Subperiosteal Digitally Manufactured Implant Combined with Guided Pterygoid Fixation for Rehabilitation of the Severely Atrophic Maxilla

Background: Severe maxillary atrophy remains a major challenge for implant-supported rehabilitation, often requiring complex grafting procedures or zygomatic implants associated with increased surgical morbidity. Advances in digital planning and additive manufacturing have enabled the development of patient-specific subperiosteal implants supported by cortical bone anchorage. Materials and Methods: This study presents a fully digital workflow combining customized subperiosteal implants (SP3D) with guided pterygoid fixation (PT3D) to achieve stable distal support and allow immediate loading in severely atrophic maxillae. Results: Nine patients presenting with advanced maxillary atrophy were treated using computer-assisted design, guided surgery, and immediate prosthetic rehabilitation. All implants were successfully placed according to the digital plan, achieving stable fixation through bilateral pterygoid engagement. No major intraoperative or postoperative complications were observed. Immediate loading was performed in all cases with stable prosthetic outcomes during the follow-up period (average follow-up period was 12.7 months). Conclusions: The combined SP3D–PT3D approach represents a minimally invasive alternative for full-arch rehabilitation in extreme maxillary atrophy, potentially reducing the need for bone grafting while improving surgical predictability and biomechanical stability.