This is a case of a 96-year-old man who came to us for dental implants. All his bridges were done almost 15
years ago, somewhere near Punjab. Over time, all the bridges, PFM crowns, and root canal treatments had
failed. The bridges had become mobile, and he was not in a position to eat anything at all. Because of this, his
overall quality of life was also affected.
He came to us with one clear goal – he wanted fixed teeth at any cost, so that he could eat properly again and
regain comfort.
We proceeded with a CBCT scan, which showed very scanty bone. There was severe bone loss, and in most
areas, there was a knife-edge ridge. This kind of bone condition makes conventional implant placement
extremely difficult, and in many cases, patients are told that fixed teeth are not possible.
In this case, instead of rejecting the case, we planned for basal implants.
Basal implants are basically bicortical implants. They are anchored into the cortical bone, also known as the
basal bone, which is dense and highly resistant to resorption. Unlike conventional implants that depend on
spongy alveolar bone, basal implants rely on strong cortical bone for long-term stability.
What are basal implants?
Basal implants are fundamentally bicortical implants, designed to gain support from the cortical bone, also
called the basal bone of the jaw. This part of the bone is denser, stronger, and far more resistant to resorption
when compared to the softer cancellous or spongy alveolar bone that conventional implants often depend on.
What makes basal implants different is their anchorage concept. Instead of relying mainly on the crestal
alveolar bone, which is the part of the jawbone most affected after tooth loss, periodontal disease, or long-term
denture use, basal implants seek fixation in the deeper and more stable cortical layers of the jaw. Because
cortical bone is mechanically stronger and biologically more stable, this approach can provide excellent
primary stability at the time of implant placement.
This is one of the main reasons why basal implants are often discussed in cases with reduced bone volume,
advanced ridge resorption, or when immediate loading is planned. Since the implant engages strong
cortical bone, it may allow the clinician to achieve the stability needed for early or immediate function in
carefully selected cases.
In simple terms, conventional implants often depend on the bone that tends to shrink first, while basal implants
are designed to engage the bone that tends to remain stronger for longer. let me explain this further so that
it sinks in,the spongy bone which hosts conventional implants tend to resorb quickly in case of infection or due
to general age related resorbtion or some times even due to overloading caused by excessive biting forces,but
basal bone is resistant to resorbtion and even in severe infections we seldom see resorbtion in the basal bone
and these specialized implants anchor to the basal bone,This makes them especially relevant in challenging
full-mouth rehabilitation cases where the available alveolar bone is limited but the deeper cortical foundation is
still usable.
Another important point is that the basal bone is generally less affected by the resorptive changes that occur
after tooth loss. This gives basal implants a biomechanical advantage in situations where traditional implant
protocols may require bone grafting, sinus lifts, or other augmentation procedures. By using the strength of the
cortical bone, basal implantology follows a philosophy of utilizing the patient’s existing stable bone rather than
trying to rebuild lost alveolar volume in every case,which tends to fail as they are always at risk of rejection by
our body as they are foreign matter basically a pig bone or an ox bone which triggers a rejection cascade even
if placed properly.and also the graft placement requires extensive and multiple surgeries and are also costly in
economical terms. So basal implants avoid all these steps and directly anchor into the basal bone for long-
term stability.
In this particular case, we operated on a 96-year-old patient with uncontrolled diabetes & hypertension, and
you see in the X-ray that every implant is engaging both the cortices of the jawbone.
Why cortical engagement matters
The success of any implant-supported restoration begins with stability. In basal implantology, this stability
comes from bicortical engagement the implant is anchored into one or more cortices of bone, creating a
firm mechanical hold. This principle is especially valuable when immediate loading is desired, because the
implant must withstand functional forces from the prosthesis soon after placement.
Because of this design philosophy, basal implants are often associated with:
● high primary stability
● better anchorage in dense bone
● usefulness in atrophic jaws
● reduced dependence on grafting procedures
● suitability for immediate loading protocols in selected cases
A patient-friendly way to explain it
You can think of it like this: instead of fixing the implant into a softer middle part of the bone, basal implants are
anchored into the hard outer structural bone of the jaw, where the support is naturally stronger. That is why
they can be an important option in patients who have been told they have “less bone” for regular implants.
Basal implants are not just another type of implant; they represent a different biomechanical philosophy — one
that depends on the strength of the cortical foundation of the jaw to achieve stability, function, and long-term
support, especially in difficult cases with compromised alveolar bone.
