{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:08:55Z","timestamp":1789384135724,"version":"build-2803163510"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Pterygoid implants are increasingly used to provide distal support in full-arch maxillary rehabilitation, improving biomechanical stability and reducing posterior cantilevers. Despite high reported survival rates, their placement is technically demanding because of the complex anatomy of the pterygomaxillary region and the proximity of critical neurovascular structures. Implant displacement into adjacent deep anatomical spaces is a rare but potentially serious complication. The aim of this report is to describe the management of sequential intraoperative complications involving pterygoid implants\u2014initial migration into the maxillary sinus followed by displacement into the pterygopalatine fossa\u2014and to analyse the technical factors that contributed to them. Case Description: A 68-year-old woman underwent full-arch maxillary rehabilitation with eight implants, including bilateral pterygoid implants. Both pterygoid implants showed progressively decreasing primary stability and migrated into the maxillary sinus. During a salvage attempt, a newly inserted pterygoid implant deviated and was displaced beyond the pyramidal process into the pterygopalatine fossa together with the insertion driver. Cone-beam computed tomography (CBCT) localized the implant\u2014lying medial to the lateral pterygoid plate, anterior to the pterygoid process\u2014and guided a targeted retrieval based on careful blunt dissection, performed in an outpatient setting without general anesthesia or endoscopic assistance. A correctly positioned pterygoid implant was then placed. The anterior implants (insertion torque &gt; 60 N\u00b7cm) were immediately loaded; at four months the right pterygoid implant was uncovered, and the left implant retained in the sinus was retrieved and replaced using a trans-sinus technique with elevation of the Schneiderian membrane. Conclusions: This case highlights the importance of accurate, consistent anatomical localization, complete osteotomy preparation, appropriate implant selection, and controlled, torque-monitored insertion during pterygoid implant placement. It also demonstrates that rare displacement of an implant into a deep anatomical space can be safely managed in an outpatient dental setting by experienced clinicians using a structured, image-guided approach.<\/jats:p>","DOI":"10.3390\/dj14090592","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"592","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Displacement of a Pterygoid Implant into the Pterygopalatine Fossa and Its Surgical Retrieval: A Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4376-4521","authenticated-orcid":false,"given":"Horia Mihail","family":"Barbu","sequence":"first","affiliation":[{"name":"Oral Implantology Department, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania"},{"name":"Prof. Dr. Barbu Academic Clinic, 011473 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7159-6284","authenticated-orcid":false,"given":"Andreea Sorina","family":"Petris","sequence":"additional","affiliation":[{"name":"Prof. Dr. Barbu Academic Clinic, 011473 Bucharest, Romania"},{"name":"Titu Maiorescu Doctoral School of Dental Medicine, 040441 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania Andrada","family":"Iancu","sequence":"additional","affiliation":[{"name":"Prof. Dr. Barbu Academic Clinic, 011473 Bucharest, Romania"},{"name":"Department of Prosthodontics, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosmin","family":"Ulman","sequence":"additional","affiliation":[{"name":"Trident Dental Clinic, 050533 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yarin","family":"Lorian Singer","sequence":"additional","affiliation":[{"name":"Lorian Medical, Tel Aviv 6438123, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adi","family":"Lorean","sequence":"additional","affiliation":[{"name":"Lorian Medical, Tel Aviv 6438123, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1097\/SCS.0000000000008517","article-title":"Pterygoid implant-based \u201cVIV\u201d design for rehabilitation of extreme maxillary atrophy","volume":"33","author":"Ren","year":"2022","journal-title":"J. Craniofac. Surg."},{"key":"ref_2","first-page":"720","article-title":"Retrospective study of 68 implants placed in the pterygomaxillary region using drills and osteotomes","volume":"24","author":"Carrillo","year":"2009","journal-title":"Int. J. Oral Maxillofac. Implants"},{"key":"ref_3","unstructured":"Worthington, P., and Br\u00e5nemark, P.