The disadvantages of the old conventional technology gave rise to Two piece cortical or TTPHIL technique, by Dr Venkat Ratna Nag.Both the implantologist and the patient requirements are not met in conventional implants . To overcome this disadvantage of conventional implants, Dr Venkat designed the two piece cortical system or TTPHIL in which immediate implantation, immediate loading  and ultimately a durable patient satisfaction is achieved.The reason why TTPHIL is successful  is because the implant apex are placed in the basal cortical bone.  Bone augmentation is not required. Risk groups like smokers and diabetics also can get TTPHIL done safely. There is cortical anchorage of TTPHIL implants that leads to instant stability, load bearing and osseointegration.

Advantage of screw retained TTPHIL is that the implant is placed like a conventional imlpant, but it transmits loads to the cortical bone load bearing area leading to no crestal bone loss

  1. Infections are not possible in TTPHIL, as the implants are placed in highly infection resistant basal bone. Conventional implants attract infection because of poor quality in alveolar bone. TTPHIL IMPLANTS are placed deep subcrestal way below the crestal cortical bone which is more prone to infections and bone loss.
  1. Peri implantitis and bone loss are not seen in TTPHIL, whereas they  are very common in conventional implants because of deep subcrestal placements and platform switch Microgrooved one time abutment placements leading to muco integration and locking mechanism.

Bone augmentation is technique sensitive, less predictable,  questionable prognosis procedure. This can be avoided completely in TTPHIL. In conventional implants bone augmentation is very commonly done. Risks, Rejections and Failures are high.

  1. Pre Implant Procedures like Bine grafting, Bone augmentation surgeries are not done in TTPHIL. Instead of intermediate or temporary dentures, permanent crowns can be fixed in a very short time. So patient is never without teeth. 

Extractions and immediate implant placement can be done, even if the teeth are periodontally compromised.

  1. TTPHIL implants require minimal maintenance. Patients have a comfortable way of cleaning dentures regularly, unlike conventional implants. Infections are rare because of the smooth polished abutment surface structures of the TTPHIL Implants. 

  1. The resorption of cortical bone is almost nil. Alveolar bone resorbs very fast. So placing TTPHIL implants in cortical bone makes them very strong. Due to the high mineralization, the cortical bone is very resistant to infections. In conventional implants bone is very susceptible to infections. 
  1. Aesthetics are not compromised in TTPHIL. Placement of implants in areas of high mineralization and low mineralization would not greatly affect crown placement. High esthetic CAD CERAMIC / ZIRCONIA/ EMAX CROWNS are given.
  1. Bone healing is excellent in TTPHIL. In conventional implants bone takes a very long time to heal. Due to the morphology of the implants, healing is fast. There are both Osseofixation and osseointegration in TTPHIL, whereas conventional implants have only osseointegration. 

  1. TTPHIL implants have gold anodized plating that fights off infections and inflammation like Peri implantitis 
  1. 14 successful years of clinical and research experience in two piece cortical or TTPHIL  implantology -having treated thousands of patients successfully, Dr Venkat Ratna Nag  has published numerous articles, won many awards and accolades, conducted  several conferences , and still going on, as the most advanced revolution in dental Implantology, the TTPHIL ALL TILT PROTOCOL , for FULL ARCH / FULL MOUTH REHABILITATION CASES as well as SINGLE TOOTH / MULTIPLE TEETH REPLACEMENT CASES.

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Implants which placed from maxillary tuberosity to pterygoid bone.
Other names: Pterygoid implants/ Tubero Pterygoid Implants/ Pterygo-maxillary Implants

1. Posterior maxilla Quality and Quantity:
QUALITY: D4 Poor Trabecular Soft Bone
QUANITY: Available bone is less. Crestal  Alveolar Bone Resorption from bottom + Sinus Pneumatization from the top

What are the different treatment options in these situations?
Sinus Lifts: Direct/ Indirect
Bone grafting/ Bone Augmentation

3. PTERYGO MAXILLARY BUTTRESS: Butress is anatomically designed to take up the forces. 6-7mm thick cortical bone attached to active muscles. 3rd cortical and 2nd cortical bones have minimum remodelling capacity. 2 to 2.5% compared to 25% of cancellous bone/ year. 
Macro mechanical anchorage
BONE QUALITY : Alveolar Bone Density
BONE QUANITY Alveolar Bone Volume
Minumum inventory: Drills Handpiece Equipment

Complicated: Pterygoid anatomy
– Part of Spenoid bone
– 2 perpendicular plates:
Lateral Pterygoid: attachment to masticatory muscles
Medial pterygoids:
– Pterygoid fossa
– Pterygoid hamulus: Medio Inferio extent of Pterygoid. Sharp point. So we need to place the implant lateral and superior to the Pterygoid hamulus.
– pyramidal process of palatine bone
Ptergo Palatine Fossa or Pterygo Maxillary Fossa
Target : pterygo maxillary fissure: Vital structures??


  • Less time consuming – 72 hours loading possible
  • Less painful – no bone graft or augmentation required
  • Less surgical procedures – minimally invasive with less drilling
  • Less expensive
  • Less number of visits

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2. Call / Whatsapp : +91 9000021174 / +91 9959448800 / 040 23350991 / 040 23372337

Smoking and Dental Implants: TTPHIL IMPLANTOLOGY?

We often get questions from patients about their smoking habits and how it impacts their teeth. Also, some are concerned if smoking affects their ability to get dental implants.

Question: I am a smoker for the past 25 years. Can I get Immediate Implants done with TTPHIL technique?

Most of my patients who are smokers ask me about the success rates of Dental Implants in Smokers when compared with others. The clear answer is that there is no problem with Smoking. There is no direct relation between Smoking and Dental Implants. Smoking indirectly affects the gums if not taken care of properly leading to peri-implantitis. Whatever you smoke and how often you smoke you can definitely have an immediate load implant – one of the reasons of course is that you don’t have a bone limitation, you don’t need a bone transplant – all these procedures which are contraindicated for smokers are not necessary and therefore you have the same chance as any other patient.

You can just live your normal life and we give you the immediate load implants. Smoking doesn’t impact dental implant as it is a complete flapless technique and there is no chance of Infection. Basal 2 Piece Cortical Implantology is based on the concept of bicortical anchorage which will allow immediate stabilization of the implant and loading of the implant.

Cigarette smoking has long been known to be associated with a variety of oral conditions including periodontal diseases which are inflammatory diseases affecting the tissues that surround and support the teeth, bone loss, tissue loss, tooth loss and dental implant failure. Nicotine in tobacco has been shown to reduce the blood flow in the mouth, pipe-smoking can be worse than cigarettes due to the higher temperatures generated in the upper jaw and excessive tooth wear as the teeth clench the pipe. Not only is smoking detrimental to implants it’s also bad for conventional bridgework. Smokers also experience a slower healing time when following implant replacements. If you’re a smoker and considering dental implants be sure to talk to your doctor about any increased health risks. So do not neglect your gums. This can lead to implant failure. #Smoking and Dental Implants
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