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Displacement of a Dental Implant into the Pterygoid Fossa: A Clinical Report

Now online in the Journal of Prosthodontics, Drs. Richard R. Dryer and Heather J. Conrad report the first known instance of a dental implant displaced into the pterygoid fossa.

Pterygomaxillary implants improve implant biomechanics and have reported mean implant survival rates comparable to traditional implant sites. To date, only minor surgical complications have been reported in the literature. This article is the first to report a major complication related to implant surgery in the pterygomaxillary region.

As described in the article, a patient presented with an implant assisted removable partial denture but complained that she could no longer tolerate the upper partial. The maxillary teeth and existing implant were removed by an oral and maxillofacial surgeon. During the surgery, 2 implants were placed bilaterally in the pterygomaxillary regions.

On placement of the left implant, the insertion torque was inadequate and the surgeon elected to remove the implant and increase the implant diameter. On insertion with the hand driver, the implant was displaced into the left pterygoid fossa. Efforts to retrieve the implant were unsuccessful.

When the patient was seen two weeks later for follow-up, she reported pain on her left side and limited mandibular opening. She was referred to a radiology team who determined that the dental implant was in close proximity to vital anatomical structures, including, the carotid artery, and was at risk of migration into these structures. The patient underwent surgery by the interventional radiology team and the implant was removed.

This clinical report provides a guideline for the management of a patient with a major surgical complication associated with dental implants in the pterygomaxillary region and highlights the importance of an appropriate referral to medical colleagues for implant removal.

Dryer, RR & Conrad, HJ: Displacement of a Dental Implant into the Pterygoid Fossa: A Clinical Report. J Prosthodont doi doi:10.1111/jopr.13126

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