CLINICIAN > STABILIZING THE CLOT
The synergy of the convergence of the Prama neck macromorphology and UTM (Ultrathin Threaded Microsurface) micromorphology allows even very complex rehabilitation to succeed, often without additional materials.
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The following case documents an instance of immediate post-extractive rehabilitation, evident both in radiographs and through clinical observation, where significant bone compensation was obtained around the neck of Prama implants, without the use of filling materials. Where necessary, the convergent intramucosal morphology allowed the implant/abutment gap to be brought out from the tissues and space to be given to the clot in the absence of bacteria, while the (UTM) Ultrathin Threaded Microsurface neck fostered optimal organization and stabilization of the fibres, which accelerated the healing process.
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All these features contributed to the natural regeneration of circumferential bone despite any initial significant deficits.
Case Report
Dr. Ignazio Loi
Upon examination, an 84-year-old female patient presented with a fracture of element 23, which had supported a bridge up to elements 26 and 27. The x-rays clearly showed an area with radiopaque particulate matter in the soft tissues surrounding the stump post. After interviewing the patient, it became clear that the particulate was the dispersion of cement, incorporated in a delimited area, making it invisible to clinical observation and difficult to remove. The fracture could have occurred over the previous six months, during which time the patient reported that she had noted some inflammation, which was treated with generic antibiotics, until the onset of the large abscess, which was the reason she came into our surgery. During this period the bridge did not move, being stabilized by elements 26 and 27.
At the patient's request, the bridge was cut between elements 25 and 26 in order to save that part of the old prosthesis. Then three Prama implants were inserted, with a diameter of 3.80 and whose neck design permitted a range of vertical positioning that could compensate for any bone defects or excesses, including any problems these issues might engender. The defect caused by the abscess in correspondence with the canine tooth had a diameter measuring about 1 cm.
Initial radiographic case: the radiopaque aura caused by the dispersion of cement in the soft tissues can be seen around the fracture of element 23.
Surgical site after extraction of the fractured element and the initial drilling to prepare the implant sites in positions 24 and 25. The circumferential defect left by the abscess is evident.
The x-ray showing the pins in the surgical sites: note the significant vertical and horizontal discrepancies, especially distally at position 23.
Implants inserted without healing screws: the blood covers the entire Prama neck; however, the connection platform position was favourable both from the standpoint of the biological maintenance of the clot, soft tissue management and future prosthetic procedures.
Healing screws placed in situ.
Transgingival sutures.
Healing at 4 weeks: note the state of the soft tissue maturation and the thickness recovered around all three fixtures.
X-ray of healing at 4 weeks: although the alveolar process is still visible, the deficit around the implant in position 23 is closing.
X-ray with prosthetic at 6 months: the deficit is completely filled in, as are the circumferential bone peaks at the implant.
Occlusal view of the definitive prosthetic in situ.