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The aim of this issue is to describe endosseous distal extension (EDE) surgical technique. This implant technique was conceived and applied since 1993 by Dr Luca Dal Carlo, as an evolution of the classical ramus blade implant technique. With this technique, you attain great stability of the blade implant, due to the following difference compared with the classical blade implant technique: the hard and soft tissues lying behind implant abutment are not being destroyed at all. A slot is made on the upper side of the bone ridge, and the blade is inserted into it and pushed backwards, so that the implant is embedded under untouched tissues. Using blade implants specially drawn for this particular surgery, the slot’s length turns out to be about half of the implant’s length. Piezo bistoury is useful to facilitate surgical proceedings. If we compare the regenerated bone on the mesial part of the implant and the bone that had remained untouched on the distal side, we will see a difference in the tissue density even after a long time. EDE technique is suitable for those cases in which the lower distal sector is characterized by scarceness of cancellous bone. Data collected during 22 years of clinical practice (97.7% 5-year success rate) allow to suggest employing this technique with asymmetric blades to treat D3-D4 narrow ridges located in the posterior mandible. Soft tissue response results are very good.