Bireyselles?tirilmis? iyiles?me bas?lıg?ı ile standart iyiles?me bas?lıg?ının, immediyat implantasyon sonrası implantı c?evreleyen yumus?ak ve sert dokulara etkisinin kars?ılas?tırılması
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: İmmediyat implant uygulaması ile birlikte yerleştirilen bireyselleştirilmiş iyileşme başlığının, implant çevresi sert ve yumuşak dokuların boyutsal değişimine etkisinin değerlendirilmesi hedeflenmiştir. GEREÇ YÖNTEM: Endodontik ve restoratif nedenlerden dolayı çekim endikasyonu konmuş olan üst premolar dişe sahip 26 birey çalışmaya dahil edildi. 28 adet diş eşit sayıda olacak şekilde rastgele test ve kontrol gruplarına ayrıldı. Atravmatik diş çekimini takiben, flep kaldırılmadan implant yuvaları hazırlandı ve implantlar yerleştirildi. İmplant ile vestibül kemik arasında kalan boşluk alloplastik kemik grefti ile dolduruldu. Kontrol grubunda standart iyileşme başlığı kullanılırken, test grubundaki implantlara ise bireyselleştirilmiş iyileşme başlığı yerleştirildi. Sert ve yumuşak dokularda meydana gelen değişimin değerlendirilmesinde standardize fotoğraflar ve konik ışın hüzmeli volümetrik tomografi (CBCT) kullanılırken, implant stabilitesi periotest kullanılarak değerlendirildi. Standardize fotoğraflar başlangıç ve 6. ayda, periotest değerleri başlangıç, 1, 3 ve 6. aylarda yapılırken, CBCT görüntüleri, 1. hafta ve 6. aylarda alındı. Bukkal kemik ve yumuşak dokudaki boyutsal değişimler implant platformundan apikal yönde 0, 1, 2 ve 4. mm'de ölçümler yapılarak hesaplanırken, vertikal kemik seviyesi değişimleri ise implant platformu ile krestal kemik tepe noktası arasındaki dikey mesafe ölçülerek saptandı. Grup içi ve gruplar arası değerlendirilmelerin yapılmasında ve değişkenler arasında korelasyonların saptanmasında parametrik testler kullanıldı. Veriler ?=0,05 anlamlılık düzeyinde istatistiksel olarak analiz edildi. BULGULAR: 27 adet implant çalışmayı tamamlarken, test grubuna ait 1 implant, operasyon sonrası 1. haftada gelişen enfeksiyon nedeniyle eksplante edildi. Periotest skorları, kontrol grubunda 1. ayda başlangıca göre anlamlı seviyede yüksek saptanırken (p<0,05), 6 ay değerleri test grubunda başlangıca göre anlamlı seviyede düşük bulundu (p<0,01). Her iki grupta vertikal yumuşak doku boyutunda 6. ayda başlangıca göre anlamlı azalma saptandı (test grubu p<0,01, kontrol grubu p<0,0001). Benzer şekilde implant seviyesindeki (0 mm) mukoza kalınlığının aynı dönemde her iki grupta başlangıca göre anlamlı seviyede azaldığı görüldü (test grubu p<0,05, kontrol grubu p<0,01). CBCT ölçümlerinde, tüm ölçüm noktalarında her iki grupta anlamlı seviyede kemik rezorpsiyonu saptandı (Test grubu: 0. mm p<0,01, 1 ve 2. mm p<0,05, 4. mm p<0,01, kontrol grubu: tüm ölçüm noktalarında p<0,0001). Test grubunda 0, 1 ve 2. mm seviyesindeki ölçümlerde horizontal kemik rezorpsiyonunun kontrol grubuna kıyasla istatistiksel anlamlı düzeyde daha az olduğu tespit edildi (0 mm p<0,001, 1 mm p<0,001, 2 mm p<0,05). Fotoğraf analizi sonuçlarına göre, her iki grupta papil seviyelerinde kayıp saptandı. Gruplar arası karşılaştırmada kontrol grubundaki kayıplar anlamlı seviyede yüksek bulundu (p<0,01). SONUÇ: İmmediyat implantasyon ile birlikte standart ve bireyselleştirilmiş iyileşme başlıklarının kullanılmasının yumuşak ve sert doku kayıplarını engelleyemediği saptanmıştır. Ancak bireysel iyileşme başlığı kullanımı ile bu kayıpların azaltılması postoperatif 6 aylık sürede mümkün olmaktadır. Bireyselleştirilmiş iyileşme başlığının dokular üzerine etkisinin incellendiği uzun dönemli çalışmalara ihtiyaç duyulmaktadır. ANAHTAR KELİMELER: İmmediyat implant yerleştirilmesi; Bireyselleştirilmiş iyileşme başlığı; Konik ışın hüzmeli volümetrik tomografi; Bukkal kemik; İmplant çevresi yumuşak doku
ABSTRACT The effect of custom and standard healing abutments on peri-implanter hard and soft tissues following immediate implant placement Purpose: The aim of the present study was to evaluate the effect of customised healing abutment on dimensional changes of peri-implant soft and hard tissues after immediate implantation. Materials and Methods: Twenty-six patients who had maxillary premolar teeth with hopeless prognosis because of endodontic or restorative reasons were included in the study. A total of 28 teeth were equally divided into test and control groups. After atraumatic extraction the implant osteotomy was prepared and the implant was placed following a flapless surgical approach. The gap between the implant and the vestibular bone was filled with alloplastic bone graft substitutes. In the control group the implants received a standardised healing abutment and in the test group a customized healing abutment was installed. The dimensional changes in the soft and hard tissues were evaluated using standardized photographs and cone beam computed tomography (CBCT). The implant stability was measured using periotest values. The standardized photographs were taken at baseline and 6th month, the periotest values were measured at baseline, 1, 3, and 6th month, and CBCT evaluations were made at 1st week and 6th month. The dimensional changes in the vestibular soft and hard tissues were calculated using the measurements beginning at implant crest level in apical direction at 0, 1, 2, and 4th mm, and the vertical hard tissue changes were calculated measuring the vertical distance between the implant crest level and alveolar crest. The statistical differences between and within groups, and the correlations between the variables were evaluated using parametric tests. ? = 0.05 was set as the significance level. Results: