Surgical Management of Severe Maxillary Atrophy Using Customized Subperiosteal Titanium Implants: Report of Two Clinical Cases With 42 Months of Follow‐Up

Abstract

Advanced imaging and direct metal laser sintering enable fabrication of patient‐specific titanium meshes with precise anatomical adaptation, improving stability, surgical predictability, and rehabilitation outcomes in edentulous patients with severe atrophic arches. This article evaluates the long‐term clinical outcomes of customized subperiosteal implants (CSIs) for the rehabilitation of severely atrophic maxillae. Two patients with Cawood and Howell Classes V and VI edentulous maxilla atrophy were treated using customized subperiosteal titanium implants. Implant design and surgical planning of CSIs were performed using cone‐beam computed tomography and intraoral scanning, followed by virtual planning and additive manufacturing. A patient‐specific three‐dimensional printed surgical guide was used to facilitate bone reduction and implant positioning. Following implant placement, an immediately loaded fixed provisional prosthesis was delivered. After a healing period of 4 months, a definitive fixed prosthesis was connected to the subperiosteal implants. Clinical outcomes were assessed over a 42‐month follow‐up period, focusing on soft tissue health, prosthetic performance, and biological or mechanical complications. Both patients demonstrated favorable esthetic and functional outcomes throughout the follow‐up period. No postoperative, biological, or mechanical complications were observed. Implant stability and peri‐implant tissue conditions remained satisfactory, with no evidence of adverse clinical findings. The findings of these case reports indicate that CSIs may represent a reliable long‐term alternative to regenerative procedures in patients with severe maxillary atrophy. This approach allows immediate implant loading and offers a potential treatment option for the fixed prosthetic rehabilitation of edentulous patients.