Alexandra Tuta

Background/Objectives: Rehabilitation of the severely atrophic edentulous jaw remains one of the most demanding challenges in oral and maxillofacial reconstruction, particularly when extensive bone augmentation is contraindicated, has previously failed, or is refused by the patient. Subperiosteal implants, first introduced in the 1940s and largely abandoned due to poor long-term performance, have re-emerged over the past decade as a viable alternative through the integration of cone-beam computed tomography (CBCT)-based virtual planning, computer-aided design/computer-aided manufacturing (CAD/CAM), and additive manufacturing. This review summarizes current evidence on the clinical outcomes, surgical workflow, and indications of customized, digitally designed subperiosteal implants. Materials and Methods: A structured literature search was performed in PubMed and Scopus, supplemented by manual searching, to identify publications relevant to the predefined clinical and conceptual scope of this narrative review. Search terms addressed subperiosteal implants, digital/CAD-CAM workflows, additive manufacturing, severe jaw atrophy, and clinical outcomes. Predefined selection criteria were applied to maintain consistency with the scope of the review, and the literature-selection process was documented using a descriptive flow diagram. Results: Sixty-two publications were retained as the core literature informing the narrative synthesis, comprising systematic reviews and meta-analyses, retrospective and multicenter clinical studies, case series, case reports, and biomechanical/technical investigations. The synthesized evidence indicates short-to-medium-term implant survival generally exceeding 90%, with soft-tissue exposure and dehiscence as the most frequently reported complications, and a decline in survival on longer follow-up. Digitally designed subperiosteal implants are increasingly reported for severely resorbed maxillae and mandibles, oncologic and post-traumatic defects, syndromic patients, and cases of failed conventional or zygomatic implant therapy. Conclusions: Digital workflows have renewed clinical interest in subperiosteal implants by enabling patient-specific design and digitally supported planning and manufacturing. However, the evidence base remains dominated by case reports and heterogeneous retrospective series, underscoring the need for prospective, standardized, long-term studies.

Background: Osteoinduction and bone regeneration are fundamental biological mechanisms enabling osseointegration and long-term durability of endosseous dental implants. In clinical practice, poor bone conditions, aesthetic demands, and peri-implant soft tissue problems commonly need the utilization of regenerative techniques targeted at optimizing both hard and soft tissue results. The purpose of this narrative review was to examine osteo-inductive and regenerative strategies currently employed in implant dentistry, with particular emphasis on the mechanobiological integration of hard–soft tissue regeneration and its implications for peri-implant tissue stability, osseointegration, and clinical predictability. Methods: A narrative literature review was done using PubMed and Scopus databases. Based on predetermined inclusion and exclusion criteria, studies published in English during the previous five years were reviewed. The core narrative analysis comprised a selection of physiologically relevant research that addressed osteo-inductive techniques, bone regeneration, osseointegration, and peri-implant soft tissue outcomes, as well as clinical studies, randomized controlled trials, systematic reviews, and narrative reviews. A narrative synthesis was carried out because of methodological variability. Special emphasis was placed on evidence addressing the biological and clinical interaction between hard- and soft-tissue regenerative strategies, reflecting the specific conceptual focus of the review. Results: The evidence presented suggests that implant surface biofunctionalization, biologically active grafting materials, guided bone regeneration, and supplementary biological treatments may have a favorable impact on implant stability and peri-implant bone healing. Several investigations also underlined the biological dependency between peri-implant bone regeneration and soft tissue architecture, stressing the significance of soft tissue thickness, keratinized mucosa, and emergence profile stability. Even in inflammatory environments, bioactive titanium surface changes showed osteogenic potential, indicating a supporting function in early osseointegration. Conclusions: By promoting osseointegration and improving peri-implant tissue outcomes, osteo-inductive and regenerative techniques are essential to modern implant dentistry; however, their greatest potential may lie in integrated hard–soft tissue regenerative approaches aimed at improving long-term clinical predictability. To further understand the clinical efficacy of combination hard–soft tissue regeneration methods, future well-designed clinical trials with standardized outcome measures are needed. Future research should further clarify the mechanobiological principles underlying these integrated regenerative approaches.

Background: Stackable metallic or magnetic multi-template systems translate a prosthetically (facially) driven plan into each surgical phase of full-arch rehabilitation. Our objective was to map and critically describe the clinical applications, accuracy, and short-term outcomes of stackable/sequential guides and to illustrate the operational steps with a standardized magnet-retained case. Methods: Following a prospectively registered protocol (OSF, June 2025), we performed a scoping review in accordance with and PRISMA guidance. PubMed, Scopus and Embase were searched to 26 June 2025 for primary human studies using stackable or sequential static guides to place ≥4 implants per arch with immediate (≤72 h) loading. Duplicate-independent screening and data-charting captured guide design, planning platform, surgical accuracy, implant survival, prosthetic outcomes and patient-reported measures. A single non-analytic clinical vignette was included solely to illustrate the facially driven stackable workflow. Results: Eight studies (five countries, 2021–2025) encompassing 351 implants and one additional clinical case met the inclusion criteria. Mechanical indexing predominated (7/9 protocols); only two papers, including our case, used magnetic retention. Mean coronal and angular deviations, reported in two cohorts, were 0.95 mm/2.8° and 0.87 mm/2.67°, respectively—well within accepted thresholds for full-arch guided surgery. Immediate loading was achieved in 100% of arches; cumulative implant survival was 97.1% after 3–12 months. Patient-reported satisfaction exceeded 90 mm on VAS scales when measured. Our case demonstrated 0.90 mm/2.95° accuracy, 100% implant stability ≥ 35 N cm and uneventful provisionalisation at 12 weeks. Conclusions: Early clinical reports show clinically acceptable accuracy and high short-term survival with streamlined workflow. However, evidence remains heterogeneous and short-term; prospective multi-centre studies with standardized accuracy metrics, ≥3-year follow-up, validated PROMs, and cost-effectiveness analyses are still needed.