İmplant Üstü Sabit Protezlerde Kullanılan Ölçü Komponentleri, İyileşme Başlıkları ve Güncel Tasarım Yöntemleri
Özet
İmplant üstü sabit protezlerin başarısı ve pasif uyumu, uygun ölçü komponentlerinin (ölçü kopingleri, implant analogları, bağlantı vidaları ve dayanak anahtarları) vakaya göre doğru seçilmesine ve uygulanmasına doğrudan bağlıdır. Ölçü kopingleri açık (pick-up), kapalı (transfer), hibrit ve dijital tarama teknolojilerine uygun taranabilen (scan body) yapıda olmak üzere çeşitlilik gösterir. Bu parçalar, implantın ağız içi konumunun laboratuvara hatasız aktarılmasını sağlar. Protez başarısındaki bir diğer kritik unsur olan iyileşme başlıkları ise kemik ve yumuşak doku büyümesini engelleyerek estetik ve biyolojik çıkış profilini şekillendirir. Prefabrike (standart) iyileşme başlıkları yumuşak dokuyu desteklemede yetersiz kalabildiğinden, günümüzde geleneksel modifikasyonlar veya güncel CAD/CAM (bilgisayar destekli tasarım ve üretim) yöntemleriyle üretilen kişiye özel iyileşme başlıkları yaygınlaşmıştır. Kişiye özel başlıkların yapımında titanyum, PEEK ve PMMA gibi biyouyumlu materyaller kullanılır. Dijital yöntemler, diş çekimi öncesi veya implant yerleşimi sırasındaki anatomik verileri kopyalayarak ideal çıkış profilinin tek aşamada elde edilmesini, doku bütünlüğünün korunmasını ve ikinci bir cerrahi işleme gerek kalmamasını sağlar. Sonuç olarak, implant üstü restorasyonların uzun ömürlü ve estetik olması için klinisyenlerin güncel dijital yaklaşımları ve kişiye özel tasarım yöntemlerini takip etmesi önerilmektedir.
The success and passive fit of implant-supported fixed prostheses directly depend on the correct selection and application of appropriate impression components (impression copings, implant analogues, connecting screws, and abutment wrenches) tailored to each case. Impression copings vary as open-tray (pick-up), closed-tray (transfer), hybrid, and digital scannable (scan body) designs, ensuring the precise transfer of the intraoral position of the implant to the laboratory. Healing abutments, another critical factor in prosthetic success, prevent bone and soft tissue ingrowth while shaping the aesthetic and biological emergence profile. Since prefabricated (standard) healing abutments may fall short in supporting soft tissues, customized healing abutments produced through either conventional modifications or modern CAD/CAM (computer-aided design and manufacturing) methods have become widespread. Biocompatible materials such as titanium, PEEK, and PMMA are utilized in fabricating these customized abutments. Digital methods replicate anatomical data before tooth extraction or during implant placement, enabling the achievement of the ideal emergence profile in a single stage, preserving tissue integrity, and eliminating the need for a second surgery. Consequently, it is recommended that clinicians follow contemporary digital approaches and customized design methods to ensure long-lasting and aesthetic implant-supported restorations.
Referanslar
Al Quran FA, Rashdan BA, Abu Zomar AA, et al. Passive fit and accuracy of three dental implant impression techniques. Quintessence International. 2012;43(2):119-125.
