Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Protez Türlerinin Kondil Bölgesindeki Trabeküler Kemik Yoğunluğuna Etkisinin İncelenmesi: Retrospektif Klinik Çalışma
Investigation of the Effect of Prosthesis Types on Trabecular Bone Density in the Condyle Region: Retrospective Clinical Study
Begüm ÜNLÜ KURŞUNa, Ender AKANa
aİzmir Kâtip Çelebi Üniversitesi Diş Hekimliği Fakültesi, Protetik Diş Tedavisi ABD, İzmir, Türkiye
Turkiye Klinikleri J Dental Sci. 2022;28(2):418-25
doi: 10.5336/dentalsci.2021-84143
Article Language: TR
Full Text
ÖZET
 Amaç: Alt-üst her iki çenesinde de tam, hareketli bölümlü ve sabit olmak üzere farklı tip protez kullanan hastaların protez öncesi ve sonrası alınan radyografilerinde kondilde meydana gelen trabeküler kemik değişimlerinin fraktal boyut (FB) analizi kullanılarak değerlendirilmesidir. Gereç ve Yöntemler: Yaşları 55-67 arasında değişen, 21'i tam, 27'si hareketli bölümlü, 25'i sabit protez kullanan, 20'si tam doğal dişli bireylerden oluşan kontrol grubu olmak üzere toplam 93 hastanın panoramik radyografisi arşivden seçilerek retrospektif olarak değerlendirilmiştir. Seçilen her hasta için tedavi öncesi ve sonrası kontrol panoramik radyografileri üzerinden sağ ve sol kondilin subkortikal bölgesi ve geometrik olarak ortasından 84x84 piksel kesitler seçilmiştir. Her bir bölge için trabeküler kemiğin FB analizi yapılarak FB değerleri hesaplanmıştır. Bulgular: Tam ve hareketli bölümlü protez kullananlarda hesaplanan FB değerlerinde zamana bağlı istatistiksel olarak anlamlı azalma gözlenirken (p<0,01), sabit protez kullananlarda (p=0,09) ve kontrol grubunda (p=0,22) istatistiksel olarak anlamlı bir fark bulunmamıştır. Zamana bağlı olarak FB değerlerinde meydana gelen değişimlerle protez türü arasındaki ilişkinin istatistiksel olarak anlamlı olduğu görülmüştür (p<0,01). Tam protez kullananlar ile sabit protez kullananlar (p<0,01) ve kontrol grubu (p<0,01) arasında meydana gelen değişimlerin ve aynı zamanda hareketli bölümlü protez kullananlar ile sabit protez kullananlar (p=0,02) ve kontrol grubu (p=0,02) arasındaki değişimlerin istatistiksel olarak anlamlı olduğu gözlenmiştir. Sonuç: Çalışmanın sınırlılıkları dâhilinde zamanla tam dişsiz veya fazla sayıda dişsizliğe sahip ve hareketli protez kullanmakta olan hastalarda kondilde meydana gelen trabeküler kemik yoğunluğu değişimin sabit protez kullanan ve tam dişli hastalara göre daha yüksek olduğu gözlenmiştir. Bu nedenle zamana bağlı olarak, farklı tür protez kullanan hastalarda kondiler trabeküler kemikte oluşabilecek kemik değişimin en aza indirgenebilmesi için meydana gelebilecek olan diş kayıpları erken teşhis edilip gerekli müdahale yapılmalıdır. Dişsiz hastalarda öncelikle sabit protezler tercih edilmelidir.

Anahtar Kelimeler: Mandibular kondil; hareketli protez; sabit protez
ABSTRACT
 Objective: The aim of this study is to evaluate the trabecular bone changes that occur in the condyle with panoramic radiograps taken before and after from the patients using different types of prostheses, including full, partial removable and fixed in both upper and lower jaws by using fractal dimension (FD) analysis. Material and Methods: Panoramic radiographs of a total of 93 patients aged between the ages of 55 and 67, consisting of 21 full, 27 removable partial, 25 fixed prosthesis, and 20 natural complete teeth in the control group, were selected from the archive and retrospectively analyzed. For each selected patient, 84x84 pixel sections were selected from the subcortical area and the geometric center of the right and left condyles on the panoramic radiographs before and after treatment. Fractal FD values were calculated by performing FD analysis of trabecular bone for each region. Results: It was observed that the statistically significant decrease in the calculated FD values depending on time in those using complete and removable partial dentures (p<0.01) and no statistically significant difference was found in those using fixed prostheses (p=0.09) and in the control group (p=0.22). It was noted that the relationship between the changes in FD values depending on the time and the type of prosthesis was statistically significant (p<0.01). It was statistically significant changes obtained between using complete denture-fixed prosthesis (p<0.01) and the control group (p<0.01), as well as those using removable partial denturesfixed prostheses (p=0.02) and the control group (p=0.02). Conclusion: Within the limitations of the study, it was found that the trabecular bone density change occurring in the condyle was higher in patients with complete edentulous or excessive toothless and using removable prostheses compared to patients with fixed prostheses and full teeth. For this reason, in order to reduce the change in condylar trabecular bone according to prosthesis type by the time, tooth losses that may occur should be diagnosed early and necessary intervention should be performed, and fixed prostheses should be preferred primarily in edentulous patients.

Keywords: Mandibular condyle; removable prosthesis; fixed prosthesis
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