Finite element method of subperiosteal implants: a systematic review on biomechanical performance and stress distribution

Background: Severe jaw atrophy limits the success of conventional implants, making subperiosteal implants a viable alternative. Advances in CBCT imaging, 3D printing, and finite element method (FEM) simulations allow precise biomechanical assessment of implant performance and stress distribution. This review evaluated FEM studies on subperiosteal implants to determine their biomechanical behavior and compare them with conventional implants. Materials and methods: A systematic search was conducted in Web of Science, PubMed, Scopus, and Lilacs until February 2025, following PRISMA guidelines. Studies using FEM to analyze subperiosteal implant stress distribution were included. Risk of bias was assessed using the ROBINS-I tool adapted for in silico studies. Results: Twelve studies met the inclusion criteria. FEM analyses showed that subperiosteal implants distribute stress more evenly than conventional implants, reducing peak stress at bone/implant interfaces. Dual-configuration implants demonstrated better biomechanical stability, while material choice (e.g. titanium vs PEEK), screw fixation, and implant thickness significantly affected performance. Oblique loading increased displacement risks. Conclusion: Subperiosteal implants offer a promising solution for severe jaw atrophy. FEM simulations suggest improved stress distribution and mechanical stability, but further optimization of fixation methods and material selection is needed. Clinical validation and standardized FEM methodologies are essential to confirm long-term success.