Navigated Antral Bone Expansion (NABE): a prospective study on 35 patients with 4 months of follow-up post implant loading

Luigi V Stefanelli,Silvia La Rosa,Antonella Polimeni,Francesca De Angelis,Stefano Di Carlo,Nicola Pranno

doi:10.1186/s12903-020-01268-3

Abstract

BackgroundThe insertion of dental implants in the atrophic posterior maxilla can be a challenge. One option is to modify the residual native bone in preparation for proper, prosthetically-driven implant placement. The procedure presented in this study is called Navigated Antral Bone Expansion (N.A.B.E). This procedure employs the use of a navigation system to plan and guide the initial pilot drilling, bone expansion, final site preparation, and implant insertion. The aim of this study was to compare the distance between the alveolar ridge and the sinus floor measured before and after the surgery performed using the N.A.B.E. technique.MethodsThirty-seven partially edentulous patients who were candidates for implant supported restoration in the posterior maxilla, with a bone height ranging from 4 to 7 mm were enrolled. The N.A.B.E procedure was used to increase the bone height. Paired-samples t-test evaluated the distance between the alveolar ridge and the sinus floor measured before and after surgery. The occurrence of post-surgical complications, and the angular deviation between the planned osteotomy and the actual placed implant trajectories were evaluated.ResultsOut of the 37 consecutive patients enrolled in the study, 35 were considered in the data analyses. Patients’ bone height after surgery compared to the bone height before surgery showed a statistically significant increase (p < .0005) of 3.96 mm (95% CI, 3.62 mm to 4.30 mm). No post-operative complications were observed in the 35 patients. The mean angular deviation between the planned osteotomy trajectory and the placed implant trajectory ranged between 12.700 to 34.900 (mean 25.170 ± 5.100).ConclusionsThis study provides evidence that N.A.B.E. technique is able to provide a significant bone increase, and could be considered an alternative method to the management of the atrophic posterior maxilla with a minimally invasive approach.

Highlights

The insertion of dental implants in the atrophic posterior maxilla can be a challenge
At the time of prosthetic loading an angled abutment was used in 3 out of 35 implants (8.6%) because the angle correction obtained with the N.A.B.E was insufficent for a straight abutment
Radiographic assessment Patients included in the analysis presented with a residual bone height ranging from 4.10 to 6.90 mm demonstrated through linear measurements on Cone beam computed tomography (CBCT) cross-sectional slices

Summary

Introduction

The insertion of dental implants in the atrophic posterior maxilla can be a challenge. The insertion of dental implants in the atrophic posterior maxilla can be a challenge due to a limited vertical alveolar bone height (often caused by post-extraction resorption of the alveolar bone or by a pneumatized sinus), low bone density (D3-D4) and difficult surgical access [1,2,3,4]. The effect of implant length on stress distribution seems to be noncritical except in D4 bone type, where the bone-implant interface length is an important key for success [17]. Another critical factor for success is the tilting degree of the implants [18]. This is important for reducing stress, and for the achieving an ideal prosthetic position for the abutment-fixture (screw retained prosthesis is desired)

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