Clinical case
Maxillary reconstruction with a subperiosteal implant in a case of severe atrophy. From planning to rehabilitation following a fully digital protocol. About a clinical case and bibliographic review
Introduction: Customized subperiosteal titanium implants, designed from planning and fabrication software, constitute an alternative in the rehabilitation of severe maxillary atrophy, avoiding more complex bone and soft reconstruction surgeries and reducing healing times. The aim of this article is to present the rehabilitation in a clinical case with severe atrophy in the upper jaw, using a structure with subperiosteal implants, by means of a digital protocol.
Clinical Case: A subperiosteal sintered titanium structure was fabricated with six transepithelial connections that were rehabilitated with an immediate implant supported fixed prosthesis made of PMMA. Two months later, a sintered chromium-cobalt framework with machined bases covered with acrylic resin teeth was fabricated as the final restoration. At one year follow-up, the case remains stable.
Conclusions: Nowadays, rehabilitation with subperiosteal implants is an alternative tool in cases of complex surgeries with large atrophies with the possibility of immediate loading.
The use of endoosseous dental implants to replace the absence of teeth has shown a great predictability over the years, being today one of the main techniques for dental rehabilitation1. However, bone in quantity and quality is necessary for its placement. In cases of severe bone resorption, more advanced surgeries are needed for bone regeneration, in which there may be more complications, morbidity and longer treatment time2.
Subperiosteal implants (SI) were developed in Sweden in the early 1940´s. The SI consisted of a custom-made implant, inserted under the periosteum and fixed with screws and the mucous tissue that covered it3,4. They were manufactured in chromium-cobalt or titanium alloys and were rehabilitated by transmucous pillars that emerged in the oral cavity5. Although they were used for years in cases of maxilla atrophies, they were replaced by endoosseous implants designed by Branemark6. This was due to its complex manufacturing. It was necessary to take an impression of the residual bone ridge, which was sent to the laboratory for the structure design, with the consequent imbalances since they were not very stable models. In this way, its placement in the patient was very difficult, and several complications could appear7,8. However, advances in the planning and manufacturing field with various materials have allowed these structures to be made digitally with an excellent predictability and fit, thus avoiding more complex surgeries9.
The objective of this work is to present implant-supported rehabilitation in a clinical case with severe atrophy in the upper maxilla, using a structure with subperiosteal implants, through a digital protocol, and the evolution one year after its placement.
