Subperiosteal implants for the rehabilitation of the atrophic jaws

AIMS: To compare intraoperative and postoperative biological and mechanical complications among different implant solutions for severe jaw atrophy; to evaluate implant and prosthetic failures; and to assess patient satisfaction and quality of life following treatment. MATERIALS AND METHODS: This prospective, multicentre, randomized controlled clinical trial enrolled 22 patients with severe maxillary or mandibular atrophy who lacked sufficient bone for placement of at least four standard implants without major augmentation. Participants were randomly assigned to CAD/CAM subperiosteal implants (n=11) or conventional graftless solutions including zygomatic, short, or narrow implants (n=11). Immediate fixed prosthetic rehabilitation was planned when adequate stability was achieved. Clinical and radiographic follow-ups were performed up to 3 years, documenting complications, implant and prosthetic outcomes, and patient-reported measures including VAS pain and OHIP-14. RESULTS: The mean age was 62.2 years, and 77% were female. Treatment included 11 subperiosteal, 5 zygomatic, 5 short, and 1 narrow implant case. Immediate loading was achieved in 95.5% of patients, with a mean follow-up of 22 months. Six patients (27.3%) developed seven complications: five mucositis episodes and two hardware exposures, all occurring in subperiosteal and zygomatic cases; no complications occurred with short or narrow implants. Higher complication incidence was associated with male sex, smoking, and diabetes. Zygomatic implants achieved the highest primary stability but demonstrated significantly greater postoperative pain. Despite early differences, all groups experienced marked improvement in quality of life at one year, with the short/narrow group showing the most favorable profile. CONCLUSIONS: All treatment modalities successfully supported immediate fixed rehabilitation in severe atrophy. Subperiosteal implants presented acceptable outcomes but intermediate complication rates, while zygomatic implants offered superior stability with higher early morbidity. Short and narrow implants showed minimal complications when bone dimensions permitted their use.