TAM KONTÜR ZİRKONYA RESTORASYONLARIN FARKLI ALL ON FOUR MANDİBULAR İMPLANT MODELLERİNDE BİYOMEKANİK DAVRANIŞLARI: 3 BOYUTLU SONLU ELEMANLAR STRES ANALİZİ ÇALIŞMASI

Amaç: Aşırı rezorbe mandibular tam dişsizlik; implant uygulamaları, oklüzyonun sağlanması ve hareketli protez kullanımı yaygın gözlenen problemlerdir. Mandibular 4 implant üzerine yapılan sabit tam ark protetik restorasyonlar alternatif bir metod sağlamaktadır. İmplant sayısının az olması, cerrahi işlemlerin kısa sürmesi ve sabit protez yapılması bu yöntemin özellikleridir. Bu çalışmanın amacı estetik ve son teknoloji ürünü olan monolitik zirkonya CAD-CAM seramik materyallerin farklı mandibuler all on four implant tasarımlarında uygulanmasının biyomekanik özellikler bakımından değerlendirilmesidir. Materyal ve metod: Katana CAD-CAM monolitik zirkonya tam ark sabit restorasyon, Biomed implant ve abutment materyalleri kullanıldı. 4 adet mandibuler all on four implant tasarımlı model hazırlandı. 1. model; anterior implantlar vertikal ve posterior implantlar 150 açılı, kantilever 5 mm, (Z-15,5); 2. model; kantilever 9 mm (Z-15,9); 3. model anterior implantlar vertikal posterior implantlar 300 açılı, kantilever 5 mm (Z-30,5); 4.model; kantilever 9 mm (Z-30,9). Yükleme koşulu; 1. molar yüklemesi sağ kantilever uzantısının merkezinden oklüzyon düzlemine 30o açılı ve 150 N kuvvet uygulandı. Üç boyutlu sonlu elemanlar stres analiz yöntemi ile mandibular kortikal ve spongioz kemik, implant ve protetik restorasyonlardaki biyomekanik stres dağılımı ölçüldü. Statik lineer analiz yapıldı. Bulgular: Bütün parametreler birlikte değerlendirildiği zaman CAD-CAM seramik materyal, kantilever uzunluğu ve stres dağılımının tipleri arasında önemli bağlantılar olduğu tespit edildi. Kantilever uzunluğu 5 mm’ den 9 mm’ ye çıktığı zaman kortikal ve trabeküler kemikte maksimum ve minimum asal gerilme stres değerleri 15’ den 32 MPa değerine yükseldi. Posterior implant açılanması 150’ den 300 ‘ye çıktığı zaman implantlarda von Mises değerleri azaldı. Sonuç: Monolitik zirkonya restorasyon 30o posterior implant açılanması ve 5 mm kantilever uzantısı biyomekanik olarak kullanılabilir. Mandibuler all on four implant destekli tam ark sabit estetik CAD-CAM restorasyonlarda biyomekanik ve klinik açıdan kantileverin kısaltılması implant açısının arttırılması ve rijit tek tabaka restorasyonların yapılması önerilebilir. Anahtar kelimeler: monolitik zirkonya, üç boyutlu sonlu elemanlar stres analizi, all on four implant tasarımı Biomechanical behaviors of full countor zirconia restorations on different all on four mandibular implant models: A 3 dimensional finite element stress analysis study ABSTRACT Aim: Extremely resorbed mandibular total edentulism is most commonly seen with implant applications, occlusion and moving prosthetic use. The fixed whole arch prosthetic restorations on the mandibular 4 implant provide an alternative method. The low number of implants, short duration of surgical procedures, and fixed prosthesis are the characteristics of this method. The aim of this study is to evaluate the application of aesthetic& state of the art technology product of monolithic zirconia CAD-CAM ceramic materials in different mandibular "all four implant" designs in terms of biomechanical properties. Material&Method: Katana CAD-CAM monolithic zirconia full-arc fixed restoration, Biomed implant and abutment materials were used. 4 models of mandibular "all-on-four implants" were prepared. 1. model; anterior implants vertical and 150 angled posterior implants, cantilever 5 mm, (Z-15,5); 2. model; cantilever 9 mm (Z-15,9), 3. model; anterior implants vertical 300 angled posterior implants, cantilever 5 mm (Z-30,5); 4. model; cantilever 9 mm (Z-30,9). Loading condition; The 1st molar loading was applied from the center of the right cantilever extension to the occlusion plane with an angle of 30 degrees and a force of 150 N. Biomechanical stress distribution of mandibular cortical and spongious bone, implant and prosthetic restorations were measured by three dimensional finite element stress analysis method. Static linear analysis was performed. Results: When all parameters were evaluated together, it was found that there were significant connections between the types of CAD-CAM ceramic material, the length of the cantilever and the types of stress distribution. When cantilever length was increased from 5 mm to 9 mm, maximum and minimum principal stress values in cortical and trabecular bone were increased from 15 to 32 MPa. When Posterior implant angles increased from 15 to 30 degrees, the von Mises values of the implants decreased. Conclusion: Monolithic zirconia restoration can be used biomechanically with 30 degree posterior implant angle and 5 mm cantilever extension. Biomechanically shortening cantilever, increasing implant angle and rigid monolithic restorations can be suggested on Mandibular "all-on-four implant" supported full-arc fixed aesthetic CAD-CAM restorations Key words: monolithic zirconia, three dimensional finite element stress analysis, all on four implant design

Anahtar Kelimeler:

monolitik zirkonya, üç boyutlu sonlu elemanlar stres analizi, all on four implant tasarımı

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