Total dişsiz bir hastanın otojen greftleme sonrası All-on-4 konsepti ile tedavisi

All-on-4 tedavi konsepti, anterior bölgeye iki adet dik ve posterior bölgeye iki adet eğimli yerleştirilen, toplam dört implant destekli, tek parça, tüm ark protez uygulamasını içeren, tam dişsiz çenelerin sabit protetik rehebilitasyonu için uygulanan bir tedavi metodudur. Yapılan çalışmalarda, posterior bölgeye eğimli yerleştirilen implantların ileri cerrahi işlemlere gerek kalmadan anatomik sınırlamalara takılmadan uygulanabildiği, biyomekanik kuvvetleri daha iyi karşıladığı, protetik kantilever uzantıların boyutunu azalmasını sağladığı ve ayrıca başarısızlık oranlarında dik yerleştirilen implantlarla karşılaştırıldığında anlamlı bir fark bulunmadığı bildirilmektedir. Dişlerin kaybının ardından çenelerde kemik rezorpsiyonunun posterior sahalarda daha şiddetli görüldüğü yapılan birçok çalışmada gösterilmiştir. All-on-4 tedavi protokolü de genellikle üst çenede posterior bölgede maksiller sinüs, mandibulada ise inferior alveolar sinir kaynaklı anatomik sınırlamalar nedeniyle tercih edilmektedir. Böylelikle posterior bölgede kemik augmentasyonu gibi ileri cerrahi işlemlerden kaçınılmaktadır. Ancak uzun yıllar süren dişsizlikle birlikte posterior bölgedeki rezorpsiyona, anterior bölgede ilk etapta horizontal bölgedeki rezorpsiyonda eşlik etmeye başlar. Bu durumda karşısında mevcut vertikal kret yüksekliğini korumak ve bölgeye implant destekli bir tedavi yapabilmek için kemik hacmini arttırmaya yönelik işlemler kaçınılmaz olmaktadır. Bu olgu sunumunda, üst çenesi total dişsiz, alt çenede ise yalnızca kanin dişleri bulunan ve öğürme refleksi nedeniyle üst total protezini takmakta zorlanan 68 yaşındaki bayan hastada, öncelikle maksilla anterior bölgenin, mandibula simfiz bölgesinden elde edilen blok kemiklerle greftlenmesi ve sonraki süreçte her iki çenenin All-on-4 konsepti ile rehabilitasyonu ve vakanın 2 yıllık takibi rapor edilmektedir.

All-on-4 treatment of an edentolous patient after autogenous grafting

All-on-4 concept is a treatment method for fixed prosthetic rehabilitationof edentulous jaws with a total of four dental implant,two anterior vertically placed and two posterior inclinedimplants, supported full arch hybrid prosthetic restorations. Ithas been reported that inclined implants placed to the posteriorregion can provide better biomechanical strength, reducedsize of prosthetic cantilever extensions, without anatomiclimitations and no need for further surgical procedures.Many studies have shown that after the loss of teeth, boneresorption in the jaws is seen more intensely in the posteriorregions. All-on-4 treatment concept is usually preferred becauseof the anatomical limitations of the maxillary sinuses in theposterior maxilla and inferior alveolar nerve in the mandible.Thus, advanced surgical procedures such as bone augmentationin the posterior region are avoided. However, over timeresorption in the posterior regions begins to accompany withhorizontal resorption of the anterior region. In this case, surgicalprocedures to increase the bone volume are inevitableto maintain the existing vertical crest height and to be able toprovide an implant-supported treatment to the region.In this case report, a 68-year-old female patient, who hasedentulous maxilla and only canine teeth in mandible, wastreated by grafting anterior maxilla with autogenous boneblock grafts obtained from mandibular symphysis, and thenthe rehabilitation of both jaws prosthetically according to theAll-on-4 concept was done. There was no complication in follow-upof the patient for 2 years and there was no bone loss inthe periimplant bone except physiologically accepted levels.Thanks to this application, the aesthetic and functional expectationsof the patient are met.

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