If you arrived at this proposal, it was probably for one of two reasons: you were told you didn’t have enough bone for conventional implants, or you were offered a full arch in a few days at a considerably lower price. Both are legitimate situations and I completely understand why the proposal is attractive. But it’s a decision worth making with full information, because it has consequences that show up years later. I’m going to explain what they are, how they differ from what I do, and why I chose not to work with them. Not to speak badly of anyone: so that you understand the technical difference and decide for yourself.
What they are
Corticobasal implants — also called strategic, basal or monobloc implants — are very thin, long implants anchored into the cortical bone layer, the hard outer layer of the jaw. They’re placed in greater numbers than conventional ones, frequently eight, ten or more per arch, and distributed seeking areas where hard bone still remains. The prosthesis is cemented on top, usually within a few days. Their promise is concrete: resolving cases with little bone, without grafts, in very little time and at lower cost.
The fundamental difference: integrating or gripping
Here’s the point I want you to understand, because everything else follows from it. A conventional implant seeks osseointegration: the bone grows around the titanium and bonds to it. The implant and the bone end up as one thing. That process takes months and is what gives it biological stability over the long term. A corticobasal implant seeks mechanical retention: it holds through the grip it makes in the hard bone. It doesn’t integrate, it anchors. It’s like a screw in a plank. A screw in a plank works, and works well as long as the plank is sound and the load is what was expected. But it’s a mechanical relationship, not a biological one. If the surrounding bone changes or the force distributes differently, there’s no integration to compensate.
Three things worth looking at
- The titanium that bends. These implants can be bent during surgery to adapt them to the available bone, and that’s presented as an advantage in adaptability. It’s worth understanding what it means. The surgical-grade titanium used in implantology doesn’t bend: it breaks before it bends. A zygomatic implant, several centimeters long, fractures if you try to bend it. That an implant allows itself to be bent says something about the properties of the material it’s made of.
- There is no osseointegration. I explained this above, but it bears repeating because it’s the central difference. Stability depends on mechanical anchorage and on the number of implants, not on integration with the bone. That’s where the need to place many comes from: since they don’t integrate individually, the system holds by number. And an arch with ten or more posts very close together is considerably harder to keep clean — and cleanliness is what sustains any rehabilitation over ten years.
- They are one-piece and cemented. This is the one that concerns me most day to day. In a corticobasal implant, the implant and the abutment come fused: there’s no connection between them, no screw, nothing to unscrew. And the prosthesis is cemented on top. That means if something needs adjusting in three years — discomfort, a change in the bite, a ceramic fracture — the only way in is to cut the prosthesis off, lose it and remake it from scratch.
What the scientific societies say
The implantology protocols backed by the leading international scientific societies — the ones that define standards of training and evidence in this specialty — are built on osseointegrated implants. Corticobasal systems are not part of those protocols, and the published evidence on their long-term behavior is limited by comparison. That doesn’t mean every case fails. It means you’re choosing a technique that doesn’t have the same accumulated scientific backing, and it’s reasonable that you know that before deciding.
Why they’re offered, then
There are patients who were told for years that nothing could be done. They arrive at a consultation where they’re offered fixed teeth in three days, without grafts and for less money, and it’s understandable that they say yes. The need is genuine. My difference isn’t with the patient who accepts. It’s with the idea that this is the only way out when there’s no bone.
What can be done when bone is missing
Before accepting a technique without scientific backing, it’s worth exhausting the ones that have it. Today there are three paths, in this order: Conventional implants, when there’s enough bone. Always the first option.
Strategic angulation. Tilting the implants to take advantage of the areas of dense bone that remain. It resolves a large number of cases that twenty years ago were dismissed, and avoids grafts that would extend treatment by months.
Zygomatic implants. When angulation isn’t enough, long implants anchored in the cheekbone are used — bone that doesn’t resorb. All three are osseointegrated, removable, and backed by long-term literature. If you were told you had no bone and went straight from there to a corticobasal proposal, my suggestion is simple: get a second opinion with a CT scan before deciding. Your case may well have another way out.
What to ask if you’re offered them
1. Does this implant osseointegrate or is it mechanically retained? 2. Is it one-piece or does it have a connection? 3. Will the prosthesis be screw-retained or cemented? 4. If something needs adjusting in three years, how is it done? 5. How many implants are there and how will I clean them at home? 6. What scientific backing does this system have over ten years?
Closing
I don’t work with corticobasal implants, and I wanted to explain why with arguments and not with adjectives. After nearly four decades in implantology I’ve learned that what defines a good result isn’t how it looks on delivery day. It’s how well it ages, and how easy it is to correct when needed. If you were offered this alternative and want a second opinion before deciding, come in with your CT scan or we’ll take a new one. I’ll tell you frankly what options your case has — including the ones I don’t perform.
Frequently asked questions
Are corticobasal implants illegal? No. They are commercially available systems and there are professionals who use them. The discussion is about scientific backing and long-term management, not legality. Can they be removed if something goes wrong? Removing them is more complex than a conventional implant, and the cemented prosthesis has to be destroyed to gain access. Why are they cheaper? Mainly because they avoid preparatory procedures such as grafts and because treatment is resolved in fewer sessions. Do they work when there genuinely is no bone? There are osseointegrated alternatives for severe atrophy, such as strategic angulation and zygomatic implants. They’re worth evaluating first.
