Subperiosteal Implants
The Story
Older than you think
The story about Subperiosteal Implants dates back to 1941, when the swedish doctor Dr. Gustav Dahl idealized a metal structure that would be placed under the gums.
This structure would retain a removable denture in a time where there was no alternative solution for this cases.
The first attempts
Several clinicians started to use and improve this technology.
Golberg and Weinberg were amongst the earlier adopters of this technology during the 40's.
Goldberg used a Vitallium alloy and coined the term "Subperiosteal Implant".
The sub mania
Lew, another clinician interested on the topic, made several developments on this field.
On the next image, you can see the evolution of his design, from a bulkier implant in 1948 (upper left) and a much slimmer structure in 1955 (bottom right).
Thrilla in Maxilla?
Yes, Lew also designed subs for the upper arch. This ones followed the same evolution of the lower ones, with progressively less and less metal as you can see on the picture.
Remember: at this time, there were no CT Scans or CAD/CAM machines.
They were doing regular impressions of the bone, creating a cast model, fabricating the implant over the model, and later placing it on the patient.
Pretty impressive, no?
Linkow
Leonard Linkow dramatically changed the game on subs with his tripoidal (three feet) subperiosteal system.
Lenny, as he was called by his colleagues, also made some remarkable innovations in Dentistry:
- Self Taping Ventplant, 1963
- Blade Implants, 1967
- Internal Hexagon
- Tripod Subperiosteal Implants, 1984
Oh, did I tell you that he was the only dentist nominated for a Nobel Prize?
Subs and subs
On the next two panoramic x-rays, you can see some examples of Dr. Linkow's subperiosteal implants.
As we can observe, the lower jaw solution was a tripoidal implant, and the upper jaw was a non-fixed metal structure with a bar as a suprastructure.
And while the lower subs had a relatively good success rate, the same was not true for the upper jaw.
Mobility and bone resorption occurred and this kind of implants were generally discontinued.
The discovery of osseointegration by Branemark in 1952, his first surgery in 1965 and the posterior boom of endosseus implants would replace subperiosteal implants.
For the most complex cases, Branemark also introduced the zygomatic implants in 1988 and 10 years later there were commercially available.
The New Age
In 2016, Rui Coelho, a former Portuguese Oral Surgeon, picked up the abandoned concept of Subperiosteal Implants and started a new journey on this field.
He founded the Bone Easy Company and today they are world-leaders on the New Patient Specific Implants.
This new "subperiosteal" implants are CAD/CAM made and offer a completely new approach on the supra-osseus application of this structures.
While this new technology may seem an updated version of the old Linkow subs, in fact they don't have many similarities.
Alternative to Zygoma
Because this new patient-specific (still called subperiosteal implants by some colleagues) are not seated on the bone, but rather fixed on the bone, several colleagues prefer this solution over zygomatic implants.
They found that this solution seems to be less destructive because they are a supra-osseus implant instead of an intra-osseus implant.
And because of the small diameter of the screws, most of the times there is no drilling to be done, preserving all the remaining bone of the patient.
This solution aims for immediate loading, with minimal trauma on very atrophic jaws.
Learning this
In 2020, Dr. Bernardo Nunes de Sousa created the Full Arch Club, with the purpose of teaching graftless, immediate loading techniques for full arch rehabilitation.
They are the first international organization providing a full-spectrum of full arch surgery courses, including the specific training and accreditation on this New Age of Custom Subperiosteal (Patient-Specific) Implants.
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