Geplaatst op Geef een reactie

All on Prama

All on Prama

16. All on Prama

Without PRAMA
With PRAMA

Voordelen Prama voor het schuin geplaatste implantaat.

Wanneer er gebruikt wordt gemaakt van het ‘all on four’ (or six) concept is het noodzakelijk om op abutmentniveau te werken (zoals P.A.D. abutments welke lichtblauw worden aangegeven in de afbeelding), zowel op de schuin geplaatste implantaten als op de recht geplaatste implantaten in het front. De distale marge van het schuin geplaatste implantaat staat heel diep waardoor er achter het implantaat een krater ontstaat mede doordat het abutment geplaatst moet worden.

Maar bij het plaatsen van Prama’s hoeven in het front geen abutments geplaatst te worden, alleen op de distaal geplaatste komen abutments. Tevens zorgt de nek van Prama er voor dat deze distaal net boven het bot zodat er geen krater ontstaat aan de distale kant.

De prothetiek kan eenvoudiger uitgevoerd worden aangezien er minder abutments geplaatst hoeven te worden. (hier staat het origineel in het engels)

 

Hieronder een casus van Dr. Marco Csonka’s

ALL ON PRAMA AND SIMPLE TECHNIQUE

Csonka M.

Numeri Uno, 22: 14-15, 2015
The rehabilitation of edentulous jaws with tightened implant-supported immediate loaded prosthesis has become recently, a method of routine use. The possibility to bypass the anatomical limits (jaw sinus, lower alveolar nerve) using tilted implants with specific angled abutments (M.U.A.or P.A.D.) has expanded the use of these kind of immediate loading rehabilitations even in the athrophic maxilla, decreasing the need to apply the additional reconstructive bone surgeries (sinus lifts, GBR, grafts) with the consistent reduction of the times, costs and the post-operative morbidity for our patients.
The accurate pre-operative study of the case and the use of surgical guides always more reliable and accurate made these techniques safe and reliable also in less experienced hands. The key elements for a clinical success of these rehabilitations are the accurate pre-operative study of the case, the underpreparation
of the implant site and the high consequent torque of the implant insertion that ideally should not be less than 45 Ncm. After many years and numerous successful rehabilitated cases using the Simple technique in combination with the submerged traditional implants, we have concluded that the use of new Prama transgingival implants for immediate loading screw retained rehabilitations has considerable advantages compared to the submerged classical implants:

  • Possibility to submerge part of the machined neck of the Prama implant under the residual bone crest in the immediate post-extraction sockets (in prevision of future bone manipulations), without the need to position the implant-post margin too subgingival;
  • Transgingival emergence of the implant neck, eliminating therefore the need to use intermediate posts and reducing the discomfort for the patient because of the subgingival work during the delicate phase of placing the temporary prosthesis with immediate loading; on the straight implants the temporary Simple posts are directly used;
  • It is possible to avoid modelling the distal bone with drills and trimmers for the angled implants by means of inserting the distal margin of the implant neck at the crest level and leaving supracrestal the mesial margin of the same, with significant time and excellent bone tissue saving, preventing the formation of “bowl shaped” distal defects to the tilted implants;
  • Possibility, once the gingiva is healed, to compensate for any gingival retractions enhancing with the permanent prosthesis on the Prama neck implant.

Ga naar de zeventiende reden: Direct Toronto bridge on Prama

Terug naar de vijftiende reden: Verschroefd of gecementeerd? Zelfde uitkomst!

Geen tijd om nu alle redenen te lezen? Hier kunt u gratis een pdf downloaden om het later na te lezen of als naslagwerk.

