| Abstract | Današnja, suvremena stomatologija zahtijeva brza rješenja koja zadovoljavaju najviše estetske i funkcionalne standarde terapije. Izrada fiksnoprotetskog rada nošenog dentalnim implantatima kod potpuno bezubih pacijenata pripada među najsloženije kliničke slučajeve dentalne implantološke protetike. Točno postavljena indikacija nakon provedene dijagnostike,odabir protokola opterećenja dentalnih implantata te provedba kirurških, protetskih i laboratorijskih postupaka glavni su razlozi tomu. Svaka faza ovakve implantoprotetske rehabilitacije ima svoje posebnosti s konačnim ciljem terapije, a to je izrada dugoročno uspješnoga funkcionalnog i estetskog fiksnoprotetskog rada. Upravo zato potrebna je bliska suradnja oralnog kirurga / implantologa, specijalista stomatološke protetike / liječnika dentalne medicine i dentalnog tehničara koji moraju biti vrlo dobro uvježbani i sigurni u području svojeekspertize. U radu je prikazan klinički slučaj od početne situacije, tj. pacijent s uznapredovalim kroničnim
parodontitisom (zbog čega je bila indicirana ekstrakcija svih zuba u obje čeljusti), nakon čega je slijedila implantoprotetska terapija potpuno bezubog pacijenta u fazama. Poslije razdoblja cijeljenja bezubih alveolarnih grebena uslijedio je kirurški postupak ugradnje dentalnih implantata (po šest implantata u bezuboj čeljusti). S obzirom na povijest bolesti pacijenta
(kronični parodontitis), kvalitetu, kvantitetu i gustoću gornjega i donjega bezubog alveolarnog grebena (dijagnostika: trodimenzionalna računalna tomografija – procjena kosti nakon razdoblja cijeljenja), bila je donesena kirurška indikacija o odabiru konvencionalnog protokola opterećenja dentalnih implantata (fiksni protetski rad izrađen je nakon razdoblja oseointegracije
od šest mjeseci). U drugoj protetskoj fazi terapije prikazani su klinički i laboratorijski postupci izrade fiksnoga protetskog rada retiniranog vijcima na tzv. multi-unit nadogradnjama koje su bile fiksirane vijcima u dentalnim implantatima. Opskrba bezubog pacijenta većim brojem implantata sigurnije je rješenje i pruža veće mogućnosti kod odabira vrste rada i protetskog materijala od kojega će se napraviti fiksni protetski rad. Protetski radovi na vijak općenito izazivaju manje bioloških komplikacija u vidu
pojavnosti periimplantitisa koji je učestaliji kod fiksnih radova koji se cementiraju na nadogradnjama. Kod fiksnih radova na vijak najvažnije je osigurati pasivan dosjed (test Sheffield) na nadogradnjama te izbacitisvaku mogućnost stvaranja naprezanja u području spoja dentalnog implantata i protetskog rada. Izbor protetskih materijala za fiksne radove nošene dentalnim implantatima također je širok, a on uglavnom ovisi o točno postavljenoj indikaciji za ovakav oblik terapije bezubog pacijenta, o znanju, vještini i iskustvu kliničara i zubnog tehničara te o opremljenosti zubotehničkog laboratorija. U svakom slučaju, protetski materijali poput metalokeramike ili suvremeniji materijali poput cirkonij-dioksidne potpune keramike pokazali su se u svakodnevnoj praksi i objavljenim znanstvenim studijama vrlo standardnim i pouzdanim materijalima koji zadovoljavaju dugoročne estetske, biomehaničke i funkcionalne zahtjeve fiksnih radova nošenih dentalnim implantatima kod potpuno bezubog pacijenta. |
| Abstract (english) | Modern dentistry demands therapeutic solutions that are fast and, at the same time, have highest aesthetic and functional standards satisfied. Full mouth rehabilitation of completely edentulous patients with fixed prosthetic restoration can easily be classified as one of the most complicated cases in dental implantology. Reasons for this claim are that, for this kind of rehabilitation to be successful, a lot of steps must be set correctly. Firstly, correct indication must be set, then protocol for dental implant loading followed with correct implementation of surgical, and in the end, prosthetic, and laboratory procedures. Every step of this kind of rehabilitation has its own specifics, but long-term aesthetic and functional success of prosthetic therapy always is the main goal. Having said that, close cooperation must be between oralsurgeon/implantologist,prosthetic specialist and dental technician and they need to be reliable in they part of this procedure. In this article a clinical case is being described from starting situation where patient was diagnosed with advanced chronical periodontitis (because of that diagnose extraction of all teeth was indicated), and in second part where, through phases, is described how patient is rehabilitated, first with dental implants, and then with screw-retained fixed prosthetic restoration supported by dental implants. Firstly, teeth were extracted and then, after healing period, patient undergone surgery where he got six dental implants, per edentulous jaw. Considering few parameters, such as history of dental periodontitis, quality, quantity and density of bone in both jaws (diagnosed with three-dimensional computed tomography- post extraction bone healing), decision was that implant loading would be conventional, which means that they will be loaded with fixed prosthetic restoration, after six months. In second, prosthetic therapy phase, both clinical and laboratory procedures in the making of fixed, screwretained prosthetic restoration are being described. Providing a patient with larger number of implants is a safer therapy plan but besides that, it gives doctor and technician more options to choose between various types of therapy plans and prosthetic materials. Screw-retained fixed prosthetic restorations show much fewer biological complications (periimplantitis) then cemented ones. In these kinds of prosthetic solutions,
frameworks need to be passive when put on multi-unit abutments (Sheffield test), without making any tensions in dental implant – prosthetic restoration/framework interface. There is a wide selection of prosthetic materials that can be used for fixed prosthetic restorations on dental implants. Which one is going to be used depends on few things such as, indication for each case, experience and knowledge of the clinician and technician and level of equipment of the dental laboratory, as well. Prosthetic materials, such as metal ceramic or modern zirconia showed, through everyday clinical practice and clinical research, as reliable materials that satisfy long-term aesthetic, biomechanics and functional demands of fixed prosthetic
restorations supported by dental implants. |
