Tam Dişsizlikte Tedavi Seçenekleri
Özet
Edentülizm (tam dişsizlik), çiğneme sistemi bütünlüğünün kaybıyla karakterize, olumsuz fonksiyonel, estetik ve psikososyal etkilere yol açan bir durumdur. Özellikle geriatrik popülasyonda yaygın olan bu durumun rehabilitasyonunda geleneksel tam protezler, implant destekli hareketli protezler (İDHP) ve implant destekli sabit protezler olmak üzere üç ana protetik seçenek mevcuttur. Geleneksel protezler ekonomik ve cerrahisiz bir çözüm sunarken, kret rezorbsiyonu fazla olan olgularda stabilite yetersizliği yaşatabilir. Bu noktada McGill konsensüsü, alt çene için en az iki implant destekli protezi asgari standart olarak önermektedir. İDHP'ler; stud, ball, locater, ERA, ZAAG, bar, manyetik ve teleskopik gibi farklı mekanik/reziliyent ataçman sistemleri kullanılarak implant sayısını azaltır, temizliği kolaylaştırır ve maliyeti düşürür. Sabit protezler ise genellikle 6-8 implant ile uygulanarak daha yüksek hasta konforu sağlar ancak kemik anatomisi, kavis formu, anterior-posterior (A-P) mesafe ve maliyet gibi kısıtlamaları barındırır. Tedavi planlamasında ve ataçman seçiminde hastanın beklentileri, oral hijyeni, anatomik yapısı, çeneler arası ilişkileri ve ekonomik durumu titizlikle değerlendirilmelidir.
Edentulism (complete tooth loss) is a condition characterized by the loss of masticatory system integrity, leading to negative functional, aesthetic, and psychosocial impacts. Particularly common in the geriatric population, three main prosthetic options are available for its rehabilitation: conventional complete dentures, implant-supported removable dentures (ISRD), and implant-supported fixed dentures. While conventional dentures offer an economic and non-surgical solution, they may cause stability issues in cases with severe ridge resorption. At this point, the McGill consensus recommends a mandibular overdenture supported by at least two implants as the minimum standard of care. ISRDs reduce the number of required implants, facilitate cleaning, and lower costs by utilizing various mechanical or resilient attachment systems such as stud, ball, locater, ERA, ZAAG, bar, magnetic, and telescopic attachments. On the other hand, fixed prostheses are generally applied with 6-8 implants to provide higher patient comfort, but they involve constraints regarding bone anatomy, arch form, anterior-posterior (A-P) distance, and cost. In treatment planning and attachment selection, the patient's expectations, oral hygiene, anatomical structure, intermaxillary relationships, and financial status must be carefully evaluated.
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