We describe the management and 3-year outcome of a fractured pterygomaxillary implant in a full-arch maxillary rehabilitation. A 48-year-old man with severe periodontitis and bruxism received a six implant full-arch prosthesis, including two pterygomaxillary implants. One year post-delivery, the prosthesis fractured. Radiographic examination revealed fracture at the apical third of the right pterygomaxillary implant. Coronal fragment and prosthesis were removed, apical fragment was retained because of its anatomical position. To restore posterior support, a short implant was placed using trans-alveolar sinus lift. After 4 months, a new prosthesis was delivered. At the 3-year follow-up, the outcome was successful. This is the first report of a fractured pterygomaxillary implant managed by retaining the apical fragment. We demonstrate that conservative retention of a fractured pterygomaxillary implant can be safe when surgical retrieval carries risks. We emphasize the importance of managing risk factors, like bruxism, in full-arch reconstructions involving pterygomaxillary implants.