We all like to show cool x-rays on social media. I’m no different.
And in my opinion, pterygoid implants are the coolest looking titanium on a post-op scan. They just sort of hang back there, floating in a magical realm of hidden torque.
As a result of this cool factor, many surgeons frequently display them on the “gram”. I’m guilty of this too.
Because of the general prevalence of pterygoid implants within the full-arch world of social media, many doctors have asked me the following questions:
- How often do you actually place pterygoid implants?
- Do you think every maxillary arch patient should receive pterygoid implants?
These questions have come from a range of different practitioners with different backgrounds and experience levels.
There are those who are interested in learning about pterygoids but aren’t sure how often they will utilize them. There are those who place pterygoids, but are wondering if they don’t place them often enough. And there are even those who have informed me that their practice has stated it is a disservice to their full-arch patients if they do not place pterygoids on every case.
There is quite an array of opinions and preferences when it comes to the pterygoid implant.
I would absolutely describe myself as a fan of pterygoid implants and I do use them on what I consider a regular basis. I find them highly valuable in my hands to help manage complex cases that would otherwise necessitate zygomatic implants.
But anywho… let’s get down to the brass tacks.
How often do I actually place pterygoid implants?
Arches Completed to Date: 1,927
Because I’m lazy and don’t want to count back through my log, I’m going to assume that ~55% of total arches cut were maxillary arches (typically more maxillary arches are cut than mandibular arches).
Maxillary Arches Cut to Date: 1,927 x 0.55 = ~1,060 Arches
Pterygoids Placed to Date: 180
(Almost always – bilateral pterygoids are placed). So let’s assume ~90 maxillary arches received pterygoid implants.
% of Time Pterygoids Placed in a Maxillary Arch: 8.49%
As you can see, I do NOT place pterygoid implants on every maxillary arch. In fact, I place them less than 10% of the time!
Here’s why I DON’T use pterygoid implants on every case:
- I only use pterygoid implants if composite torque or A-P spread are inadequate. So, to say that in a different way – if composite torque is adequate and I’m happy with my A-P spread – I do not feel pterygoid implants are indicated.
- There are risks associated with pterygoid placement based on the surrounding anatomy that are not associated risks with traditional implants. I do not feel those risks are warranted unless the implant is truly needed for that case to be successful.
- My restorative doctors don’t like to work with pterygoid implants due to difficult access – UNLESS it truly helps load a case and increase the longevity of the prosthetic.
- I use other options to improve spread such as increased angulation and palatal root implants BEFORE going to pterygoid implants.
I’ve said many times that I love ptergyoid implants. And I do.
But I often feel that other practitioners think I use them much more frequently than I actually do. I do place them on a regular basis and have placed almost 200 to date. However, remember that I am often cutting 40-60 arches a month. So, even if I placed 6 pterygoids that month (3 arches) – statistically that’s not a significant percentage.
I hope this article has adequately answered the pterygoid questions many of you have asked and also provided you insight into how you can shape your own practice should you choose to use, or not to use pterygoid implants.
Matthew Krieger DMD
“Sometimes the answer is Yes and sometimes the answer is No.”
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Q & A with Dr. K
“Why do you wear sterile gloves?” |
You are correct in acknowledging that this is not a sterile procedure.
I wear “sterile”, OR style gloves simply because I like the fit and feel of them much better than “out of the box” nitrile gloves. I feel that they give me a better tactile sensation and therefore help me operate at a higher level for full-arch surgery.