After the implant has been correctly fitted to the bone (56), the tissues are reapproximated over the portions to be buried under the modified Dolder or Andrews type bar. They are sutured closed. Mattress sutures are used for the thicker tissues, and simple sutures for the thinner.

The denture is once again relieved and fitted to prevent the palatal tissue from dropping. The denture must be carefully adjusted to retain its original occlusion against whatever serves in the lower arch. The patient is dismissed until the tissues heal, when impressions can be made for the final prosthesis. Today, no struts rest on the hard palate so there is no need to place immediate pressure on the soft tissues covering the hard palate.

The type of final prosthesis depends in large part upon the amount of bone loss anteriorly. If it has been extensive, leaving a low and fragile anterior ridge, a palateless, removable prosthesis with internal clips is suggested. The pink acrylic used to restore vertical dimension and a natural ridge contour provides a good buttress against the tongue. When the anterior ridge is relatively tall and sturdy, a full arch fixed prosthesis, fabricated preferably of a nonporous, lightweight metal with porcelain or acrylic teeth, can be used. Today, most pterygoid extension implants are constructed to contain two parallel bars (rather than the vertical posts) containing intra-coronal attachments for a snap-on removable prosthesis.

The Totally Edentulous Maxillae:

The Bladevent-Assisted Pterygoid Extension Implant

Originally, bladevents were routinely incorporated into the anterior portion of a pterygoid extension implant for the totally edentulous maxillae. The strong abutment potential of a correctly seated bladevent had been amply demonstrated in other situations. However, this stability depends in large part upon rapidly establishing balanced occlusion if the bladevent is to be under mechanical stress, or keeping the bladevent out of occlusion to avoid traumatization. As with the old-fashioned toroplant (q.v.), it has been very difficult to adequately protect the anterior bladevents in a totally edentulous situation. Time lapse between the various stages; patient impatience with wearing a modified conventional denture over the bladevents and subsequent misuse; the denture's developing a loose fit as the swollen tissues under it healed; and delay in laboratory procedures are a few of the impediments that make a practical principle difficult to apply.

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