CATEGORY 90 AUSTRALASIAN DENTIST CLINICAL Abstract. The aim of this study was to retrospectively analyse a series of patients with posterior mandibular atrophy rehabilitated with custom-made subperiosteal implants. The study included patients with severe posterior mandibular atrophy who had undergone rehabilitation with subperiosteal implants between September 2018 and August 2022 in the Maxillofacial Surgery Operative Unit of the University Hospital of Sassari. Complications and the success rate were reviewed. Data from 30 implants placed in 17 patients were included and analysed. There were no major complications during the surgeries. The main postoperative sequela was oedema, which was reported as moderate by most patients and had completely regressed within 10 days of surgery. No partial or complete exposures, infections, or loss of the implants were detected during follow-up (average followup 22.5 months). Control computed tomography scans, performed at 6 months and then annually in all cases, did not show significant bone loss below the abutments, displacement of the implants, or loss or loosening of the osteosynthesis screws. Subperiosteal implants may represent a safe and reliable technique for the rehabilitation of severe atrophy of the posterior mandible. Prospective studies with a long follow-up will be needed to establish the long-term results of this type of implant-prosthetic rehabilitation. The implant-prosthetic rehabilitation of severe atrophy of the posterior mandibular region is a difficult challenge1,2. Guided bone regeneration with autologous and alloplastic grafts currently represents the gold standard for the treatment of this type of condition, as it allows the bone volumes required for correct positioning of the implants to be restored3–5. However, the long rehabilitation times and need for multiple surgeries often make this procedure unacceptable for patients seeking a less biologically burdensome solution. The failure rate of bone grafts is still significant, ranging from 5% to 20%6. Furthermore, implants inserted in reconstructed bone have a significantly higher failure rate than those positioned in the native bone, which can reach 13% after 1 year7, compared to the 1–3% failure rate for implants placed in native bone8. Only a few graftless techniques are available for the implantprosthetic rehabilitation of the edentulous posterior mandible. Short implants are a safe and effective solution, supported by solid scientific evidence, however their use is not applicable if the bone height above the inferior alveolar nerve (IAN) is less than 5 mm or if the bone thickness does not allow the placement of implants of a sufficient diameter9,10. Lateralization of the IAN is another technique by which a sufficient bone height for immediate implant placement can be obtained11,12. However, this is burdened by a significant rate of persistent neurological complications13,14 and is becoming increasingly less popular. In 2017, Mommaerts15 developed and proposed a new concept of subperiosteal implantology for graftless rehabilitation of the maxilla. This concept made it possible to manufacture custom-made implants using computer-aided design and manufacturing (CAD/ CAM) and laser melting technologies, with a new design that allows rigid fixation of the implant on the maxillary pillars, thereby making it possible to overcome all of the limitations historically associated with this type of rehabilitation. In recent years, an increasing amount of scientific evidence has been published regarding the short- and medium-term safety and efficacy of this new generation of subperiosteal implants for the rehabilitation of the atrophic upper jaw16–22. The rehabilitation of the posterior mandible with new generation subperiosteal implants is a topic much less addressed in the literature to date, and there are no precise indications regarding the design of the implants, the surgical technique, and the short-, medium-, and long-term outcomes. The aim of this study was to retrospectively analyse a series of patients with posterior mandibular atrophy who were rehabilitated with additively manufactured custom-made subperiosteal implants. Materials and methods This study included consecutive patients with severe posterior mandibular atrophy (e.g. Cawood and Howell class V and VI) who underwent rehabilitation with subperiosteal implants between September 2018 and August 2022 in the Maxillofacial Surgery Operative Unit of the University Hospital of Sassari. All patients had been followed up for a minimum of 6 months, during which they had regular clinical and radiological examinations. The study received ethical approval from the Ethics Committee of the University of Sassari (PG/2023/6411). This study has been reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines23. Implant-prosthetic rehabilitation of the atrophic posterior mandible with additively manufactured custom-made subperiosteal implants: a cohort study Luigi. A. Vairaa,b, A. Biglioa, A. Favroa, G. Salzanoc, V. Abbatec, J.R. Lechiend,e, G. De Riua a Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy; b School of Biomedical Science, Biomedical Sciences Department, University of Sassari, Sassari, Italy; c Maxillofacial Surgery Operative Unit, University Hospital of Naples “Federico II”, Naples, Italy; d Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; e Department of Otolaryngology–Head Neck Surgery, Elsan Polyclinic of Poitiers, Poitiers, France Luigi. A. Vaira
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