Bicortical Anchorage
The bicortical anchorage is the fundamental mechanical principle on which the Bilateral Sinus Solution™ (BSS) is based. It consists of the engagement of the pterygoid implant in two distinct bone cortices, guaranteeing exceptional primary stability.
| Bicortical Anchorage | |
|---|---|
| First cortex | Maxillary tuberosity |
| Second cortex | Pterygoid plates of the sphenoid |
| Density | D1-D2 |
| Torque | >50 Ncm |
| Immediate loading | Possible |
Mechanism
Bicortical anchorage is achieved when the pterygoid implant, placed at 45°-60°, crosses two distinct cortices: the first cortex of the maxillary tuber (entry point) and the second cortex of the sphenoid plates (terminal anchorage, about 1 cm). Between the two cortices, the implant crosses the medullary bone of the tuber and of the pyramidal process of the palatine bone.
The pterygoid implant, placed with an inclination of 45°-60°, crosses in order:
- First cortex: the cortical wall of the maxillary tuber (entry point)
- Medullary bone: the body of the tuber and the pyramidal process of the palatine bone
- Second cortex: the cortical plates of the sphenoid (terminal anchorage point, about 1 cm)
Biomechanical advantages
Bicortical anchorage offers primary stability with torque above 50 Ncm, comparable to bone screws. The masticatory forces are distributed on two separate cortices reducing peri-implant stress. It allows immediate loading within 24-48 hours and prevents implant failure by reducing micromovement, the main cause of dental implant failure.
- Primary stability: the insertion torque exceeds 50 Ncm, comparable to bone screws
- Load distribution: the masticatory forces are transferred onto two separate cortices, reducing peri-implant stress
- Immediate loading: bicortical stability allows loading the implant within 24-48 hours
- Failure prevention: bicortical anchorage reduces micromovement, the main cause of implant failure
Role in basal implantology
Bicortical anchorage is the heart of basal implantology. While traditional implantology relies on the alveolar bone, often resorbed in atrophies, the Bilateral Sinus Solution™ (BSS) uses two basal bone sites that are always present and stable. The comparison is clear: traditional mono-cortical implant with 25-40 Ncm torque vs bicortical pterygoid implant with torque above 50 Ncm.
The bicortical anchorage is the heart of basal implantology. While traditional implantology relies exclusively on the alveolar bone (often resorbed in atrophies), the bicortical anchorage in the Bilateral Sinus Solution™ (BSS) uses two basal bone sites that are always present and stable.
Comparison with traditional implantology
| Parameter | Traditional implant | Bicortical pterygoid implant |
|---|---|---|
| Anchorage | Mono-cortical | Bi-cortical |
| Bone used | Alveolar | Basal |
| Typical torque | 25-40 Ncm | >50 Ncm |
| Immediate loading | Not always possible | Always possible |
| Need for grafts | Often necessary | Never necessary |
Video: the anchorage areas
Zone 18 — 21×4.5 implant in the cortical plates of the sphenoid
The left posterior pillar: bicortical anchorage, torque 100-150 N.
Zone 28 — 21×4.5 implants in posterior basal bone
The right posterior pillar: bone that never resorbs.
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