Skip to main content
+ 1 (418)-527-0388     [email protected]

Treating posterior mandibular atrophy using CAD/CAM subperiosteal implants: clinical case and literature review

by Drs. Mathieu Goudal and Cécile Bailly

To this day, the dental implant rehabilitation of atrophic mandibular lateral regions remains a biological, temporal, and financial challenge. Thanks to CAD/CAM, titanium subperiosteal implants have become a viable alternative to conventional axial implants and bone regeneration.

Summary

Subperiosteal implants have a bad reputation due to outdated practices. The main drawbacks—lack of adjustment and biocompatibility—were corrected using CAD/CAM and titanium. New products have entered the market over the past few years. The SUB implant by Panthera Dental, developed in collaboration with Dr. Yvan Poitras, offers a solution in managing atrophic posterior mandibular regions.

History

First described by Dr. Gustav Dahl in 1940, subperiosteal implants allowed for fixed denture rehabilitation for complete or posterior edentulism (Class I)(1). These implants were custom-made cobalt-chrome subperiosteal frames with transmucosal abutments to anchor implant-supported dentures. Made-to-measure implants were created using a direct bone impression after elevating large, full-thickness flaps. The frame was placed on the residual bone and stabilized using retaining screws, while possible adjustment defects were corrected through drilling or filling the space with bone substitute(2). Subperiosteal implants had a survival rate of 50 to 60% after 15 years with significant complication risks(3). The lack of osseointegration and the poor precision of the impression caused a lack of stability and adaptation of the metal frame and led to infection, inflammation, and bone resorption(4, 5). These implants gradually became less popular and were replaced by endosseous implants, which were more reliable in the short and long term(6).

Physiopathology of the mandible:

However, in severe cases of atrophy, denture rehabilitation using axial implants can be very complex due to the loss of the alveolar bone. The alveolar bone exists solely for the dental organ, which is where this bone develops and grows. Teeth, the periodontal ligament, and the alveolar bone are therefore interdependent. After edentulism, the labial alveolar bone will gradually decrease in height, density, and thickness. The loss of function of the alveolar bone and the stress it undergoes will cause resorption that begins in the periosteum, and bone apposition may decrease or even cease(7, 8). If edentulism is not compensated, the alveolar bone will continue to undergo resorption and may even be lost completely. In the most serious cases of mandibular atrophy, basal bone loss can occur. Conversely, an alveolar osteolysis caused by periodontitis leads to dental organ loss. Some bacteria involved in periodontal disease associated with unfavourable local and immune factors cause alveolar bone loss leading to edentulism(9). In advanced stages, periodontitis can cause complete alveolar bone loss, even after edentulism.

This bone loss intensifies with age. The expression of homeogenes and hormones responsible for alveolar bone maintenance decreases with age, causing decalcification and bone destruction. Denture rehabilitation may be iatrogenic for the remaining bone, and wearing unstable and poorly adapted removable dentures may overload the alveolar bone, causing resorption as a defence mechanism. A failed implant rehabilitation may also increase the loss of residual bone volume. Alveolar bone loss follows a predictable pattern represented by the Cawood physiopathological classification. This classification allows you to choose the denture rehabilitation approach best suited to each situation(10).

The edentulous mandible undergoes significant resorption and loses 40 to 60% of its height on average. At atrophic stages, the mandibular canal may be level with the alveolar ridge, compromising denture rehabilitation(11).

Placing axial implants in severe cases of atrophy may require rearranging bone mass through guided bone regeneration, distraction osteogenesis, or crestal reconstruction through bone grafting(12-14). With these implant surgeries in atrophic areas, there are risks of hemorrhage and lesions to neighbouring anatomical and nervous structures. The results of mandibular bone volume reconstruction are fairly unpredictable, as the spongy bone is dense and the cortical bone is thick, thereby reducing blood flow and regenerative potential. It is a long, expensive technique that requires two surgeries with significant healing periods: one for crestal reconstruction and another for implant placement. Success depends heavily on the surgeon’s experience with the procedure. For the rehabilitation of atrophic posterior mandibular regions, subperiosteal implants are an alternative worth exploring. Placing this implant is technically simpler for the surgeon and can be done in a single procedure with a shorter healing period.

