A subperiosteal implant is a custom metal frame implant that goes OVER the bone rather than into the bone. They are an option for patients with dentures who were told they cannot have implants due to severe bone loss.
Regular dental implants are basically screws that are inserted INTO the bone.
A subperiosteal dental implant is nothing new. Actually they were used in the 1970s and 1980s, but then became less popular when screw-type implants became popular. Think of it like a taco shell.
A subperiosteal implant is used for patients who have little to “no bone.” When the lower jaw loses so much bone it cannot even have regular implants because it is too thin. If you drill into a thin lower jaw to place regular implants, the jaw could break.
Even if you could fit a small, short implant the remaining super skinny bone is so overly dense that it has no blood in it. Dental implants require blood in the bone marrow in order for them to integrate and actually work.
Most patients have also lost a lot of facial muscles and they feel like they have a caved-in look because they have been wearing dentures for so long.
There is only so much glue you can use to hold a denture in. This is no way to live.
Subperiosteal dental implants for the lower jaw
Subperiosteal dental implants can be used on the upper or lower jaw, but they are much better for the lower jaw. For patients who have extreme bone loss of the upper jaw I prefer other options such as zygomatic, pterygoid, trans-nasal, trans-sinus or other nonconventional implant positions rather than an upper subperiosteal.
The upper subperiosteal implants have a history of failure while the lower subperiosteal is very successful.
Why are subperiosteal implants becoming popular again? Technology and need!
In my practice I treat a lot of patients who have extreme bone loss. They have little to no options to dentures.
The subperiosteal implant has become more streamlined because of technology. The way that I make these in my practice are with digital CBCT x-ray scanning, along with digital face and intraoral scanning.
This allows me to make a custom subperiosteal implant without ever cutting the gum open before the surgery.
In the past this procedure was completed by opening the gums at one visit and taking a dental mold of the actual bone. Then the surgeon would suture up the gums and make the custom implant out of chromium-cobalt metal. Then during the second surgery, the gum would be reopened and the subperiosteal would be inserted and MAYBE it would fit!
and 3D printed model of lower jaw with severe bone loss)
With digital technologies there is no first surgery. I am able to precisely make the subperiosteal and the teeth before ever even opening the gums for surgery. On the day of surgery, the custom implant is placed and the patient gets teeth usually on the same day or within 24 hours!
There are extremely few labs and dentists in the United States or the world who can truly provide this service safely and predictably. Literally there are 0.1% of dental surgeons who do this procedure.
Subperiosteal implants for patients who are missing all lower teeth
Most of the subperiosteal implants that I make are for patients who are missing all of their lower teeth and have been told they cannot have implants on the lower jaw.
They suffer with dentures.
A subperiosteal dental implant can also be made for just one side of the mouth where there is severe bone loss with the nerve in the way and/or nerve repositioning is not an option.
- The subperiosteal dental implants that I make are from milled titanium rather than cast chromium-cobalt. Both are good materials but I prefer titanium. This gives the advantage of higher biocompatibility and may help long-term problems where the gum could open and develop infection, or where the abutments protrude through the gum onto the bridge.
- Subperiosteal dental implants are really only needed for about 1% of patients. That number has expanded as we are all living longer.
- Sometimes the subperiosteal can be used as a bail out for a failed all on 4 procedure or for our aging parents!
- The teeth on top of a subperiosteal dental implants have traditionally been an overdenture. That means that the teeth snap in and out. But recently, with my lab partner, I create custom designs to provide nonremovable options for the lower subperiosteal implant!
More options for subperiosteal dental implants
Most of the time if a patient needs a lower subperiosteal implant, they are missing all their upper teeth as well. You can have a lower subperiosteal and an upper denture! You do not have to have implants on both jaws.
That will give the most longevity to the lower because of less bite force. The other common option that I do is a quad zygoma or double zygomatic with pterygoids for the upper jaw and subperiosteal custom implant for the bottom jaw.
These usually take more time before having the surgery done under sedation in our office. Surprisingly the procedure does not usually have a lot of pain because no big holes are drilled into the jaw. The subperiosteal implant is off and anchored with small bone fixation screws instead of large implants.
The risk of subperiosteal implant surgery is usually temporary or permanent numbness. This is because the nerve that gives sensation to your lip and chin is often exposed on the surface of the lower jaw if you have severe bone loss.
It is realistic to expect that 50% of patients who have this level of bone loss (where the lower jaw is pencil thin) to have some loss of sensation of the lip and/or chin.
Of my patients who have gone through this, they have said it is so worth it because they were unable to wear dentures and would rather put up with some numbness than to not have teeth for the rest of their lives.
It can provide a wonderful quality of life, eliminate loose dentures and let you enjoy the foods you want without denture glue.
How much could be cost of a subperiosteal implant for a mandible with severe bone loss ? Not the procedure but an implant itself.
It is custom made for the patient by the surgeon’s design. It is not something that can be bought.
I was not going to buy it! At the clinic I visited I was told that the implant for me (similar to that for the low jaw on your x-ray picture) could be ordered abroad and would cost $20 000. I’d like to know how much it can be in your clinic, just the range.
Most of these are removable. This one is not and it is not denture teeth. It is a premium prosthetic. Less than 1% of people would even need this so you likely do not. For pricing I would need to see you but it can almost double of the cost you mentioned.
