
For about a year now, I have been collaborating with this company and utilizing their services in the field of surgical guide manufacturing, particularly for patients with complex anatomy or movements. The use of 3D analysis and surgical predictions, orthogonal splints, surgical cutting guides for procedures like mandibuloplasty, and custom plates for complex movements have been invaluable.
The Farinroshaan company provides a comprehensive solution for maxillofacial surgeries. They offer a full range of services, including the fabrication of custom prosthetics, various devices, and surgical splints using intraoral scanning technology. They also create jaw molds and a navigation system that is particularly useful for complex tumors in the temporomandibular joint area.
Fortunately, Farinroshaan has the capability to produce patient-specific maxillofacial prosthetics using 3D titanium printing technology. This technique allows for the manufacture of highly precise and robust prosthetics and implants tailored to the specific requirements of the maxillofacial surgical field. With this technology, we can create highly accurate orthognathic surgical guides, custom plates, and facial aesthetic implants.
One of the excellent, knowledge-based, and active companies is the respected Farinroshaan Teb Company. I have had the privilege of working with this company and its highly scientific and academic team.
In orthognathic patients, the complete design and fabrication of splints was carried out in a very short time frame with excellent quality, and the surgical outcome was very good. The total cost incurred was also reasonable. Furthermore, our patients were completely satisfied.
The achievements of the Farinroshaan Teb Company have greatly impressed me. Their use of specialized materials, highly advanced and robust scientific and practical technologies, minimizes the surgeon's work in the operating room, reduces errors to near zero, and ultimately eliminates the need for surgery, whether for patients who have undergone trauma and lost parts of their limbs, or those who require radical surgical procedures, or those suffering from other conditions. The materials and technologies offered by Farinroshaan are fascinating, scientific, and practical, and I highly recommend them to my colleagues.