Coming back to this particular case that we were discussing
In this patient, the implants were strategically placed into basal bone areas such as the nasal floor, the
pterygoid region, and the base of the mandible. Since there was no bone in the posterior region, we also
performed nerve bypass techniques to safely utilize the available bone below the nerve.
We followed the International Foundation for Implants (IF) principles and achieved good bicortical stability.
Because of this strong anchorage and high primary stability, we were able to load the implants within just four
days using a DMLS PFM prosthesis.
One of the most important aspects of this case is the patient’s medical condition. The patient is 96 years old
and has uncontrolled diabetes. In such cases, implant selection becomes extremely critical because healing
and infection control are major concerns.
Basal implants are particularly advantageous in diabetic patients because of their smooth and polished
surface. These implants are designed in such a way that they are more resistant to bacterial adhesion. The
bacterial adhesion or smear layer adhesion is the starting point for any infection, and this is basically to avoid
peri-implantitis in the very 1st step. Isn’t it wonderful ??
In contrast, conventional implants usually have a rough surface. While the rough surface helps in
osseointegration, it also tends to attract oral bacteria and all the sticky food and dairy products that we take
generally get attached to it as a smear layer,which again causes bacterial colonization. This increases the
chances of peri-implantitis, especially in patients with compromised immunity, such as diabetics and elderly
patients.
With basal implants, the smooth, polished surface reduces bacterial accumulation, thereby significantly
lowering the risk of infection. This is one of the main reasons why basal implants are preferred in elderly
patients, diabetic patients, and medically compromised individuals.
Another important difference is related to the type of bone used for implant anchorage.
Conventional implants are generally placed in the alveolar bone, which is spongy in nature. This bone has a
higher turnover rate, approximately 20% per year, and is more prone to resorption over time. That is, every 3
months, the bone remodels by about 5 percent, and in this remodeling, it continues for a lifetime, and this
remodeling generally leads to crestal bone loss in conventional implants, which slowly progresses to total bone
loss around the implants ,leading to failure.
On the other hand, basal implants are placed in cortical bone. This bone is denser, more stable, and does not
undergo significant resorption even over long periods. This makes basal implants a more reliable and long-
term solution in cases of severe bone loss. It’s measured as less than 2 percent annually.
This is the major advantage of bicortical fixation.
Nowadays, many clinicians are attempting bicortical engagement even with rough surface implants, and we, at
your dentist, Dr. E. Surendranath, also do bicortical engagement with both conventional and basal implants.
However, in this particular case, considering the patient’s uncontrolled diabetes, advanced age, and reduced
immunity, we preferred smooth surface basal implants.
The surgical approach made a major difference.
Another very important aspect of this treatment was the surgical approach itself.
In this case, we used a keyhole surgery technique, which is a flapless and minimally invasive approach.
This means there were no large incisions, no extensive tissue reflection, and minimal or no sutures,
making the procedure far less traumatic compared to traditional implant surgery.
This approach becomes especially valuable in geriatric patients, where healing capacity, medical status, and
overall comfort are major concerns. In elderly individuals, reducing surgical trauma can make a significant
difference in post-operative recovery.
Because keyhole surgery is minimally invasive, healing is usually much faster. In many cases, patients
become comfortable within 2 to 3 days, with much less swelling, discomfort, and interruption to their routine.
By contrast, in conventional flap surgery, the gums are reflected more extensively to expose the bone. While
this may be necessary in certain cases, it is generally associated with more swelling, edema, inflammation,
and a longer recovery period, often taking 10 to 15 days before the patient begins to feel normal again.
For elderly patients, especially those with systemic conditions such as diabetes and hypertension, this
difference is extremely important. A minimally invasive technique like keyhole surgery can offer a clear
advantage by promoting faster healing, reduced post-operative discomfort, and better overall patient
acceptance.
Implant selection and prosthetic execution
For this case, we used ROOTT implants, which are Swiss-made implants known for their precision
engineering, high-quality titanium, and reliable mechanical strength. In demanding cases, implant quality and
design play an important role in achieving stability and long-term confidence
Once the implants were placed, we moved quickly into the restorative phase. Pickup impressions were made
soon after surgery, and the prosthetic workflow was completed efficiently so that the patient could receive
fixed teeth within just 4 days.
This is what we call a fast and fixed protocol a treatment philosophy focused on reducing delay,
minimizing patient discomfort, and restoring function in the shortest possible time.
Who is a good candidate for basal implants?