I have had full dentures for many years and now I am considering getting a subperiosteal implant for the low jaw. I was told that the cost would be around $45000 including $20000 for the implant ordered abroad. As I understood the procedure in my case would not seem to be very complicated. Could you please tell me what the full cost range can be at your clinic? I am 85 which makes getting the decision harder.
$45,000 would cover the entire procedure. You are welcome to see me in Southern California.
This patient has one: https://youtu.be/_eyAloJqD0w
Thank you, Dr Amin for the answer. I watched the video. By the x-ray image and the patient’s mouth appearance, the teeth were placed almost right on the jaw. Is this a specific case or it always is being done in such a way? Low position of teeth because of bone loss is exactly my problem. Can it somehow be solved?
Everything is unique and specific to each patient.
Can implants be done without the use of blood? I am a Jehovah’s Witness and blood is sacred according to Bible texts and should not be consumed. Isn’t applying it in a bone graft the same as consuming it? My belief is that it is. So what can I do instead?
Speaking with your pastor. Since it’s your own blood it’s generally not an issue. You wont be consuming the blood because you won’t eat it. It is not a transfusion. Respectfully, Dr. Amin 🤗
This looks like it would be helpful for an older family friend in Texas! She was promised a “beautiful smile” and was super excited about finally getting a beautiful smile, but the dentist/peridontist/oral surgeon (not sure which she went to) said it would be faster if she extracted all her (remaining?) teeth because she never had braces and her teeth were crooked/discolored. Unfortunately, the implants failed (possibly all on 4?) and her bone was no longer strong enough to support implants. Now she has NO teeth. If she still has the funds, I wonder if this would be an option for her, and if it is prohibitively expensive.
Sorry somehow I missed this comment! So sad that she has NO teeth! Yikes! Yes, this may be a very viable option!
I think I already posted about 6 mm implants in lower jaw. Sorry for the redundancy.
Subperiosteal dental implants are typically used in cases where there is a severe deficiency of bone in the jaw. They may be an option for people who have lost bone due to periodontal disease, trauma, or other causes.
In some cases, a subperiosteal dental implant may be used instead of short dental implants in the lower jaw. However, the suitability of a subperiosteal implant versus short implants will depend on the specific circumstances of the individual patient, including the amount of available bone and your specific needs. The bone would have to be pretty wide and the implants would need to be splinted to use short implants safely.
Can this type of implant be used successfully for upper implant replacements near the molar region, or is it basically for lower jaw?
Best for lowers only. Zygomatic implants are better for complex uppers with major bone loss.
Sorry , I meant subperiosteal implant.
Hello – Can periosteal implant be done on an upper canine tooth with moderate bone loss around it ? Bone loss probably not helped by the fact tooth next to it in back had been extracted many years ago.
This canine tooth was extracted in August of this year due to periapical abscessI . Took Amoxicillin as ordered post the extraction . I am wondering if I would have to wait a certain time period for an implant (the abscess seems to have cleared – no further problems ) and whether a bone graft is necessary for this type of implant. Thank you — Harvey.
That would not be a great idea. You would be better served by a block bone graft. I have done at least 1000 of these!
An autogenous bone graft, also known as a block bone graft, is a type of bone graft that is obtained from the patient’s own body. It is typically taken from a donor site near the wisdom teeth and is then transplanted to the area where the bone graft is needed.
Autogenous bone grafts are often used in conjunction with dental implant treatment to increase the volume of bone in the jaw. This may be necessary in cases where there is insufficient bone to support a dental implant, or if the patient has lost bone due to periodontal disease, trauma, or other causes.
Autogenous bone grafts have several advantages over other types of bone grafts. They are a natural source of bone, and they have a high rate of success because they are derived from the patient’s own body. However, they do require a second surgical site to harvest the bone, and there is a risk of complications associated with the donor site.
Thank you, Dr Amin for your reply. I am on a course of antibiotics at the moment to help with the infection, and provide pain relief.
Hello, I am in Europe. I am just doing some research because I have been told by a specialist dentist that I have several teeth requiring extensive treatment. I have a large infection where a root canal will have to be redone and the ‘amount of tooth remaining is very poor to support a new crown and to seal the tooth’. The prognosis for my root canaled teeth is ‘poor to hopeless’. I have four root canals. Extraction and replacement is recommended. The most urgent tooth is the upper left second molar, (where the large infection is; ‘Tooth 27’) followed by the upper right first molar. Both of these teeth were root-canaled previously. When I was younger I had two teeth removed on my lower jaw, (LL6, LR6) due to cracked fillings and subsequent tooth infection. I wish I saved those teeth now, that ‘s why I opted for root canals in later years, believing I was saving my teeth. I am a middle aged woman, and very conscious of my teeth, especially if missing teeth are noticeable. I have been told to act urgently, and implants are recommended, and that ‘any clinician who assesses my teeth, the outcome will be the same.’ Treatment will take up to a year. I’m still not sure how many teeth the dentist recommends removing besides the two urgent ones. Before I get back to my dentist, I am researching my options. Should I ask for the other teeth to be saved (the ones requiring ‘extensive treatment’ but not ‘urgent’ (re do root canals?) What would you recommend in my situation. Thank you, doctor.
This is a very broad question about very specific teeth all over the mouth. There’s no way that I could answer or give you medical advice without seeing you and an x-ray.
The best advice would be to see a dentist that has a good reputation and that you trust.
Root canals can be a great option as long as the tooth has a predictable prognosis.
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I’m not sure I understand your question as they are just a few letters here.