Additively Manufactured Subperiosteal Implants for the Rehabilitations of Lateral Incisors Agenesis - a case series.

Abstract

Background: Tooth agenesis, particularly the absence of upper lateral incisors, presents substantial challenges for clinicians due to the associated bone atrophy, which limits the use of traditional implant solutions. Current options, such as endosseous implants combined with guided bone regeneration (GBR), often fail due to insufficient osseointegration in atrophic bone. This study aims to evaluate the effectiveness of custom-made, additively manufactured subperiosteal implants in addressing these challenges METHODS: This retrospective study assessed 16 custom-made subperiosteal implants used in 12 patients (10 females, 2 males; mean age 25 ± 2.3 years) with lateral incisor agenesis who had previously experienced early implant failure with conventional endosseous implants. The protocol included subperiosteal implants combined with bovine bone grafts and PRF membranes, allowing for immediate loading and correct prosthetic alignment. Clinical evaluations focused on implant stability, peri-implant tissue health and esthetic (including probing depths and bleeding on probing), and prosthetic success over time.

Results: During a follow-up period of 18 to 64 months (mean 48 ± 6.7 months), all patients maintained stable implants, with no implant failures reported. Biological outcomes demonstrated stable peri-implant health, with probing depths averaging 3 mm and minimal signs of inflammation. The mean pink esthetic score was 12.3 ± 1.1 (range: 10 to 14). Prosthetic complications were limited to minor adjustments, with two cases requiring recementing of crowns after three years.

Conclusions: The results indicate that this new protocol provides a reliable, single-procedure solution for the rehabilitation of lateral incisor agenesis in patients with significant bone atrophy, achieving a 100% success rate in this study. Despite promising outcomes, the study is limited by a small sample size and the need for longer follow-up to assess durability. This approach offers a viable alternative for patients where traditional implants are not feasible due to bone deficiencies.