Procedure for Inserting Pterygoid and Subnasal Implants
The surgical procedure begins with the patient under sedation. Extractions and complete debridement are performed, followed by the use of a scalpel to incise the periosteum in the posterior region of the maxilla. Once the pterygoid bone portion has been skeletonized, a drill is used to create the entry hole for the pterygoid implant.
During this phase, it is crucial for the patient to remain still in the chair, avoiding abrupt movements, as the anatomical engagement area contains the greater and lesser palatine arteries. Once the canal is created, the surgeon proceeds to manually insert the pterygoid implant into the freshly drilled hole.
Manual insertion is essential as the surgeon needs to sense the vibrations during the screwing phase. Too rapid screwing could result in bone breakage and implant failure. Upon completion of the insertion, the head portion of the implant in the posterior region is closed with a healing cap screw.
The same procedure is applied in the frontal area below the nose, using drills for the entry hole. Subsequently, transitioning from a smaller to a larger drill, the entry hole for the dental implant is widened for proper screwing. Before implant insertion, a disinfecting liquid is applied, followed by the implant screwing.
After insertion, a healing cap screw is placed. In the frontal area below the nose, two to four subnasal implants are inserted. Continuing in the other semi-arch, the procedure continues with additional pterygoid and nasal implants to close the sinus and avoid grafts and lifts.
At the end of the procedure, the gum is sutured, and the patient is ready for immediate load fixed prosthesis if their case allows it. The sustainability of a fixed provisional prosthesis for chewing in the next six months of healing or a removable prosthesis for the same period is assessed based on the patient’s specific situation.