Rashidan N, Alikhasi M, Samadizadeh S, et al. Accuracy of implant impressions with different impression coping types and shapes. Clinical Implant Dentistry and Related Research. 2012;14(2):218-225. doi:10.1111/j.1708-8208.2009.00241.x
Derksen W, Tahmaseb A, Wismeijer D. Randomized Clinical Trial comparing clinical adjustment times of CAD/CAM screw‐retained posterior crowns on ti‐base abutments created with digital or conventional impressions. One‐year follow‐up. Clinical Oral Implants Research. 2021;32(8):962-970. doi:10.1111/clr.13790
Lin W-S, Harris BT, Morton D. The use of a scannable impression coping and digital impression technique to fabricate a customized anatomic abutment and zirconia restoration in the esthetic zone. The Journal of Prosthetic Dentistry. 2013;109(3):187-191. doi:10.1016/S0022-3913(13)60041-4
Shim JS, Ryu JJ, Shin SW, et al. Effects of implant angulation and impression coping type on the dimensional accuracy of impressions. Implant Dentistry. 2015;24(6):726-729. doi:10.1097/ID.0000000000000336
Bhakta S, Vere J, Calder I, et al. Impressions in implant dentistry. British Dental Journal. 2011;211(8):361-367. doi:10.1038/sj.bdj.2011.862
Fernandez MA, Paez de Mendoza CY, Platt JA, et al. A comparative study of the accuracy between plastic and metal impression transfer copings for implant restorations. Journal of Prosthodontics. 2013;22(5):367-376. doi:10.1111/jopr.12015
Jo S-H, Kim K-I, Seo J-M, et al. Effect of impression coping and implant angulation on the accuracy of implant impressions: an in vitro study. The Journal of Advanced Prosthodontics. 2010;2(4):128-133. doi: 10.4047/jap.2010.2.4.128
Chee W, Jivraj S. Impression techniques for implant dentistry. British Dental Journal. 2006;201(7):429-432. doi:10.1038/sj.bdj.4814118
Lee J-H, Bae J-H, Lee SY. Trueness of digital implant impressions based on implant angulation and scan body materials. Scientific Reports. 2021;11(1):1-7. doi: https://doi.org/10.1038/s41598-021-01442-9
Sabouhi M, Bajoghli F, Dakhilalian M, et al. Effects of Impression Coping Design, Impression Technique, and Dental Undercuts on the Accuracy of Implant Impressions Assessed by 3-Dimensional Optical Scanning: An: In Vitro: Study. Implant Dentistry. 2016;25(2):238-246. doi:10.1097/ID.0000000000000389
Khan SA, Singh S, Neyaz N, et al. Comparison of Dimensional Accuracy of Three Different Impression Materials Using Three Different Techniques for Implant Impressions: An In Vitro Study. The Journal of Contemporary Dental Practice. 2021;22(2):172-178. doi:10.5005/jp-journals-10024-3014
Nissan J, Ghelfan O. The press-fit implant impression coping technique. Journal of Prosthetic Dentistry. 2009;101(6):413-414. doi:10.1016/S0022-3913(09)60088-3
Tsagkalidis G, Tortopidis D, Mpikos P, et al. Accuracy of 3 different impression techniques for internal connection angulated implants. The Journal of Prosthetic Dentistry. 2015;114(4):517-523. doi:10.1016/j.prosdent.2015.05.005
Selecman AM, Wicks RA. Making an implant-level impression using solid plastic, press-fit, closed-tray impression copings: A clinical report. The Journal of Prosthetic Dentistry. 2009;101(3):158-159. doi:10.1016/S0022-3913(09)60020-2
Ismail IA, Alhajj MN. Accuracy of different impression techniques for multiunit implant restoration: A qualitative in vitro study. The Journal of Prosthetic Dentistry. 2020;124(6):729.e1-729.e5. doi:10.1016/j.prosdent.2020.04.025
Mizumoto RM, Yilmaz B. Intraoral scan bodies in implant dentistry: A systematic review. The Journal of Prosthetic Dentistry. 2018;120(3):343-352. doi:10.1016/j.prosdent.2017.10.029
Sawyers J, Baig MR, ElMasoud B. Effect of Multiple Use of Impression Copings and Scanbodies on Implant Cast Accuracy. International Journal of Oral & Maxillofacial Implants. 2019;34(4):891-898. doi:10.11607/jomi.6945
Lin W-S, Harris BT, Zandinejad A, et al. Use of digital data acquisition and CAD/CAM technology for the fabrication of a fixed complete dental prosthesis on dental implants. The Journal of Prosthetic Dentistry. 2014;111(1):1-5. doi:10.1016/j.prosdent.2013.04.010
Fluegge T, Att W, Metzger M, et al. A novel method to evaluate precision of optical implant impressions with commercial scan bodies—An experimental approach. Journal of Prosthodontics. 2017;26(1):34-41. doi:10.1111/jopr.12362
Ireland AJ, McNamara C, Clover M, et al. 3D surface imaging in dentistry–what we are looking at. British Dental Journal. 2008;205(7):387-392. doi:10.1038/sj.bdj.2008.845
Jahn D, inventor.NT-Trading GmbH, assignee. Scan body for determination of positioning and orientation of a dental implant. US patent 14 011 936. December 25, 2014.
