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

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.