Not every implant case is the same, and not every patient requires the same treatment approach. Some
people have a specific combination of general health factors, bone conditions, and treatment needs that
make them particularly suitable candidates for basal implants. At the same time, the opposite is also true some patients may be better treated with conventional implant protocols depending on their clinical situation.
Basal implants are especially useful in patients where the alveolar bone, the bone that usually holds
conventional implants, has already undergone significant resorption. This commonly happens in people who
have been missing teeth for many years, have worn dentures for a long time, or have suffered from advanced
gum disease and bone loss. In such cases, the remaining crestal bone may not be sufficient for standard
implants without grafting procedures.
This is where basal implantology offers a different advantage. Because basal implants are designed to engage
the cortical bone, which is denser, stronger, and more resistant to resorption, they can often be used in
situations where conventional implants become more difficult or may require additional surgeries like sinus lifts
or bone grafts.
Patients who may be good candidates for basal implants
A patient may be a strong candidate for basal implants when one or more of the following conditions are
present:
- Severe bone loss in the jaws
Patients with advanced resorption, especially in the posterior maxilla or mandible, often do not have enough
alveolar bone for conventional implants. Basal implants can make use of deeper and stronger cortical bone. - Long-term denture wearers
People who have worn removable dentures for many years often experience progressive bone shrinkage. In
these cases, basal implants may offer a way to achieve fixed teeth without extensive augmentation. - Patients seeking immediate loading
Basal implants are often chosen in cases where a clinician aims to provide fixed teeth quickly, because cortical
anchorage can offer strong primary stability. - Patients where grafting is not desirable
Some patients do not want bone grafting, sinus lift surgery, or multiple staged procedures. Others may not be
ideal candidates for such additional surgeries because of age, cost, healing limitations, or medical concerns. - Geriatric or medically compromised patients
In selected elderly patients or patients with systemic health issues, reducing the number of surgeries and
shortening the treatment timeline may be a major advantage. A treatment approach that avoids extensive
grafting and allows faster rehabilitation can be very valuable.
Why general health also matters
General health plays an important role in treatment planning. A patient’s age alone does not decide whether
implants are possible. What matters more is the overall medical condition, healing potential, bone quality,
oral hygiene, and the ability to tolerate the planned procedure.
For example, some patients with diabetes, hypertension, advanced age, or medically complex histories may
benefit from a treatment approach that is less invasive, more efficient, and involves fewer surgical stages.
In such cases, basal implantology may be considered as part of a carefully planned rehabilitation strategy.
At the same time, this does not mean that basal implants are automatically suitable for everyone with medical
issues. Every case needs proper evaluation with clinical examination, radiographic planning, and an
understanding of the patient’s functional and prosthetic requirements.
The opposite is also true. For some people, conventional implants work better.
Just as some patients are ideal for basal implants, others may be better suited for conventional
implantology.
If a patient has:
● good bone height and width
● healthy surrounding tissues
● favorable jaw anatomy
● No need for urgent immediate loading
● enough alveolar bone for standard implant placement, and this allows immediate loading too.
Then a conventional implant approach may be more appropriate and equally successful.
This is why implant dentistry should never be reduced to one rigid philosophy. The best treatment is not about
forcing every patient into one system. It is about selecting the technique that best matches the patient’s
anatomy, biology, and expectations.
Our treatment philosophy
At Your Dentist, we practice both conventional implantology and basal implantology. Every patient is
different, and every jaw presents a different challenge. That is why we do not follow a one-size-fits-all
approach.
Instead, we carefully evaluate each case and select the technique that is most suitable for the available
bone, the patient’s age, the medical condition, and the overall treatment goals. Whenever primary
stability and case conditions permit, we aim for immediate loading, allowing patients to receive fixed teeth in
a remarkably short time.
This approach helps us rehabilitate even highly complex cases efficiently and predictably.
A message from Dr E Surendra Nath
This case is a strong reminder that age alone is not the limiting factor in implant dentistry. Even at the age
of 96, with severe bone loss and uncontrolled diabetes, it was still possible to restore function, comfort,
and quality of life through the right treatment planning, the correct implant technique, and a minimally
invasive surgical approach.
With proper case selection, sound surgical judgment, and efficient prosthetic execution, even the most
challenging patients can often be given a fixed solution much faster than they expect.
This case proves that with the right diagnosis, the right implant system, and the right surgical protocol, even
extremely elderly patients with compromised bone and medical challenges can regain fixed teeth, comfort, and
confidence in just a few days.