Customized Subperiosteal Dental Implants: A State-of-the-Art Narrative Review

Objective This state-of-the-art review aims to consolidate current clinical knowledge, emerging technologies, and evolving applications of customized subperiosteal dental implants for jaw reconstruction in patients with severe atrophic jaws. Background Although historically abandoned due to high failure rates, subperiosteal implants have re-emerged as a viable graftless solution, driven by advances in digital workflows, implant design, and biomaterial technology. Methods A focused literature search was conducted in June 2025 using PubMed, Scopus, Web of Science, and Google Scholar to identify relevant case reports, case series, and reviews. As this is a narrative review, no quality assessment or meta-analysis was performed. Results Contemporary subperiosteal implants, fabricated using CBCT, CAD/CAM, and 3D printing technologies, demonstrate excellent bone adaptation, favorable biomechanics, and 5-year survival rates exceeding 90%. However, the available evidence is primarily derived from low-to-moderate certainty sources. Recent innovations include the use of titanium or PEEK frameworks, bioactive surface modifications, and immediate loading protocols. Primary indications include Cawood–Howell class V–VIII atrophy, failed bone grafts, and medically compromised patients. Contraindications comprise poor oral hygiene and uncontrolled systemic disease. Conclusion Customized subperiosteal implants represent a promising digital approach for the rehabilitation of complex atrophic jaws. While high-level evidence remains limited, this narrative review highlights their expanding clinical applications and identifies key areas requiring future systematic investigation.