Basal Implant - A Boon to Immediate Implant Loading: A Case Report

Introduction

Dental implants are now the preferred method of rehabilitation over traditional fixed partial dentures (FPDs) and removable partial dentures (RPDs). However, the main disadvantage of conventional implants is the delay in loading, which typically involves waiting a minimum of 4-6 months after placement. This is one of the reasons for implants not being a popular option for rehabilitation. Introduction of basal implants and its design developments have made immediate loading possible, making it a popular choice.¹ More aggressive threads of basal implants have made placement possible even in cases of trauma where bone is compromised and success of conventional implants is in doubt.²

Conventional Crestal Implantology

When an implant is placed into the jaw bone from the crestal alveoli and has vertical primary load-transmitting surfaces, it is referred to as a crestal-type implant in crestal implantology. The alveolar bone, which is used by conventional implants, is lost following tooth extraction and diminishes over the course of a person's life as function declines. As the front section of the jaw typically provides sufficient vertical bone, it is customary to place screws which are at least 10 - 13 mm long in this area. Crestal implants are not advised for patients with very limited available vertical bone.

Basal Implantology

Modern implantology systems, such as basal implantology or bicortical implantology, use the basal cortical section to hold dental implants in place. The retention of these exceptional and cutting-edge implants is made possible owing to the design.³ The term "orthopedic implant" is also used to distinguish basal implants from the more common phrase "dental implant", as basal implantology involves the use of orthopedic surgery guidelines. The limitation of basal implants is that it is not indicated in single tooth replacement and requires a greater number of implants to be placed for rehabilitation.⁴

Case Report

A 35-year-old male patient reported to the Department of Prosthodontics, Crown and Bridge, with multiple missing teeth in mandibular arch which were extracted following an accident one year ago. On examination, only second molars and impacted third molars were present in the mandibular arch (Figure 1). Areas of irregular healing following trauma were noted on the ridge. Patient desired rehabilitation with fixed implant prosthesis with minimum time for the completion of procedure. Considering the time factor and the age of patient, implant placement followed by immediate loading was decided as a suitable treatment choice. Since immediate loading was required, basal implant was the best choice available. Pre-operative orthopantomogram (OPG) was advised. The patient underwent standard blood investigations including clotting time and bleeding time, and the findings were deemed to be within normal limits. The local anesthesia was achieved with infiltration technique using lignocaine 2% to ensure the responsiveness of the mandibular nerve. Then, utilizing a flapless rapid method, ten basal implants were inserted which was single piece (Figure 2).

Polyvinyl siloxane material was used to record impressions and Aluwax was used to record tentative jaw relations. An OPG was made to verify their positions and angulations (Figure 3). Definitive jaw relation records were made on the second day following the successful completion of the metal try-in procedure and the metal framework trial within the patient's mouth. On the third day, a cement-retained porcelain-fused to metal (PFM) FPD was functionally loaded onto every implant, resulting in a bilateral balanced occlusion. Final smile evaluation was done (Figure 4).

Discussion

Since basal implants are positioned in the cortical bone which provides a greater primary stability, immediate loading is feasible and results are more predictable. As soon as feasible, the metal framework should be splinted to prevent further deterioration of the peri-implant bone structures due to the 72-hour bone remodeling process.

The masticatory forces that are generated in the bone surrounding the implants are also distributed to other cortical locations by the splinting. Traumatology is familiar with this process and its guiding principles.⁵ Using handgrip equipment, ten implants were inserted using a flapless technique into the mandibular jaw. It is possible to introduce the aggressively threaded, smooth surface basal implants into contaminated sockets.⁶ Without corticalization, excellent primary stability may be attained along the vertical surfaces of implants. They can therefore be utilized for both immediate loading and placement.⁷ In this instance, the entire process was completed in five days.

Basal implants support single and multi-unit restorations in the upper and lower jaws. They can be placed both in extraction socket as well as in the healed bone. Their structural characteristics enable their implantation in a bone with insufficient height and width. In cases where alternative treatment plans involve uncertain augmentations, basal implants should always be the first choice. The method of basal implantology provides solutions for any issue related to traditional (crestal) implantology. This shortens the time required for the treatment completion.

Conflict of Interest

Nil