KONJENİTAL BİR OLİGONTİ VAKASININ ALL-ON-4 DENTAL İMPLANT KONSEPTİ İLE TEDAVİSİ
Oligodonti; süt, kalıcı veya her iki dentisyonda
altıdan fazla dişin konjenital eksikliği ile
karakterize, nadir bir genetik hastalıktır. Genellikle
bir sendromun parçasıdır, ancak nadiren izole
olarak ortaya çıkabilir. Oligodonti hastalarında
dişlerin hiç oluşmamasına paralel olarak genellikle
alveolar kretlerde de ciddi atrofiler mevcut
olmaktadır. Dolayısıyla bu hastaların protetik
rehabilitasyonları da klinisyenler için oldukça güç
olabilmektedir. 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.
Bu olgu sunumunda, maksillada sadece üç dişi
ve mandibulada sadece ön grup dişleri olan 22
yaşındaki erkek hastanın, All-on-4 dental implant
konsepti ile her iki çene için rehabilite edilmesi
sunulmaktadır. Hastanın 2 yıl izleminde herhangi
bir komplikasyon olmadığı ve fizyolojik olarak
kabul edilen periimplant kemik kayıpları dışında
kayıp yaşanmadığı görülmüştür. Bu tedavi
sayesinde tam teşhisi konulamamış bir sendrom
sebebiyle oligodontik olan hastanın fonksiyonel ve
estetik beklentileri yeterince karşılanabilmiştir.
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- 1. Branemark PI. Vital microscopy of bone
marrow in rabbit. Scand J Clin Lab Invest.
1959; 11 Supp 38: 1-82.
2. Babbush CA, Hahn JA, Krauser JT,
Rosenlicht JL. Dental Implants: The Art and
Science. 2nd ed: Saunders; 2010. 544 p.
3. Misch CE. Contemporary Implant Dentistry.
3rd ed: Mosby, Elsevier; 2007. 1120 p.
4. Malo P, de Araujo Nobre M, Lopes A, Ferro
A, Gravito I. All-on-4(R) Treatment Concept
for the Rehabilitation of the Completely
Edentulous Mandible: A 7-Year Clinical and
5-Year Radiographic Retrospective Case Series
with Risk Assessment for Implant Failure and
Marginal Bone Level. Clin Implant Dent Relat
Res. 2015; 17 Suppl 2: e531-541.
5. Malo P, de Araujo Nobre M, Lopes A,
Francischone C, Rigolizzo M. “All-on-4”
immediate-function concept for completely
edentulous maxillae: a clinical report on the
medium (3 years) and long-term (5 years)
outcomes. Clin Implant Dent Relat Res. 2012;
14 Suppl 1: e139-150.
6. Soto-Penaloza D, Zaragozi-Alonso R,
Penarrocha-Diago M, Penarrocha-Diago M.
The all-on-four treatment concept: Systematic
review. J Clin Exp Dent. 2017; 9: e474-e488.
7. Malo P, Rangert B, Nobre M. “All-on-Four”
immediate-function concept with Branemark
System implants for completely edentulous
mandibles: a retrospective clinical study. Clin
Implant Dent Relat Res. 2003; 5 Suppl 1: 2-9.
8. Clelland NL, Gilat A, McGlumphy EA,
Brantley WA. A photoelastic and strain gauge
analysis of angled abutments for an implant
system. Int J Oral Maxillofac Implants. 1993;
8: 541-548.
9. Bellini CM, Romeo D, Galbusera F,
Agliardi E, Pietrabissa R, Zampelis A, et
al. A finite element analysis of tilted versus
nontilted implant configurations in the
edentulous maxilla. Int J Prosthodont. 2009;
22: 155-157.
10. Baggi L, Pastore S, Di Girolamo M, Vairo
G. Implant-bone load transfer mechanisms
in complete-arch prostheses supported by
four implants: a three-dimensional finite
element approach. J Prosthet Dent. 2013;
109: 9-21.
11. Babbush CA, Kanawati A, Kotsakis GA,
Hinrichs JE. Patient-related and financial
outcomes analysis of conventional full-arch
rehabilitation versus the All-on-4 concept: a
cohort study. Implant Dent. 2014; 23: 218-224.
12. Malo P, Rangert B, Nobre M. All-on-4
immediate-function concept with Branemark
System implants for completely edentulous
maxillae: a 1-year retrospective clinical study.
Clin Implant Dent Relat Res. 2005; 7 Suppl 1:
S88-94.
13. Bural C, Oztas E, Ozturk S, Bayraktar G.
Multidisciplinary treatment of non-syndromic
oligodontia. Eur J Dent. 2012; 6: 218-226.
14. Chan MH, Holmes C. Contemporary “Allon-
4” concept. Dent Clin North Am. 2015; 59:
421-470.
15. Dhanrajani PJ. Hypodontia: etiology,
clinical features, and management.
Quintessence Int. 2002; 33: 294-302.
16. Gorlin RJ, Cohen M Jr, L L. Syndromes
of the head and neck. 3rd ed. ed. New York:
Oxford University Press; 1990.
17. Polder BJ, Van’t Hof MA, Van der Linden
FP, Kuijpers-Jagtman AM. A meta-analysis of
the prevalence of dental agenesis of permanent
teeth. Community Dent Oral Epidemiol. 2004;
32: 217-226.
