OBJECTIVES The purpose of this study was to assess the frequency and variety of surgical complications and adverse patient reactions associated with the implantation and explantation of palatal implants. MATERIALS AND METHODS The implantations and explantations of palatal implants in 146 patients who had undergone orthodontic treatment using a palatal implant for anchorage in the time period 1999-2010 were evaluated retrospectively. All complications and adverse patient reactions associated with the surgical intervention of implantation and explantation of the implant were assessed. RESULTS Of the 146 palatal implants reviewed, 104 implantations and 44 explantations met the inclusion criteria and their data could be extracted. Of the 104 implantations, 25 (24.0%) surgical complications and adverse patient reactions could be documented. They consisted of lack of primary stability: 7 (6.7%), prolonged pain: 7 (6.7%), secondary bleeding: 6 (5.8%), perforation of nasal floor: 2 (1.9%), necrotic mucosa anterior of the implant: 2 (1.9%) and sensory impairment of the anterior palate: 1 (1%). The respective incidents for the 44 explantations were: disturbed wound healing: 3 (6.8%), perforation of nasal floor: 1 (2.3%), secondary bleeding: 1 (2.3%) and fracture of the implant: 1 (2.3%). CONCLUSIONS A wide spectrum of surgical complications and adverse patient reactions after palatal implant insertion and removal was found. All complications were of minor severity and duration except after one implantation, where a prolonged hypoesthesia of the anterior palate was found. Although only a small risk of a permanent sensory impairment of the anterior palatal region remains, patients must be well informed accordingly.