Dr. Ronald B. Odrich, Dr. Alan A. Winter, and Dr. Alan S. Pollack
Park Avenue Periodontal Associates, P.C.
532 Park Avenue, New York, NY 10021
212-838-0940   Fax: 212-355-4784
e-mail: parkaveperio@earthlink.net

Lecture Schedule and Information

From the moment titanium implants came on the scene, periodontists and oral surgeons needed to acquire new skills for successful integration of implants to bone. We learned that heat harmed osteoblasts, so we used slow-rotating handpieces. We knew to irrigate with water, but we were used to doing that. We were told that any implant length would do as long as it was fused to the bone; we now know that short implants don't work as well as longer fixtures. Prostheses of the 1980s often employed cantilevers; today we try to avoid them. We learned about torque, about healing periods, and about proper occlusion. So as long as we didn't burn the bone, we saw that implants were successful.

Repetition made us better. Experience taught us limitations. We had mastered the learning curve and were cruising along without a hitch...or so we thought. So why, after an aggregate of 47 years of placing cylindrical titanium implants, have we disrupted our comfort zone that employs familiar techniques for a new system that requires us to climb the proverbial "learning curve" yet one more time in our careers?

Before tackling the answers to these questions, we need to point out our perception of the modern-day history of implant placement. In the early years, surgeons and periodontists placed the implants where they thought best or where there was enough bone. Of late, the restorative dentists have had more say in wanting us to place implants in more "optimal" sites for better esthetics. If the bone is too thin, make it wider. If there's not enough room under the sinus, graft it. Move the nerve, grow the bone...anything for better implant placement. The trouble is that existing techniques have their limitations and results are not always as good as we want them to be.

Searching for ways to overcome these limitations, an outstanding team of Italian surgeons - Dr. Gianni Bruschi and Dr. Agostino Scipioni - adapted surgical techniques taught them by Dr. Ronald B. Odrich that were based on partial thickness flaps. These periosteal retention techniques were applied to splitting thin alveolar ridges that were "too narrow" for implant placement and "swaging" the maxillary bone in order to avoid the traditional sinus lift currently being performed. Bruschi and Scipioni based their revolutionary surgeries on classic wound healing, and depend on partial-thickness flaps to maintain the blood supply.

But placing these implants requires greater skill. Care must be taken in flap design and learning how to preserve the periosteum. Placing the screw-type fixtures is better served by tapping them most of the way down rather than screwing them into the sites. For these techniques, the Beaver Blade is indispensable. Besides using this versatile instrument to incise our flaps, we use it to split ridges (the E.R.E.™ or edentulous ridge expansion), swage bone next to the sinus (the L.M.S.F™ or localized management of the sinus floor), and in some cases, twirl it to create the entire implant site without using a bur. This reduces trauma and preserves bone. These surgeries work best with tapered implants.

Case 1: ERE™
A. Thin mandibular process split in 1993.	B. Implant fixtures in place.

Case 2: LMSF™

A. Pre-op. Alveolar crest in-fractured under right and left maxillary sinus. No bone graft nor membranes was used.

B. Four months post-op. Bone is filling in between implants; sinus is raised.

A New Biological Approach for Better Implant Placement

E.R.E™ and L.M.S.F™ are trademarks owned by Park Avenue Peridontal Seminars Ltd.

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Park Avenue Periodontal Associates
532 Park Avenue, New York, NY 10021
Telephone (212) 838-0940   Fax (212) 355-4784
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