Evaluation of pterygoid bone volume in resorbed maxilla using dental volumetric tomography for pterygoid implant applications

Rehabilitation of the severely resorbed maxilla remains a major challenge in implant dentistry, particularly in the posterior region where reduced bone height and sinus pneumatization often necessitate complex surgical interventions. While sinus lifting and grafting are frequently employed, they carry risks and may lower patient satisfaction. As an alternative, pterygoid implants offer a promising solution by anchoring into the dense cortical bone of the pterygomaxillary region, enabling implant placement without sinusrelated procedures and reducing cantilever lengths in prosthetic designs. However, the anatomical complexity of this region—marked by its proximity to critical neurovascular structures such as the greater and lesser palatine foramina—demands precise surgical planning and a deep understanding of the surrounding anatomy. This study aimed to assess the spatial relationship between pterygoid implants and adjacent anatomical structures, as well as the bone density at the implant sites in severely resorbed maxillae. Using high-resolution CBCT imaging, 64 virtual implants were placed, and their distances to the greater and lesser palatine foramina and other critical landmarks were measured. Concurrently, the Hounsfield Unit (HU) values were analyzed to evaluate bone quality and its implications for implant stability and osseointegration. The findings of this study are intended to contribute to safer and more predictable surgical planning for pterygoid implant placement, emphasizing the value of three-dimensional imaging in optimizing outcomes for patients with advanced maxillary atrophy.