Survival of Immediate-Loaded Pterygoid Implants with Multi-Unit Abutments in the Atrophic Posterior Maxilla

Objective: Rehabilitation of the atrophic posterior maxilla is challenging due to insufficient bone quantity and quality. Conventional approaches, such as sinus floor elevation or onlay bone grafting, are associated with higher morbidity, longer treatment times, and increased complications. Pterygoid implants offer a less invasive alternative, utilizing dense cortical bone in the pterygoid apophysis and posterior maxillary tuberosity to provide distal anchorage and full-arch prosthetic support, while avoiding the need for sinus augmentation. Clinical evidence indicates high survival rates, making them a reliable option for posterior maxillary rehabilitation. Materials and Methods: This prospective clinical study included 15 patients (aged 49–78 years) with unilateral posterior maxillary tooth loss that was unsuitable for conventional implants. Each patient received one pterygoid implant and two compressive implants. Preoperative planning included CBCT scans. Surgical procedures involved flap elevation, precise drilling, and manual insertion with high insertion torque. Immediate prosthetic loading was performed within seven days. Postoperative care included antibiotics, analgesics, chlorhexidine mouthwash, and oral hygiene instructions. Implant failure was defined as detectable mobility or conditions requiring removal. Results: All 45 implants (15 pterygoid and 30 compressive) survived over the 12-month follow-up, with no failures observed at 3, 6, or 12 months. Survival rates were 100% for both implant types, and no differences were noted across follow-up periods. Conclusions: Pterygoid implants demonstrate high survival rates and represent a predictable, minimally invasive option for posterior maxillary rehabilitation. Proper preoperative planning and surgical expertise are essential, and further long-term studies are recommended to confirm standardized protocols and durability.