Anatomy review and surgical approach:

The mandible is characterized by the presence of the mandibular canal containing the inferior alveolar nerve, along with venous, arteries, and lymphatic vessels. This canal enters the mandible at its ramus through the mandibular foramen, runs through the body of the mandible, and exits through the mental foramen. The inferior alveolar nerve is the motor for the anterior belly of the digastric and the mylohyoid muscles. It also supplies sensation for mandibular teeth, the lower lip, and the chin. The pathway of the mandibular canal is variable and must undergo peroperative examination by analyzing a CBCT.

The lateral aspect of the posterior region of the mandible presents the external oblique ridge and is the insertion for the cutaneous muscles of the cheek. Its medial aspect is connected to the floor of the mouth formed by the mylohyoid and geniohyoid muscles, as well as the tongue. It presents the internal oblique ridge, the insertion point for the superior pharyngeal constrictor, the pterygomandibular ligament, and the mylohyoid muscle in continuity with the periosteum. This area is adjacent to the submandibular and sublingual spaces, which are rich in neurovascular structures.

The submandibular space is characterized by the presence of the submandibular salivary gland, the hypoglossal nerve (XII, motor nerve of the tongue), the lingual nerve, the facial and lingual artery, and the facial and superior thyroid veins. The sublingual space, located between the floor of the mouth and the mylohyoid muscle, contains the sublingual salivary gland, the deep-lingual vein, the hypoglossal nerve (taste and tongue sensation, visceral motor of the salivary glands), and the submandibular duct(15) (Figure 1).

Figure 1: Transverse section diagram passing through the submandibular space

Surgery in the posterior region of the mandible is delicate due to the proximity of the sublingual and submandibular spaces and the presence of the inferior alveolar nerve. Two full-thickness flaps are reflected to access the underlying bone. The crestal incision needs to separate the residual keratinized gingiva in two equal vestibular and lingual portions. Posteriorly, the releasing incision must be made toward the anterior border of the mandibular ramus to avoid cutting the lingual nerve. Anteriorly, the vestibular incision must go around the mental foramen to preserve the inferior alveolar nerve and extend toward the symphysis for laxity without a releasing incision.

During implant surgery on the posterior region of the mandible, two main priorities must be taken into account when elevating flaps: pushing back the sublingual space rich in neurovascular structures and avoiding damage to the mylohyoid muscle, which would lead to communication between the oral cavity and the submandibular space. This could lead to a hemorrhage obstructing the upper aerodigestive tract(16).

Placing axial implants is limited in the atrophic posterior mandibular region due to the proximity of the inferior alveolar nerve in the body of the mandible and the risk of nerve injury it could cause. The Panthera SUB subperiosteal implant, shown below, is a viable treatment option in this situation. It is done in a single surgery: the proximity of the inferior alveolar nerve to the alveolar crest and the low bone volume available are not a contraindication.

Characteristics and design of the SUB implant:

The Panthera SUB implant is produced by Panthera Dental (Québec), and was developed by Dr. Yvan Poitras (Québec). Data collection is similar to that performed when planning axial implants:

  • A CBCT
  • A recording of the dental and mucosal surfaces
  • A mock-up

The quality and precision of the CBCT are critical the main factors determining how accurately the subperiosteal implant adapts to the bone surface. It is therefore necessary to optimize the dental X-ray equipment settings to obtain high-resolution images with enough contrast to visualize the bones in other structures. Moreover, a wide field allowing for a single pass of the molar zone to be implanted, the ipsilateral ramus posteriorly, and the symphyseal region up to the contralateral canine is a minimum requirement. Stitching (overlapping several “narrow-field” images) is strongly discouraged, given the risks of distortion. Finally, the data must be exported to the universal DICOM format.

