İmplant Üstü Hareketli Protezlerde Çiğneme Performansının Değerlendirilmesi

Year 2016, Volume: 2 Issue: 2, 81 - 94, 01.01.2016

Zeynep Başağaoğlu Demirekin Süha Türkaslan

Abstract

Amaç: Diş eksikliği, bireylerin estetik özelliklerini, fonksiyon ve fonasyonlarını kötü yönde etkilemektedir. Özellikle tam dişsizlik olgularında, hazırlanacak protezler, çiğneme fonksiyonunu etkinleştirip kolaylaştırarak hayat kalitesini yükseltmelidir.Tam protez kullanan hastaların büyük bölümü özellikle alt protezlerin tutuculuğu ve stabilitesinden şikayetçidirler. Tam protez kullanımıyla çiğneme kas aktivitelerinde belirgin bir azalma olduğu bilinmektedir. Tam protez kullanan hastaların, hasta memnuniyetini artırmak amacıyla birçok yöntem denenmiş ve implant destekli tam protezlerle hasta memnuniyetinin belirgin bir düzeyde arttığı görülmüştür. uygulanan tam protezlerin implant yardımıyla stabilitesinin artırılması ile kas aktivitelerinde artış sağlanarak, tam protez kullanan hastaların çiğneme etkinliklerinin artırılması amaçlanmıştır.Gereç ve Yöntemler: Anatomik koşullar göz önüne alınarak, tam dişsiz hastaların her iki çenesine de 2 adet implant yerleştirildi. implantların osseointegrasyonunun ardından protezleri uygulandı. Protezlerin uyum süreci olan 1 aylık kullanımdan sonra test materyali olarak ceviz verildi, hastalar tarafından çiğnemeleri istendi ve hastaların çiğneme performanslarının değerlendirilmesi amacıyla, elek analizi yöntemi kullanıldı. Bu test, implant destekli hareketli protez hastalarının dışında, tam protez ve tam dişli hastalara da uygulandı. Bulgular: Hasta gruplarının elek üzerinde kalan materyal miktarlarının ortalamaları arasındaki farklılıklar değerlendirildiğinde, istatistiksel olarak anlamlı sonuçlar elde edilmiştir.Sonuç: Tam protez kullanan hasta grubu elek açıklığı en geniş olan 8 nolu elekte en yüksek değeri göstermiştir. Bu veriye göre tam protez hastalarının daha küçük boyutlara test materyalini getirebilecek yeterli çiğneme performansının olmadığını göstermektedir. Daha dar açıklığa sahip olan 45-60 nolu eleklerde iDHP hastalarının TD hastalarıyla benzer sonuçlar göstermesi, iDHP hastalarının implantın retansiyona ve stabiliteye katkı sağlaması nedeniyle daha iyi çiğneme performası gösterdiğini ve hastaların daha stabil protezler ile daha rahat çiğneyebildiklerini gösterdi

Keywords

Mastikatör performans, implant üstü hareketli protezler, Çiğneme performansı, Dental implant, Elek testi

Evaluation of Chewing Performance with Implant Supported Overdentures

Abstract

objective: Missing teeth negatively affect aesthetic characteristics of individuals besides the function and phonation. Especially, in the case of edentulous patients, prepared dentures activate and also facilitate the chewing function. What’s more, they improve the quality of life for individuals.The majority of patients treated with complete dentures particularly suffer from lower denture retention and stability. It is known that a marked decrease occurs in the activity of the muscles of mastication with the use of complete dentures. Many methods have been tried to increase the satisfaction of patients using complete dentures and patient satisfaction has been shown to increase with complete dentures and implant–supported prostheses. Patients treated with complete dentures are intended to increase the chewing efficiency by providing an increase in muscular activity by increasing the stability with the help of an implant in implementing complete dentures.amacıyla gereksinim duydukları fazladan çiğneme darbelerinin sayısı ile hesaplanmaktadır. Çiğneme performansının değerlendirilmesi ile dentisyonun kapasitesi ve etkinliği, objektif ve tekrarlanabilir laboratuvar testleriyle incelenmektedir 7 .Çiğneme performansı ilk kez, 1901 yılında Gaudenz tarafından elek analizi yöntemi kullanılarak değerlendirilmiştir. Çiğneme performansının tayininde araştırmacılar, bireylerin test materyallerini saniye düzeyinde belirli sürelerde 8 , farklı sayıdaki çiğneme darbeleriyle ya da yutulmaya hazır hale gelinceye kadar çiğnemelerine izin vermişlerdir 6,9,10 . Çiğneme performansının değerlendirilmesinde çok sayıda yöntem bulunmasına karşın, elek analizi yönteminin, en güvenilir ve sık uygulanan analiz şekli olduğu belirtilmektedir. Elek analizi ile çiğneme performansının değerlendirilmesinde standart bir protokol göze çarpmamaktadır. Araştırmacılar testlerinde doğal ve yapay pek çok materyal kullanmıştır 11 .Araştırmacılara göre ideal test materyeli; kolayca bulunabilir olmalı, su ve tükrük içinde çözünürlük göstermemeli, standart kalitede olmalı ve çiğneme sırasında içeriğinde belirli bir değişiklik olmadan parçalanabilir olmalıdır 12,13 .Yapılan pek çok araştırmada çiğneme performansı testleri sırasında kullanılan çiğneme sayıları, hastaların ağzındaki diş sayılarına ve kullanılan test materyallerinin nitelik ve sertlik durumlarına göre değişmektedir. Çiğneme performansının belirlenmesi amacıyla doğal test gıdaları için; 5,10, 20, 40, 60, 80, 100 çiğneme darbe sayısı kullanılırken, yapay test gıdaları için ise 10, 15, 20, 40, 55, 60, 80, 160 çiğneme darbesi kullanılmaktadır. Bu sayılarla ilgili Fontjin-Tekamp ve ark. 2000 yılında yaptıkları çalışmalarında, hastaların test gıdasını yutmadan önce kaç kez çiğnediklerini kaydetmişlerdir. Araştırmaya katılan tüm hastaların 200’den az çiğneme darbesi ile test gıdasını yutulmak üzere hazırladığını tespit etmişler ve araştırmalarda 200 çiğneme material and methods: According to anatomical conditions, 2 implants were placed in both jaws for edentulous patients. Following the osteointegration, a prosthesis was placed. After 1-month use of the prosthesis, which is the adaption process, a test material was given in the form of a walnut. Patients were asked to chew and the sieving analysis method was used for evaluating the chewing performances. This test, other than patients treated with implant-supported and removable prostheses, was administered patients in full gear and complete dentures.results: When groups were evaluated, a significant statistical difference was found in the mean amount of material remaining on the sieve. conclusion: The TP group was shown to have the highest value in the widest sieve mesh size of 8 . According to this data, the TP group did not have sufficient chewing performance to convert the test material to a smaller size. The IDHP group showed similar results with the TD group with a narrower opening sieve mesh size of 45 and 60 . According to this data, the IDHP group can chew more comfortably due to implant retention and with a more stable prosthesis with the help of implants= retention and the implant also contributes to stability

Keywords

Masticatory performance, implant-supported removable prostheses, chewing performance, dental implants, sieving analysis method

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