Duygu KILIÇ, Kerem KILIÇ, Emir ESİM, İkbal LEBLEBİCİOĞLU KURTULUŞ

'All-On-Four', 'All-On-Five' ve 'All-On-Six' KonseptiKullanılarak Üretilen Protezlerin Stres Dağılımının SonluElemanlar Analiz Yöntemi İle İncelenmesi

Amaç: Bu çalışmanın amacı; tam dişsiz üst çenede All-on Four, All-on-Five ve All-on-Six tekniğine göre yerleştirilmişimplantlar üzerine yapılan protezlerin 3 boyutlu modellerininkemik, implant elemanları ve protetik elemanlar üzerindeoluşturduğu stresleri sonlu elemanlar analiz yöntemi iledeğerlendirmektir. Gereç ve Yöntemler: Tamamen dişsiz atrofik maksillada, All on-Four, All-on-Five ve All-on-Six konseptine göre üç farklıtedavi planı oluşturulmuştur. En posterior implantlar bütüngruplarda premolarlar bölgesinde, distale doğru 30 dereceeğimli olarak konumlandırılmıştır. Alt yapı; krom-kobalt (Cr-Co)alaşımından kesilmiş diş formunda, üst yapı ise monolitikzirkonya olarak ayrı ayrı modellenmiş, daha sonra kontaktnoktalarından temas sağlanmıştır. Protez kantilever uzunluğu10mm olarak sabit tutulmuştur. Kuvvetler; palatobukkal yönde45° açıyla, 3,4,5,6 no’lu dişlere sırasıyla; 100N, 150N, 150N,200N olacak şekilde çift taraflı olarak uygulanmıştır. VonMisses, maksimum principal stres ve minimum principalstresler elde edilmiştir. Bulgular: All-on-Six konsepti sırasıyla kortikal kemikte, implantve protetik elemanlar üzerinde ve spongiyöz kemikte dahadüşük maksimum principal ve minimum principal stresgöstermiştir. Sonlu elemanlar analizinin sonuçlarına görebakılan tüm parametrelerde protez altyapısındaki stress veimplantlardaki stres dışında en fazla von Misses stresine sahipolan konsept All-on-Four olarak görünmektedir. Sonuç: İmplant sayısı arttıkça implant elemanları ve protetikelemanlarda görülen stres azalmıştır ancak araştırılan 3 tedavikonseptinde de stres değerleri kemik direnci sınırlarını aşmadı.All-on-Six tedavi konseptinin, atrofik maksillanınrehabilitasyonunda All-on-Four ve All-on-Five konseptlerinegöre daha iyi biyomekanik davranış sergilediği söylenebilir.

Analysis of Stress Distribution of Prostheses Produced byUsing 'All-On-Four', 'All-On-Five' And 'All-On-Six' Conceptwith Finite Elements Analysis Method

Background: The aim of this study was to evaluate the stressdistrubution of 3D models of prostheses on bone, implantelements and prosthetic elements which were placed on implantsaccording to All-on-Four, All-on-Five and All-on-Six concepts in afully edentulous upper jaw. Methods: Three different treatment plans were created incompletely edentulous atrophic maxilla according to the All-on Four, All-on-Five and All-on-Six concepts. The most posteriorimplants were positioned in the premolar region, inclined 30degrees distally in all groups. Substructure was modeled in theform of prepared teeth from chrome-cobalt (Cr-Co) alloy, thesuperstructure was modeled separately as monolithic zirconia,then contact points were provided. The prosthetic cantileverlength was kept constant at 10mm. Forces; in the palatobuccaldirection with an angle of 45 °, to the teeth numbered 3,4,5,6respectively; It has been applied double-sided as 100N, 150N,150N, 200N. Von Misses, maximum principal stress and minimumprincipal stresses were obtained. Results: The All-on-Six concept showed lower maximum principaland minimum principal stress on cortical bone, implant andprosthetic elements and cancellous bone respectively. Accordingto the results of the finite element analysis, the concept with thehighest von Misses stress appears to be All-on-Four, except forthe stress in the prosthetic substructure and the stress in theimplants. Conclusion: The stress on the implant elements and prostheticelements decreased, where as the number of implants increased;but the stress values did not exceed the bone resistance limits inall 3 treatment concepts investigated. It can be said that the All on-Six treatment concept exhibits better biomechanical behaviorin the rehabilitation of atrophic maxilla than the All-on-Four andAll-on-Five concepts.

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