A conventional physical impression that is later scanned by a laboratory scanner or a native digital image using an intraoral camera allows for initial dental and mucosal surfaces to be recorded. The file must be exported to STL or PLY format.

A physical or digital mock-up must match up with the dental and mucosal surfaces. The surgeon and technician use the protocol with which they are most familiar (fully digital workflow, dual scan with radiopaque markers, etc.).

This data is recorded on the Panthera order platform. Using a simple step-by-step process, you can indicate the number of teeth to be replaced, the desired position of the prosthetic platforms, etc. Once the order has been placed and the data sent, you can use the dashboard to track the progress of the work:

  • Confirmation of data receipt
  • Confirmation of data quality
  • Fusion of three-data layers
  • Implant design proposal
  • validation by the surgeon
  • Implant production
  • Implant shipping

Panthera designers use proprietary software to perform a precise fusion of the three data types. The design is produced in-house according to the surgeon’s order and in accordance with the mock-up, all while following the same blueprint: In the vestibular region, the skeleton extends anteriorly by an arm going around the emergence of the inferior alveolar nerve, posteriorly by a loop up to the outer surface of the mandibular ramus. In the lingual region, the frame stops distally in vertical alignment with the most distal prosthetic platform and apically over the mylohyoid ridge. However, a loop extends the implant to the symphyseal region of the mandibular. Finally, the external oblique ridge, which is highly corticalized, is the anchoring location for osteosynthesis screws (Figures 2A and 2B).

CAD/CAM
Proprietary Software
FIGURES 2A AND 2B: PANTHERA DENTAL PLATFORM INTERFACE VIEWS OF THE SUBPERIOSTEAL IMPLANT; VESTIBULAR (A)

After validation by the surgeon, five-axis CNC milling machines with a precision of 5 μm (far superior to the acquisition of the CT scan) produce subperiosteal implants in disks made of Ti6Al4V ELI (Grade 23), a titanium-aluminum-vanadium alloy that is purer than the standard Ti6Al4V alloy. After machining, the surface in contact with the bone and the periosteum is sanded.

The combination of these three characteristics:

  • Biocompatible material
  • Precise adjustment (CT scan, CAD/CAM, machining)
  • Rough surface

Clinical case and planning:

Our patient is consulting for pain in the right mandibular molar region and difficulty chewing (Figure 3). Her history is quite common: discomfort, followed by a failure to wear the removable denture with a metal framework, and finally neglecting care for family reasons. At age 77, she is perfectly healthy enough for oral surgery. However, she would prefer not to undergo long and complex implant treatment. Her request is first and foremost functional. Aesthetics and price are secondary concerns. We therefore offer the following treatment plan: keep the malpositioned anterior mandibular teeth with only mild gingivitis, rehabilitate the left posterior mandibular region with a subperiosteal implant, extract molars 47 and 48, and reassess the best implant solution for this region after healing.

Mandibular molar panoramic
FIGURE 3: INITIAL PANORAMIC IMAGE

Given the initial anatomical situation (strong resorption, significant mobile soft tissue, blockage by the tongue, V-shaped mandible), a conventional impression with a CIT and a physical mock-up with radiopaque markers are preferred.

Data is exported to the Panthera platform, and we receive a design proposal within a few days. The visualization tools allow us to scroll freely in the three-dimensional reconstruction area. Each element (implant, mock-up, bone) can be viewed separately, hidden, made opaque or clear (Figures 2a, 2b, 5a, 5b, and 5c). The proposal is validated by the surgeon for the implant to be produced and shipped.

Once it is received, the implant is cleaned, decontaminated, and sterilized at the dental office.

