Implant placement in the tuberosity–pterygoid region represents a highly challenging surgical procedure, as it is essentially a blind technique performed without direct visualization of the anatomical structures in an anatomically demanding area.
In this case, the initial periapical radiograph (PAR) provided crucial intraoperative information. The initial entry point and angulation were identified as incorrect on the first radiograph.
After modifying the angulation and slightly shifting the entry point mesially, a subsequent PAR obtained immediately after implant insertion confirmed an optimal trajectory and demonstrated the implant apex engaging the pyramidal process.
A 4.13 × 18 mm implant was successfully placed with high insertion torque, ensuring mechanical stability and precise anatomical adaptation.