A digitally designed fixed subperiosteal implant solution for the treatment of the severely atrophic full‐arch with an immediate‐load protocol

Alveolar bone morphology drives the edentulous patient's rehabilitation. In edentulism, maxillary resorption is often in three vectors: superiorly, medially, and posteriorly, leading to a prosthetically unfavorable pseudo-class III ridge relationship. Longstanding edentulism, especially in the context of ill-fitting dentures, can result in severe maxillary atrophy. Rehabilitation of the severely atrophic maxilla remains a challenge, frequently requiring extensive bone grafting procedures in combination with endosseous dental implants. Graftless options, using longer endosseous and/or tilted dental implants placed into the nasal, pyriform rim, pterygoid process, and zygomatic bone, have been developed to solve this treatment dilemma. These options have specific patient anatomy limitations, can be technique sensitive, and can result in increased patient morbidity. Digitally planned, custom-milled, and rigidly fixated subperiosteal implants offer a recently introduced immediate fixed option when conventional solutions fail or are contraindicated. Cone-beam computed tomography (CBCT) and computer-aided design and computer-aided manufacturing (CAD-CAM) redefine a controversial 70-year-old concept, using prosthodontic reverse-engineering to offer stability, reduced morbidity, and improved patient satisfaction. Long-term follow-up for the use of this technique in fixed definitive restorations is not available at this time.