The typical patient is a 50-year-old man who smokes; his medical history is unremarkable except for a successfully treated heart attack ten years previously. One day, slight mobility of a tooth prompts him to consult several practitioners, and he is surprised to learn that for the past 10 years periodontal disease has silently eroded the bone supporting what he thought were healthy teeth.
Rather than undergo periodontal surgery immediately, as recommended, he puts it off for a year or two. During this period, his teeth become increasingly mobile, rendering his situation highly uncomfortable. When one day three teeth are lost at one time, he realizes that something has to be done.
The idea of a removable denture is unacceptable, and he can afford implants. After having alternative treatment solutions explained to him, he rejects conventional (axial) imlplants not only because of the long time period involved but also because the thought of bone grafting worries him.
Instead, he opts for basal implantology, a technique that obviates the need for grafts and promises a fixed, implant-supported prosthesis in just one day. Once his decision is made, his practitioner makes sure all legal obligations are respected: detailed estimate of fees signed by both parties, informed consent signed and dated, period of reflection.

The preparatory phase can now begin. In an initial step, impressions are taken of both arches to prepare temporary acrylic restorations. Try-in of these prostheses is obviously impossible before surgery because the patient’s diseased teeth will not be removed until the day of the operation. The dental technician must thus be familiar with this approach so that the patient is not disappointed when he wakes up from general anesthesia (a consultation with the anesthesiologist is mandatory at least 48h prior to surgery).

The implant procedure itself involves three phases:

In the initial, “septic” stage, all necessary extractions are performed, followed by curettage of granulation tissue, and preparation of the bone and gingiva.

In the second step, the disk implants that will support the two full restorations are gently impacted laterally into sites prepared in the bone.

For the maxilla (upper jaw), if there is not enough bone in the posterior quadrants, the mucosal floors of the maxillary sinuses are elevated using a now classical technique. The disks are then inserted underneath this mucosal membrane and placed across the bone cavity such that they are supported by all of the cortical bone surrounding the sinus walls.

Following sinus elevation, the space freed under the mucosal membrane is filled in with a layer of a neutral material that surrounds the implants. This aim of this material is not to form bone, but rather to maintain a distance between the sinus mucosa and the implants. This is important to prevent complications should sinusitis develop in the future for some reason completely unrelated to the implants.

Actually, complete “ ossification” of this filling material is not even desirable. While this would mechanically strengthen the sinus floors, such reinforcement is rarely necessary. By contrast, it would also reduce the resilience of the implants that pass through it. This resilience is important in basal implantology because it permits the fabrication of prostheses supported by both implants and natural teeth..

Likewise, when the amount of bone is insufficient in the posterior quadrants of the mandible (lower jaw), basal implants can be placed below the level of the inferior alveolar nerve (the implant shaft is positioned to one side of the nerve). This approach is possible even in cases of severe atrophy: when necessary, creation of a bone window permits displacement of the nerve for just a short period, the time needed to insert the disk implant.

In conclusion, all cases of maxillary and mandibular atrophy, no matter how severe, can be managed with basal implants and loaded the same day.

The third and final step is the prosthetic phase: the two full arch restorations are relined with a self-polymerizing acrylic resin and are placed in the patient’s mouth, one against the other, in occlusion. The patient is then helped to «bite» down (he is still anesthetized) until the product sets. These temporary bridges are then trimmed, polished and cemented in place so that the patient awakens with brand new, fixed restorations.

The postoperative course can be divided into two periods that are usually uneventful, with minimal pain, if any.

The first period lasts less than 15 days, the time necessary for gingival healing. Extensive but nonpainful edema sometimes occurs (swelling of the cheeks and the eyelids), as can bruising that is more unsightly than painful. During this period, patients are instructed to stay on a liquid diet to avoid damaging the sutures. It is also reasonable to stay home from work for the first 8 to 10 days after surgery.

At the end of these two weeks, the patient has resumed his normal appearance: the gingiva has healed and he can eat, cautiously, with his new teeth. At this point, patients feel so comfortable with their new prostheses that the need to wait an additional month may seem unnecessary. However, this additional time is necessary for proper bone healing.
Over the following month, frequent office visits may be needed check the condition of the gingiva and the occlusion and to make any necessary adjustments to the restorations.

Six weeks later, surgery is a thing of the past, and bone healing is now complete. Several office visits are now scheduled to fabricate the definitive prostheses. The temporary bridges are removed at the start of each visit for impressions and try-ins and are replaced at the end of the session. No surgery is involved, and the patient suffers no pain or discomfort.

Thanks to the resilience of basal implants, porcelain restorations can be made using dental ceramics without any risk of implant loss.