All on 6 Dental Implants in Vijayawada | A Case Study

People nowadays are opting for faster treatment times, and gone are the days when people can wait for 3 months to get their implants loaded. Due to the complexity of life and lifestyle changes, people are opting for fixed teeth at a faster pace, typically within a week. Most of them are from abroad or planning to go abroad shortly.

Well, in such cases, the dentist should opt for a more suitable option according to the patient's will and comfort, and in those options, the 1st and foremost option is all-on-6 with pterygoids.

Here in this blog, I will discuss all on 6 with pterygoids, presenting the case I did today as an example for more clarity, so this is like explaining the patients with a real case as an example.

What is an all-on-6 with Pterygoids?

It is basically an advanced version of all-on-6, where BI-CORTICAL engagement is very much an essential part, so that immediate loading is always predictable. and also 4 implants will be engaging the jawbone and the nasal floor (anterior implants), and two implants will be engaging the jaw bone and the pterygoid plate of the spenoid bone, thus it is always bicortical in nature and so the implants will acheive massive torques often more than 70 ncm and so immediate loading is possible instaed of waiting for 3 months after implant placement. Please examine this X-ray of our patient so that you can appreciate the nasal floor engagements and pterygoid engagement.

Why do many clinics prefer unicortical engagement instead of bicortical engagement?

In simple words unicortical engagement is very easy and surgically less demanding for a surgeon, that is to engage the 1st cortical of the bone which is called NEAR cortical (the second cortical is called as FAR cortical), the engagement of 1st cortical is easy as it require smaller implants and it entirely remains in the jaw bone and never engages the nasal floor, and in cases where there is no bone espescially in the posterior maxilla as in this case, they often say that implants and fixed teeth are not possible and so only removable dentures are an option.

They never even try to engage the pterygoid bone when the posterior bone of the jaw is lost. Mind you, the pterygoid bone is a dense cortical bone and is resistant to resorption, and also, pterygoid implants offer excellent long-term survival rates, well documented in recent studies, and the success rate is over 98 percent. As many dentists never engage the second cortex, they either reject the case for lack of bone quantity or quality, or they reject immediate loading as an option; they simply place implants and ask you to wait for 3 months before giving you a fixed teeth set.

It's interesting to note that 100 percent of practicing orthopedic surgeons use bicortical fixation as the standard for surgery, and only 10 percent of dentists use it as the standard for implant surgeries.

Why is bicortical engagement the best option for you as a patient?

The bone typically has 2 cortices, the 1st cortex called the near cortex and the second cortex called the far cortex. The 2nd cortical bone is a dense bone and is often very, very less susceptible to infection and resorbtion and so it's also called a stable cortex.

To engage this kind of quality bone is a choice that every surgeon should prefer, and also due to these stable cortices, the primary stability of an implant is raised by many folds, and so the case is eligible for immediate loading, but also the long-term success rate is increased dramatically.

That's the reason orthopedic surgeons never miss the far cortical engagement, and there are many studies that state that bicortical engagement in dental implants shows long-term success and stability.

That's why we at your dentist dental hospital, located in Vijayawada, Andhra Pradesh, always use bicortical engagements in our daily practice of (all-on-6 dental implants) implantology, and so almost all the cases done here are loaded within a week, just like in the United States or the United Kingdom. Almost all the developed countries use bi-cortical engagement for implant placement, and also all of them give teeth within a week.

Here are a few studies you can research further: they were published in reputable international journals.

1) Hsu et al., 2016

“Comparison of Initial Implant Stability of Implants Placed Using Bicortical Fixation, Indirect Sinus Elevation, and Unicortical Fixation.”

This study specifically compared bicortical fixation with other approaches in the posterior maxilla and supports the idea that bicortical fixation can improve initial stability and allow the use of longer implants.

2) Mantovani et al., 2018

“Influence of cortical bone anchorage on the primary stability of dental implants.”

This paper found that insertion torque values and ISQ were influenced by cortical bone contact, supporting your statement that cortical engagement improves primary stability.

3) Pałka et al., 2019

“Immediately Loaded Bicortical Implants Inserted in Fresh Extraction and Healed Sites…”

This clinical study reported cumulative survival of 99.3% at 12 months, 98.6% at 24 months, and 97.0% at 35 months for immediately loaded bicortically anchored implants, which is useful when you want to connect bicortical anchorage with successful immediate loading outcomes.