18. Jepson NJ, Nohl FS, Carter NE, Gillgrass
TJ, Meechan JG, Hobson RS, et al. The
interdisciplinary management of hypodontia:
restorative dentistry. Br Dent J. 2003; 194:
299-304.
19. Hall RK. Congenitally missing teeth--a
diagnostic feature in many syndromes of the
head and neck. J Int Assoc Dent Child. 1983;
14: 69-75.
20. Dermaut LR, Goeffers KR, De Smit AA.
Prevalence of tooth agenesis correlated with
jaw relationship and dental crowding. Am J
Orthod Dentofacial Orthop. 1986; 90: 204-210.
21. Kotsiomiti E, Kassa D, Kapari D.
Oligodontia and associated characteristics:
assessment in view of prosthodontic
rehabilitation. Eur J Prosthodont Restor Dent.
2007; 15: 55-60.
22. Bailleul-Forestier I, Berdal A, Vinckier F,
de Ravel T, Fryns JP, Verloes A. The genetic
basis of inherited anomalies of the teeth. Part 2:
syndromes with significant dental involvement.
Eur J Med Genet. 2008; 51: 383-408.
23. Prabhu NT, John R, Munshi AK. Rieger’s
syndrome: a case report. Quintessence Int.
1997; 28: 749-752.
24. Jumlongras D, Bei M, Stimson JM, Wang
WF, DePalma SR, Seidman CE, et al. A
nonsense mutation in MSX1 causes Witkop
syndrome. Am J Hum Genet. 2001; 69: 67-74.
25. Gurrieri F, Franco B, Toriello H, Neri G.
Oral-facial-digital syndromes: review and
diagnostic guidelines. Am J Med Genet A.
2007; 143A: 3314-3323.
26. McGovern E, Al-Mudaffer M, McMahon
C, Brosnahan D, Fleming P, Reardon W. Oculofacio-
cardio-dental syndrome in a mother and
daughter. Int J Oral Maxillofac Surg. 2006; 35:
1060-1062.
27. Minic S, Novotny GE, Trpinac D, Obradovic
M. Clinical features of incontinentia pigmenti
with emphasis on oral and dental abnormalities.
Clin Oral Investig. 2006; 10: 343-347.
28. . !!! INVALID CITATION !!! {}.
29. Mostowska A, Kobielak A, Trzeciak
WH. Molecular basis of non-syndromic tooth
agenesis: mutations of MSX1 and PAX9 reflect
their role in patterning human dentition. Eur J
Oral Sci. 2003; 111: 365-370.
30. Bellini CM, Romeo D, Galbusera F,
Taschieri S, Raimondi MT, Zampelis A, et al.
Comparison of tilted versus nontilted implantsupported
prosthetic designs for the restoration
of the edentuous mandible: a biomechanical
study. Int J Oral Maxillofac Implants. 2009;
24: 511-517.
31. Aparicio C, Perales P, Rangert B. Tilted
implants as an alternative to maxillary sinus
grafting: a clinical, radiologic, and periotest
study. Clin Implant Dent Relat Res. 2001; 3:
39-49.
32. Krekmanov L, Kahn M, Rangert B,
Lindstrom H. Tilting of posterior mandibular
and maxillary implants for improved prosthesis
support. Int J Oral Maxillofac Implants. 2000;
15: 405-414.
33. Malo P, de Araujo Nobre M, Lopes A, Moss
SM, Molina GJ. A longitudinal study of the
survival of All-on-4 implants in the mandible
with up to 10 years of follow-up. J Am Dent
Assoc. 2011; 142: 310-320.
34. Galindo DF, Butura CC. Immediately
loaded mandibular fixed implant prostheses
using the all-on-four protocol: a report of 183
consecutively treated patients with 1 year of
function in definitive prostheses. Int J Oral
Maxillofac Implants. 2012; 27: 628-633.
35. Butura CC, Galindo DF, Jensen OT.
Mandibular all-on-four therapy using angled
implants: a three-year clinical study of 857
implants in 219 jaws. Dent Clin North Am.
2011; 55: 795-811.
36. Babbush CA, Kutsko GT, Brokloff J. The allon-
four immediate function treatment concept
with NobelActive implants: a retrospective
study. J Oral Implantol. 2011; 37: 431-445.
37. Babbush CA, Brokloff J. A single-center
retrospective analysis of 1001 consecutively
placed NobelActive implants. Implant Dent.
2012; 21: 28-35.
38. Graves S, Mahler BA, Javid B, Armellini D,
Jensen OT. Maxillary all-on-four therapy using
angled implants: a 16-month clinical study of
1110 implants in 276 jaws. Oral Maxillofac
Surg Clin North Am. 2011; 23: 277-287, vi.
39. Chrcanovic BR, Albrektsson T, Wennerberg
A. Survival and Complications of Zygomatic
Implants: An Updated Systematic Review. J
Oral Maxillofac Surg. 2016; 74: 1949-1964.
40. Aparicio C, Manresa C, Francisco K,
Claros P, Alandez J, Gonzalez-Martin O, et al.
Zygomatic implants: indications, techniques
and outcomes, and the zygomatic success code.
Periodontol 2000. 2014; 66:41-58.