TWO-PHASE INTEGRATION BRAKET

Numerous techniques have been used to bypass anatomic limits over the years.
It is worth recalling maxillary sinus cerclage, lateral insertion implants. More recently, considerable emphasis was given to major sinus lifting. However, this type of surgery was relatively invasive and required long waiting times before implant structures could be used and above all led to severe sequelae in the event of failure.
Oro-antral communications may be created that are sometimes very difficult to close. To this should be added the fragility of the endostial membrane which is prone to spontaneous intraoperative laceration, caused merely by the patient’s respiratory movements and not by inappropriate surgical procedures. In the event of scarce or insufficient perimplant ossification, another immediate and also long-term complication is the dislocation of the implant inside the sinus.

Sinus lifting showing postoperative failure

"Sinus lifting failed after 11 years. In compliance with the asymptomatic patient’s wishes, work was carried out in situ under periodical control. Note pins inserted later for support

For these reasons, an attempt was made to find alternative techniques that would respect the physiological anatomic structure.
Credit should be given to Apolloni for having explored the possibilities leading to extrasinal cortical support.
The disadvantage of this type of bracket is the lack of primary stability and the seal is similar to subperiosteal implants. Lastly, it is worth recalling the possibility of externalising the vestibular decubitus branch from the mucosa in this site, which is sometimes particularly thin and often subject to the traction of muscle insertions.

LORENZON’S TWO-PHASE INTEGRATION BRACKET

The two-phase bracket offers considerable primary stability, above all due to the teeth at the outside edges which allow immediate stapling. It is also embedded by a graft that not only transforms it into a bicortical endosseous implant, but also avoids externalisation by providing a support base

Increased primary stability also allows its use as a distal and not only intermediate post.

Postoperative stratigraphy

Control postoperative X-ray after 3 years

Two-phase integration brackets, on the left the final version which allows perfect adaptation to the crest