Maxillary Subperiosteal Implants with pterygoid anchorage and immediate loading

Severely atrophic maxillae (Cawood and Howell Class V-VI) often prevent conventional implant placement without extensive bone grafting, which carries risks, especially in elderly patients. Modern subperiosteal implants, digitally designed and manufactured via additive technologies in titanium, offer a graftless solution by anchoring to basal bone structures like the canine pillars and zygomatic buttress. This video explores the clinical feasibility of adding pterygoid anchorage to enhance the stability of subperiosteal implants. A 71-year-old edentulous female with extreme maxillary atrophy received two custom subperiosteal implants designed with fixation points in the canine, zygomatic, and pterygoid regions. The digital workflow included CBCT imaging, digital smile design, and implant modeling with a TPMS-Gyroid structure to promote osseointegration. The implants were manufactured via Direct Metal Laser Sintering in Ti-6Al-4V ELI titanium and loaded immediately with a provisional titanium-reinforced PMMA bridge. Surgical placement included bicortical pterygoid screws penetrating the pterygomaxillary suture, increasing posterior support and countering occlusal forces associated with anterior cantilevers. Postoperative results showed excellent implant stability and patient satisfaction. This video confirms that pterygoid anchorage is a viable addition to subperiosteal implant design. It offers improved mechanical stability and expands treatment options for patients with extreme bone loss, without requiring bone grafting. Further biomechanical and long-term studies are recommended to validate these promising findings.