Şadiye GÜNPINAR, Mehmet Cihan ŞENGÜN, Ayşe Sevim SEVİNÇ

İnferior Alveolar Sinir Transpozisyonu ile Eş zamanlı Dentalİmplant Yerleştirilmesi: 4 Yıl Takipli Bir Vaka Raporu

Mandibula posterior bölgede implant uygulamalarında dikkatedilmesi gereken önemli anatomik oluşumlardan biri inferioralveolar sinirdir. Diş çekimi ve uzun süreli dişsizlik durumundaalveolar kret rezorbe olmakta ve inferior alveolar sinir alveolar krettepesine yaklaşmaktadır. Bunun sonucunda, çoğu vakada altçene arka bölgede implantı yerleştirecek yeterli vertikal kemikmesafesi bulunamamaktadır. Sinire zarar vermeden implantyerleştirilmesi için çeşitli yöntemler geliştirilmiştir. Kısaimplantların kullanılması, otojen/ allojenik kemik greftlerininkullanılmasıyla yapılan vertikal kemik ogmentasyonları, sinirinyeniden konumlandırılması (sinirin lateralizasyon veyatranspozisyonu) ve distraksiyon osteogenezisi gibi yöntemler ileatrofik alt çeneye implant uygulaması yapılabilmiş ve böylecebireylerin protetik rehabilitasyonu sağlanabilmiştir. Buseçeneklerin içerisinde sinirin yeniden pozisyonlandırılması risklibir cerrahi gibi görülse de teknik hassasiyet ilegerçekleştirildiğinde bireyin tedavi süresini kısaltması, ikinci bircerrahiye gerek kalmaması, ekstra bir maliyete neden olmamasıve bölgeye uzun implantların yerleştirilebilmesine olanaksağlaması gibi birçok avantajı bulunmaktadır. Bu vaka raporunda; alt çene arka bölgede osseointegrasyonubaşarısız olmuş implantın çıkarılma işlemi ve sinirin repozisyonu,ardından uzun implant yerleştirilmesi sonrası vakanın dört yıllıktakibi sunulmaktadır. Bu vakanın sınırları dahilinde doğruendikasyon, hassas çalışma ve iyi bir anatomi bilgisi neticesindesinir repozisyonu tekniği ile başarılı olunabileceği sonucunavarılabilir.

Inferior Alveolar Nerve Transposition with SimultaneouslyDental Implant Placement: A Case Report with 4 YearsFollow-Up

Inferior alveolar nerve is one of the important anatomicallandmark in implant surgery in the posterior region of themandible. Following tooth extraction and long-term edentualism,the alveolar crest becomes resorbed and the inferior alveolarnerve gets close to the alveolar crest hill. As a result, in mostcases, there is not enough vertical bone distance for to place theimplant in the posterior mandibular region. Various methodshave been developed for implant placement to avoid nerve injuryin the mandibular posterior region. These include, utilizing shortimplants, vertical augmentations using autogenous or allogenicbone grafts, repositioning the nerve (lateralization ortransposition) and distraction osteogenesis. Althoughrepositioning of the inferior alveolar nerve seems to be ahazardous surgery, this procedure has many advantages, whenperformed with technical precision, such as shortening the totaltreatment time, not requiring a second surgery, not necessitatingan extra cost and enabling longer implants to be placed in thearea. In this case report, the removal of the failed implant and also thefour-year follow-up of the patient with a long implant placementsimultaneously with nerve reposition was presented. Within thelimits of this case, it can be concluded that, successful resultscan be obtained with nerve reposition technique as aconsequence of proper diagnosis of the patient, precisemanuplation and comprehensive knowledge of the regionalanatomy.

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