Patient-specific subperiosteal implants for oral and maxillofacial rehabilitation: a narrative review of current evidence, clinical decision-making, and unresolved questions

Purpose Contemporary patient-specific subperiosteal implants (PSSIs) have re-emerged as digitally planned reconstructive devices for severe jaw atrophy, previous treatment failure, and complex maxillofacial defects. This narrative review critically evaluates current evidence, clinical decision-making, and unresolved questions across indications, design, treatment workflows, outcomes, complications, and maintenance. Methods Evidence identification drew on the structured search developed for the companion Delphi study. PubMed/MEDLINE, Embase, and CENTRAL were searched from 2000 to 19 December 2025, supplemented by trial registries, grey literature, and reference-list screening. Targeted PubMed searches and reference screening were updated through 31 August 2026. Clinical, biomechanical, technical, and translational evidence was synthesized narratively. Results Modern PSSIs integrate three-dimensional imaging, virtual prosthetically driven planning, CAD/CAM design, additive manufacturing, and planned skeletal fixation. Available evidence supports feasibility and high short-term survival in selected patients, but longer-term cohorts and procedure-specific analyses indicate that implant retention may overestimate durable clinical success. Soft-tissue recession, dehiscence, mucositis, and framework exposure are the dominant biological complications and appear central to late failure. Applications are expanding beyond full-arch atrophic jaws to sectional, congenital, salvage, and oncologic reconstruction despite marked heterogeneity in indications, device design, loading protocols, and outcome definitions. Direct comparative evidence remains scarce. Conclusions PSSIs should be considered a selected prosthetically driven reconstructive option rather than a broadly equivalent alternative to conventional implants or established reconstruction. Future studies require standardized success and failure definitions, longer follow-up, comparative treatment-pathway evaluation, and greater integration of soft-tissue, prosthetic, patient-reported, maintenance, and cost-effectiveness outcomes.