Basal bone anchorage for immediate loading in the atrophic maxilla: A technical note with surgical case series.

Abstract

Background: This clinical study presents a novel technique for basal bone anchorage, a surgical approach designed for immediate loading in the atrophic maxilla, specifically in Cawood Class VI cases. By leveraging the structural integrity of basal bone, this method eliminates the need for invasive bone grafting procedures, reducing patient morbidity, shortening treatment timelines, and enhancing overall patient acceptance.

Methods: A single-arm clinical investigation, involving a carefully selected cohort of seven patients, assessed the feasibility, functional outcomes, and implant stability over a 24-month period.

Results: Between 2022 and 2024, seven patients received fixed implant-supported rehabilitations with 47 implants (4 mm diameter, 11.5-25 mm length). The average follow-up was 4 years and all implants demonstrated 100% survival and success rates. No failures or complications occurred, except for minor prosthetic chipping in one patient, easily repaired. Postoperative pain was minimal, and patients reported improved confidence, speech, and mastication.

Conclusion: The present technique presents certain challenges and limitations. The surgical approach requires advanced expertise in basal bone anchorage, meticulous case selection, and precise execution to avoid complications. Despite these challenges, the present technique offers significant advantages for managing atrophic maxillae, providing a minimally invasive alternative to zygomatic implant placement. This approach holds substantial promise for advancing oral rehabilitation and improving outcomes in complex implantology cases.

Key points: Basal bone anchorage provides a graftless solution for immediate loading in atrophic maxillae, leveraging dense cortical structures for high primary stability. The BAT technique distributes long implants in transnasal, pterygoid, and spinal sites, maximizing anterior-posterior spread and enabling predictable cross-arch stabilization. This approach may reduce morbidity and streamline rehabilitation, though it demands advanced surgical skills and further long-term evaluation.

Plain language summary: This study presents a new surgical approach for placing dental implants in patients with severely resorbed upper maxilla, where conventional methods often require complex bone grafting or zygomatic implants. The technique relies on anchoring implants in the basal bone a more stable and resorption-resistant area allowing for immediate loading without additional bone reconstruction. In this clinical case series, seven patients received a total of 47 implants and were followed for an average of four years. The results showed excellent outcomes, with 100% implant survival and success, minimal postoperative discomfort, and high patient satisfaction in terms of speech, function, and confidence. While the method requires surgical precision and experience in basal bone techniques, it offers a promising, less invasive alternative for managing extreme bone atrophy in the maxilla. This approach may expand treatment possibilities in complex oral rehabilitation and reduce both the surgical burden and recovery time for patients.