3D visualization
3D Software
conventional impression
FIGURES 5A, 5B, AND 5C: VISUALIZATION OF THE SUBPERIOSTEAL IMPLANT IN RELATION TO THE MOCK-UP

Surgical procedure:

The procedure begins with local anesthesia at multiple points, vestibular and lingual, from the symphyseal region to the ascending ramus. However, an infiltration in the lingula of the mandible is not necessary. The incision is performed using the technique described above (Figures 6a and 6b).

Mandibular procedure
Mandibular incision
FIGURE 6A: INITIAL CLINICAL VIEW / FIGURE 6B: ACCESS FLAP

It is imperative to carefully reflect a full-thickness flap following the periosteum. After reflection, an atraumatic periosteal expansion using a soft brush
(Figure 7) will allow for the flaps to be repositioned without tension over the implant and bony surfaces at the end of the procedure.

After the soft tissue is prepared, the bony surface is carefully cleaned. For easy insertion, the healing abutments are left in place and the implant is held firmly with hemostatic forceps (Figure 8).

Atraumatic periosteal
Hemostatic forceps
FIGURE 7: PERIOSTEAL EXPANSION USING A SOFT BRUSH / FIGURE 8: PREHENSION OF THE SUBPERIOSTEAL IMPLANT

The implant is inserted via distal translation in the direction of the angle of the mandible, then a mesio-anterior rotation. The surgeon must control the lack of mobility and the adaptation of the implant to the bony surface at all points (Figures 9a, 9b, 9c, and 9d).

bony surface implant_1
bony surface implant_2
bony surface implant_3
bony surface implant_4
FIGURES 9A, 9B, 9C, AND 9D: PLACING THE SUBPERIOSTEAL IMPLANT AND MONITORING ITS ADAPTATION

To ensure the implant is stable during the osseointegration period, an osteosynthesis screw is placed in the prepared space (Figures 10a, 10b, 10c, and 10d).

osteosynthesis screw
osteosynthesis screw_2
osteosynthesis screw_3
osteosynthesis screw_4
FIGURES 10A, 10B, 10C, AND 10D: SCREWING THE DRILLING ANCILLARY INSTRUMENT TO THE LOCATION OF THE OSTEOSYNTHESIS SCREW (A), DRILLING (B), MANUALLY PLACING THE SCREW IN THE INITIAL DRILLING (C AND D)

The flaps are carefully repositioned and sutured without tension with Halsted and over-and-over sutures (Figures 11a and 11b).

suture implant
FIGURES 11A: CLINICAL POSTOPERATIVE SITUATION
Rayscan implant
FIGURES 11B: RADIOLOGICAL POSTOPERATIVE SITUATION

Healing and osseointegration:

Osseointegration takes four months to complete and occurs through two mechanisms:

  • first through direct contact of the bone with the rough titanium finish of the inner surface of the implant,
  • next through progressive bone apposition on the equally rough outer surface.

In fact, the passive repositioning of the flap at the end of the procedure creates a space between the periosteum (inner surface of the flap) and the implant placed over the bone where the blood clot will be trapped (17-19). (Figure 12)

Periosteum
FIGURE 12: INTEGRATED SUBPERIOSTEAL IMPLANT (COURTESY OF DR. YVAN POITRAS, QUÉBEC)

The patient returns four months later for a clinical follow-up (Figures 13 a and b) and X-rays (Figure 14).

Patient return_1
Patient return_2
Patient X-ray
FIGURES 13A, 13B: CLINICAL POSTOPERATIVE SITUATION AFTER FOUR MONTHS (A AND B) / FIGURE 14: POSTOPERATIVE X-RAY FOLLOW-UP AFTER FOUR MONTHS

The permanent dentures are then placed over a titanium frame processed by Panthera Dental and stratified in composite at the denture laboratory (Figures 15 a, b, and c).

Permanent dentures
Permanent dentures_1
Composite
FIGURES 15A, 15B, AND 15C: PERMANENT DENTURE (A AND B), INTRAORAL VIEW (C)

Literature review and success rate:

We are at the stage where we can see if the survival rates of subperiosteal implants have improved compared to more common techniques such as mandibular grafts for implant rehabilitation of atrophic posterior mandibular regions. The systematic literature review below compares the clinical results of these two techniques and justifies the use of CAD/CAM subperiosteal implants.

