The aim of this issue is to describe endosseous distal extension (EDE) surgical technique. This implant technique was conceived and applied since 1993 by Dr Luca Dal Carlo, as an evolution of the classical ramus blade implant technique. With this technique, you attain great stability of the blade implant, due to the following difference compared with the classical blade implant technique: the hard and soft tissues lying behind implant abutment are not being destroyed at all. A slot is made on the upper side of the bone ridge, and the blade is inserted into it and pushed backwards, so that the implant is embedded under untouched tissues. Using blade implants specially drawn for this particular surgery, the slot’s length turns out to be about half of the implant’s length. Piezo bistoury is useful to facilitate surgical proceedings. If we compare the regenerated bone on the mesial part of the implant and the bone that had remained untouched on the distal side, we will see a difference in the tissue density even after a long time. EDE technique is suitable for those cases in which the lower distal sector is characterized by scarceness of cancellous bone. Data collected during 22 years of clinical practice (97.7% 5-year success rate) allow to suggest employing this technique with asymmetric blades to treat D3-D4 narrow ridges located in the posterior mandible. Soft tissue response results are very good.

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Intense forces are naturally downloading on molar roots. Due to inflammation, the post-extraction sockets of the upper molars are often poor of bone on one side. A single implant supporting a prosthetic crown can easily go subject to displacing forces that reabsorbed and recently healed bone can hardly bear. By utilizing a couple of prosthetic roots, i.e.: one screw implant in the side in which bone is richer and one blade implant in the side in which the bony wall has gone subject to reabsorption, it is possible to build a better supported prosthetic crown. The clinical cases performed by the Authors confirm the validity of this implant architecture. Aim of the work is to describe a post-extraction multi-modal implantological technique useful for replacing the roots of upper molars with poor bone support on one side. Materials and Methods: Combination of submerged screw implant and submerged blade implant or emergent screw implant and emergent blade implant welded intraorally. Discussion: The combination of a palatal screw implant and a buccal blade implant, or vice versa, allowed to solve clinical cases and to make reliable prosthetic crowns. Conclusions: The presence of variable residual anatomies in the molar area of the upper jaw recommends the use of morphologically different implant shapes, suitable for the construction of a biomechanically functional prosthetic abutment. Specifically in the presence of bone resorption, the combination of a screw implant and a blade implant allowed us to obtain a reliable abutment. Given the small number of cases performed, further research will confirm the positive results of this technique.

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