The principe of the minimally invasive implant surgery is more than a procedure, it is a full concept were all steps are contributing to reach the major keys for a long term implant outcome. Minimally Invasive Surgery is not only a surgical technique were smaller incisions are performed. It is also a coherent assessment were surgical impact and its associated products such as biomaterials or sutures are banned or at least minimized.

    Minimally Invasive Implant Implant placement shouldn’t be only subtractive but a real rational tissue management where bone volumes are displaced by condensation or expansion ending by emphasizing the bone density. In raising the bone density the advantages are multiples like better primary stability and Bone/Implant Contact (BIC) that are the 2 most well spread cited factors for long-term implant survival and success. Immediate post-extractive implant placement is now accepted in clinical dentistry for reconstruction of partially or completely edentulous mandible or maxilla. Advantages of immediate implantation are numerous: post-extraction alveolar process resorption is reduced, diminution of surgical visits, shortening the treatment time by the diminution of the healing process, higher patient acceptance and satisfaction, improved functional and esthetic results. The clinical survival rates of immediately placed implants are comparable to those of implants placed following tooth extraction and wound healing. Preservation of the buccal plate allows precise implant placement, improves the prosthetic emergence profile and more over preserves the morphology of the peri-implant soft tissues thereby affording improved esthetic-prosthetic performance. The surgical requirements for immediate implantation include extraction with the least trauma possible, preservation of the extraction socket walls and thorough alveolar curettage to eliminate all pathological material. Some new devices like mechanical periotomes or osteotomes coupled to laser technology can be now utilize to enhance these objectives. Then since we know that primary stability is an essential requirement the use of an aggressive implant shape and surface with deep threads combine to a condensation bone technique will help to reduce the healing period. The esthetic emerging profile issue will be achieve by a 1-2 mm sub-crest implant placement using a platform switching and a morse taper. This predictable treatment modality will lead to a high rate of crestal bone preservation with a minimally invasive approach.

    But one of the first dilemma in immediate implant surgery is : shall we fill the gap (between implant and bone) or not ? The major issue is represented by the fact that during healing this hiatus will be contaminated by germs and eventual undifferentiated cells from the epithelium lineas. We all know that the following cell competition will ends up by a loss of bone. If we don’t want to use bone substitutes, the only alternative will be Guided Bone Regeneration without Biomaterial Barrier Membrane and bone volume managing procedure. This suppose tissues themselves must have the sufficient barrier effect again any buccal fluid leakage. A bone regeneration must be induce by selectivity but we don’t want to delay the catabolic phase. Such an arrangement can be found with a special management of natural fully biocompatible vital tissues, think autogenous like the periosteum and the use of platelet concentrates witch are considered as innovative tools of regenerative medicine, particulary in oral and maxillofacial surgery.

    In these conditions one of the key factors in immediate post extractional implant is represented by the vaporisation of the infected or potentially infected surface of the socket (collagen and Sharpey fibres + granulation tissue) that until now no other device or procedure can substitute and will contribute in reducing drastically the catabolic phase of healing or reconstruction.

    Following these principles the catabolic phase during the healing time will be substantially reduce allowing a quicker loading and the esthetic outcome more predictable.

An other hot topic is the placement of implant under the sinus in the posterior maxilla. What choice should we make ? Avoid the sinus cavity by placement of short implants or pterigoid implants, lateral sinus-lift or crestal approach ? Grafting or non grafting ? Delayed, early or immediate loading ? So many questions and complicated solutions when an original, easy and predictable surgical technique will allow the placement of end osseous implants in the atrophic posterior maxilla in conjunction with sinus elevation without bone grafting ending in a reduce healing period with significant amount of bone formation around the implants at the sinus floor, resulting in successful restorations and eliminating the need for bone grafting.