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.

The human tongue is a muscular organ with a variety of life-important functions. Mastication and swallowing, taste, and speech are vital functions. From the analysis of the lingual function, clinical considerations during the oral-pharyngeal phase of swallowing, the tongue thrusts anteriorly and laterally, creating enormous pressure. If it applies to freshly inserted dental implants, it could be leading to early implant failure. Different authors have calculated this pressure between 20 and 200 kPa, depending on tongue volume, producing resultant torsion forces on implant abutment. The work aims to understand the importance of the destabilizing action of the tongue in the post-operative period. When the use of implants resting in quiescence for a long time under the gums is not possible, because of anatomical reasons (for example: thin ridge), or: immediate loading is planned, the action of the tongue must be considered. We are proposing some solutions to the problem to improve therapeutic safety: 1)Attach immediate provisional prostheses to existing adjacent teeth. 2)Immediately upon implants insertion, rigidly connect implants. 3)When an immediate loading protocol is implemented, the operator should follow the guideline, taking care to apply correctly balanced axial forces, without any lateral stress. Our professional experience, based on over 10.000 clinical cases performed during 35 years, confirms that, with implants emerging in the oral cavity, handling in proper way the tongue thrust during the healing period makes the difference. All what has been here implemented about this subject, represents the development of the legacy left by Prof. Ugo Pasqualini, an Italian dentist who, since the seventies, has been deepening the topic of the risks tied to the intra-oral stresses acting on the emerging part of the implants.

Doctor Luca Dal Carlo, Venice, Italy, introduced the Auriga protocol. Auriga protocol is suggested for rehabilitating partially edentulous, potentially fully edentulous, and fully edentulous patients with immediate interim and nal xed prostheses. After the patient's evaluation and treatment plan are completed, stage one: implants are placed bilaterally into the maxillary tuberosities. After implants are integrated, usually 4-6- month, the stage two, the remaining teeth on the maxillae are removed and immediately replaced with dental implants. All implants are rigidly connected (welded) with a chairside fabricated titanium bar. Prefabricated interim prosthesis adopted and attached to the formed rigid structure. Auriga protocol offers different methods to attach an interim and a nal prosthesis. During a period of over 20 years (1998-2019) 223 implants have been inserted into 47 maxillary arches, providing 18 full-arch and 29 unilateral x prostheses. Just 3 implants were lost: no one of the 47 rehabilitations was compromised