Byrne D, Jacobs S, O'Connell B, et al. Preloads generated with repeated tightening in three types of screws used in dental implant assemblies. Journal of Prosthodontics: Implant, Esthetic and Reconstructive Dentistry. 2006;15(3):164-171. doi:10.1111/j.1532-849X.2006.00096.x
Winkler S, Ring K, Ring JD, et al. Implant screw mechanics and the settling effect: an overview. Journal of Oral Implantology. 2003;29(5):242-245. doi:10.1563/1548-1336(2003)029<0242:ISMATS>2.3.CO;2
Siamos G, Winkler S, Boberick KG. The relationship between implant preload and screw loosening on implant-supported prostheses. Journal of Oral Implantology. 2002;28(2):67-73. doi:10.1563/1548-1336(2002)028<0067:TRBIPA>2.3.CO;2
Martin WC, Woody RD, Miller BH, et al. Implant abutment screw rotations and preloads for four different screw materials and surfaces. The Journal of prosthetic dentistry. 2001;86(1):24-32. doi:10.1067/mpr.2001.116230
Kim S, Lee J, Koak J, et al. An abutment screw loosening study of a Diamond Like Carbon‐coated CP titanium implant. Journal of Oral Rehabilitation.2005;32(5):346-350. doi:10.1111/j.1365-2842.2004.01475.x
Prado CJd, Neves FDd, Soares CJ, et al. Influence of abutment screw design and surface coating on the bending flexural strength of the implant set. Journal of Oral Implantology. 2014;40(2):123-128. doi:10.1563/AAID-JOI-D-11-00116
de Moura MB, Rodrigues RB, Pinto LM, et al. Influence of screw surface treatment on retention of implant-supported fixed partial dentures. Journal of Oral Implantology. 2017;43(4):254-260. doi:10.1563/aaid-joi-D-16-00145
Hill EE, Phillips SM, Breeding LC. Implant abutment screw torque generated by general dentists using a hand driver in a limited access space simulating the mouth. Journal of Oral Implantology. 2007;33(5):277-279. doi: 10.1563/1548-1336(2007)33[277:IASTGB]2.0.CO;2
Drago C. İmplant Üstü Restorasyonlar: Adım Adım Uygulama Aşamaları. (İ.Bülent ŞERMET, Duygu KÜRKLÜ, Çev. Ed.). İstanbul: Nobel Tıp Kitabevleri;2012.
Yao KT, Kao HC, Cheng CK, et al. The effect of clockwise and counterclockwise twisting moments on abutment screw loosening. Clinical oral implants research. 2012;23(10):1181-1186. doi: 10.1111/j.1600-0501.2011.02282.x
Alikhasi M, Kazemi M, Jalali H, et al. Clinician-generated torque on abutment screws using different hand screwdrivers. The Journal of Prosthetic Dentistry. 2017;118(4):488-492. doi:10.1016/j.prosdent.2016.12.004
Engquist B, Åstrand P, Anzén B, et al. Simplified methods of implant treatment in the edentulous lower jaw. A controlled prospective study. Part I: one‐stage versus two‐stage surgery. Clinical Implant Dentistry and RelatedResearch.2002;4(2):93-103. doi:10.1111/j.1708-8208.2002.tb00158.x
Suchetha A, Phadke PV, Sapna N, et al. Optimising esthetics in second stage dental implant surgery: Periodontist's ingenuity. Journal of Dental Implants. 2014;4(2):170-175. doi:10.4103/0974-6781.140898
Assaf M, Alaa'Z AG. Screw-retained crown restorations of single implants: A step-by-step clinical guide. European Journal of Dentistry. 2014;8(04):563-570. doi: 10.4103/1305-7456.143645
Alshhrani WM, Al Amri MD. Customized CAD-CAM healing abutment for delayed loaded implants. The Journal of Prosthetic Dentistry. 2016;116(2):176-179. doi:10.1016/j.prosdent.2016.01.024
Harshakumar K, Deepthi V, Ravichandran R, et al. Customized healing abutment for enhancing pink aesthetics in implants. Journal of Dental Implants. 2013;3(2):172-176. doi: 10.4103/0974-6781.118862
Abichandani SJ, Nadiger R, Kavlekar AS. Abutment selection, designing, and its influence on the emergence profile: A comprehensive review. European Journal of Prosthodontics. 2013;1(1):1-10.
Dos Santos M, Da Silva Neto J, Consani R, et al. Three‐dimensional finite element analysis of stress distribution in peri‐implant bone with relined dentures and different heights of healing caps. Journal of Oral Rehabilitation.2011;38(9):691-696. doi:10.1111/j.1365- 2842.2011.02217.x
Janakievski J. Case report: maintenance of gingival form following immediate implant placement—the custom-healing abutment. Advanced Esthetics & Interdisciplinary Dentistry. 2007;3(4):24-28.
