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ePaper created 2016-01-07, 12:59:38 | version 1.38.0
_The success rate in implantology is close to 96 per cent. Thanks to well-established implant placement protocols, with a few differences accord- ing to the implant system used, the predictability of the result under optimum tissue conditions is quite significant. It is very different when these conditions donotmeettherecognisedstandardsintermsofvol- ume and quality for reproducibility in implantology. Thin ridges, for example, which are frequent occur- rences, will require a long and costly process for pa- tients,becausetheyentailboneaugmentationorpos- sibly support tissue grafts. Is there a minimally invasive alternative for these patients, which allows them to be treated without theseproblems?Onelineofthinkingistostopthesys- tematicpracticeofimplantologyassubtractiveatthe tissue level, but rather to transfer these volumes and thereby ensure a minimally invasive procedure. This implies reviewing all the biomechanical principles of implantology, not only in terms of the implant struc- tureanddesignbutalsoinrelationtoperi-implanttis- sue.Thegeneralsurgicalprincipleofmodernimplan- tology since Brånemark has been bone preparation, called osteotomy, as close as possible to the dimen- sions of the implant that will be placed. This principle isstillwidelyprevalent.However,softtissuemanage- ment has evolved and the trend over the past few years has been to manage soft tissue from the first surgical step. With the arrival of self-tapping conical implants, a new technique was developed that en- ableslateralaswellasverticalbonecompressing,con- densing or expanding. In addition, in 1994 Summers, practising his crestal sinus lift technique with careful choice of conical taps, was the first to demonstrate the capacity of cancellous bone to be modelled (Fig.1).1 In two clinical cases we will see that it is possible to be minimally invasive, precise and also avoid the use of biomaterials simply by exploiting the biome- chanicalpropertiesofbonetissueanditscapacityto regenerate. Respecting guided regeneration princi- ples, which means the implementation of physical barriers to isolate the epithelial and connective tis- sue cells from the operating site, enables regenera- tion of the different tissues. These principles are (Fig. 2): I case report Fig. 1_Original explanatory sketch of Summers' technique. Minimally invasive implant placement without the use of biomaterials The bone expansion technique Author_Dr Gilles Chaumanet, MSc, France/Italy 20 I implants4_2015