Post-extraction Prama RF implant in site 2.4, with immediate provisionalization and resin crown previously made in the laboratory to conform the tissues after surgery
Dr. Guillermo Cabanes Gumbau, DT Violeta Alapont Asensio, Vila Real, Spain
32-year-old female patient without previous medical records. An avulsion procedure is planned for the root residue of the element 2.4, with immediate insertion of a post-extraction implant immediately temporized. In the same surgical step, a narrow Outlink2 Slim implant is also inserted in position 2.6.
“The absence of a determined closure line allowed me to establish the prosthetic margin with maximum freedom from the provisional stage. A simple precaution such as the creation of two lateral retainers resting on adjacent elements allows to transfer to the patient’s mouth the same occlusion studied on the model in the articulator.”
cit. Dr. Guillermo Cabanes Gumbau
Clinical image showing the residue of the root of the element 2.4.
Radiograph showing the residue of the root of the element 2.4.
On the model, a resin crown is made with retainers on the adjacent occlusal elements to guide its positioning in the mouth. The crown is pierced at the time of surgery.
Atraumatic extraction of the root residue with the aid of a Benex extractor and debridement of the alveolus.
Measurement of gingival thickness using a probe with a rubber stop to establish the length of the preparation.
Osteotomy and recovery of autologous bone debris thanks to the geometry of the cutting edges of the drill.
Immediate positioning of a Prama RF implant (4.25x13 mm). In the same surgical phase, a narrow Outlink2 Slim implant is inserted in position 2.6.
Immediate positioning of a Prama RF implant (4.25x13 mm). In the same surgical phase, a narrow Outlink2 Slim implant is inserted in position 2.6.
Placement of the prosthetic abutment and perforation of the resin crown in the center of the occlusal face. The peri-implant gap is temporarily protected with a hemostatic sponge to prevent possible contamination with resin during the relining.
The crown is relined with self-curing resin (Reef Crown & Bridges) and is placed on the abutment. To leave the screw hole free it is filled with Teflon, which will be easily removed at the end of the polymerization.
The crown, which incorporated the prosthetic abutments, is removed for finalization.
Filling of the peri-implant gap with bone fragments collected during drilling, mixed with PRF.
The crown is shaped with an adequate emergence profile, using adhesive and light-curing fluid composite. The procedure is simplified by inserting a silicone o-ring on the neck of the analogue, which acts as a stop for the fluid composite at the desired cervical level of the crown. After the crown is bound to the post, at the desired level respect to the adjacent elements, it is possible to remove the lateral extensions with a disk.
Occlusal, lateral and radiographic images when the temporary crown is screw retained to the implant, after removing the lateral extensions. It is not necessary to suture, since the crown itself acts as an “alveolar cap”.
Intraoral situation 20 days after surgery.
Intraoral situation 20 days after surgery.
After 3 months the prosthetic crown is removed to check the evolution of the healing process and to take an impression. A healed and organized trans gingival path is clearly visible, with a well-defined emergence profile.
Preparation of the emergence profile on the model. Construction of the crown with a castable post with titanium base screw retained on Prama in position 2.4 and crown luted with “stud screw” on Outlink2 Slim in position 2.6.
Preparation of the emergence profile on the model. Construction of the crown with a castable post with titanium base screw retained on Prama in position 2.4 and crown luted with “stud screw” on Outlink2 Slim in position 2.6.
Preparation of the emergence profile on the model. Construction of the crown with a castable post with titanium base screw retained on Prama in position 2.4 and crown luted with “stud screw” on Outlink2 Slim in position 2.6.
Preparation of the emergence profile on the model. Construction of the crown with a castable post with titanium base screw retained on Prama in position 2.4 and crown luted with “stud screw” on Outlink2 Slim in position 2.6.
Clinical and radiographic aspect after 6 months.