BIMAXILLARY IMPLANT-PROSTHETIC REHABILITATION IN SEVERE BONE ATROPHY USING ZYGOMATIC AND PTERYGOID IMPLANTS AND BILATERAL INFERIOR ALVEOLAR NERVE TRANSPOSITION

¹ Private practice, Via Azzurra 26, 40138 Bologna, Italy
² Private practice, Forlì, Italy
³ Private practice, Naples, Italy
⁴ Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy

Correspondence to:

Annals of Stomatology 2026 September-December 6(3): Ahead of Print
https://doi.org/10.69129/stomatol/2026v6iss3_3

Received: 19 September 2026 Accepted: 16 October 2026

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Abstract

Severe bimaxillary atrophy may preclude conventional implant placement because of maxillary sinus pneumatization, limited residual alveolar bone and the superficial course of the inferior alveolar nerves. Remote cortical anchorage and nerve-repositioning procedures may provide an alternative in carefully selected patients. An adult patient with terminal dentition and advanced bimaxillary bone deficiency underwent full-arch rehabilitation. The maxilla was treated with four zygomatic implants and two pterygoid implants. The mandible was treated by bilateral inferior alveolar nerve transposition, followed by placement of four implants in the interforaminal region and two posterior implants in the gonial regions. The mandibular implants were rigidly connected by an intraorally welded titanium framework. Retained full-arch overdenture prostheses were delivered, and postoperative radiographic and clinical documentation demonstrated the intended broad anteroposterior implant distribution and restoration of occlusion and smile. The combination of quad zygomatic and bilateral pterygoid anchorage in the maxilla, with bilateral nerve transposition, interforaminal implants, and gonial implants in the mandible, can provide an extensive supporting polygon in extreme bimaxillary atrophy. The approach is highly technique-sensitive and requires advanced anatomical knowledge, comprehensive consent, neurosensory and sinus surveillance, passive prosthetic fit, and long-term maintenance.

Keywords: full-arch implant rehabilitation, gonial region, inferior alveolar nerve transposition, maxillary atrophy, pterygoid implants, zygomatic implants