Materials and method:

The literature review was performed using the PRISMA protocol criteria. Searches took place in March 2021 using the PubMed, DOSS, Embase, and Cochrane databases, and it was split into two parts: A search focused on mandibular subperiosteal implants using the following keywords: “subperiosteal implant” AND (“CAD/CAM” OR “3D printing” OR “direct metal laser sintering” OR “additive manufacture”) and “dental implantation, subperiosteal” [MeSH Terms] AND “computer-aided design” [MeSH Terms] (Figure 16).

mandibular subperiosteal implants_1
FIGURE 16: SUBPERIOSTEAL IMPLANT WORKFLOW

A search focused on inlay bone grafts using the following keywords: “mandible” AND “vertical ridge augmentation” AND (“sandwich osteotomy” OR “inlay bone graft” OR “interpositional bone graft”) and “alveolar ridge augmentation” [MeSH Terms] AND “mandible” AND “alveolar bone atrophy” [MeSH Terms] AND (“bone grafting” [MeSH Terms] OR “mandibular osteotomy” [MeSH Terms]) (Figure 17).

mandibular subperiosteal implants_2
FIGURE 17: INLAY GRAFT WORKFLOW

Results:

These searches found 30 articles meeting the selection criteria for this literature review: Five on subperiosteal implants (20–24) and 25 on inlay grafts (25–49). By analyzing the results, we can measure the implant survival rate (number of patients who did not lose any implants/total number of patients). Among the 86 patients who participated in studies on subperiosteal implants, three lost an implant due to recurring infections. The implant survival rate between eight months to three years is 96.5%. For inlay grafts, implant survival depends on the success of the graft. Among the 345 patients who participated in studies, 28 grafts failed, and therefore no implants could be placed.

Two studies did not specify the number of patients, but rather the number of implants when calculating the survival rate. The number of patients therefore decreases from 345 to 250. Among these patients, 19 lost one or more implants, for an implant survival rate of 92.5% between eight months and five years.

Discussion:

Analyzing these articles shows promising survival rates for the rehabilitation of atrophic posterior mandibular regions using subperiosteal implants. These articles are few and their level of evidence is low. Most are clinical case reports with few patients (less than 100) with short-term follow-ups. Long-term clinical studies with a high level of evidence are required to reaffirm the true success of subperiosteal implants in a clinical setting.

A number of elements were unable to be assessed in this review, including the implant success rate, which is a better predictor of the long-term efficiency of implant-supported rehabilitation. However, the few prosthetic and biologic complications reported in the study seem to indicate high success rates for subperiosteal implants. Compared to inlay graft techniques, these implants have the advantage of requiring a single surgery with a short healing period and few postoperative and prosthetic complications, making them a reliable and promising alternative.

Conclusion:

Thanks to CAD/CAM, Panthera SUB subperiosteal implants solve most issues encountered (lack of adjustment, two procedures, etc.) with their traditional counterparts. Moreover, using biocompatible titanium instead of cobalt-chrome allows for a true osseointegration of the implant. Finally, the literature tends to show good results with this technique in treating posterior mandibular edentulation.

