Maxillofacial Surgeons

Subperiosteal Implants (ISP) Proficiency Level

Estimated duration: 7-9 minutes 12 questions 4 answer options

This questionnaire analyzes your clinical profile in severe maxillary atrophy rehabilitation and experience with subperiosteal implants (PSI). It is not an assessment: it is a diagnostic tool to understand your starting point and guide an adapted professional development plan. There are no right or wrong answers.

Back

1 Clinical experience and autonomy in subperiosteal implants

What is your autonomy level in indicating and placing subperiosteal implants?

I have never prescribed or placed any. My knowledge is purely theoretical.

I have indicated or placed a case under supervision. I have initial criteria but unexpected scenarios cause hesitation.

I plan and execute cases autonomously, consulting senior colleagues for complex presentations.

I master the complete workflow, including extreme complexity. My clinical criteria serve as a benchmark for peers.

2 Clinical experience and autonomy in subperiosteal implants

Approximately how many subperiosteal implants have you placed to date?

None. I know the technique but have not incorporated it into my surgical practice.

Fewer than 5. I completed my first cases and am in active learning.

Between 5 and 10. I have solid clinical experience and consolidating criteria.

More than 10. It is a routinely integrated technique in my surgical practice.

3 Clinical experience and autonomy in subperiosteal implants

How do you envision the integration of this treatment in your daily practice?

I do not expect to incorporate it. It does not fit my current clinical profile.

I see it as possible in the medium term, requiring deeper training and protocols first.

I am in active adoption. I have taken first steps and want to systematize the surgical workflow.

It is already part of my surgical armamentarium and I anticipate increasing case volume.

4 Diagnosis and indications

Are you familiar with the planning workflow for a custom subperiosteal implant?

I do not distinguish the planning for a PSI from other conventional implant treatments.

I know it partially. I know high-resolution imaging is needed, but lack clarity on medical CT vs CBCT protocols.

I know and follow it: dual-scan CT with prosthesis in occlusion and radiopaque markers at connection sites.

I master it completely: dual-scan protocol, slice thickness calibration, prosthetic alignment, and bioengineering prescription.

5 Diagnosis and indications

How do you assess PSI indications against alternatives in severe jaw atrophy?

I know the concept theoretically but have not applied it clinically.

I evaluate the indication integrating bone resorption stages (Cawood & Howell).

Beyond volumetric analysis, I weigh grafting, zygomatic implants, and systemic patient conditions.

Indications stem from an algorithmic protocol: Cawood V-VI atrophy, graft failure/contraindication, systemic health, and long-term prosthetic viability.

6 Co-design and technical specifications

What is your level of involvement in PSI co-design with the bioengineering team?

I have not yet participated in any PSI co-design session.

I provide scans and prescription, and the engineer produces the design. I review and sign off without active design input.

I actively join co-design sessions, providing direction on adaptation, screw vectors, connection emergence, and framework extension.

I lead the co-design with autonomous biomechanical authority, mastering every clinical ramification.

7 Surgical technique and soft tissue management

What is your proficiency in the surgical placement technique of a custom PSI?

I have never performed one. I know the technique strictly in theory.

I have assisted in surgeries but have not operated as primary surgeon.

I perform the technique safely across diverse scenarios: mandible, maxilla, and severe resorption.

I master the procedure in any anatomical presentation, including scarred tissue, resections, or failed previous reconstructions.

8 Surgical technique and soft tissue management

How do you manage periosteum and soft tissues during surgery?

I follow standard incision protocols without specific soft tissue augmentation techniques.

I tailor dissection to local morphology, taking biotype and keratinized tissue into consideration.

I actively manage soft tissues: periosteal release, tension-free closure, and complete framework coverage.

I integrate advanced mucogingival surgery: connective tissue grafts, coronal flap advancement, and vestibuloplasty for long-term health.

9 Prosthetic rehabilitation and multidisciplinary teamwork

How do you integrate prosthetics into subperiosteal implant planning?

I have never participated in PSI prosthetic planning; my understanding is purely theoretical.

I coordinate connection points and strut orientation with the prosthodontist without leading prosthetic design.

I integrate prosthetics from day one: abutment positions, emergence profile, and retention mechanics in close collaboration.

Surgical and prosthetic planning are indivisible: I lead multidisciplinary synergy from initial CBCT to final occlusal delivery.

10 Prosthetic rehabilitation and multidisciplinary teamwork

What criteria do you use to time provisional and definitive prostheses?

I have never managed the prosthetic loading phase; I only know criteria theoretically.

I delegate loading protocol decisions entirely to the restorative dentist.

I combine healing timelines with rigid framework stability, soft tissue maturation, and balanced occlusion.

I lead the full surgical-prosthetic timeline, anticipating mechanical and biological risks.

11 Prosthetic rehabilitation and multidisciplinary teamwork

What type of subperiosteal prosthetic rehabilitation do you manage?

I have never restored a PSI. I know options theoretically without hands-on clinical cases.

Fixed partial or full-arch rehabilitation in close liaison with the laboratory team.

Full-arch fixed rehabilitation, including immediate provisional loading when primary stability permits.

The full spectrum, including extreme aesthetic demands, complex maxillomandibular relationships, and oncology deficits.

12 Complications management and advanced clinical criteria

How do you handle intraoperative or postoperative complications in PSI cases?

Last question

I only know the theoretical guidelines.

I manage basic complications autonomously, consulting or referring in unexpected situations.

I have clear protocols for exposure, wound dehiscence, and infection, auditing occurrences to refine execution.

I preempt risks during CAD planning, manage adverse events with full surgical mastery, and audit findings systematically.