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Direct Toronto bridge on Prama

Direct Toronto

17. Direct Toronto bridge on Prama

Met de connectie boven het tissue is het eenvoudig.

Er zijn op zijn minst drie redenen om Prama te overwegen als een effectieve oplossing voor een complexe rehabilitatie van een complete brug.

  1. Uit respect voor de crestale bot anatomie
  2. Opvangen van botpieken door de conische kelk
  3. Geen noodzaak voor gehoekte P.A.D. abutments

Dit betekend minimaal invasieve chirurgie, snellere heling en wel de mogelijkheid om implantaten schuin te plaatsen.

De rehabilitatie van een complete boog op Prama geeft de technieker de mogelijkheid om de constructie op een afstand van ten minste 2.8mm te plaatsen vanaf het osseointegratie gebied. Hierdoor ontstaat een gingivaal protectie gebied welke zorgt voor ondersteuning van de weke delen met gegarandeerde eenvoudige reiniging en esthetische stabiliteit. (hier staat het origineel in het engels)

Hieronder twee casussen.


Dr. Giuseppe Vignato and Dr. Costantino Vignato

Clinical case 1

Male 63-year-old patient with removable prosthesis in the upper arch and a removable partial dentures with hooks connected with 6 dental elements in the lower arch. The treatment plan consists in the complete rehabilitation of both arches with Toronto type prosthesisdirectly screw-retained on Prama implants fabricated in zirconium-ceramic: six Prama RF implants are inserted in the upper arch, the dental elements from 3.3 to 4.3 are removed from the lower arch and five Prama and Prama RF implants are inserted.

Initial situation with prosthesis and without prosthesis
Initial X-ray.
Post-extraction surgery with open flaps for the insertion of six Prama RF implants in the upper jaw and five in the lower jaw.
Gingival situation of the upper and lower arch 3 months after surgery.
Upper and lower final prosthesis.
Final prosthesis in zirconium-ceramic in articulator
Gingival situation of the upper and lower arch at the delivery of the final prosthesis. The soft tissues seem healed and healthy.
Final prosthesis
X-ray at delivery of the final prosthesis

Clinical case 2

Male patient with severe bone resorptionin both arches.
The treatment planned consists of a complete rehabilitation of both arches with a composite Toronto prosthesis directly screw-retained on Prama implants. Following the extraction of the damaged teeth, five Prama RF implants are inserted in the upper arch while five Prama and Prama RF implants are inserted in the lower arch.

Initial situation: bone resorption is evident both in the maxilla and mandible
Occlusal view of the preoperative case in which the resorption, both vestibular and lingual, of the lower arch is evident. The movement of elements 24 and 26, following the loss of 25, also is noticeable.
Open tray impression with Pick-up transfer.
Clinical follow up 3 months after surgery in the upper and lower arch.
Final situation.
Final X-ray.

Ga naar de achttiende reden: Stabiliteit

Terug naar de zestiende reden: All on Prama

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



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


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