A perfect snap-fit without a single screw will get any clinician’s heart racing—but what does that moment really mean ten years later? We take a hard look at custom subperiosteal implants and ask where they truly belong: why well-designed mandibular subs can solve brutal atrophy with durability, and why maxillary applications remain a minefield of thin bone, complex loading, and fragile claims. Along the way, we strip the shine from marketing slides and focus on what actually carries cases across the finish line—passivation, surface finishing, serviceable prosthetics, and designs that respect mucosa, biomechanics, and maintenance.

We walk through the real trade-offs between milling and DMLS, why the cheapest print can become the most expensive complication without proper finishing, and how remote frameworks, tripodial mandible designs, and meso bars distribute force where bone will accept it. We debate embedded MUAs versus removable, make the case for overdentures in extreme resorption, and share the uncomfortable truth about U.S. liability, FDA constraints, and evidence gaps that can leave clinicians exposed. Records and planning matter more than ever, and a multi-app digital pipeline only works when the data is precise and the clinician leads the design intent—not the other way around.

Credentials, community, and communication shape outcomes as much as titanium. From rescue stories to cautionary tales, we outline a professional path that prioritizes serviceability, hygiene, and legal defensibility while still embracing the progress that PSIs promise. If you’re weighing subs for your practice, this is the field guide you need: what to adopt now, what to delay, and how to prepare for the AI-enabled future without outsourcing your judgment. If this resonates, follow the show, share it with a colleague, and leave a review—then tell us: fixed or removable for the severely resorbed mandible, and why?