DÖRT FARKLI TIP ALVEOLER DEFEKTE SAHIP MAKSILLADA DÖRTLÜ ZIGOMATIK İMPLANT UYGULAMASININ BIYOMEKANIK ETKILERININ DEĞERLENDIRILMESI

Bulgular: Beş model arasında, kemikte görülen en yüksek Von Mises Stres değeri, tek taraflı kusurlu (1/3 kusurlu) maksillada bulundu. Deformasyon değeri 2/3 kusurlu maksilla modelinde en yüksek bulundu. Asimetrik defekt modellerinde, maksilla'nın sağlam kısmında daha yüksek stres değerleri elde edildi. Simetrik kusurlu modellerde, stresin daha homojen bir şekilde dağıldığı görüldü. Anahtar Kelimeler: Zigomatik implant, kuad zigoma, maksillar defekt, sonlu elemanlar analizi Evaluation of Biomechanical Effects of Quad Zigomatic Implant Applications in Four Different Maxillary Defect Types Abstract Purpose: The purpose of this study is to evaluate the biomechanical effects of quad zygomatic implant use in four different type alveolar defected maxilla. Materials and Methods: Three dimensional models of human skull, zygomatic implants, bar attachment and hybrid prosthesis was modeled using SolidWorks Computer-Aided Design (CAD) program. Four different defect locations were modeled on intact model to mimic different alveolar defect scenarios. In all models, four zygomatic implants were placed on maxilla models at the location of first premolar and second premolar tooth, assembly of the modeled parts were completed. The data were processed by ANSYS Workbench software, 150N vertical occlusal and 300N masseteric load were simulated on modeled prosthesis. The Maximum Von Mises Stress in bone/implants and deformations were visualized and comparatively evaluated with color distribution scale. Conclusion: Cortical bone thickness, defect size and localization are among the factors closely related to the stability and success of the implant. Keywords: Zygomatic implant, quadrant zygoma, maxillary defect, finite element analysis

Anahtar Kelimeler:

