3 YEAR 4 MONTHS FOLLOW UP: TTPHIL ALL TILT PROTOCOL: GRAFTLESS FLAPLESS ALTERNATE TREATMENT OPTION. Implant dentistry has growing leaps and bounds in recent years after the successful introduction of osseointegration concept by Prof. P.I Branemark in the early 1960s. Rehabilitation of the maxillary anterior region has been far easier than the maxillary posterior region due to various factors. The posterior maxillary region is characterized by inadequate residual bone height due to maxillary sinus expansion and/or alveolar bone resorption and poor bone density (Type III or IV) according to Lekholm and Zarb classification system. Considering these challenges posed by the anatomy, few techniques have been in use such as sinus lift procedures, guided bone regeneration grafting with bone autogenous and allogenous grafts; and later tilted implants (All-on-4), zygomatic implants were introduced. However, these procedures have complications such as sinus membrane perforation, rejection of graft, graft displacement into sinus cavities, and screw loosening of tilted implants. To prevent such problems posterior-most area of maxillary tuberosity; distal to maxillary sinus can be utilized for implant placement. Implants placed in the compact bone of the pterygomaxillary region shows ossteogration and provides retention and stability. This area is pterygoid or pterygomaxillary region. It was introduced by Tulasne (1992). Tulasne (1989) credited Paul Tessier for proposing an idea of placing implants in the pterygoid region. Due to their long path, length of pterygoid implants ranges from 15 mm to 20 mm. Pterygoid implants take bicortical anchorage, due to which the axial loading is improved and posterior cantilever is eliminated. Throughout literature, several terms are being used to define #pterygoidimplants #tuberosityimplants #tuberopterygoidimplants #pterygomaxillaryimplants” are interchangeable. WhatsApp 9963511139 for complete article https://www.instagram.com/p/B5VkjwwJaig/?igshid=10m7yi10le0b7