wider the paddle (35). Sometimes the paddle mushrooms onto part of the hard palate for more support (36) .

From five to seven days after surgery, the sutures are removed. Usually the patient must again be dismissed until the laboratory fabricates the implant. Then the tissues are again incised along the original incision line, still clearly visible, and the tissues reflected to expose the underlying sites.

The pterygoid extension implant is tried in the mouth. The anterior segment (37) must fit exactly over the cantilevered anchorage device if it contains a crown with an internal screw devise or fit into the female figure eight lock if it is used with the palatal strut closely fitted to the alveolar process. The posterior portion (38) must be securely lodged in the notch, against the pterygoid process, with the buccal strut tightly gripping the tuberosity.

The tissues are then brought together to check the proximity of the horizontal modified Andrews or Dolder bar to the tissues themselves, as well as to check occlusal clearance when the patient is brought into a centric relationship. The horizontal bar and its pontics should in no way compress the mucoperiosteal tissues nor should the pontics directly occlude with whatever serves in the lower jaw. Enough occlusal clearance is needed between the pontics and opposing teeth to allow for the proper fabrication and occlusion of the final fixed partial prosthesis.

If the fit is correct, the implant is permanently inserted. The implant is held in position manually while the cement inside the coping hardens. Once the cement is set, all excess is removed. The anterior bridgework and implant are cemented simultaneously.

The tissues are sutured over the crest and under the bar (39), and the patient instructed to return within a week for removal of the sutures. No temporary acrylic splint is necessary. The pontics extending from the horizontal bar should not contact the opposing arch, and occlusal balance is not a problem. The patient will be eating soft foods, and the wound will heal faster without the splint.

When bilateral pterygoid extension implants are used, both should be carefully checked on the stone model to see that they fit correctly before exposing the sites. If one of the implants is not secure on the stone model, the patient should wait until both can be inserted simultaneously. The delay is primarily for patient comfort.

After the soft tissues have healed to their normal contours, an elastic impression is taken of the pterygoid extension implant(s) to construct the final partial fixed prosthesis(es) .

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