Dental İmplantolojide Otojen Blok Kemik Greftleri
Özet
Dental implantolojide alveolar kemik yetersizliklerini gidermek amacıyla kullanılan otojen blok kemik greftleri, dikey ve yatay geniş augmentasyonlarda sahip oldukları osteojenik, osteoindüktif ve osteokondüktif özellikler sayesinde "altın standart" olarak kabul edilmektedir. Makroskopik olarak spongiyöz, kortikal ve kortikospongiyöz; morfolojik olarak ise partiküler ve blok şeklinde sınıflandırılan bu greftlerin başarısı, alıcı alana rijit fiksasyonla sabitlenmelerine ve flebin gerilimsiz kapatılarak revaskülarizasyonun korunmasına doğrudan bağlıdır. Küçük kemik eksikliklerinde cerrahi erişim kolaylığı sunan mandibular simfiz veya ramus gibi intraoral donör sahaları tercih edilirken; dört dişten büyük daha geniş defektlerin rekonstrüksiyonunda genel anestezi ve hastanede yatış gerektiren iliak krest, kosta veya kalvaryum gibi ekstraoral bölgeler kullanılır. Donör alan seçiminde defektin boyutu, ihtiyaç duyulan kemik hacmi ve komplikasyon riskleri belirleyicidir. İntraoral donör sahalardan yapılan işlemlerde en sık yara açılması, kanama ve geçici ya da kalıcı duyu değişiklikleri (odunsu his) gözlenirken, ekstraoral saha operasyonlarında hematom, pnömotoraks, dural laserasyon ve nörolojik sekel gibi daha ciddi morbiditeler rapor edilmiştir. Sonuç olarak, donör alan anatomik sınırlarının iyi bilinmesi ve cerrahi tekniklerin titizlikle uygulanması implant başarısını doğrudan artırmaktadır.
This method, recognized as the gold standard in extensive vertical and horizontal dental implantology augmentations due to its osteogenic, osteoinductive, and osteoconductive properties, utilizes autogenous block bone grafts to resolve alveolar bone deficiencies. Macrostructurally classified as spongy, cortical, or corticospongy, and morphologically as particulated or block, the success of these grafts strictly depends on rigid fixation to the recipient site and tension-free flap closure to maintain revascularization. Intraoral donor sites such as the mandibular symphysis or ramus are preferred for smaller defects due to easy surgical access, whereas larger defects exceeding four tooth spaces require extraoral sites like the iliac crest, ribs, or calvarium, which necessitate general anesthesia and hospitalization. The choice of donor area is determined by the defect size, required bone volume, and complication risks. While wound dehiscence, bleeding, and temporary or permanent sensory changes (woody sensation) are commonly observed in intraoral procedures, more severe morbidities like hematoma, pneumothorax, dural laceration, and neurological sequelae are reported in extraoral surgeries. Consequently, precise knowledge of donor site anatomy and meticulous application of surgical techniques directly enhance implant success.
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