Mastering Full-Arch Implant Planning with the PATZI Protocol

Understanding a Smarter Way to Approach Complex Maxillary Cases

For patients with severe upper jaw bone loss, traditional All-on-4 or grafting methods may not provide enough long-term stability.

In recent years, the PATZI protocol — combining Pterygoid, Anterior, Tilted, and Zygomatic Implants — has emerged as a systematic approach to address these challenging cases.

This article draws on insights gained from a PATZI protocol training led by Dr. Tomas Kaczynski, an experienced implantologist and educator.

The Prosthetically Driven Logic Behind PATZI

Successful full-arch rehabilitation starts with prosthetic planning — not surgery.

Before a single implant is placed, the amount of alveoloplasty (bone reduction) required to hide the transition line between natural gum and prosthetic pink acrylic or zirconia must be calculated.

This single step determines:

  • How much residual bone height remains after leveling the ridge

  • Whether anterior implants can be placed at all

  • If posterior anchorage (such as pterygoid or zygomatic implants) will be necessary

By evaluating prosthetic space first, we plan the surgery backward — from prosthetic design to bone availability, not the other way around. This is the essence of the PATZI mindset.

Step-by-Step Overview of the PATZI Protocol

PATZI is an adaptive workflow designed for severely atrophic maxillae, proceeding through a logical sequence:

  1. Pterygoid (P) – Posterior anchorage in dense pterygoid bone. Often the key to eliminating distal cantilevers.

  2. Anterior (A) – Placement of conventional or angled anterior implants when bone allows.

  3. Tilted (T) – Strategically angled implants in mid-maxillary areas to optimize antero-posterior spread.

  4. Zygomatic (Z) – If posterior anchorage cannot be achieved, zygomatic implants provide support from the cheekbone.

  5. Immediate (I) – Whenever possible, immediate loading is achieved if insertion torque and primary stability meet protocol requirements.

Each stage builds on the previous one, offering intraoperative flexibility and minimizing surprises.

Why Pterygoid Implants Are the Cornerstone of PATZI

From my perspective — and echoed by many experienced clinicians — pterygoid implants are the most critical component of the PATZI protocol.

They:

  • Provide remote posterior anchorage without sinus grafting

  • Expand the antero-posterior spread, improving biomechanics

  • Allow for shorter prosthetic cantilevers

  • Preserve precious anterior bone for esthetics

When placed properly, a pterygoid implant can dramatically simplify a case that might otherwise require zygomatic intervention.

Advantages of the PATZI Approach

  • Avoids major grafting procedures

  • Improves implant distribution and prosthetic stability

  • Reduces stress on anterior implants

  • Enables immediate full-arch loading

  • Standardizes communication and planning between surgical and prosthetic teams

Key Takeaway

The PATZI protocol isn’t a “trick” or a replacement for experience — it’s a structured, decision-making framework rooted in prosthetically driven principles.

By analyzing bone volume after alveoloplasty, and deciding when pterygoid or zygomatic support is necessary, clinicians can achieve predictable results even in the most resorbed maxillae.

About the Author

Dr. Onur Cavus, BDS, PhD, is a general dentist certified by the RCDSO and based in Toronto and North York.

He provides advanced implant, surgical, and sedation dentistry, integrating digital planning, and modern protocols such as PATZI to achieve functional and aesthetic full-arch outcomes.

Upper and Lower Full Arch Fixed Dentures

Frequently Asked Questions About the PATZI Protocol

PATZI stands for Pterygoid, Anterior, Tilted, Zygomatic, and Immediate loading. It’s a structured decision-making framework for implant placement in atrophic maxillae, helping clinicians adapt in real time to anatomical challenges.

While All-on-4 relies on four implants per arch, PATZI is more flexible and includes posterior remote anchorage (pterygoid and zygomatic implants). This reduces the need for bone grafting and improves prosthetic biomechanics.

The decision depends on the bone available after alveoloplasty. If adequate bone remains in the posterior maxilla, pterygoid implants are preferred. If not, zygomatic implants provide the necessary anchorage.

No. PATZI is primarily for patients with severe bone loss in the upper jaw where conventional implants cannot provide adequate support. A thorough 3D CBCT analysis determines candidacy.

Yes — the “I” in PATZI stands for Immediate Loading. When insertion torque is sufficient, a temporary fixed prosthesis can often be delivered the same day, ensuring function and esthetics during healing.

Previous
Previous

Pterygoid Implants in Full-Arch Rehabilitation — Expanding Treatment Possibilities

Next
Next

Understanding Moderate IV Sedation in Dentistry | Toronto Sedation Dentist – Dr. Onur Cavus