-I. (1992). Osseointegrated fixtures in the pterygoid region. Advanced Osseointegration Surgery: Applications in the Maxillofacial Region, Quintessence."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1111\/jopr.70031","article-title":"Survival outcomes of implants placed in the pterygoid region: A retrospective study of up to 9 years","volume":"35","author":"Bidra","year":"2025","journal-title":"J. Prosthodont."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Raouf, K., and Chrcanovic, B.R. (2024). Clinical outcomes of pterygoid and maxillary tuberosity implants: A systematic review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13154544"},{"key":"ref_6","first-page":"e82820","article-title":"Clinical outcomes and success factors of pterygoid implants in the posterior atrophic maxilla: A prospective study","volume":"17","author":"Mirdah","year":"2025","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.ijom.2015.12.009","article-title":"Anatomical and radiological approach to pterygoid implants: A cross-sectional study of 202 cone beam computed tomography examinations","volume":"45","author":"Elnayef","year":"2016","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s40729-024-00560-z","article-title":"Anatomical study of pterygoid implants: Artery and nerve passage through bone dehiscence of the greater palatine canal","volume":"10","author":"Taniguchi","year":"2024","journal-title":"Int. J. Implant Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/jopr.13126","article-title":"Displacement of a dental implant into the pterygoid fossa: Clinical report","volume":"28","author":"Dryer","year":"2019","journal-title":"J. Prosthodont."},{"key":"ref_10","first-page":"205","article-title":"Misplaced pterygoid implant removed following surgical exploration","volume":"12","author":"Surya","year":"2023","journal-title":"J. Evol. Med. Dent. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s40729-023-00472-4","article-title":"Virtual pterygoid implant planning in maxillary atrophic patients: Prosthetic-driven planning and evaluation","volume":"9","author":"Sun","year":"2023","journal-title":"Int. J. Implant Dent."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Franchina, A., Stefanelli, L.V., Gorini, S., Fedi, S., Lizio, G., and Pellegrino, G. (2020). Digital approach for the rehabilitation of the edentulous maxilla with pterygoid and standard implants: The static and dynamic computer-aided protocols. Methods Protoc., 3.","DOI":"10.3390\/mps3040084"},{"key":"ref_13","first-page":"825","article-title":"Accuracy of dynamic navigation surgery in the placement of pterygoid implants","volume":"40","author":"Jung","year":"2020","journal-title":"Clin. Oral Implants Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100001","DOI":"10.1016\/j.adoms.2020.100001","article-title":"Retrieval of displaced dental implant: A case of buccal space displacement and an analysis of the literature (2015\u20132019)","volume":"1","author":"Yoshida","year":"2021","journal-title":"Adv. Oral Maxillofac. Surg."},{"key":"ref_15","first-page":"1547","article-title":"Modified surgical protocol for placing implants in the pterygomaxillary region: Clinical and radiologic study of 454 implants","volume":"27","author":"Vela","year":"2012","journal-title":"Int. J. Oral Maxillofac. Implants"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"917.e1","DOI":"10.1016\/j.prosdent.2024.02.014","article-title":"Identifying an optimal approach for the placement of pterygoid implants: A 3D finite element analysis","volume":"131","author":"Chen","year":"2024","journal-title":"J. Prosthet. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1371","DOI":"10.4317\/jced.61787","article-title":"Optimizing pterygoid implant placement without sinus intrusion in edentulous Vietnamese patients: A comprehensive tomographic analysis and cross-sectional study","volume":"16","author":"Luong","year":"2024","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.5195\/d3000.2025.1063","article-title":"Survival of immediate-loaded pterygoid implants with multi-unit abutments in the atrophic posterior maxilla","volume":"13","author":"Droubi","year":"2025","journal-title":"Dentistry 3000"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"de Ara\u00fajo Nobre, M., Lopes, A., Ferro, A., Moura Guedes, C., Almeida, R., Nunes, M., Gouveia, M., Santos, D., and Vitor, I. (2026). Immediate Full-Arch Maxillary Rehabilitation Supported by Four Implants: A Retrospective Study with 15 to 20 Years of Follow-Up. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020446"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Coskun, U., and Altintas, N.Y. (2025). Comparison of posterior support strategies with pterygoid implants for full-arch implant rehabilitation in the atrophic maxilla: A finite element study. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-07060-5"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.prosdent.2020.12.045","article-title":"Implant placement in the pterygoid region with dynamically navigated surgery: A clinical report","volume":"128","author":"Yao","year":"2022","journal-title":"J. Prosthet. Dent."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Misch, C.E. (2015). Dental Implant Prosthetics, Elsevier. [2nd ed.].","DOI":"10.1016\/B978-0-323-07845-0.00016-6"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4251","DOI":"10.1007\/s00784-021-03939-z","article-title":"Low-speed drilling without irrigation versus conventional drilling for dental implant osteotomy preparation: A systematic review","volume":"25","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_24","first-page":"353","article-title":"1-year results from a split-mouth randomised controlled pilot trial comparing implants with 0.75 mm of machined collar placed at bone level or supracrestally","volume":"11","author":"Meloni","year":"2018","journal-title":"Eur. J. Oral Implantol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"300060520948736","DOI":"10.1177\/0300060520948736","article-title":"Accidental migration of a dental implant into the nasal cavity","volume":"48","author":"Li","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_26","first-page":"e459","article-title":"Accidental displacement of a dental implant into the sublingual space: A case report","volume":"8","author":"Cariati","year":"2016","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e403","DOI":"10.1097\/SCS.0000000000003768","article-title":"Displacement of dental implant into the submental space after surgical integration","volume":"28","author":"Kirtay","year":"2017","journal-title":"J. Craniofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.bjoms.2020.01.006","article-title":"Intraconal orbital displacement of a dental implant treated with an endoscopically-assisted approach","volume":"58","author":"Bocchialini","year":"2020","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"B\u00e4r, A.-K., Werkmeister, R., Becker, P., Lindwedel, K., and Al-Nawas, B. (2024). Displacement of maxillary dental implants: A case series on various scenarios. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-05022-x"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"16179","DOI":"10.1038\/s41598-019-52672-x","article-title":"Three-dimensional descriptive study of the pterygomaxillary region related to pterygoid implants: A retrospective study","volume":"9","author":"Rojo","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.ijom.2022.06.009","article-title":"Characteristics and management of dental implants displaced into the maxillary sinus: A systematic review","volume":"52","author":"Seigneur","year":"2023","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4440","DOI":"10.1038\/s41598-021-83721-z","article-title":"Evaluation of different surgical approaches to remove dental implants from the maxillary sinus","volume":"11","author":"Hamdoon","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.ijom.2020.01.009","article-title":"Endoscopic sinus surgery for dental implant displacement into the maxillary sinus: A retrospective study","volume":"49","author":"Safadi","year":"2020","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_34","first-page":"9","article-title":"Functional rehabilitation of the maxillary sinus after modified endoscopic sinus surgery for displaced dental implants","volume":"9","author":"Eo","year":"2023","journal-title":"Int. J. Implant Dent."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s13005-022-00339-w","article-title":"Removal of dental implants displaced into the maxillary sinus: A retrospective single-center study","volume":"18","author":"Bennardo","year":"2022","journal-title":"Head Face Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Gong, Z., Shen, Y., Qi, S., Cao, L., Fan, X., Lu, C., and Wang, J. (2024). Influence of bone conditions on the accuracy of implant placement. Bioengineering, 11.","DOI":"10.3390\/bioengineering11111161"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/592\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:59:20Z","timestamp":1789383560000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["dj14090592"],"URL":"https:\/\/doi.org\/10.3390\/dj14090592","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]}}}