Change is not pleasant, but change Is constant. Only when we change and grow, we’ll see a world we never know.
As we all know, that change is inevitable and the only thing that is constant is change. So, today’s discussion would involve a comparison of 2 different techniques of implant systems; the conventional and the changing trends i.e the basal implant system.
Pertaining to the present scenario in implantology, more and more research is moving towards varied aspects of implant systems , and we as progressive dentists should enrich and grow our clinical as well as academic acumen so as to be at par with the changing trends and technologies.
We have been practising conventional implantology from the past 7 years and basal implantology from the past 3 years. So, here we are just sharing our experiences and not supporting any company or brand thereof.
As the title of my article suggests BASAL- IS IT BASE OR BASS. So, here base refers to that the basal implants engage the base(all) bone i.e the cortical bone and not the cancellous bone which the conventional implants get placed into and the second half of the title, the Bass suggests that this ‘Buzz’ or the sound which we hear nowaday’s that the basal implants are the next new thing; well the technology is not recent but its quite old but its adaptation, implementation as well as modification is new.
People usually don’t know the basal implantology. Basal, as the name suggests get mechanically interlocked inside the basal bone. They are of two types- lateral basal which are laterally placed by performing lateral osteotomy.
And crestal basal which are placed crestally; and in turn are much like the conventional implants i.e. engaged in the crest or cancellous portion of bone.
The principle of mechanical interlocking is the design of threads; which are most in the apical region thus engaging the hard basal cortical bone thus providing good primary stability.
Based on our experiences, we have evaluated conventional vs. basal implants on certain parameters :-
A) Bone interaction
Conventional implants are based on the truest concepts of Branemark’s principle of osteointeintegration. When the implant is placed, a gap of 3 months is required.
In case of basal implants, Mechanical interlocking into the hardcortical bone leads to high primary stability. The micro movement is minimised by splinting I.e all the implants are connected and formed as a single prosthesis and hence forth, immediate loading is possible.
The mechanical interlocking can be done in the maxilla – 2 sites maxillary sinus floor and nasal cortical floor- these are the areas utilised for primary stability. In mandible since it is dense bone, the concept of mechanical interlocking debatable I.e whether b+ bone is present or not. But greater interlocking is achieved.
B) Surgical Protocol
In case of conventional implants, osteotomy is performed sequentially. The pilot drill is placed first and accordingly the further drills are placed as according to the implant to be placed.
In case of basal implants, the osteotomy is longer but narrow. ( 2 mm)
So in case of conventional, it is shorter and wider whereas in case of basal, it is longer and narrower.
The bone grafting procedures also vary. In case of conventional, the bone grafting ,bone regeneration , save bone.
In case of basal, apical bone is engaged. So, no / less /minimal bone grafting is performed.
C) Prosthetic basis
In case of conventional- 2 piece implant, we can fabricate cement or screw retained, CAD CAM or precision type of prosthesis.
In case of basal implants, single piece implant prosthesis are cement retained. But nowadays, friction locked, coronometric sleeves/ copings friction locked, helps in the retrievable prosthesis. Helps in the maintenance of good oral hygiene.
In case of immediate loading, the basal implants have an edge. There’s a concept of compulsory load, as there are single piece abutment in mouth. The loops are rigidly splinted as these implants are anchored into basal bone resistant to resorption. ( Advantage) In case of conventional implants, osteointegration takes time, there’s an osteoclastic phase of 21 days followed by osteoblastic phase. Cycle in the cancellous bone.
In face Malo’s All on 4 concept in which conventional implants are utilised are basically placed in the cortical portion of bone only. The sites, implant sizes ( smaller ) and osteotomy is different.
D) Favourability in esthetic zone
In case of conventional implants, there exists high favourability. There are many options available like angle correction, milled abutments that are better, customised abutments etc.
In case of basal implants, isoelastic implants which are bendable. The implant and abutment is isoelastic. In case of angle correction, angular correction copings are fabricated.
In case of conventional implants, nowadays ceramic abutments are available and hence an EMax crown can be placed.
According to our experience, in case of esthetic zone, conventional implants portray better esthetic whereas in case of basal implants, since they have metal abutments, they portray better in non esthetic areas.
In case of single, conventional. Posterior- Pt is not concerned whereas in ant temporisation is required so time effort and money is spent on.
In case of multiple implant sites, ACC. To our clinical experience, less bone volume, flapless, less traumatic, Lodi g is immediate and hence basal implants score an edge.
Even conventional implants can be immediately loaded if they engage the basal bone just like all on 4 concept. The basal implants can be placed multiple, full arch, quad arch or full mouth placement can be done.
So the BUZZ in the mainstream is that the literature is less as readable literature is not available and the available literature is in Russian language. The prosthetics are improving and the research is also being published.
Summary – end write – So, yes Basal is both base and bass indeed. As bass, this low frequency humming sound everywhere that what these basal implants are, which is going to transform into a very high pitch