Basal implants for patients with bone loss
Basal dental implants offer an option to patients with severe bone loss who would otherwise need bone augmentation surgery before receiving conventional implants.
Patients with significant jawbone loss come to Dr Haim Aseriel's clinic in Jerusalem, sometimes after years of neglect, chronic gum disease or early tooth loss. For these cases, basal implantology is one of the options considered, alongside a bone graft, a sinus lift, short implants and zygomatic implants (compared in the table below).
What are basal implants?
Basal implantology, also called bicortical or cortical implantology, uses the basal bone (the deep, dense and stable part of the jaw) to anchor the implants, unlike conventional implants placed in the softer alveolar bone.
The method was first developed in 1972 by Dr Jean-Marc Julliet, who designed the first one-piece implant (Ghalaut et al., National Journal of Maxillofacial Surgery, 2019). A group of German dentists later refined the technology into the modern system that includes BCS (Bicortical Screw) implants. The clinic places both conventional and basal implants, on site and under local anesthesia; surgery is performed at the clinic together with Dr Yves Weinberg, head of the Oral and Maxillofacial Surgery Department at Barzilai Medical Center. Which approach suits you is decided at the consultation, according to your needs; for the general principles, see the guide to dental implants in Jerusalem.
How a basal implant is built
Structurally, a basal implant has an upper part that connects to the prosthesis and an elongated lower part anchored in the cortical layers. A conventional implant usually waits 3 to 6 months for gradual osseointegration (bonding with the bone); a basal implant relies on immediate mechanical anchorage in the cortex. Basal implants can be combined with short implants depending on each patient's anatomy.
How are basal implants placed?
01
3D imaging and digital planning
Treatment starts with 3D CBCT imaging of the jaw, taken at the clinic (Planmeca ProMax 3D), to map the available cortical bone. The dentist plans the position of each implant with planning software, identifying the palatal, tuberopterygoid and inter-foraminal areas.
02
Implant placement and temporary prosthesis
The basal protocol includes placing the implants and attaching a temporary prosthesis within 72 hours of surgery: the principle of immediate loading, which allows chewing early on (Gangadhar et al., Journal of Orthodontic Science, 2023).
03
The permanent prosthesis
Once the tissues have stabilized, the temporary prosthesis is replaced with the permanent one. In complex cases the approach can be combined with a bone graft. In practice, most patients have functional temporary teeth within a few days of surgery.
What do studies show about basal implant success?
In a small prospective study of 157 basal implants in 10 patients with severely resorbed jaws, the survival rate was 97.5% (Patel et al., Annals of Maxillofacial Surgery, 2021).
However, most studies on the method are small, with relatively short follow-up.
97.5%
- survival: 157 basal implants in 10 patients
90.7%
- survival: 30 basal implants in 11 patients
Another study of 30 basal implants in 11 patients aged 20 to 55 with ridges damaged by trauma in the upper and lower jaws reported three failures, a survival rate of about 90.7% (Mitra et al., Cureus, 2023). In the absence of large long-term studies, these data and the alternatives are presented to patients before the treatment is chosen.
Types of basal implants
There are several main types of basal implants, chosen according to the location, the amount of available bone and the goals of treatment.
A one-piece implant anchored in two cortical layers for maximum stability.
Anchored in the pterygoid region, for extreme bone loss in the upper jaw.
Uses the cheekbone for anchorage when the upper jaw bone is insufficient.
Placed between the mental foramina in a lower jaw with front bone loss.
Relatively simple, suitable for moderate bone loss with a stable cortex.
The choice between types of basal implants depends on the specific jaw anatomy and on the digital planning beforehand.
Advantages of basal implants
Conventional implants in patients with bone loss sometimes require a preliminary bone graft and months of waiting; basal implants often make it possible to restore the mouth without these preparatory steps. This is the main advantage for patients with bone loss.
Basal implants also allow full mouth dental implants in a single surgery. Because they are one-piece implants, there is no separate implant uncovering stage. In practice, the patient may avoid additional surgeries and waiting periods.
Basal implants: drawbacks and side effects
The method has three main drawbacks:
- Limited evidence: studies on basal implants are small, with short follow-up, and there are no long-term data on the scale available for conventional implants.
- Complex surgery: anchoring in the deep bone layers, sometimes close to the sinus or a nerve, requires precise 3D planning.
- An experienced surgeon is needed: the outcome depends to a large extent on the surgical team's experience with this specific method.
As with any oral surgery, defined, time-limited side effects can be expected after basal implants.
- Swelling and pain: common in the first days; the pain reliever and dose are decided with the dentist or pharmacist.
- Temporary difficulty chewing: until the temporary prosthesis has settled, usually a week to ten days.
- Tenderness at the implant sites: gradually eases over about two weeks.
- Light bleeding: possible on the day of surgery, usually stops within a few hours.
Treating the gums before surgery, including a gum graft when needed, can reduce soft-tissue complications. Fever, spreading swelling or pain that gets worse after the first few days require contacting the dentist right away.
