Rehabilitation of severely resorbed ridge in the aesthetic area with Prama Slim
Dott. Andrea D. Di Domenico, Cava De’ Tirreni (SA)
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The 38-year-old patient came to our observation with a Maryland bridge in position 1.2, asking to improve the aesthetics and stability of the rehabilitation. Clinical examination shows severe three-dimensional tissue contraction in position 1.2, later confirmed by Cone Beam images.
During the anamnestic phase, the patient says that she lost her tooth when she was 26, as a result of a traffic accident.
Severe bone resorption, in the bucco / palatal direction, is attributed to the loss of the buccal alveolar wall after traumatic avulsion of element 1.2.
Based on the patient's requests, we decide to replace the outdated Maryland bridge with an implant-supported prosthesis.
Once studied the morphology of the residual bone crest, we choose to place a Prama Slim implant with a 3.30 mm diameter that will allow the complete housing of the rough portion inside the bone.
The 1.80 mm high neck will facilitate the management of the vestibulo-palatal discrepancy, interacting on one side with the soft tissues and on the other with the bone.
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In the first surgical phase, through a conservative crestal incision, the implant is inserted and immediately restored with a screw-retained provisional crown.
At 3 months, we decide to increase the volume of the vestibular soft tissues by inserting a cross-linked collagen membrane slowly reabsorbable.
A half thickness flap is opened, with coronal repositioning, and the membrane is stabilized in the periosteum with a suture. The rounded cervical profile of the provisional crown has the function of supporting and stabilizing the flap.
After a month and a half, the interproximal areas are modified to make room for the development of the papillae. At this stage an excellent maturation of the mucous tunnel can already be recorded.
After 6 months, the temporary crown is replaced by a final screw-retained zirconia-ceramic crown.
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The aesthetic result at 13 months, with papillae perfectly adapted to the profile of the crown and supported by a very natural vestibular contour, meets the expectations of both the patient and the clinician.
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Initial case
Preoperative tomographic evaluation
Frontal and occlusal view when removing the Maryland bridge
Exposition of the surgical site: vestibular resorption is further visible
Preparation of the surgical site
Prama Slim positioning in the surgical site
Preparation of the temporary post
Fabrication of the temporary screw retained crown
Immediate placement of the provisional rehabilitation and flap repositioning around the crown
Healing after 7 days
Healing at 3 months: considering the vestibular depression that compromises aesthetics, we decide for the insertion of a membrane
Tomographic control
Removal of the provisional crown
Flap incision, passivation and exposure of the vascular bed
Placement of a cross-linked collagen membrane to increase buccal volume.
Healing after 7 days
Remodelation of the interproximal areas of the crown to allow space for the development of papillae
Comparison between healing at 45 and 90 days
Healing at 3 months
Healing at 6 months
Healing at 13 months
Radiographic control with provisional and definitive rehabilitation