11/11/2025
Upper Arch PFAST Case – Clinical Reflection
The incorporation of pterygoid implants into my full-arch rehabilitation protocol has proven to be a transformative advancement in achieving enhanced prosthetic support and long-term stability.
In this recent case involving an elongated and narrow maxillary arch, the access channel of the posteriorly tilted implant emerged between the premolars on the right side. The addition of pterygoid implants effectively eliminated the need for a distal cantilever, thereby reducing occlusal loading on the tilted fixtures and optimizing force distribution across the arch.
Preoperative assessment of the soft tissue architecture—particularly in key anatomical areas—is essential to ensure precise soft tissue management and to promote ideal transmucosal healing. In this case, due to preoperative tissue deficiency, a vascularized interpositional periosteal connective tissue flap (VIP-CT) was performed around the tilted implants. This approach plays a critical role in minimizing soft tissue complications and enhancing long-term maintenance of full-arch restorations.
Ultimately, while bone sets the tone, it is the soft tissue that defines the long-term success of the restoration.
If you want to learn more about cases like this, come join ORCAA Symposium January 15-17 in Las Vegas. Get your tickets before it’s too late!
https://orcaa.zohobackstage.com/ORCAAsFullArchSymposium2026 #/