4 Cases Where Remote Anchorage is the Best Option

Implant dentistry has revolutionized the way clinicians restore edentulous patients, but not every case can be managed with standard implant procedures. One of the greatest challenges in implantology is dealing with patients who have insufficient bone volume in the maxilla or mandible, especially in the posterior regions. In such situations, remote anchorage provides a crucial solution.

Remote anchorage refers to the placement of implants in structures that are anatomically distant from the original edentulous site, such as the zygomatic bone, pterygoid bone, or mandibular symphysis, providing a stable foundation for implants. This technique allows for the restoration of both function and aesthetics, especially in cases where conventional implants cannot be placed due to bone resorption, anatomical constraints, or other factors.

This article highlights four clinical cases where remote anchorage is the best option for ensuring optimal implant stability and improving patient outcomes.

1. Severe Maxillary Atrophy

Maxillary atrophy is a common condition encountered in edentulous patients, especially those who have been missing teeth for an extended period. This leads to the resorption of the maxillary alveolar ridge, making traditional dental implant placement challenging. When the bone volume is insufficient, remote anchorage in the form of zygomatic implants becomes the best solution.

A. Clinical Scenario:

A 65-year-old male patient presents with a completely edentulous maxilla due to periodontal disease and years of tooth loss. Upon evaluation, the maxillary alveolar ridge shows severe resorption, especially in the posterior maxilla. CBCT imaging reveals that there is no adequate bone height or width in the posterior regions to place traditional dental implants. The patient is in good overall health and desires a permanent, functional solution to restore his dentition.

B. Why Remote Anchorage is the Best Option:

In this case, zygomatic implants offer a solution by anchoring into the zygomatic bone (cheekbone), which is a dense, stable bone structure. Zygomatic implants are longer than traditional implants and are inserted at an angle into the zygomatic bone, bypassing the need for bone grafting or sinus lift procedures.

By using remote anchorage in the zygomatic bone, this patient can achieve immediate functional and aesthetic restoration with full-arch fixed prostheses. This approach eliminates the need for extensive bone grafting, minimizes surgical risk, and allows for the immediate loading of implants, providing the patient with a faster recovery and restoration timeline.

2. Insufficient Bone Volume in the Posterior Maxilla

One of the primary reasons remote anchorage is used is to address insufficient posterior maxillary bone volume. In many edentulous patients, the bone in the posterior maxilla undergoes significant resorption due to the lack of tooth support, often accompanied by sinus expansion. This makes implant placement in the posterior maxilla challenging.

A. Clinical Scenario:

A 50-year-old female patient presents with a severely resorbed maxillary posterior ridge and an enlarged maxillary sinus. After multiple failed attempts to place conventional implants, the patient’s existing bone is too thin and low in height to support traditional implants. Sinus lift procedures were attempted but were unsuccessful, leaving the patient with no viable options for restoring her posterior teeth.

B. Why Remote Anchorage is the Best Option:

In this case, pterygoid implants are the best solution. Pterygoid implants are placed in the pterygoid bone, which lies behind the maxilla, close to the pterygoid plates of the sphenoid bone. The pterygoid region provides dense, stable bone that can anchor dental implants effectively, bypassing the need for a sinus lift.

The pterygoid implants provide the necessary stability for a full-arch restoration, offering the patient the possibility of immediate implant loading and a fixed prosthesis. This technique has a high success rate and is less invasive than other approaches, such as bone grafting, while delivering superior functional and aesthetic results.

By utilizing remote anchorage in the pterygoid region, this patient can regain functional occlusion and aesthetics with minimal surgical intervention.