Basal implant: why do our experts advise against it?
Dental implants supporting dental prostheses are one option for replacing missing teeth or filling gaps in the mouth. Implant treatment can restore chewing, speech and facial support. Implants made from biocompatible materials such as titanium can function for many years, but require maintenance and are not guaranteed to last a lifetime.
Several types of dental implants are available, and the implantologist chooses the best option based on the implant site, bone condition, and dental history. Conventional implants are placed in the alveolar ridge; their dimensions depend on the available bone and treatment plan. Basal implants seek anchorage in cortical bone and may be considered in selected patients with marked bone loss. They should not be confused with long zygomatic implants anchored in the cheekbone. Alternatives such as bone grafting, other implant designs or removable dentures should be discussed individually.
The classic implant: a tried and tested choice
Modern titanium implant treatment developed from Per-Ingvar Brånemark’s work on osseointegration in the 1950s and clinical treatment beginning in the 1960s. Decades of development have improved implant designs, surgical techniques and prosthetic options. Osseointegration describes the direct structural connection between living bone and an implant surface; it does not eliminate the possibility of complications.
A dental implant is usually a titanium screw that integrates with the jawbone, replacing the root of a missing tooth. This anchor serves as the base for a crown, bridge or prosthesis that restores the form and function of missing teeth. Implant placement is a surgical procedure, usually performed under local anaesthesia. Its complexity depends on the site and any additional bone reconstruction required.
Integrated into the jawbone, implants can provide stable support and improve chewing compared with an unstable removable denture. Loads are transmitted through the implant to the surrounding bone. Implants lack the periodontal ligament of natural teeth, and their biting function should not be described as universally equal or superior. Bone remodelling and peri-implant bone loss remain possible.
Dental implants can provide replacement of a single tooth (via a crown), multiple teeth bound together (via a bridge), or support entire fixed prostheses like the All-On-4 or All-On-6 solutions to replace a whole set of teeth. Healing and the timing of the final prosthesis depend on implant stability, bone quality and the treatment plan. Some conventional implant protocols permit immediate loading in selected patients (Soto-Penaloza et al., 2017). Temporary teeth may be provided, but patients must follow the prescribed diet while the implants heal.
By selecting high-quality implants and having them placed with precision by an implant surgeon with extensive experience, dental implants can offer remarkable enduringness and longevity. A balanced diet, avoiding smoking and diligent oral hygiene can support the long-term health of the tissues around an implant. However, the visible crown portion may necessitate replacement after a span of several years due to accumulated wear and discoloration, without necessarily requiring replacement of the anchoring implant itself.
Integrated into the jawbone, implants provide support for artificial teeth and can improve bite function and facial support. They can accommodate fixed or removable prostheses. However, they do not prevent all bone loss, and the tissues around them require regular hygiene and professional monitoring. The implant and prosthesis may require treatment, repair or replacement over time.
The basal implant: a controversial alternative
The basal implant was developed as an option for patients with limited alveolar bone. In cases of severe atrophy, the choice between basal implants, conventional implants with or without augmentation, and other rehabilitation options requires specialist assessment.
The name “basal implant” refers to designs that seek anchorage in basal or cortical bone. Conventional implants can also engage cortical bone; the distinction is not simply hard bone versus spongy bone. Basal implant protocols often use immediate loading, relying on adequate initial stability and a suitable prosthetic design. The timing and type of the temporary prosthesis, and any later definitive restoration, depend on the system and clinical circumstances. Neither same-session restoration nor a universal three-to-six-month replacement schedule applies to every case.
Basal implantology may be considered for selected patients with severe jaw atrophy, including some patients seeking alternatives to bone augmentation or following graft failure. There is no single threshold of less than 5 mm that establishes suitability for all basal implant systems. Assessment requires three-dimensional imaging and appropriate surgical expertise.
Basal implants and zygomatic implants are distinct treatment categories. Zygomatic implants anchor in the cheekbone and may be used for selected severely resorbed upper jaws. Their indications and risks differ from those of basal implants. Whether sinus lift bone grafts or another approach is appropriate depends on the anatomy and overall restorative plan.
Some dental practices recommend basal implants for patients with severe bone deficiencies as an alternative to removable dentures. Immediate loading is possible in selected basal and conventional implant protocols; it is not an exclusive advantage of basal implants. The timing of definitive teeth depends on stability, tissue healing and prosthetic planning. A universal six-month wait for conventional implants, or a four-to-six-month gum-healing period for all basal implants, is not supported.
Risks of basal implants
Deeper anchorage does not by itself make basal implants safer than conventional implants. A 2026 systematic review found limited follow-up and low-certainty survival evidence, with no eligible direct comparison against contemporary conventional implants (Panday et al., 2026). Infection, tissue recession, implant failure, mechanical problems and injury to nearby anatomical structures must be considered according to implant design and placement. Conventional implants also have biological and mechanical risks; neither approach is risk-free. Immediate loading requires appropriate case selection and does not automatically compromise osseointegration.
Removal and revision can be complex, depending on implant design, position and surrounding bone. Some basal systems use one-piece implants with more limited prosthetic options than modular two-piece designs. This does not mean that replacing every prosthesis necessarily weakens the implant or the surrounding bone.
The choice should rest on a documented diagnosis, the available evidence and an explanation of alternatives and long-term maintenance.
Sources
Panday, S., Kotrashetti, S. M., John, S. S., & Mishra, R. (2026). Survival rate and prevalence of complications in basal implants: A systematic review and meta analysis. Journal of Maxillofacial and Oral Surgery. Advance online publication. https://doi.org/10.1007/s12663-026-03060-2
Soto-Penaloza, D., Zaragozí-Alonso, R., Peñarrocha-Diago, M., & Peñarrocha-Diago, M. (2017). The all-on-four treatment concept: Systematic review. Journal of Clinical and Experimental Dentistry, 9(3), e474–e488. https://doi.org/10.4317/jced.53613