Prosthetic-Guided Pterygoid Anchorage for HUG® Subperiosteal Implants: A Technical Report.

Severe maxillary atrophy presents significant challenges for implant-supported rehabilitation due to sinus pneumatization, extensive bone resorption, and reduced posterior anatomical support. Modern digitally designed subperiosteal implants have re-emerged as graftless alternatives enabled by advanced computer-aided design-computed-aided manufacturing (CAD-CAM) workflows and optimized anatomical anchorages. Pterygoid fixation provides valuable posterior stability; however, free-hand drilling carries risks of injury to critical vasculonervous structures, including the descending palatine artery and the pterygopalatine fossa contents. This technical report describes a novel prosthetic-guided approach to ensure drilling in the pterygoid process utilizing an integrated semi-cylindrical guide incorporated directly within the definitive prosthetic framework of the HUG® (Biotech Dental®, Salon-de-Provence, France) subperiosteal implant. Postoperative computed tomography (CT) scans superimposed onto preoperative planning data show minimal deviation in apex positioning, as well as minimal angular deviation of the pterygoid screws between planned and executed positions. This technique aims to secure reproducible and accurate pterygoid anchorage while minimizing iatrogenic risk associated with freehand posterior maxillary access in the management of severe maxillary atrophy.