Click here to see references

1. Silvestri KD, Carlotti AE. Subperiosteal implant : serving the dental profession for over 50 years. R I Dent J. 1995;28(1):11‑23.
2. Sconzo J. The complete mandibular subperiosteal implant : an overview of its evolution. J Oral Implantol. 1998;14‑5.
3. Schou S, Pallesen L, Hjorting-Hansen E, Pedersen C, Fibaek B. A 41-year history of a mandibular subperiosteal implant. Clin Oral Implants Res. 2000;(11):171‑8.
4. Bodine R, Yanase R, Bodine A. Forty years of experience with subperiosteal implant in 41 edentulous patients. J Prosthet Dent. janv 1996;75(1):33‑44.
5. Nguyen TM, Caruhel JB, Khonsari RH. A subperiosteal maxillary implant causing severe osteolysis. J Stomatol Oral Maxillofac Surg. déc 2018;119(6):523‑5.
6. Van Steenberghe D, Branemark PI, Quirynen M, De Mars G, Naert I. The rehabilitation of oral defects by osseointegrated implants. J Clin Periodontol. 1991;18(6):198‑205.
7. Nefussi JR. Le volume osseux résiduel après extraction dentaire est-il prédictible ? In: Mise en place chirurgicale et gestion des tissus muqueux péri-implantaires. p. 102‑21.
8. Nefussi JR. Biologie et physiologie du volume osseux implantable. In: EMC. Elsevier Masson SAS. Paris; 2011. p. 1‑12. (Medecine buccale; vol. 28).
9. Hienz SA, Paliwal S, Ivanovski S. Mechanisms of Bone Resorption in Periodontitis. J Immunol Res. 2015;2015:1‑10.
10. Cawood J, Howell R. A classification of the endetulous jaws. Int J Oral Maxillofac Surg. 1988;(17):232‑6.
11. Pietrokovski J, Massler M. Alveolar ridge resorption following tooth extraction. J Prosthet Dent. 1967;21‑7.
12. Urban IA, Nargusky H, Lozada JL. Horizontal ridge augmentation with a resorbable membrane and particulated autogenous bone with or without anorganic bovine bone-drived mineral : a prospective case series in 22 patients. Int J Oral Maxillofac Implants. avr 2011;26(2):404‑14.
13. Guillaume B. Accroissement osseux préimplantaire par disjonction osseuse. Inf Dent. 2004;86(1640).
14. Khoury F, Hanser T. Three-dimensional vertical alveolar ridge augmentation in the posterior maxilla : a 10-year clinical study. Int J Oral Maxillofac Implants. avr 2019;34(2):471‑80.
15. Laurentjoye M, Ella B, Caix P. La tête. In: Anatomie tête et cou. 2015e éd. Bordeaux: Bergeret; 2015. p. 3‑101.
16. Coutant JC, Martin R, Huault L, Ella B. Chirurgie du lambeau lingual. Inf Dent. 24 avr 2019;(16/17):35‑40.
17. Minichetti J. Analysis of HA-coated subperiosteal implants. J Oral Implantol.2003;29(3):111-6.
18. Cohen DJ, Cheng A, Kahn A, Aviram M, Whitehead AJ, Hyzy SL, et al. Novel Osteogenic Ti-6Al-4V Device For Restoration Of Dental Function In Patients With Large Bone Deficiencies: Design, Development And Implementation. Sci Rep. avr 2016;6(1):20493.
19. Claffey N, Bashara H, O’Reilly P, Polyzois I. Evaluation of New Bone Formation and Osseointegration Around Subperiosteal Titanium Implants with Histometry and Nanoindentation. Int J Oral Maxillofac Implants. sept 2015;30(5):1004-10.
20. Cerea M, Dolcini G. Custom-Made Direct Metal Laser Sintering Titanium Subperiosteal Implants: A Retrospective Clinical Study on 70 Patients. BioMed Res Int. 28 mai 2018;2018:1‑11.
21. Mangano C, Bianchi A, Mangano F, Dana J, Colombo M, Solop I, et al. Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series. 3D Print Med. déc 2020;6(1):1.
22. Cohen DJ, Cheng A, Kahn A, Aviram M, Whitehead AJ, Hyzy SL, et al. Novel Osteogenic Ti-6Al-4V Device For Restoration Of Dental Function In Patients With Large Bone Deficiencies: Design, Development And Implementation. Sci Rep. avr 2016;6(1):20493.
