A 44-year-old patient reported to the Department of Periodontics and Oral Implantology, Rajarajeswari dental college and hospital, Bangalore with a chief complaint of mobile lower anterior teeth for the last 2 years. Clinical examination revealed mandibular arch with missing 31 and grade III mobile 32, 33 (Figure 1). Radiographic investigation (CBCT) showed vertical and horizontal bone loss in lower alveolar arch (Figure 2): barely sufficient bone (width 2.5-5 mm, height >10-13 mm) according to Misch et al, 1987. 4 The patient was in good health and had no contraindications to surgical therapy with absence of mucosal disease.

Figure 2

Pre surgical radiographic evaluation was carried out with CBCT and IOPA (Figure 3) for appropriate treatment planning. After measuring, the implants (MONO IMPLANTS) of size 3.5 × 14 mm and 2.7 × 12 mm were selected (Figure 4).

Basal implants are advanced dental implants that utilises the basal cortical portion of the jaws for their retention. They possess a unique and specific design aimed at the sole purpose of gaining anchorage from the basal bone and had underwent several modifications in the past decades. These modern implants have a simple design, yet sophisticated surgical protocol and acquire a prosthetic friendly system. Several practitioners around the globe have been practicing basal implantology and so far this implant system has provided equitably successful results, due to their attractive properties. 5

One of the common reasons that result in failure of endosseous implant is the inadequate bone width. 6 Further, long-standing edentulous situations commonly lead to ridge resorption. In this instance, basal implants can be used to support single & #8209; or multiple‑unit restorations in the upper and lower jaws with compromised bone width. Moreover, they can be implanted in the extraction sockets or even in the healed bone as the structural characteristics of these implants allow placement in deficient bone height and width. Whenever ridge augmentations come as a part of an alternative treatment plan, basal implants can be considered the devices of first choice. The concept of cortical implantology resolves all problems associated with conventional (crestal) implantology since it is a customer & #8209; oriented therapy, which meets the necessities of the patients’ ideally. 7

A case report was done by Ghalaut et al to study full mouth rehabilitation in a severe periodontally compromised patient who received 18 single piece basal implants. The study concluded that immediate loading of basal implants can be done, when they are placed in the dense cortical bone, as they attain high primary stability. Therefore, though there are high chances of crestal bone loss, they are more predictable than before. Hence, single & #8209; and multiple & #8209;unit restorations in the upper and lower jaws can be supported by cortical implants. 7

Another study carried out by Garg et al aimed to evaluate the survival of endo-osseous immediate loading (IL) implant and basal IL implants in atrophic jaws, to compare implant survival for full mouth rehabilitation between endo-osseous IL and endo-osseous delayed loading (DL) versus basal IL implants during 3-year follow-up. The study concluded that achieving primary stability was easy for basal implants in mandible compared to endo-osseous implants as basal implant are cortical engagement, whereas in maxilla, both exhibit similar results. They also found out that basal implant placement was comparatively minimal technique sensitive and does not require minimal bone width or length. 8

In this case report, two smooth surface straight basal implants were placed immediately after extraction of grade III mobile tooth in an atrophied anterior mandible. The implants were placed uneventfully achieving satisfactory primary stability. Temporary provisionalization was done within 72 hours to ensure immediate loading. Permanent prosthesis was delivered after one week.

Endosseous implants are the primary choice in normal bone conditions whereas single stage basal implants can be an option where conventional implant fails and in cases where residual bone height and width is reduced as in moderately or severely atrophied ridges. Further, long term follow-ups, larger sample and comparative studies are necessary to appraise the survival of basal implants. Basal implant therapy has numerous advantages, as it allows rehabilitation of maxilla and mandible that is deficient in height and width, decreases the treatment length, reduces the number of surgical procedures, helps in immediate loading and provides better patient compliance.