İntraoral Sert Doku Hacim Arttırma Teknikleri
Özet
Diş kayıpları ve çenelerdeki hastalıklara bağlı olarak oluşan defektlerin protetik rehabilitasyonunda dental implantların doğru konumlandırılması, yetersiz alveolar kemik hacmi nedeniyle zorlaşabilmektedir. Bu gibi durumlarda, gerekli yapısal desteği sağlamak amacıyla çeşitli intraoral sert doku hacim arttırma teknikleri ve biyomateryaller uygulanmaktadır. Tedavi öncesinde veya eş zamanlı olarak planlanabilen bu cerrahi prosedürler temel olarak, kemik greftinin kortikal kemik üzerine konulduğu onley greftleme veya kemik içine yerleştirildiği interpozisyonel greftleme şeklinde gerçekleştirilir. Bu yöntemler arasında; kemik kaybını önleyen çekim soketi koruma ve soket kalkanı teknikleri, bariyer membranların kullanıldığı yönlendirilmiş doku rejenerasyonu (YDR), horizontal atrofili kretlerin genişletilmesini sağlayan kret ayırma tekniği, üç boyutlu hacim artışı sunan halka kemik tekniği, otojen blokların vidalandığı Khoury ve kutu teknikleri ile koruyucu matris görevi gören titanyum ağ kullanımı yer almaktadır. Ayrıca, geniş vertikal defektlerin onarımında segmental sandviç osteotomisi ve yapay kırıklar yardımıyla hem kemik hem de yumuşak doku adaptasyonu sağlayan alveolar distraksiyon osteogenezisi de etkili alternatiflerdir. Başarılı bir implant rehabilitasyonu için hastanın detaylı radyolojik ve topografik analizinin yapılması ve primer kapama, anjiyogenez, alan bakımı ile yara stabilitesini içeren PASS prensiplerine eksiksiz uyulması kritik önem taşımaktadır.
Prosthetic rehabilitation of defects caused by tooth loss or jaw diseases can be complicated due to insufficient alveolar bone volume, making the accurate placement of dental implants difficult. In such cases, various intraoral hard tissue augmentation techniques and biomaterials are utilized to provide the necessary structural support. These surgical procedures, which can be planned prior to or simultaneously with implant placement, are basically performed as onlay grafting, where the bone graft is placed on the cortical bone, or interpositional grafting, where it is placed into the existing bone. Among these methods are socket preservation and socket shield techniques that prevent bone loss, guided tissue regeneration (GTR) using barrier membranes, the split-crest technique for expanding horizontally atrophic ridges, the bone ring technique providing three-dimensional volume increase, Khoury and box techniques where autogenous blocks are screw-fixed, and the use of titanium mesh functioning as a protective matrix. Furthermore, segmental sandwich osteotomy for repairing large vertical defects and alveolar distraction osteogenesis, which creates simultaneous bone and soft tissue adaptation through artificial fractures, serve as effective alternatives. For a successful implant treatment, a detailed radiological and topographic analysis of the patient is critical, alongside strict adherence to the PASS principles, including primary closure, angiogenesis, space maintenance, and wound stability.
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