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C.E. article_ bone-expansion technique I Fig. 11 Fig. 12 last millimeter under the sinus floor. If a maxillary implant is to be placed completely in native bone, convex inserts suffice. The last insert that is placed is smaller in diameter than the implant that is chosen. The advantage of this technique was noted start- ing in 1996 by Summers himself with the use of coni- cal osteotomes as opposed to cylindrical osteotomes, which were all that were available up until then. The idea was actually to enable lateral peri-implant bone condensing in order to increase notably the primary stability and compensate for the lack of vertical di- mension of the sub-sinus native bone. The objective of this technique is to maintain, if possible, the entire maxillary bone by laterally pushing back the bone with minimal trauma while creating a precise osteotomy that breaks the last mil- limeter of the sinus floor while protecting the sinus membrane. The consequence is the notable increase in peri-implant bone density with a high elevation of BIC (bone implant contact) and, therefore, bone stability. _Case No. 2 The patient presented with a fracture of #24 with significant periapical infection (Figs. 9,10). It was decided that an extraction would be per- formed with immediate placement and loading of an implant after complete decontamination of the extraction socket using lasers (Figs. 11, 12). Next, Osteo Safe was used (Fig. 13) to enable gentle trabecular expansion and placement of a self- tapping conical implant (Axiom PX® Anthogyr). In this case, where bone recovery along the oste- otomy walls was not necessary, only convex inserts were used. The palatal and subcrestal position of the implant is respected (Fig. 14). The gap between the implant and the vestibular cortical bone is not filled. Careful choice of the implant abutment enables an ideal emergence both in terms of hard tissue and soft tissue. The temporary crown is thereby shaped in such a way that it closes the gap by slightly compress- ing the marginal gum (Fig. 15). Fig. 11_Laser decontamination. Fig. 12_Laser degranulation. Fig.13_Use of Osteo Safe in the extraction socket after debridement and decontamination. Fig. 13 It is mounted out of functional occlusion. Of course, the patient was advised to avoid voluntary chewing on this implant and only use local cleaning with cotton soaked in Chlorhexidine. Following verification of the osseointegration (Fig. 16), the impression was made eight to 10 weeks after surgery, followed by placement of the perma- nent prosthesis (Fig. 17). _Conclusion The implant placement technique with the use of osteotomes is not a new concept. On the other hand, using an automatic osteotome provides a better view of the site and makes it possible to practice flapless surgery, to position more precisely and obtain more homogeneous progression, in comparison to using bone taps with a surgical mallet. From the patient’s perspective, surgical comfort is significant and very noticeable. implants 2_2017 I 07