## 3 Results and Discussion
### Recent Clinical Innovations and New Clinical Protocols (2020-2024)  
The recent innovations in implant dentistry and prosthetic rehabilitation have influenced the clinical protocols related to Prama implants, impacting both the surgical and prosthetic phases. Digital Intraoral Scanner Workflow  
The recent innovations and advances regarding digital intraoral scanners enabled their use for dental implant rehabilitation. High levels of accuracy and precision regarding the digital intraoral scanners, in particular when dealing with partial dedentulous areas, have recently been reported [16; 60]. In these areas, the differences are very minimal, around 8 \(\upmu\)m when considering the digital impressions taken on single implants and around 18 \(\upmu\)m regarding two adjacent implants [60]. A different context could be when in the presence of total dedentulous areas [61] with markedly higher trueness values (from 96 \(\upmu\)m to 140 \(\upmu\)m) [60]. Different from traditional analogic impression, the digital impressions were well-tolerated by the patients since they do not require the use of conventional materials and involve a technically simpler process for trained professionals [60]. The quality of the digital impression can be immediately visualized and verified through computer-assisted software without producing a physical model/cast [18], saving additional time. The impressions can also be directly sent to the dental laboratory by e-mail or by dedicated software. The use of a digital workflow could support clinicians in replicating the previous anatomic characteristics of a hopeless tooth and studying/analyzing the correct occlusal function [62]. Some research groups combined the digital impression mesh with the CBCT data to design a surgical guide to place implants in a prosthetically driven way [63]. The application of a digital workflow with a Prama transmucosal implant led to the possibility to perform a prosthetic rehabilitation using a minimally invasive concept. Indeed, the supracreal position of the Prama implant enables a simpler way to acquire the scan body and limits the possibility of scan body misplacement or incorrect reading (Figures 5 and 6). Figure 5: Clinical case performed in 2021. Single dedentulous area due to the extraction of an upper left molar with recurrent endodontic pathology (**a**). Typical morphology of Prama neck (**b**) and prosthetic crown placed with the margin at gingival level (**c**). Note the integrity of cortical bone and its stability during time (follow-up at 3 years from insertion) (**d**). The implant authentic connection was internal to the crown, leading to decreased possibility of bacterial infections and also decreased chance of screw loosening. Digital impression images before and after scan body positioning and analysis of the occlusal contacts (**e**,**f**). The possibility to design provisional crowns and definitive crowns through a digital workflow also allows us to perform all the steps using one digital impression (Figure 7). The acquisition of the subgingival portion of the Prama implant is much easier compared to other dental implants with an intramucosal implant abutment connection (such as platform switch or external hex implants). The possibility to end the crown at the Prama implant neck enables a more predictable procedure as the dental technician possesses all  
Figure 6: Digital acquisition of scan body (Carestream CS) (**a–e**) of Prama implant and prosthetic workflow of provisional (**e,f**) and definitive restoration (metal and ceramic structure) (**g,h**). Figure 7: Digital workflow around Prama Short neck implant. (**a**) The implant has a shorter convergent neck compared to traditional Prama implant. (**b,c**) Provisional crown was designed with graphene-reinforced resin. (**d**) Full monolithic zirconia definitive crown was subsequently digitally designed and cemented. the required information about the implant neck morphology.