Element 1.4 rehabilitation after ridge preservation technique
Prof. Antonio Barone, Geneva, Dr. Fortunato Alfonsi, Domodossola (VCO)
DT Marco Stoppaccioli, L’Aquila
The patient came to our observation showing a radicular fracture on the element 1.4. It was decided to proceed with the extraction of the element and a socket preservation, which allowed us to maintain the volumes of the alveolus.
“The decision to face this case with Prama was inspired by the need, in a site like this with a high aesthetic value, to maintain, optimize and stabilize the soft tissue structure. The Prama IN healing abutments, which embrace the implant neck, have contributed to shaping the tissue profile, to maintain the biological width, a concept from which we start in designing the emergence profile of the crown. Prama makes simple the clinician’s daily work.”
cit. Prof. Antonio Barone, Dr. Fortunato Alfonsi and DT Marco Stoppaccioli
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_827797eadd1e43d88d10141ead849a8b~mv2.jpg/v1/fill/w_147,h_126,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_827797eadd1e43d88d10141ead849a8b~mv2.jpg)
Initial situation.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_3e18f4a6dc6840edb21a18193e4108f4~mv2.jpg/v1/fill/w_147,h_88,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_3e18f4a6dc6840edb21a18193e4108f4~mv2.jpg)
Pre-operative intraoral radiograph of the element 1.4.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_cc69bedded78411d9e870ad6aaeec89f~mv2.jpg/v1/fill/w_147,h_99,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_cc69bedded78411d9e870ad6aaeec89f~mv2.jpg)
Occlusal view of the post-extraction socket with evidence of loss of the vestibular bone wall.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_34c3f07f2b48456b96ef71d0aef51cb2~mv2.jpg/v1/fill/w_147,h_69,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_34c3f07f2b48456b96ef71d0aef51cb2~mv2.jpg)
A socket preservation technique is chosen to preserve the alveolar bone volumes, carried out with -tricalcium phosphate and a collagen membrane with a fibrin sponge covering the alveolus.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_7725a9437c184fca9f31d460a2c994ea~mv2.jpg/v1/fill/w_147,h_61,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_7725a9437c184fca9f31d460a2c994ea~mv2.jpg)
A socket preservation technique is chosen to preserve the alveolar bone volumes, carried out with ß-tricalcium phosphate and a collagen membrane with a fibrin sponge covering the alveolus.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_348e4d011dce47d08c6f2465b5596a0a~mv2.jpg/v1/fill/w_147,h_72,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_348e4d011dce47d08c6f2465b5596a0a~mv2.jpg)
A socket preservation technique is chosen to preserve the alveolar bone volumes, carried out with -tricalcium phosphate and a collagen membrane with a fibrin sponge covering the alveolus.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_cbe8f3f2b7d34b8eab26fabc229306c2~mv2.jpg/v1/fill/w_147,h_85,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_cbe8f3f2b7d34b8eab26fabc229306c2~mv2.jpg)
The alveolus is sutured to induce a healing by second intention.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_51d7369acf654d42bc2cf7e087da8607~mv2.jpg/v1/fill/w_147,h_113,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_51d7369acf654d42bc2cf7e087da8607~mv2.jpg)
Radiographic healing of the alveolus after 6 months.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_3432e7ae70224a5599061dd954d1a49d~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_3432e7ae70224a5599061dd954d1a49d~mv2.jpg)
Clinical healing of the post-extraction site after 6 months.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_73738ca88c064c5eae78b147063baa2a~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_73738ca88c064c5eae78b147063baa2a~mv2.jpg)
Insertion of the Prama RF implant. Then a Prama IN healing abutment will be placed: it surrounds the implant neck by 0.5 mm.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_dadc3aa6dd8244c491ff8cf7f7b62b57~mv2.jpg/v1/fill/w_147,h_94,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_dadc3aa6dd8244c491ff8cf7f7b62b57~mv2.jpg)
Clinical healing after 6 months.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_defb65ac8b204f79a901d4ea5c89aa15~mv2.jpg/v1/fill/w_147,h_96,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_defb65ac8b204f79a901d4ea5c89aa15~mv2.jpg)
Gingival profile after removal of the Prama IN: the connection platform is at the level of the soft tissues, far from the bone for a length of 2.8 mm, which corresponds to the biological width.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_450d6e70beb14322904e66d7d628a23b~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_450d6e70beb14322904e66d7d628a23b~mv2.jpg)
Laboratory phase with the analogue in the model.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_3ec3acc2500e4c20b96adfd2a38bedef~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_3ec3acc2500e4c20b96adfd2a38bedef~mv2.jpg)
Screw retained temporary crown in resin, made on Prama IN healing abutment, which maintains the same emergence profile and the same closure around the implant neck of the relative healing screw.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_bfcaccf18f7a40b8ab71c2102b1d62b4~mv2.jpg/v1/fill/w_156,h_151,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_bfcaccf18f7a40b8ab71c2102b1d62b4~mv2.jpg)
Temporary crown in place: occlusal view.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_d3be58a2f1de484d92bd01134c30daa8~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_d3be58a2f1de484d92bd01134c30daa8~mv2.jpg)
Temporary crown in place: clinical photo and radiograph.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_b93f913784e34698b0d3cbb5cf279ef6~mv2.jpg/v1/fill/w_147,h_110,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_b93f913784e34698b0d3cbb5cf279ef6~mv2.jpg)
Temporary crown in place: clinical photo and radiograph.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_8c14fb927b124cfbae2da5195bf1adec~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_8c14fb927b124cfbae2da5195bf1adec~mv2.jpg)
Laboratory phases to produce the definitive crown, made with Prama IN T-Connect.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_3a18b31e1ffd4b97b5102f340b16e0a5~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_3a18b31e1ffd4b97b5102f340b16e0a5~mv2.jpg)
Laboratory phases to produce the definitive crown, made with Prama IN T-Connect.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_2ffaba3e985d4486a692eeaec756831f~mv2.jpg/v1/fill/w_147,h_127,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_2ffaba3e985d4486a692eeaec756831f~mv2.jpg)
Adjustment and laboratory preparation of the T-Connect support.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_70ecc58850ec4ad894025058959b9129~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_70ecc58850ec4ad894025058959b9129~mv2.jpg)
Luting of the crown on the model.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_225569efe62d4e5a8f18cf343df327ee~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_225569efe62d4e5a8f18cf343df327ee~mv2.jpg)
Luting of the crown on the model.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_7cb238f159fb4432a2f1f19d06ee2b3e~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_7cb238f159fb4432a2f1f19d06ee2b3e~mv2.jpg)
Finishing phases of the crown in the laboratory.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_d11258a4a1f6402c94e54cc543e15267~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_d11258a4a1f6402c94e54cc543e15267~mv2.jpg)
Finishing phases of the crown in the laboratory.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_fff337f1a1d54848a6a6eb9d1897bc9b~mv2.jpg/v1/fill/w_147,h_113,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_fff337f1a1d54848a6a6eb9d1897bc9b~mv2.jpg)
Radiographic follow up at 12 months.
![Image courtesy of: Dr. Costantino Vignato, Dr. Giuseppe Vignato.](https://static.wixstatic.com/media/53bf88_b0fb313abe834cf4a19e6b9781807f76~mv2.jpg/v1/fill/w_147,h_98,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/53bf88_b0fb313abe834cf4a19e6b9781807f76~mv2.jpg)
Clinical follow up at 12 months.