Basal implants or another option for bone loss?
The table summarizes the four main options; the choice between them is made from the CBCT scan.
| Option | Anchorage | When it is considered | What studies show |
|---|---|---|---|
| Basal implants | The deep cortical bone layers of the jaw | Severe bone loss, when immediate loading without bone augmentation is wanted | Small studies with short follow-up |
| Short implants | The existing bone, without reaching the sinus or the nerve | Limited bone height | Up to 5 years: results similar to a standard implant after bone augmentation, with fewer complications (Esposito et al., Cochrane Database of Systematic Reviews, 2014) |
| Bone graft and a standard implant | Rebuilt bone (the patient's own bone or a bone substitute) | Lack of bone width or height | An established method, but it adds a surgery and several months of waiting before the implant |
| Zygomatic implants | The cheekbone, using long implants | Upper jaw with very little bone | In a systematic review, about 95% of implants survived 12 years (Chrcanovic et al., Journal of Oral and Maxillofacial Surgery, 2016) |
What causes jawbone loss?
Jawbone loss results from several biological and clinical processes, which call for an individual assessment before any implant planning.
The most common cause is long-standing untreated tooth loss: without the stimulation of a tooth root, the alveolar bone gradually resorbs. Chronic gum disease speeds up this process, which is why a comprehensive full mouth rehabilitation is often needed in these situations. Other factors include trauma, previous oral surgery, long-term smoking and uncontrolled diabetes. Basal implants were developed for these patients, because they use the deep basal bone, which remains relatively stable even after years of resorption.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Basal implants cost: what affects the price
There is no uniform cost for basal implants: each treatment plan is based on the 3D imaging findings and the patient's specific needs. The cost depends on the number of implants needed, the jaw anatomy and the type of prosthesis chosen.
After a thorough consultation and imaging, you receive a detailed, personalized written quote, and itemized receipts you can submit to your insurer (reimbursement depends on your policy). In some cases a basal approach may cost less overall than a conventional treatment requiring several bone augmentation procedures, because it reduces the number of surgeries and the total treatment time. See also dental implant cost.
What to expect after basal implants
For conventional implants, a meta-analysis found that about 96% of dental implants survived 10 years (Howe et al., Journal of Dentistry, 2019). Basal implants do not yet have long-term follow-up data on a comparable scale.
Once the permanent prosthesis is stable, most patients gradually return to normal chewing, usually within a few weeks. Regular check-ups are needed to monitor implant stability and maintain the prosthesis. Unlike removable dentures, which are taken out for cleaning, basal implants stay fixed and need daily cleaning and follow-up like any implant.
Basal implants in Jerusalem: consultation at Dr Haim Aseriel's clinic
Basal implants are one of the options for patients with severe bone loss; the decision is made after comparing them with the alternatives and explaining the level of scientific evidence. The team led by Dr Haim Aseriel (DDS, NYU College of Dentistry) offers a consultation in English, with a clinical exam, imaging and personal planning, at 12 HaTnufa Street in Talpiot, south Jerusalem. At the end you receive a detailed written quote, with no obligation. You can also read patient reviews.
Basal implants: frequently asked questions
Basal dental implants, also called bicortical or cortical implantology, use the basal bone (the deep, dense and stable part of the jaw) to anchor the implants, unlike conventional implants that are placed in the softer alveolar bone. They are mainly intended for patients with severe bone loss.
A basal implant has an upper part that connects to the prosthesis and an elongated lower part anchored in the cortical layers of the jaw. Cortical bone is dense and hard, and it resorbs less than alveolar bone after tooth loss.
The main advantage of basal implants is that, in many cases of bone loss, a preliminary bone graft and the months of waiting it involves can be avoided, and a temporary prosthesis can be attached within a few days of surgery. The decision is made after comparing them with the alternatives, such as a bone graft, a sinus lift or short implants.
The success of basal implants has mainly been studied in small studies with relatively short follow-up: one study of 157 implants in 10 patients found a survival rate of 97.5%, and another of 30 implants in 11 patients about 90.7%. Further long-term studies are needed.
There is no single cost for basal implants: each treatment plan depends on the 3D imaging findings and the patient's needs, such as the number of implants, the jaw anatomy and the type of prosthesis. A detailed written quote is given after the consultation and imaging.
Sources
- Patel K et al., Annals of Maxillofacial Surgery, 2021 – Link to study
- Mitra V et al., Cureus, 2023 – Link to study
- Gangadhar B et al., Journal of Orthodontic Science, 2023 – Link to study
- Ghalaut P et al., National Journal of Maxillofacial Surgery, 2019 (case report) – Link to study
- Howe MS et al., Journal of Dentistry, 2019 – Link to study
- Esposito M et al., Cochrane Database of Systematic Reviews, 2014 – Link to study
- Chrcanovic BR et al., Journal of Oral and Maxillofacial Surgery, 2016 – Link to study