Zigomatik implant, kuad zigoma, maksillar defekt

PDF

___

1. Baqain ZH, Anabtawi M, Kraky M, Malkawi Z. Morbidity from anterior iliac crest bone harvesting for secondary alveolar bone grafting: an outcome assessment study. J Oral Maxillofac Surg 2009;67:570-5.
2. Pellegrino G, Tarsitano G, Basile F, Pizzigallo A, Marchetti C. Computer-Aided Rehabilitation of Maxillary Oncological Defects Using Zygomatic Implants: A Defect-Based Classification. J Oral Maxillofac Surg 2015;73: 2446 e1-2446 e11.
3. Vosselman N, Merema BJ, Schepman KP, Raghoabar GM. Patient-specific sub-periosteal zygoma implant for prosthetic rehabilitation of large maxillary defects after oncological resection. Int J Oral Maxillofac Surg 2019;48:115-117.
4. Chigurupati R, Aloor N, Salas R, Schmidt BL. Quality of life after maxillectomy and prosthetic obturator rehabilitation. J Oral Maxillofac Surg 2013;71:1471-8.
5. Devlin H, Barker GR. Prosthetic rehabilitation of the edentulous patient requiring a partial maxillectomy. J Prosthet Dent 1992;67:223-7.
6. Akay C, Yalug S. Biomechanical 3-dimensional finite element analysis of obturator protheses retained with zygomatic and dental implants in maxillary defects. Med Sci Monit 2015;21:604-11.
7. Block MS, Haggerty CJ, Fisher GR. Nongrafting implant options for restoration of the edentulous maxilla. J Oral Maxillofac Surg 2009;67(4): 872-81.
8. Ömezli MM, Ertaş Ü. Zigoma İmplantları. Atatürk Üniv. Diş Hek. Fak. Dergi 2015;10:190-195.
9. Duan Y, Chandran R, Cherry D. Influence of Alveolar Bone Defects on the Stress Distribution in Quad Zygomatic Implant-Supported Maxillary Prosthesis. Int J Oral Maxillofac Implants 2018;33:693-700.
10. Bothur S, Jonsson G, Sandahl L. Modified technique using multiple zygomatic implants in reconstruction of the atrophic maxilla: a technical note. Int J Oral Maxillofac Implants 2003;18:902-4.
11. Stievenart M, Malevez C. Rehabilitation of totally atrophied maxilla by means of four zygomatic implants and fixed prosthesis: a 6-40-month follow-up. Int J Oral Maxillofac Surg 2010;39:358-63.
12. Davo R, Pons O. Prostheses supported by four immediately loaded zygomatic implants: a 3-year prospective study. Eur J Oral Implantol 2013;6:263-9.
13. Trivedi S. Finite element analysis: A boon to dentistry. J Oral Biol Craniofac Res 2014;4:200-3.
14. Ramoğlu S, Ozan O. Diş Hekimliğinde Sonlu Elemanlar Stres Analizi Yöntemi. Atatürk Üni. Diş Hek. Fak. Dergi 2014;9:175-180.
15. Tepper G, Haas R, Zechner W, Krach W, Watzek G. Three-dimensional finite element analysis of implant stability in the atrophic posterior maxilla: a mathematical study of the sinus floor augmentation. Clin Oral Implants Res 2002;13:657-65.
16. Gumrukcu Z, Korkmaz YT, Korkmaz FM. Biomechanical evaluation of implant-supported prosthesis with various tilting implant angles and bone types in atrophic maxilla: A finite element study. Comput Biol Med 2017;86:47-54.
17. Branemark PI, Grondahi K, Ohrnell LO, Nilsson P, Petruson B, Svensson B, Engstrand P, Nannmark U. Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results. Scand J Plast Reconstr Surg Hand Surg 2004;38:70-85.
18. Duarte LR, Filho HN, Francischone CE, Peredo LG, Branemark PI. The establishment of a protocol for the total rehabilitation of atrophic maxillae employing four zygomatic fixtures in an immediate loading system--a 30-month clinical and radiographic follow-up. Clin Implant Dent Relat Res 2007; 9:186-96.
19. Aboul-Hosn Centenero S, Lazaro A, Giralt-Hernando M2, Hernández-Alfaro F3. Zygoma Quad Compared With 2 Zygomatic Implants: A Systematic Review and Meta-analysis. Implant Dent, 2018;doi: 0.1097/ID.0000000000000726.
20. Piccioni MA, Campos EA, Saad JRC, Andrade MF, Galvao MR, Rached AA. Application of the finite element method in Dentistry. RSBO, 2013;10:369- 377.
21. Uckan S, Oguz Y, Uyar Y, Ozyesil A. Reconstruction of a total maxillectomy defect with a zygomatic implant-retained obturator. J Craniofac Surg 2005; 16:485-9.
22. Wen, H, Guo W, Liang R, Xiang L, Long G, Wang T, Deng M, Tian W. Finite element analysis of three zygomatic implant techniques for the severely atrophic edentulous maxilla. J Prosthet Dent 2014;111:203-15.
23. Holmes DC, Loftus JT. Influence of bone quality on stress distribution for endosseous implants. J Oral Implantol 1997;23:104-11.
24. Bardyn T, Gedet P, Hallermann W, Buchler P. Quantifying the influence of bone density and thickness on resonance frequency analysis: an in vitro study of biomechanical test materials. Int J Oral Maxillofac Implants 2009;24: 1006-14.
25. Roze J, Babu S, Saffarzadeh A, Gayet-Delacroix M, Hoornaert A, Layrolle P. Correlating implant stability to bone structure. Clin Oral Implants Res 2009; 20:1140-5.
26. Sugiura T, Horiuchi K, Sugimura M, Tsutsumi S. Evaluation of threshold stress for bone resorption around screws based on in vivo strain measurement of miniplate. J Musculoskelet Neuronal Interact 2000;1:165-70.
27. Cezayirlioglu H, Bahniuk E, Davy DT, Heiple KG. Anisotropic yield behavior of bone under combined axial force and torque. J Biomech 1985; 18: 61-9.