Severe mandibular atrophy often precludes the use of conventional endosseous implants. Recent advances in 3D imaging, CAD/CAM design, and direct metal laser sintering (DMLS) of titanium alloys have improved the clinical viability of custom-made subperiosteal implants.

This retrospective study included 10 patients with Cawood and Howell Class IV–VI mandibular atrophy who received additively manufactured, patient-specific titanium subperiosteal implants. Designs were based on CT scans and fabricated via DMLS. Clinical and radiological assessments were conducted postoperatively to evaluate implant survival, complications, and bone stability over a follow-up period of up to 12 years.

Seven implants (70 %) remained functional and clinically stable. Three were removed due to late complications, including bone resorption and granulation tissue formation. Early postoperative complications included oedema and pain in all cases, all of which were effectively managed with conservative treatment. These complications did not compromise implant functionality. Late complications were observed in three patients that ultimately led to implant removal. The overall implant survival rate in this cohort was 70 %.

DMLS-fabricated, custom-designed subperiosteal implants offer a promising solution for patients with severe mandibular atrophy. Despite some late complications, the technology demonstrates favorable long-term outcomes, especially when conventional implants are contraindicated.