Everything you need to know about pterygoid implants

Dr Pretam Gharat explores the indications, placement technique, anatomical considerations and potential complications of pterygoid implants.

Pterygoid implants represent an effective fixed implant treatment for the atrophic posterior maxilla. They provide a highly stable, fixed alternative for treating a severely resorbed maxillary jaw without complicated bone grafting procedures. By anchoring directly into the dense, non-resorbing D1 cortical bone of the pterygoid process of the sphenoid bone, they bypass the need for sinus lifts in majority of cases (subject to anatomy).

In combination with zygomatic, trans-sinus and trans-nasal implants, they constitute the foundation of the Maxilla-For-All treatment concept for severe maxillary atrophy. (https://jdentalcare.com/en/maxilla-for-all-treatment-concept/)

The pterygoid implant is the first implant utilised in the PATZi protocol, which is a systematic algorithm for maxillary full arch implant treatment planning that addresses intra-operative surprises (Ponnusamy S et al, 2023).

Indications of pterygoid implants

1. Additional support

Pterygoid implants will increase the A-P spread in a full arch rehabilitation. Increasing the A-P spread (the distance from the anterior most implant to the posterior most implants) provides critical stability, reduces cantilever length and prevents mechanical failures like screw loosening.

2. Increase cumulative torque value and thereby facilitate immediate load

Pterygoid implants usually anchor into the dense basal cortical bone (D1) of the pterygoid plates or pyramidal process which provides the ideal conditions for high insertion torques. This helps increase the cumulative torque across the arch and enables the clinician to immediately load the implants in a full arch situation (Jensen et al 2012, Papaspyridakos P et al 2014).

3. Avoid sinus lifts

In posterior edentulous spaces, we could place Pterygoid implants most times bypassing the sinus, thereby avoiding sinus lifts. This makes the process faster and less complex.

4. Improves A-P spread

The position of Pterygoid implants improves the A-P spread. This is biomechanically favourable for full arch prosthetics.

5. Eliminates cantilevers

SkalakY (1983) theorised that during cantilever loading, the best force distribution could be achieved by spreading out the maximum number of abutments as much as possible. According to his theoretical construct, he believed that this would decrease the load per implant as much as possible.

6. Alternative to Zygomatic implants

Since they are positioned far back in the arch near the maxillary tuberosity, they provide a stable posterior support for a full-arch bridge and may negate the use of zygomatic implants; which could be used, if necessary, in the future.

7. Rescue implant

If all other anchorage options in the posterior maxilla have been exhausted, pterygoid implants could quickly salvage a failing posterior or angled conventional implant without requiring complex bone grafting or sinus lift surgery and provide a very stable posterior support for a full arch bridge even provide immediate load.

Anatomical pathway and placement

The path

The implant passes through the maxillary tuberosity and the pyramidal process of the palatine bone before deeply engaging the pterygoid process.

Angulation

They are typically inserted at a 30 to 45-degree angle relative to the occlusal plane to bypass the maxillary sinus and maximise contact with dense Type I bone of the pyramidal process.

Medio-lateral angulation pointing towards the hamular notch.

One Hour marker medial – as shown in the image. Average angulation is nine to 33 degrees.

Bicortical/multi-cortical anchorage

Engaging these dense structural plates yields high initial torque (often over 60 Ncm), which can allow for immediate functional loading.

JD Pterygo retractor

JD Pterygo Retractor is a phenomenal tool designed to make the placement easier for  beginners.

Surgical and anatomical complications (including, but not limited to)

Haemorrhage

Bleeding from the greater palatine artery or pterygoid venous plexus due to the dense local blood supply. This is thankfully rare due to anatomical position of the blood vessels.

Implant misplacement

Angular deviations leading to failure to engage the pterygoid cortical bone or accidental perforation of the internal pterygoid plate.

Nerve injury and paresthesia

Temporary or permanent sensory disturbances affecting local palatine and maxillary branches.

Trismus

Restricted mouth opening or muscle spasms post-surgery. This has also been reported to be transient.

Tuberosity fracture

Mechanical fracture of the bone if placement is positioned excessively distal.

Conclusion

Placement of pterygoid implants is an extremely viable solution in rehabilitating posterior atrophied maxillae due to their high insertion torques and increase A-P spread. They have exhibited an excellent long term survival rate. Bone loss level around the implants when compared was in line with that of conventional implants, making them a viable treatment modality in immediate full arch load situations (Marco R et al, 2026).

Bibliography

• https://jdentalcare.com/en/maxilla-for-all-treatment-concept/ 24.07.2026 1300hrs GMT
• Ponnusamy S, Gonzalez J, Holtzclaw D. A Systematic Approach to Restoring Full Arch Length with Maxillary Fixed Implant Reconstruction: The PATZi Protocol. Int J Oral Maxillofac Implants. 2023 Oct 17;38(5):996-1004. doi: 10.11607/jomi.10153. PMID: 37847841.
• Jensen OT, Adams MW. Secondary stabilisation of maxillary m-4 treatment with unstable implants for immediate function: biomechanical considerations and report of 10 cases after 1 year in function. Int J Oral Maxillofac Implants. 2012
• Benic G. I., Mir-Mari J., Hämmerle C. Loading protocols for single-implant crowns: a systematic review and meta-analysis. The International Journal of Oral & Maxillofacial Implants. 2014;29:222–238. doi: 10.11607/jomi.2014suppl.g4.1
• Papaspyridakos P., Chen C.-J., Chuang S.-K., Weber H.-P. Implant loading protocols for edentulous patients with fixed prostheses: a systematic review and meta-analysis. The International Journal of Oral & Maxillofacial Implants. 2014;29:256–270. doi: 10.11607/jomi.2014suppl.g4.3
• Skalak R. Biomechanics considerations in osseointegrated prostheses, J Prosth Dcnt 1983;49:843-848
• Tommaso Grandi, Paolo Toti, Cesare Paoleschi, Matteo Giorgi, Ugo Covani and Giovanni Battista Menchini-Fabris, J. Clin. Med. 2025, 14(10), 3544 DOI: org/10.3390/jcm14103544
• Raouf K, Chrcanovic BR Clinical Outcomes of Pterygoid and Maxillary Tuberosity Implants: A Systematic Review. J. Clin. Med. 2024, 13(15), 4544
• Raouf K, Chrcanovic BR Clinical Outcomes of Pterygoid and Maxillary Tuberosity Implants: A Systematic Review. J. Clin. Med. 2024, 13(15), 4544
• https://www.prosthodontics.org/about-acp/position-statement-use-of-implants-in-the-pterygoid-region-for-prosthodontic-treatment-/ 25.07.2026 1400hrs GMT
• Broumand, V., Kirchhofer, J. Pterygoid implants as alternative to bone augmentation in implant dentistry. Br Dent J 238, 99–109 (2025). https://doi.org/10.1038/s41415-024-8274-y
• Marco Roy, Luigi Angelo Vaira, Barbara Dorocka Bobkowska, Pterygoid implants, a graftless alternative solution to rehabilitate posterior maxillary atrophy: A retrospective analysis, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, Volume 38, Issue 5, 2026,Pages 897-901

This article is sponsored by Dr Pretam Gharat Dental Implants.