Management of the Posterior Maxilla in the Compromised Patient: Historical, Current, and Future Perspectives
CONTINUED (Page 5)
Thomas J. Balshi & Glenn J. Wolfinger
Periodontology 2000, Vol 33, 2003, 67-81.
Treatment planning
Several factors should be weighed by the treatment team when considering the use of implants in the tuberosity or pterygomaxillary region. Access to the oral cavity is often limited. Prior to surgery, therefore, it is critical to measure the vertical opening available for fixture placement and restoration. The amount of space required for the drilling instrumentation and the fixture mount, as well as the length of the implant to be placed, must be considered.
Accurate radiographic analysis of the available bone using computerized tomography and panoramic radiographs also is important in planning implant placement in this complex region.
Finally, because of the limited access in the pterygomaxillary area, placement of implants here requires considerable surgical skill. Extensive experience in fixture placement in other areas of the maxilla is recommended.
Clinical results
Given adequate surgical expertise, the success rate for implants in the pterygomaxillary regions compares favorably with the results of previous studies of implants placed in the maxillary arch. In 1999, the author reported on the results of placing 356 pterygomaxillary implants in edentulous arches and found a cumulative survival rate of 88.2 percent after an average functional period of 4.68 years31. Five other studies of pterygomaxillary implants32-36 also have revealed cumulative survival rates that were consistently above 86.0 percent.