Twenty-seven implants completed the study protocol. One implant in the test group was explanted because of infection detected at 1st week after the implantation. Periotest values were significantly higher in control group at 1st month compared to baseline (p<0.05), where as the values were significantly lower at 6th month in test group compared to baseline (p<0.01). The soft tissue vertical dimensions (0 mm) in both groups were significantly decreased at 6th month compared to baseline (test group p<0.01, control group p<0.0001). The soft tissue thickness at implant crest level (0 mm) in both groups were also significantly decreased at 6th month compared to baseline (test group p<0.05, kontrol group p<0.01). CBCT evaluations revealed significant bone resorption in both groups at all measurement points (Test group: 0. mm p<0.01, 1. mm p<0.05 2. mm p<0.05, 4. mm. p<0.01, control group: in all points p<0.0001). The amount of horizontal bone resorption in the test group was significantly lower at 0, 1 and 2nd mm (0 mm p<0.001, 1 mm p<0.001, 2 mm p<0.05) compared to control group. Analyses in the standardized photographs revealed recessions in the papillary height in both groups at 6th month compared to the baseline. However the recession was significantly higher in the control group compared to test group (p<0.01). Conclusion: Even though the standardized and customised healing abutments do not prevent soft and hard tissue loss around the implants in immediate implantation, utilization of customised healing abutments decreases the amount of tissue loss by 6th month. Long term studies evaluating the effect of customised healing abutments on peri-implant tissues are emerging in the field. KEY WORDS: Immediate implant placement; Custom healing abutment; Cone beam computed tomography; Buccal bone; Peri-implanter soft tissue.
ABSTRACT The effect of custom and standard healing abutments on peri-implanter hard and soft tissues following immediate implant placement Purpose: The aim of the present study was to evaluate the effect of customised healing abutment on dimensional changes of peri-implant soft and hard tissues after immediate implantation. Materials and Methods: Twenty-six patients who had maxillary premolar teeth with hopeless prognosis because of endodontic or restorative reasons were included in the study. A total of 28 teeth were equally divided into test and control groups. After atraumatic extraction the implant osteotomy was prepared and the implant was placed following a flapless surgical approach. The gap between the implant and the vestibular bone was filled with alloplastic bone graft substitutes. In the control group the implants received a standardised healing abutment and in the test group a customized healing abutment was installed. The dimensional changes in the soft and hard tissues were evaluated using standardized photographs and cone beam computed tomography (CBCT). The implant stability was measured using periotest values. The standardized photographs were taken at baseline and 6th month, the periotest values were measured at baseline, 1, 3, and 6th month, and CBCT evaluations were made at 1st week and 6th month. The dimensional changes in the vestibular soft and hard tissues were calculated using the measurements beginning at implant crest level in apical direction at 0, 1, 2, and 4th mm, and the vertical hard tissue changes were calculated measuring the vertical distance between the implant crest level and alveolar crest. The statistical differences between and within groups, and the correlations between the variables were evaluated using parametric tests. ? = 0.05 was set as the significance level. Results: Twenty-seven implants completed the study protocol. One implant in the test group was explanted because of infection detected at 1st week after the implantation. Periotest values were significantly higher in control group at 1st month compared to baseline (p<0.05), where as the values were significantly lower at 6th month in test group compared to baseline (p<0.01). The soft tissue vertical dimensions (0 mm) in both groups were significantly decreased at 6th month compared to baseline (test group p<0.01, control group p<0.0001). The soft tissue thickness at implant crest level (0 mm) in both groups were also significantly decreased at 6th month compared to baseline (test group p<0.05, kontrol group p<0.01). CBCT evaluations revealed significant bone resorption in both groups at all measurement points (Test group: 0. mm p<0.01, 1. mm p<0.05 2. mm p<0.05, 4. mm. p<0.01, control group: in all points p<0.0001). The amount of horizontal bone resorption in the test group was significantly lower at 0, 1 and 2nd mm (0 mm p<0.001, 1 mm p<0.001, 2 mm p<0.05) compared to control group. Analyses in the standardized photographs revealed recessions in the papillary height in both groups at 6th month compared to the baseline. However the recession was significantly higher in the control group compared to test group (p<0.01). Conclusion: Even though the standardized and customised healing abutments do not prevent soft and hard tissue loss around the implants in immediate implantation, utilization of customised healing abutments decreases the amount of tissue loss by 6th month. Long term studies evaluating the effect of customised healing abutments on peri-implant tissues are emerging in the field. KEY WORDS: Immediate implant placement; Custom healing abutment; Cone beam computed tomography; Buccal bone; Peri-implanter soft tissue.
Açıklama
Anahtar Kelimeler
Diş Hekimliği, Dentistry
