CLINICIAN > IDEAL FOR THIN RIDGES
Faced with particularly thin crests, or with a knife-edge conformation (in which the most coronal part of the crest is very thin, and then widens widely after a few millimeters) the use of bone-level or transmucosal implants with traditional divergent morphology would oblige to use regeneration material to cover the exposed threads, then protecting the site with membranes.
Prama allows you to face this type of clinical challenge with greater predictability and confidence.
CLINICAL CASE COURTESY OF DR. ANDREA DI DOMENICO, CAVA DE' TIRRENI (SA)
With Prama even surgery in very thin ridges is simpler and safer thanks to the Slim implant, with a constant diameter of 3.30 mm along the entire implant length. The presence of such a thin ZirTi treated portion allows you to make the most of the scarce amount of bone available and the UTM neck (which in the SLIM implant is available in both 1.80 mm and 2.80 mm lengths) maintains the cylindrical geometry of the implant and exploits the benefits that its particular micro-threaded surface brings both in contact with the bone and with soft tissues.
Initial clinical and radiographic situation showing the difficult anatomical condition of the bone crest.
Insertion of the Prama Slim implant, which thanks to its geometry make the most of the scarce bone availability. Compensation of the defect with deproteinized bovine bone mineral particles.
Surgical detail of the implant in place: the neck is positioned out of the bone on the palatal side, as the UTM surface will be an adequate substrate for soft tissue growth.
After surgery CBCT.
Clinical and radiographic healing 13 months after surgery.
Clinical healing 15 months after surgery.
P-SLIM IMPLANT AS REPLACEMENT OF A MAXILLARY PREMOLAR
COURTESY OF DR. GUILLERMO CABANES GUMBAU
In this clinical case, the use of the Prama Slim implant is presented for the replacement of the upper left first premolar.
Prama Slim is useful to rehabilitate the small edentulous spaces due to long term premolars absence, which have generated small interproximal empty areas due to the progressive mesialization of the remaining posterior teeth.
In these cases, a therapeutic option is slightly increasing the small edentulous space by gently grinding and parallelizing the interproximal surfaces of the adjacent teeth, followed by the surgical insertion of a Prama Slim at the same visit, and the following prosthodontic rehabilitation after the end of the osseointegration period using a crown without palatal cusp (like a second canine), and without lateral contacts, thus avoiding any type of biomechanical overload on the abutment-implant interface.
Surgical insertion of Prama Slim into the small edenthal space at the level of the left upper first premolar
Preparation of the emergence profile on the model, selectively removing material around the neck of the analog.
Metal-ceramic Cron design, without palatal cusp and with B.O.P.T. profile: physiological over-contouring in the vestibular side and scalloping in the interproximal áreas for adequate modulation of the morphology of peri-implant mucosal tissues by controlled mucosal compression.
Appearance of the peri-implant soft tissues at the delivery of prosthesis, and controlled gingival compression between the cemented crown and the new morphology, drawn above the cervical profile of the soft tissues. The gingival ischemia that is generated by this coronal compression disappears after about 15 minutes. It can be noted a small amount of anesthesia in the apical portion of the gingiva to avoid discomfort to the patient during compression of the cementation.
Appearance of the restoration and pericoronary mucosal tissues 6 days after placement.
Intraoral Radiographs corresponding to the day the surgical insertion, and the day of restoration placement after 3 months.
CLINICAL CASE COURTESY OF DR. MARCO CSONKA, CATANIA
In the case of "hybrid" crests, in which the first millimeters are particularly thin and then gradually widen, the peculiar conformation of Prama allows to deepen it into the bone for the entire ZirTi portion, thus bringing the threads where the bone has a suitable thickness to host them: the convergent portion of the neck will adapt to the shape of the bone and give more space to soft tissues, in a single surgery and without having to resort to large amounts of biomaterial.
