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implants 1_2016 I C.E. article_ bone-expansion technique Author_Gilles Chaumanet, DMD, MSc Minimally invasive implant placement without the use of biomaterials using the bone-expansion technique This article qualifies for C.E. credit. To take the C.E. quiz, log on to www.dtstudyclub. com. Click on ‘C.E. articles’ and search for this edition (Implants C.E. Magazine — 1/2016). If you are not regis- tered with the site, you will be asked to do so before taking the quiz. You may also access the quiz by using the QR code below. _c.e. credit 04 I _The success rate in implantology is close to 96 percent. Thanks to well-established implant place- ment protocols, with a few differences according to the implant system used, the predictability of the result under optimum tissue conditions is quite significant.Itisverydifferentwhentheseconditions do not meet the recognized standards in terms of volume and quality for reproducibility in implantol- ogy. For example, thin ridges, which are frequent occurrences, will require a long and costly process forpatientsbecausetheyentailboneaugmentation or possibly support tissue grafts. Isthereaminimallyinvasivealternativeforthese patients that allows them to be treated without these problems? One line of thinking is to stop the systematic practice of implantology as subtractive at the tissue level, but rather to transfer these vol- umes and thereby ensure a minimally invasive pro- cedure. This implies reviewing all the biomechanical principles of implantology, not only in terms of the implant structure and design but also in relation to peri-implant tissue. Thegeneralsurgicalprincipleofmodernimplan- tology since Brånemark has been bone preparation, called osteotomy, as close as possible to the dimen- sionsoftheimplantthatwillbeplaced.Thisprinciple is still widely prevalent. However, soft-tissue management has evolved, and the trend the past few years has been to man- age soft tissue from the first surgical step. With the arrival of self-tapping conical implants, a new technique was developed that enables lateral as well as vertical bone compressing, condensing or expanding.Inaddition,in1994,Summers,practicing hiscrestalsinuslifttechniquewithcarefulchoiceof conicaltaps,wasthefirsttodemonstratethecapac- ity of cancellous bone to be modeled (Fig.1). Through two clinical cases, we will see it is pos- sible to be minimally invasive, precise and also avoid the use of biomaterials simply by exploiting the biomechanical properties of bone tissue and its capacitytoregenerate.Respectingguidedregenera- tion principles, which means the implementation of physical barriers to isolate the epithelial and con- nective tissue cells from the operating site, enables regeneration of the different tissues. These principles are (Fig. 2): • Primary closure of the surgical site to enable Fig.1_Original explanatory sketch of Summers’ technique. (Photos/Provided by Dr. Gilles Chaumanet) Fig. 2_Bone expansion through the septum with the use of osteotomes (2a, 2b). Choice of healing screw that enables primary closure of soft tissue (2c, 2d). Fig. 1 Fig. 2 2a 2b 2c 2d