History of the tripodal mandibular subperiosteal implant and the evolution of its design are discussed. Basic principles of bone physiology are reviewed especially as they relate to bone response to loading. Modeling and remodeling are controlled by a strain-related environment. Modeling can alter the shape and volume of bone. This aspect of bone growth has been reported with transosteal implants. A case report is presented in which apparent bone growth occurred following placement of a hydroxylapatite-coated subperiosteal implant. The implant was successfully revised following an acute infection around one of the permucosal sites.