Dental İmplant Uygulamalarında Tartışmalı Konulara Bakış
Özet
Dental implantolojide tam bir fikir birliğine varılamayan üç temel konu olan mini implantlar, kısa implantlar ve büyüme çağındaki hastalarda implant uygulamaları klinik ve bilimsel açıdan incelenmektedir. Atrofik kemiklerde invaziv ogmentasyondan kaçınmak amacıyla tercih edilen mini implantlar, düşük maliyet, kısa tedavi süresi ve minimal invaziv cerrahi gibi avantajlar sunmakla birlikte, standart implantlara kıyasla artan biyomekanik stres ve kırılma riskleri taşımaktadır. Vertikal kemik yetersizliklerinde ve maksiller sinüs gibi anatomik sınırlılıklarda alternatif olan kısa implantlar, cerrahi morbiditeyi ve maliyeti düşürürken, posterior mandibulada uzun implantlara benzer sağ kalım oranları göstermekte; ancak atrofik posterior maksillanın düşük kemik kalitesi nedeniyle bu bölgede uzun dönemli başarı için sinüs ogmentasyonu gibi greftleme prosedürlerinin ön planda tutulması gerekmektedir. Büyüme çağındaki çocuk ve ergenlerde ise konjenital veya edinsel diş eksikliklerinin tedavisinde implant destekli protezler düşünülse de devam eden iskeletsel ve dentoalveolar büyüme nedeniyle bu implantlar ankiloze diş gibi davranarak oklüzal olarak gömülü kalabilmekte, estetik ve fonksiyonel sorunlara yol açabilmektedir. Bu nedenle, şiddetli ektodermal displazi vakaları dışında, çocuklarda diş ve iskelet gelişiminin tamamlanmasının beklenmesi ve kararların hastanın iskeletsel maturasyon düzeyi ile anatomik risklerine göre multidisipliner bir yaklaşımla verilmesi önerilmektedir.
Three fundamental controversial topics in dental implantology, including mini implants, short implants, and implant applications in growing patients, are evaluated from both clinical and scientific perspectives. Mini implants, preferred to avoid invasive augmentation in atrophic bones, offer advantages such as lower cost, shorter treatment time, and minimally invasive surgery, but they carry risks of increased biomechanical stress and fracture compared to standard implants. Short implants, which serve as an alternative in vertical bone deficiencies and anatomical limitations like the maxillary sinus, reduce surgical morbidity and cost, while showing survival rates similar to longer implants in the posterior mandible; however, due to the low bone quality of the atrophic posterior maxilla, grafting procedures such as sinus augmentation should be prioritized for long-term success in this region. In children and adolescents during the growth period, although implant-supported prostheses are considered for the treatment of congenital or acquired tooth loss, because of ongoing skeletal and dentoalveolar growth, these implants behave like ankylosed teeth and can remain occlusally submerged, leading to aesthetic and functional problems. Therefore, except for severe ectodermal dysplasia cases, waiting for the completion of dental and skeletal development in children is recommended, and decisions must be made with a multidisciplinary approach based on the patient's skeletal maturation level and anatomical risks.
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