Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice.

Implant-supported prosthetic rehabilitation for patients with severely atrophic jaws is challenging due to complex anatomical considerations and the limitations of conventional augmentation techniques. This study explores the potential of subperiosteal (juxta-osseous) implants as an alternative solution, using finite element analysis (FEA) to evaluate mechanical performance. Realistic jaw models, developed from radiographic data, are utilized to simulate various implant configurations and load scenarios. Results indicate that different screw placements, implant designs, and structural modifications can significantly influence stress distribution and biomechanical behavior. Upper and lower jaw models were assessed under multiple load conditions to determine optimal configurations. Findings suggest that strategic adjustments, such as adding posterior screws or altering implant connections, can enhance load distribution and reduce stress concentration, particularly in critical areas. Tensile loads in critical bone areas near cortical fixing screws exceeded 50 MPa under anterior loading, while configurations with larger load distributions reduced stress on both implant and bone. The study provides evidence-based insights into optimizing subperiosteal implant design to improve stability, longevity, and patient outcomes.

Aim: To critically appraise the methodological quality and historical evolution of prognostic models for periodontitis. Materials and Methods: A systematic search was conducted in three databases. Eligible studies were classified as conceptual tools, category‐based tools and data‐driven models. Category‐based and data‐driven models were evaluated with PROBAST. Risk of bias (ROB) was compared across four domains: Participants, Predictors, Outcome and Analysis. Results: Twenty‐seven studies were included. Prognostic methods evolved from qualitative risk categories and expert‐based classifications towards quantitative, individualised probability estimates generated through multivariable statistical and machine‐learning models, alongside progressive improvements in outcome definition, prediction time and risk expression formats. Conceptual tools were not evaluable under PROBAST due to the absence of empirical data. Category‐based tools showed limitations in predictor handling and validation rather than bias per se. Data‐driven models demonstrated progressive refinement: earlier studies lacked consistent validation, whereas recent models more frequently report internal validation, calibration metrics and external validation. However, all studies except one were classified as high ROB. Domain‐level assessment showed strengths in the Participants domain but persistent limitations in the Analysis domain. Methodological improvements after TRIPOD were modest. Conclusion: Prognostic models reflect distinct methodological profiles across design type. Conceptual and category‐based frameworks remain clinically relevant historically, while data‐driven models represent the contemporary standard but retain important methodological gaps. Trial Registration: PROSPERO number: CRD42024525505

Implant-supported prosthetic rehabilitation for patients with severely atrophic jaws is challenging due to complex anatomical considerations and the limitations of conventional augmentation techniques. This study explores the potential of subperiosteal (juxta-osseous) implants as an alternative solution, using finite element analysis (FEA) to evaluate mechanical performance. Realistic jaw models, developed from radiographic data, are utilized to simulate various implant configurations and load scenarios. Results indicate that different screw placements, implant designs, and structural modifications can significantly influence stress distribution and biomechanical behavior. Upper and lower jaw models were assessed under multiple load conditions to determine optimal configurations. Findings suggest that strategic adjustments, such as adding posterior screws or altering implant connections, can enhance load distribution and reduce stress concentration, particularly in critical areas. The study provides evidence-based insights into optimizing subperiosteal implant design to improve stability, longevity, and patient outcomes.