The sinus cavity and the rarefied posterior maxillary bone make it difficult to place implants posterior to the first premolar. Placement of an implant into the pterygoid plate area has been used to overcome these anatomic obstacles, allowing successful restoration of the area. Sixty-four implants were placed in 49 patients. Forty-three implants are in function. There have been 7 failures. The technique is described and a typical case is illustrated.