(T07) Bridging the Gap: Pterygoid Implant-supported Quadrant Rehabilitation for Posterior Maxillary Defects

Purpose of the Study: To present a graftless approach for fixed posterior maxillary rehabilitation using a pterygoid implant in combination with immediate implant placement and provisionalization. This technique, termed the “pterygoid bridge,” offers a minimally invasive solution for patients with severe posterior maxillary defects or complications such as oroantral fistula, reducing the need for sinus augmentation and extended treatment protocols.

Methods: A 75-year-old male patient presented with loss of maxillary premolars and molars, complicated by the development of an oroantral fistula following extractions. After successful surgical closure of the fistula, treatment planning considered removable prosthetics, sinus augmentation with staged implant placement, or a graftless approach. The selected plan involved:

Placement of a pterygoid implant for distal anchorage.

Extraction, socket grafting, and immediate implant placement in the premolar region (#5).

Digital planning and prosthetically driven positioning.

Immediate loading with a screw-retained 2–6 provisional bridge.

Results: The pterygoid implant provided stable posterior support, eliminating the need for sinus augmentation. ISQ values confirmed implant stability, permitting immediate loading. The patient received a functional and esthetic screw-retained provisional restoration on the day of surgery. Postoperative healing was uneventful, with successful maintenance of the oroantral fistula closure and preservation of grafted sites. The patient reported high satisfaction with both esthetics and function.

Conclusion: Pterygoid implants can serve as a predictable and efficient alternative to sinus grafting in compromised posterior maxillary cases. Incorporating a pterygoid implant into quadrant rehabilitation allows for immediate function, reduced morbidity, shorter treatment time, and improved patient satisfaction. The “pterygoid bridge” technique expands the treatment options for patients who might otherwise face invasive or prolonged interventions.

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Books: 1.Holtzclaw D. Remote anchorage solutions for severe maxillary atrophy: zygomatic implants, pterygoid implants, transnasal implants, piriform rim implants, nasopalatine implants, and trans-sinus dental implants. Coppell, TX: Zygoma Partners, LLLP; 2025.
2.Holtzclaw D. Pterygoid dental implants: the art and science. DIA Management Services Inc; 2020.