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►ERA Implant Surgical and Prosthetic Procedure   Adobe pdf The ERA Implant was originally developed in 1999 because of dissatisfaction with the types of mini implants that were available to stabilize an overdenture. Some implants employ a ball on the implant with a ring or female cap in the denture. This configuration requires more vertical and lateral space than the ERA. The ERA has the same universal joint hinging motion as the ball attachments, but also has true resiliency with 0.4 mm of vertical movement. This may be why the ERA has been shown to transmit significantly less force to the implants than many other attachment systems, including the ball.1 The ERA’s aggressive thread depth helps to create mechanical locking while cutting through even dense bone. In fact, unless the bone is very dense, the implant is allowed to self-tap. The ERA Implants are available with either a 2.2 mm or a 3.25 mm screw, with a machined or an acid etched surface, and serve several purposes (Fig. 1). One is to provide immediate stabilization for an overdenture, both on a temporary or a permanent basis. The 3.25 ERA Implant is the only mini implant that is approved for permanent use by the Food and Drug Administration of the United States to immediately stabilize an overdenture. It is also the only implant to actually correct misalignment of the screw. If bone augmentation is part of the treatment plan, the ERA Implants provide a positive vertical stop and lateral stability to limit the force applied to the augmented area. The surgical procedure for the ERA Implant is comprised of only a few simple steps. Many general dentists, who might not perform traditional implant surgery, have found placement of the ERA a quick, simple, and predictable procedure.    A normal tissue flap procedure may be used, but a minimal flap or tissue punch may also be used in certain cases, while preserving as much keratinized tissue as possible (Fig. 2.) After making a shallow pilot hole with a round bur the appropriate length Countersink/Drill is used to prepare the osteotomy and to create a flat area on the surface of the bone (Fig. 3). An ERA Correct Angle Gauge is used as a guide when preparing the next hole (Fig. 4). The Insertion Tool is used to carry the implant to the site and to begin turning the implant into the bone (Fig. 5). The ERA Driver in a surgical handpiece may be used to complete the seating of the implant or the ERA Socket may be used in a torque wrench set at a maximum of 60 Ncm. Slowly rotate the implant until the head is completely seated on the bone (Fig. 6). If an angle correction ERA Implant is used, add a small quantity of ERA Lock Cement into the socket of the base. Also apply a small amount of cement to the button on the bottom of the female. Snap the female into the base in the proper alignment (Fig. 7 & 8). Snap a black fabricating male or a metal jacket onto each female. Small pieces of rubber dam are very effective at blocking out any exposed metal surface (Fig. 9). Process the black males or metal jackets into the denture using acrylic or composite (Fig. 10). Using the Micro ERA Core Cutter in a straight handpiece, cut out the center button of the black male, remove the male’s outer ring, and snap a white Micro ERA Overdenture Male into the denture, using the Micro ERA Seating Tool (Fig. 11, 12, 13). Seat the overdenture with finger pressure (Fig. 14). A significant number of those who might otherwise decide against implant dentistry, based on cost or the fear of complicated surgery, will accept the ERA Implant procedure. Not only will this provide a new source of income to the practice, but promoting the ERA will generate income from other procedures as well. References 1. Porter, Joseph A., Petropoulos, Vicki C., Brunski, John B., Comparison of Load Distribution for Implant Overdenture Attachments. The International Journal of Oral & Maxillofacial Implants, Vol. 17, Number 5, 2002.