Atrofik Total Dişsiz Maksillada Kullanılan Titanyum Ve Peek Materyalinden Üretilmiş Farklı Subperiosteal İmplant Tasırımlarının Çevre Dokulardaki Biyomekanik Etkilerinin Sonlu Elemanlar Analizi Kullanılarak İncelenmesi

Abstract

ABSTRACT Kasap T. Investigation of the Biomechanical Effects of Different Subperiosteal Implant Designs Made of Titanium and PEEK Materials Used in Atrophic Total Edentulous Maxilla on Surrounding Tissues Using Finite Element Analysis, Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Specialization Thesis, 2024. Depending on the long term edentulous treatment of maxillary atrophy may be impossible with the use of endooseos implants. Zygomatic implants, autogenous block grafting and subperiosteal implants are frequently used methods in the care of these patients and provide advanced protection. With the recent advancement of medical and digital measurement methods, subperiosteal implants can be produced individually. Custom-made subperiosteal implants have advantages such as a near perfect fit to the bone, no need for enlargement, a small portion of the complement sinuses, and the ability to start using replaceable prostheses immediately after the procedure. Thanks to this feature, it stands out as an alternative to other distortions. On the other hand, periimplantitis or periimplant mucositis is one of the wide-ranging episodes that can be seen in subperiosteal implants. Treatment of such therapies and debridement are aimed at treating complications. It is recommended that periimplantitis that spreads to deeper tissues where antibiotic treatment fails is removed by cutting the relevant abutment arm or the relevant subperiosteal implant wing. In such a case, the remaining part of the implant does not prevent the use of the prosthesis. Accordingly, in our study, in addition to the one-piece and two-piece subperiosteal implant models, a third design consisting of two posterior and one anterior sections was included. Thanks to this design, we aimed to protect a smaller part of the subperiosteal implant compared to the other two casings and to make the remaining part easier to close in case a complication occurs in any part of the subperiosteal implant that requires cutting the wing or support arm. We compared the biomechanical effects created on the surrounding bone tissue of three different subperiosteal implants designed for this target project, using the finite element analysis method. Among the custom-made subperiosteal implants, digital products are designed everywhere by modeling the jawbone and then designing the implant based on this model in the computer environment. The designed implants and prostheses are then produced using digital printers. In the past, vitalium alloy was used in the first subperiosteal implants produced with the lost wax technique. Nowadays, it is used periodically. However, in addition to the many advantages of the case, its elasticity module is very strong compared to the psychological one, and this may hinder the transmission of functional forces on the implant to the bone. Introduced in 1998 as a biomaterial for longer-lasting implants, polyether ether ketone (PEEK) material elastic modulus (3-4 GPa) can sustain high stresses during power transfer similar to bone. PEEK material, produced as an alternative to metal materials like today, is a biocompatible material with superior mechanical and chemical properties. It is very difficult to analyze clinically and meticulously the biomechanical events that occur in structures with complex anatomy such as the maxilla. Finite Element Stress Analysis Method (FEA) allows programming of the physical parts of the stresses occurring in such complex structures. In our study, we used the material in the first three models, consisting of six different models in three different designs, and PEEK material in the other three models. The models we created were subjected to 50 N oblique and 150 N vertical force movements that mimic the breaking forces. With SEA analysis, the maximum and minimum principal stress values in the bone tissue and the von Mises stress measurements in the implants and fixation screws were measured. According to the time taken, no pathological force occurred in the bone tissue in any model. In addition, the von Mies stress values in the implants and fixation screws were lower than if the full titanium and PEEK material were not pulled. With these results, all models used were formed successfully and the probability of complexity was low. In all models, PEEK material created more comphresive stress in cortical and trabecular bone than titanium under vertical and oblique forces. In addition, in all models that can be produced from PEEK material, Von Mises stress values occurring on subperiosteal implants at lower temperatures than titanium. The results need to be evaluated through collective clinical studies. Key words: Subperiosteal Implant, PEEK, Finite Element Analysis