4) Di Stefano et al., 2021

“Stability of Dental Implants and Thickness of Cortical Bone: Clinical Research and Future Perspectives. A Systematic Review.”

5) Rues et al., 2021

“Effect of bone quality and quantity on the primary stability of dental implants in a simulated bicortical placement.”

This study found that primary stability tended to increase with higher bone mineral density and greater overall cortical bone thickness, and that optimum stability in their model was seen with overall cortical thickness >2.0 mm.

6) Javed & Romanos, 2010

“The role of primary stability for successful immediate loading of dental implants. A literature review.”

How do pterygoid implants act as a biomechanical advantage for all-on-6?

Pterygoid implants can give an All-on-6 a real biomechanical advantage, mainly because they let you place the most distal support much farther posteriorly. That changes the force system of the whole prosthesis. Clinical reviews describe pterygoid implants as useful for avoiding cantilevers and improving biomechanical stability in the atrophic maxilla (where the upper jaw is severely resorbed).

Here is the practical biomechanical logic:

1. They increase the anteroposterior spread

When the posterior implant is placed into the pterygomaxillary region, the terminal support moves more distally than a conventional anterior-only or premolar-ending full-arch design. A wider A-P spread improves the load distribution of the prosthesis and is one of the implant-distribution factors associated with better outcomes in maxillary full-arch prostheses.

2. They reduce or eliminate the distal cantilever length

This is the biggest advantage. In a standard upper full-mouth implant without posterior support, the molar region often becomes a cantilever. Cantilevers increase bending moments on the distal implants, prosthetic screws, framework, and crestal bone. The literature on full-arch maxillary prostheses notes that distal cantilevers can raise mechanical risk, while pterygoid implants are specifically used to avoid those cantilevers.

3. They convert the prosthesis from a “lever” into a better-supported arch

Without pterygoids, posterior occlusal forces act farther away from the terminal implant, so the framework behaves more like a long lever arm. With pterygoid implants, the point of posterior support shifts backward, so the same chewing load creates a smaller moment arm. In practical terms, that means less torque on the anterior implants and less stress concentration at the crestal bone of anterior implants. This is the core mechanical reason surgeons like pterygoids in maxillary All-on-6 cases. The recent comparison studies on posterior support strategies were designed specifically to address the biomechanical risk associated with cantilevering.

4. They improve posterior occlusal support

A maxillary full-arch works better when posterior loading is carried by actual posterior fixtures rather than by a long distal extension. That can make the restoration feel more stable during mastication, especially in stronger biters or patients with broader arches. Clinical series of pterygoid implants in atrophic maxillae report good primary stability and high survival, which is why they are used in fixed full-arch prostheses.

5. They help you preserve a more favorable force pathway in soft maxillary bone

The maxilla already has poorer bone quality,often D4 for indian population, than the lower jaw, so long cantilevers are even less desirable there. A recent systematic review found that in maxillary fixed prostheses, the all-on-6 implant group had less marginal bone loss than the all-on-4 implant group, and that anteroposterior implant distribution was an important factor in survival. That supports the idea that an All-on-6 benefits not just from more implants, but from where the implants are placed.

So, in one sentence:

Pterygoid implants make an All-on-6 biomechanically stronger by providing support posteriorly, increasing A-P spread, reducing cantilever, lowering bending moments on the framework and implants, and improving posterior load sharing.

All-on-6 Dental Implants Vijayawada

And Dr. Edara Surendranath is well-versed in placing pterygoid implants, with an almost 98 percent success rate. That's the reason we, at your dentist, with our lead implant surgeon, Dr. Surendranath, will always say yes to a case that was rejected elsewhere for lack of bone.

When the implants are tilted in this way, how are the angulations managed?

We manage the angulations by using multiunit abutments, which typically come in different angulations to counter the implant angulation and give a stable, straight platform for prostheses to be seated.

That is the reason we at your dentist dental hospital,dr surendranath and his team, always use multi-unit abutments for each and every case, even though they are more costly than the normal abutments.

Moreover, multi-unit abutments will give us the option to give the patient a screw-retained teeth set, which could be screw-retained DMLS, screw-retained zirconium, or screw-retained hybrid denture; any option of screw-retained starts with a multi-unit abutment.