Abstract: The technique of TPP (T:maxillary tuberosity,P:pterygoid plate,P:palatine) implants has been proposed, that the pillar composed of maxillary tuberosity,the pyramidal process of the palatineand the pterygoid process of the sphenoid in pterygomaxillary region can provide a certain volume of compact bone. Inclined implants of 30-50 degrees are placed in pterygoid region. As it is located in the end of distal part of maxilla, the distal cantilever of the prosthesis is completely eliminated. TPP implants with good initial stability are often applied in combination with the implants in anterior and bicuspid areas to provide favorable conditions for immediate loading. This technique can be applied for immediate implant and immediate restoration of maxillary complete arch or unilateral multiple posterior teeth loss with alveolar bone atrophy. Furthermore,the success rate is high (>90%). Due to avoiding the procedure of bone augmentation approach in maxillary sinus region and simplifying the procedure of implant surgery, it could reduce the trauma of patients, relieve postoperative reaction and pain, shorten the course of treatment and provide a new clinical solution for patients with insufficient bone in maxillary posterior area, especially for the patients who can not undergo bone graft procedure. However, clinicians still face many difficulties achieving effectively clinical application of this technique, including standard surgical protocol, the correct position of the placement site, preoperative evaluation, the design of length and placement angle, the safety procedure of the surgery and implant direction control and risk management, etc. Our team established standard surgical protocol of TPP technique for immediate implant and immediate loading with severe bone deficiency in maxillary posterior area. We sincerely hope that the article will provide a reference and basis for clinicians when applying the technique to avoid complex operation and complications related to bone augmentation, popularize the clinical application of the technique.

Key words: Pterygoid plate implants, Anatomy of pterygoid maxillary, Osteotome preparation, Immediate loading, Standardized surgery