What are pterygoid Implants?
Pterygoid dental implants are a specialized positioning technique of dental implants to provide support for prosthetic teeth in patients who have experienced significant bone loss in their upper jaw, specifically in the posterior part of the maxilla, or have a significantly increased sinus in combination with a reduced amount of alveolar bone. Dental implants, which are placed in the pterygoid bone, at the back of the maxilla, offer a unique solution for stabilizing dental implants and reaching high initial stability in regions that weren’t used in the past by oral surgeons. They are often used to fulfill the All-on-4 implant technique.
Advantages of Pterygoid Implants
Bone Loss Mitigation
In the older days of implantology, implants required sufficient bone volume in common areas of the jaw, which extends from the 3rd molar to the third molar of the opposing quadrant. In cases where this concept isn’t viable anymore because of bone for various reasons, pterygoid implants can be an option to function as an anchor in bone structures of higher density.
Immediate Load Capability
Dental implants placed into the pterygoid bone can often be loaded immediately, meaning patients can receive the prosthetic work immediately after the implant placement. It’s because the pterygoid plate, the backside of this bone, where the medial and lateral pterygoid muscles attach, is a cortical bone, which helps stabilize the implants. Immediate loading reduces the waiting time for the final restorations and can enhance patient satisfaction.
Minimally Invasive
The placement of pterygoid implants can, in some cases, replace the traditional bone augmentation, which is either a sinus lift or a ridge augmentation, in this specific area of the mouth, resulting in a less invasive procedure. This can lead to reduced total length of the procedure and lower risk of complications.
Restoration of Function
For patients who have been living with dentures or who have lost the ability to chew effectively, pterygoid implants can significantly improve oral function and quality of life. They provide a stable base for fixed prosthetics, which are much more advanced in terms of chewing and speaking than removable solutions.
Indications for Pterygoid Implants
Pterygoid implants are indicated for patients who:
⦁ Patient lacks a large amount of bone in the posterior maxilla and does not wish to undergo extensive bone grafting procedures such as sinus lift and/or ridge augmentation.
⦁ It requires immediate restoration after tooth extraction or loss.
⦁ Seek a fixed prosthesis rather than a removable prosthetic solution(complete dentures/partial dentures).
⦁ Candidates in general, without absolute contraindications.
Surgical Considerations
Due to the anatomical complexity, no beginner should perform this kind of surgery. The procedure involves the following steps:
Preoperative Assessment:
3-dimensional imaging studies, such as cone-beam computed tomography (CBCT), are used to assess bone volume and quality, as well as the anatomical landmarks around the pterygoid area. The pterygoid fossa doesn’t contain significant structures; the major and minor palatine arteries are structures that can be affected. Nevertheless, with the proper planning and positioning of the implants, it’s a relatively safe procedure.
Drill Guides:
In our office, the standard before placing this type of implant is to design it virtually. Afterwards, physically manufactured drill guides (3D printed) are mandatory for this type of procedure.
Anesthesia:
Standard Local anesthesia is given; optionally, conscious sedation may be provided for patient comfort.
Prosthetic Attachment:
If a high initial stability is achieved, the prosthetic restoration can be installed immediately. In case the initial stability is below the threshold(varies between authors[1]; most researchers propagate 35ncm or above), the traditional loading protocol, which indicates an osseointegration period of around 3 -6 months before loading, would be the treatment of choice.
Postoperative Care
The postoperative instructions include:
⦁ Maintaining good oral hygiene to prevent periimplant infections.
⦁ Attend follow-up appointments to monitor the healing process.
Conclusion
Pterygoid dental implants are beneficial in providing additional support.
The long-term results of pterygoid implants are promising and similar to regular implant survival rates[2]. With their ability to provide immediate restoration, restore function and esthetics, they can significantly enhance the quality of life for many individuals seeking to regain their smile and confidence. As with any other dental procedure, a thorough consultation with one of our qualified dental staff is essential to determine the best possible plan based on individual needs.
1. Primary stability of implant placement and loading related to dental implant materials and designs: A literature review
Yu-Che Huang a, Yen-Chang Huang a, Shinn-Jyh Ding a,b,∗
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PMCID: PMC10548003 PMID: 37799926
https://docs.google.com/document/d/1LIf6JyeafQkHN-YEV5RSyYLXWwng3iFPYiJTUbEYlf0/edit?tab=t.0
2. Long-term results in the placement of screw-type implants in the pterygomaxillary-pyramidal region
Valerón JF, Valerón PF. Long-term results in the placement of screw-type implants in the pterygomaxillary-pyramidal region. Int J Oral Maxillofac Implants. 2007 Mar-Apr;22(2):195-200. PMID: 17465343.