23. Oren D, Dror AA, Bramnik T, Sela E, Granot I, Srouji S. The power of three-dimensional printing technology in functional restoration of rare maxillomandibular deformity due to genetic disorder: a case report. J Med Case Reports. déc 2021;15(1):197.
24. Gellrich NC, Zimmerer RM, Spalthoff S, Jehn P, Pott PC, Rana M, et al. A customised digitally engineered solution for fixed dental rehabilitation in severe bone deficiency: A new innovative line extension in implant dentistry. J Cranio-Maxillofac Surg. oct 2017;45(10):1632‑8.
25. Bolle C, Felice P, Barausse C, Pistilli V, Trullenque-Eriksson A, Esposito M. 4 mm long vs longer implants in augmented bone in posterior atrophic jaws: 1-year post-loading results from a multicentre randomised controlled trial. Eur J Oral Implant. 2018;11(1):31‑47.
26. Esposito M, Cannizzaro G, Soardi E, Pellegrino G, Pistilli R, Felice P. A 3-year post-loading report of a randomised controlled trial on the rehabilitation of posterior atrophic mandibles: short implants or longer implants in vertically augmented bone? Eur J Oral Implant. 2011;4(4):301‑3011.
27. Felice P, Barausse C, Pistilli R, Ippolito DR, Esposito M. Five-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws. Int J Oral Implant. 2019;12(1):25‑37.
28. Felice P, Pistilli R, Barausse C, Piattelli M, Buti J, Esposito M. Posterior atrophic jaws rehabilitated with prostheses supported by 6-mm-long 4-mm-wide implants or by longer implants in augmented bone. Five-year post-loading results from a within-person randomised controlled trial. Int J Oral Implant. 2019;12(1):57‑72.
29. Esposito M, Barausse C, Pistilli R, Piattelli M, Simone SD, Ippolito DR, et al. Posterior atrophic jaws rehabilitated with prostheses supported by 5 × 5 mm implants with a nanostructured calcium-incorporated titanium surface or by longer implants in augmented bone. Five-year results from a randomised controlled trial. Int J Oral Implant. 2019;12(1):39‑54.
30. Esposito M, Pellegrino G, Pistilli R, Felice P. Rehabilitation of posterior atrophic edentulous jaws: prostheses supported by 5 mm short implants or by longer implants in augmented bone? One-year results from a pilot randomised clinical trial. Eur J Oral Implant. 2011;4(1):21‑30.
31. Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical trial: Vertical augmentation vs. 7-mm-long implants. Clin Oral Implants Res. déc 2010;21(12):1394‑403.
32. Felice P, Marchetti C, Iezzi G, Piattelli A, Worthington H, Pellegrino G, et al. Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone. Clinical and histological results up to one year after loading from a randomized-controlled clinical trial. Clin Oral Implants Res. déc 2009;20(12):1386‑93.
33. Brandtner C, Borumandi F, Krenkel C, Gaggl A. A New Technique for Sandwich Osteoplasty with Interpositional Bone Grafts for Fixation. Int J Oral Maxillofac Implants. 19 sept 2014;29(5):1164‑9.
34. Geng Y, Zhou M, Parvini P, Scarlat S, Naujokat H, Abraha SM, et al. Sandwich osteotomy in atrophic mandibles: A retrospective study with a 2‐ to 144‐month follow‐up. Clin Oral Implants Res. oct 2019;30(10):1027‑37.
35. Marconcini S, Covani U, Giammarinaro E, Velasco-Ortega E, De Santis D, Alfonsi F, et al. Clinical Success of Dental Implants Placed in Posterior Mandible Augmented With Interpositional Block Graft: 3-Year Results From a Prospective Cohort Clinical Study. J Oral Maxillofac Surg. févr 2019;77(2):289‑98.