 

Alle redenen:

  1. Niet alleen transgingivaal
  2. Horizontale en verticale platform shift
  3. Asymmetrisch extractie alveole
  4. Smalle/Dunne botkam
  5. Botkam afvlakken of de pieken behouden?
  6. Flapless Protocol
  7. Meer ruimte voor Soft Tissue
  8. Connective tissue Coronal Migration
  9. Short Epithelial Sulcus
  10. Ideaal voor de B.O.P.T. technniek
  11. Mimetische Nek (Mimetic Neck)
  12. UTM behandeling van de nek (UTM = Ultrathin Threaded Microsurface)
  13. Kijk naar het effect op de Gingiva!
  14. Geen marge, 360º vrijheid
  15. Verschroefd of gecementeerd? Zelfde uitkomst!
  16. All on Prama
  17. Direct Toronto bridge on Prama
  18. Stabiliteit
  19. Het effect op hard weefsel

Testemonials van:

  • Gioacchino Cannizzaro en Paolo Viola
  • Costantino Vignato en Giuseppe Vignato
  • Giuseppe Pellitteri
  • Luigi Canullo
  • Ugo Covani
  • Marco Csonka
  • Luigi Paolo Sandri

 

Testemonials

Gioacchino Cannizzaro
Paolo Viola

“The characteristic conical shape of the neck of the Prama implant has Break down the walls imposed by the implant systems of companies, brands and multinational companies that, compared one to the other, are all very similar. The conical morphology comes from years of application of B.O.P.T. with exciting results.
To be able to move from a predefined “margin line” to a “margin area” that also gives chance the choose the margin on implant prosthesis is a real gift for surgeons and prosthodontists. Prama already claims a substantial scientific background in which the biological advantages are described, but it is daily use that makes us appreciate the prosthetic specificity of the platform. The use for immediate loading combined with the Flapless technique represents at the same time what is most modern and conservative in the implant rehabilitation therapies scenario. The 2.8 mm height of the conical neck allows a visual check during insertion since in most cases the connection emerges at gingival level, it does not sink into the alveolus and the gingival tissue firmly surrounds the platform; indeed it is better to insert a healing abutment so as to keep an alveolar access for the prosthesis insertion. The impression phase is simplified by the dry bloodless environment and the posts or the transfers engage without having to pass through the mucosa. The geometry of the gingival tissue does not depend on the healing but remains stable and this is the only condition that allows to place immediately the final prosthesis. The volume and the morphology of the biological space to be restored are delegated to the technician, who will determine where and how much to “move” the soft tissue  modeling it through the crown. If we think that the desirable anatomy is the compromise between width and depth, it seems evident how favourable a closure area of almost three millimeters where to choose to position the emergence profile is. If we carefully observe the implant neck shape at gingival level, we recognize the characteristics of an one piece implant with clear biological advantages. The implant-abutment connection often is out of the soft tissue thanks to the conservative control of the insertion procedure with the Flapless technique. For the same reason important advantages have been noticed with Toronto Bridge restorations. The geometry of the implant with prosthetic connection outside the gingiva and flapless surgery contribute to obtain a transgingival seal which is considerable and stable over time. The association of Prama with Flapless surgery has produced some truly significant results from every point of view: surgical, biological and prosthetic, but most of all it has fostered the passionate side of this work freeing us from some constraints and giving us the opportunity to carry out a subjective interpretation that we were missing a little.
A brilliant idea!!!”

Gioacchino Cannizzaro, Paolo Viola
Costantino Vignato
Giuseppe Vignato

“Prama is part of a new generation of implants.
It consists of the perfect combination, in a single piece, of a rough surface suitable for osseointegration and of a conical micro-lined geometry capable of supporting the healing of soft tissues. […] The two parts together set a delicate biological environment favourable for bone cells, the periosteum, the connective tissue and the epithelium.