Eliasson A, Örtorp A. The accuracy of an implant impression technique using digitally coded healing abutments. Clinical Implant Dentistry And Related Research. 2012;14(1):e30-e38. doi:10.1111/j.1708-8208.2011.00344.x
Grossmann Y, Pasciuta M, Finger IM. A novel technique using a coded healing abutment for the fabrication of a CAD/CAM titanium abutment for an implant-supported restoration. The Journal of Prosthetic Dentistry. 2006;95(3):258-261. doi: 10.1016/j.prosdent.2005.12.013
Akin R. A new concept in maintaining the emergence profile in immediate posterior implant placement: the anatomic harmony abutment. Journal of Oral and Maxillofacial Surgery. 2016;74(12):2385-2392. doi: 10.1016/j.joms.2016.06.184
Beretta M, Poli PP, Pieriboni S, et al. Peri-implant soft tissue conditioning by means of customized healing abutment: a randomized controlled clinical trial. Materials. 2019;12(18):3041. doi:10.3390/ma12183041
Pow EH, McMillan AS. A modified implant healing abutment to optimize soft tissue contours: A case report. Implant Dentistry. 2004;13(4):297-300. doi:10.1097/01.id.0000144510.66524.87
Proussaefs P. Custom CAD-CAM healing abutment and impression coping milled from a poly (methyl methacrylate) block and bonded to a titanium insert. The Journal of Prosthetic Dentistry. 2016;116(5):657-662. doi:10.1016/j.prosdent.2016.03.026
Gowda VS, Anand D, Sundar MK, et al. Custom anatomic healing abutments. The Journal of the Indian Prosthodontic Society. 2016;16(4):386-389. doi:10.4103/0972-4052.176518
Canullo L, Tallarico M, Pradies G, et al. Soft and hard tissue response to an implant with a convergent collar in the esthetic area: Preliminary report at 18 months. The International Journal of Esthetic Dentistry. 2017;12(3):306-323.
Rompen E. The impact of the type and configuration of abutments and their (repeated) removal on the attachment level and marginal bone. European Journal of Oral Implantology. 2012;5(Suppl):83-90.
Sánchez‐Siles M, Muñoz‐Cámara D, Salazar‐Sánchez N, et al. Crestal bone loss around submerged and non‐submerged implants during the osseointegration phase with different healing abutment designs: a randomized prospective clinical study. Clinical Oral Implants Research. 2018;29(7):808-812. doi:10.1111/clr.12981
Weinlaender M, Lekovic V, Spadijer‐Gostovic S, et al. Soft tissue development around abutments with a circular macro‐groove in healed sites of partially edentulous posterior maxillae and mandibles: a clinical pilot study. Clinical Oral Implants Research. 2011;22(7):743-752. doi:10.1111/j.1600-0501.2010.02054.x
Menchini-Fabris G-B, Crespi R, Toti P, et al. A 3-year retrospective study of fresh socket implants: CAD/CAM customized healing abutment vs cover screws. International Journal Of Computerized Dentistry. 2020;23(2):109-117.
Perez A, Caiazzo A, Valente NA, et al. Standard vs customized healing abutments with simultaneous bone grafting for tissue changes around immediate implants. 1‐year outcomes from a randomized clinical trial. Clinical Implant Dentistry and Related Research. 2020;22(1):42-53. doi:10.1111/cid.12871
Doliveux S, Jamjoom FZ, Finelle G, et al. Preservation of Soft Tissue Contours Using Computer-Aided Design/Computer-Assisted Manufacturing Healing Abutment with Guided Surgery in the Esthetic Area: Case Report. International Journal of Oral & Maxillofacial Implants. 2020;35(1):e15-e20. doi:10.11607/jomi.7668
Yilmaz B, McGlumphy E, Turkyilmaz I. A technique to modify the length of an implant healing abutment. Journal of Oral Implantology. 2009;35(4):201-203. doi:10.1563/AAID-JOI-D-09-00001R1.1
Abduo J, Lyons K. Rationale for the use of CAD/CAM technology in implant prosthodontics. International Journal of Dentistry. 2013;2013: 768121 doi:10.1155/2013/768121
Raheem IMA, Hammad IA, Kader SHA, et al. Fabrication of a CAD-CAM custom healing abutment guided by a conventional dental radiograph for delayed loaded dental implants: A dental technique. The Journal of ProstheticDentistry.2022;127(1):49-54. doi:10.1016/j.prosdent.2020.09.022