36. Felice P, Pistilli R, Lizio G, Pellegrino G, Nisii A, Marchetti C. Inlay versus Onlay Iliac Bone Grafting in Atrophic Posterior Mandible: A Prospective Controlled Clinical Trial for the Comparison of Two Techniques. Clin Implant Dent Relat Res. oct 2009;11:69‑82.
37. Laviv A, Jensen OT, Tarazi E, Casap N. Alveolar Sandwich Osteotomy in Resorbed Alveolar Ridge for Dental Implants: A 4-Year Prospective Study. J Oral Maxillofac Surg. févr 2014;72(2):292‑303.
38. Bianchi A, Felice P, Lizio G, Marchetti C. Alveolar distraction osteogenesis versus inlay bone grafting in posterior mandibular atrophy: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. mars 2008;105(3):282‑92.
39. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment. In: Cochrane Database of Systematic Reviews. 2009. (Issue 4).
40. Starch-Jensen T, Nielsen HB. Sandwich osteotomy of the atrophic posterior mandible with interpositional autogenous bone block graft compared with bone substitute material: a systematic review and meta-analysis. Br J Oral Maxillofac Surg. déc 2020;58(10):e237‑47.
41. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. The Efficacy of Horizontal and Vertical Bone Augmentation Procedures for Dental Implants: A Cochrane Systematic Review. Chiappelli F, éditeur. Eur J Oral Implant. 2009;2(3):167‑84.
42. Jensen OT. Alveolar Segmental “Sandwich” Osteotomies for Posterior Edentulous Mandibular Sites for Dental Implants. J Oral Maxillofac Surg. mars 2006;64(3):471‑5.
43. Pelo S, Boniello R, Moro A, Gasparini G, Amoroso PF. Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants. Int J Oral Maxillofac Surg. mars 2010;39(3):227‑34.
44. Marchetti C, Stefano T, Corinaldesi G, Felice P. Interpositional bone graft. Int J Periodontics Restorative Dent. 2007;27(6):547‑55.
45. Sohn DS, Shin HI, Ahn MR, Lee JS. Piezoelectric Vertical Bone Augmentation Using the Sandwich Technique in an Atrophic Mandible and Histomorphometric Analysis of Mineral Allografts: A Case Report Series. Restorative Dent. 2009;30(4):11.
46. Felice P, Iezzi G, Lizio G, Piattelli A, Marchetti C. Reconstruction of Atrophied Posterior Mandible With Inlay Technique and Mandibular Ramus Block Graft for Implant Prosthetic Rehabilitation. J Oral Maxillofac Surg. févr 2009;67(2):372‑80.
47. Felice P, Piana L, Checchi L, Corvino V, Nannmark U, Piattelli M. Vertical Ridge Augmentation of an Atrophic Posterior Mandible with an Inlay Technique and Cancellous Equine Bone Block : A Case Report. Int J Periodontics Restorative Dent. 2013;33(2):159‑66.
48. Roccuzzo A, Marchese S, Worsaae N, Jensen SS. The sandwich osteotomy technique to treat vertical alveolar bone defects prior to implant placement: a systematic review. Clin Oral Investig. mars 2020;24(3):1073‑89.
49. Elnayef B, Monje A, Albiol G, Galindo-Moreno P, Wang HL, Hernández-Alfaro F. Vertical Ridge Augmentation in the Atrophic Mandible: A Systematic Review and Meta-Analysis. Int J Oral Maxillofac Implants. mars 2017;32(2):291‑312.

NEED MORE INFORMATION?

Canada (HQ)


9105 rue John-Simons
Quebec, QC Canada,
G2B 0S6
+ 1 (418) 527-0388

USA


22343 La Palma Ave, Ste 128
Yorba Linda, CA
USA 92887
+ 1 (418) 527-0388

France


38 rue Jean Mermoz
78600 Maisons-Laffitte
France,
+ 1 (418) 527-0388

Newsletter

By clicking on “Submit”, you agree to our Privacy Policy and to receive Panthera’s latest news and promotional emails.

+ 1 (418)-527-0388      [email protected]


Newsletter


By clicking on “Submit”, you agree to our Privacy Policy and to receive Panthera’s
latest news and promotional emails.

Panthera Dental