This new vision is called the ‘conical revolution’ and the gingival anatomy that we manage to reconstruct houses the prosthetic element and becomes an aesthetic shape itself, protecting the integration of the implant over time. ”

Costantino Vignato, Giuseppe Vignato
Giuseppe Pellitteri

“The PRAMA implant is giving me great satisfaction […] This is an implant that in my opinion is very “biological”, indeed it is evident how it greatly facilitates firstly osteoblastic and then osteocytic activities, also in its smooth part that has always been considered a very risky area for the maintenance of the bone crest.
The credit for this nice biological healing and for this total lack of inflammation of the tissues around the neck of the implant certainly is not mine but, analyzing things well, it is of the structure that Sweden & Martina has designed to create an extremely tight connection between the extraosseous part (smooth neck and implant head) and the prosthetic post. Indeed, tightening to 25 Ncm, the head of the post, which in all its circumference has an inclination of 2 degrees on the surface of the implant, creates such a tight connection that I almost feel like calling it a “cold welding”.
Given the clinical and radiological images that we have after 2 years, I can affirm that in these cases the Prama implant guarantees an almost total absence of bacterial activity in its connection.
[…] The Prama implant is simplistically considered a transgingival implant, in the following cases I will show how the specific implant architecture adapts perfectly to be placed both with the smooth neck above the bone crest, and with all its structure completely into the bone.”

Giuseppe Pellitteri – From the Premium Day 2017 Sweden & Martina presentation
Luigi Canullo

“The reason why I choose Prama, especially in the aesthetic anterior areas, is that the convergent neck allows a new prosthetic approach: the emergence profile of the restoration (post and crown) can be modulated depending on the prosthetic requirements, positioning it at different levels of the transgingival path following the different anatomical and clinical situations. This also has a positive effect on the soft tissue: a greater three-dimensional space available for soft tissues allows them to thicken, specially when compared with an implant with a predefined cylindrical or divergent neck.”

Luigi Canullo
Ugo Covani

“The Prama implant does not have a single margin line, but a margin surface, a margin area. The biological advantage is that of a juxta-gingival position that allows us to position the prosthetic margin at different levels because there is an area on which the closure can be done and not a precise and inevitable line as with the traditional “tissue level” implants. And it is not the only advantage. […] with Prama the thickness of the cervical soft tissues is objectively greater, especially as regards the connective tissue component. Therefore  a tissue collar practically forms, giving the whole implant-prosthetic structure a great stability. Finally, Prama offers a vaster opportunity of counterbalancing malpositionings: one of the problems in the aesthetic area is an implant placed too vestibular; if I place a traditional transgingival implant in that position I will certainly have big problems. With Prama I can manage it way better.”

Ugo Covani – From the Premium Day 2017 Sweden & Martina presentation
Marco Csonka

“Why use a Prama implant?
In my opinion the question should be: why not use it??
The Prama implant is:

  • AESTHETIC (less titanium volume in the transgingival portion results in thicker and more stable soft tissues);
  • BIOLOGICAL (the microgap is far from the bone crest, thus avoiding premature crestal bone resorption);
  • VERSATILE (the UTM conical neck allows totally or partially submerged transgingival positioning, very useful in case of tilted implants);
  • CONSERVATIVE (the machined neck, left deliberately exposed in case of thin crests in the most coronal section, avoid many horizontal GBR procedures).

Therefore……why not use it?”

Marco Csonka
Luigi Paolo Sandri

“The new Prama implant, starting from the principles of B.O.P.T. technique on natural teeth, enables me to exploit its design features during the surgical phases. Its conical UTM neck allows to place the implant exploiting the anatomical conditions of soft tissues, with variable thickness compared to hard tissues. Therefore, the possibility of managing the insertion level diversifies the surgical strategy and, consequently, the following prosthetic phases. This creates the conditions for a perfect clinical outcome, respecting the biology of soft and hard tissues . The integration between the implant and the prosthetic crown creates a natural area, maintaining the rehabilitation over time. Anatomical and esthetic stability are the aim of my rehabilitations, and the Prama implant allows “odontological pragmatism” without any sacrifice.”

Luigi Paolo Sandri

 

Geef een reactie

Het e-mailadres wordt niet gepubliceerd. Vereiste velden zijn gemarkeerd met *

Deze website gebruikt Akismet om spam te verminderen. Bekijk hoe je reactie-gegevens worden verwerkt.

Pin It on Pinterest

Share This