Dr. Ali Direnç Ulaşan – Oral and Maxillofacial Surgeon, Milim Dental Bursa

An ndealaigh do bhuille isteach sa bhéal roimh, agus an bhfuil fadhbanna ag tarlú thar na blianta?

An bhfuil do sreang ag druidim, an bhfuil do chosa tarraingthe siar, an bhfuil tú dissatisfaction aesthetic, nó an bhfuil tú ráite, "Tá an cnámh imleáite, ní bheidh na implants ag coimeád níos mó"?

Mar gheall ar na cur chuige reatha i mbunachar maxillofacial agus implantology, is féidir go leor cásanna implant "gan chiall" a shábháil trí chairt faoi athbhreithniú. Ina Theannta sin, i gcásanna forleathna, is féidir fadhb na neamhábaltachta cnámh a shárú le roghanna speisialta cosúil le zygomatic implants

Sa alt seo, marDr. Ali Direnç Ulaşan, dochtúir maxillofacial agus oral a chleachtar i mBursa ag Milim Dental, déanfaimid freagra a thabhairt ar na ceisteanna coitianta seo go mion:

1. An féidir liom mo shean-implantáistí a athsholáthar go hiomlán?
2. Cén saghas cásanna a dhéantar deireadh leis an implant, agus cá saghas cásanna a chosnaítear?
3. Conas atá pleanáil ar obair athbhreithnithe, agus cé na rioscaí a bhaineann léi?
4. Má tá mo chailleadh cnámh trom, an féidir zygomatic implant a bheith ina rogha dom?

1. An bhfuil Faoistin ag Implantáistí? Cén fáth a gcuirtear na hiarratais ar athbhreithniú?

Féadfaidh implantáistí fiacla, nuair a dhéantar le pleanáil chóir agus le hobair mhaith, bheith in úsáid gan fadhbanna ar feadh na mblianta — go minic ar feadh deich mbliana. Ach, is struchtúr atá ag obair trí bheith comhoiriúnach leis an cnámh agus leis an bhfíochán bog laistigh de timpeallacht bhithéagsúil. Dá réir sin, is éifeacht é ar choinníollacha bainistíochta béil agus ar shláinte ginearálta an duine.

Na príomh chúiseanna a éilíonn obair athbhreithnithe ná:

1. Fadhbanna Duáin (Peri-implant Mucositis / Peri-implantitis):
2. Inflameadh na duáin timpeall na n-implantáistí.
3. Fuilse, síothlú, boladh bruscar.
4. Caillteanas cnámh timpeall na n-implantáistí os cionn ama.
5. Fao-ll-‘a“lam al-tarweejeya:
6. al-‘azmat al-‘idhaariyyah hawl al-‘imad al-‘ulumi li-maraah awwaliyyah ناجح.
7. al-‘awamil al-musahima: al-dukhan, jawd al-fam siyyas, al-marad al-nizamiy (kama huwa al-sukkr ghayr mutawaffir).
8. Azh-‘imad ad-dahriyyat wa mashakil al-jamaal:
9. al-tukasir fi al-masnah aw zirconium crown hawl al-‘imad.
10. تكامل أو انكسار مسامير الأَساس.
11. مشاكل ميكانيكية ناتجة عن طحن الليل (البركسزم).
12. almukhattar wa tanbeeh aw tatbeeqat jarria:
13. al-‘imad maqhtou’ fi zawayah ghair sahihah.
14. al-‘imad maqhtou’ fi manatiq bi ‘idha bahsha jiddan.
15. altaqsim al-ghalta li-quwwat almukhallas li-terfit al-kahr.

fi hathihi al-hala, bi-‘an yastaṭi’ ba’d al-‘imad an yuhfaz bi-dh-ilaj, walakin, li-ba’d al-‘imad, qad yakun izalatuhu wa’ijra’at al-tashih al-jirahi yahtaj ilayh an-naql ya jama’ah.

2. hal yajib istikhraj al-‘imadat al-qadima bi-kull thouq?

Laysa. La huwma qawa’id annna kull imad mushkil yajib istikhrajuhu.

D'fhéin rannpháirtíocht mionsonraithe agus meastóireacht radagrafaíochta ar chóir a dhéanamh ar dtús. Is féidir na céimeanna a leanann muid ag Milim Dental a choigeartú mar:

1. Rannpháirtíocht Chliniciúil:
2. Staidiúir na matáin gaimne ar fud na hinleagtha.
3. Tomhas na doimhneachta phocaithe le próbán.
4. Bardas nó neamhbhrí níos mó ar ghluaiseacht.
5. Rannpháirtíocht Radagrafaíochta (Féilire Panoramic agus is fearr CBCT 3D – Tomagrafaíocht):
6. Meastóireacht ar chán méadaithe na cnámha timpeall na hinleagtha.
7. Gaol le struchtúir eitneacha cosúil leis an sinus, canal na néaróg, agus urlár na nimíne.
8. Tomhas tiubhaithe cnámha agus airde sa fromach uachtarach nó íochtarach.
9. Meastóireacht Prostaice:
10. Occlusion agus briseadh tráchta na croinní nó na droichidí tacaíochta emphasophiala.
11. Comhoiriúnacht leis an líne gháire esthetiúil.
12. Stádas Cothrom na Féine an Phaitinéalaigh agus Nósanna Sláinte Béil:
13. Diaibéiteas, osteoporóis, riochtanna reumatóideacha, deochanna a úsáidtear.
14. Agus múintear, grindáil na hoíche, cloí le seiceáil thrioblóide rialta.

De bharr an mheasúnachta seo, féadfar toradh ar roinnt implántí:

1. Cosaint den chóras le fístúlacht peri-inleagtha + cúrétáid + lasair + glacadh rialta.

Agus le haghaidh cúntóirí eile:

1. Implant removal and bone regeneration in the area.
2. In more severe cases with bone deficiency, zygomatic-implants or other advanced surgical solutions may be considered.

3. How is Implant Removal Performed? Is it a Procedure to Be Feared?

Implant removal, when done with proper planning and the correct technique, is a controlled surgery. The goal here is to remove the implant while preserving the surrounding bone tissue as much as possible.

The main techniques that can be used are:

1. Anti-rotation and Reverse Torque Techniques:
2. Used especially for implants that are not fully integrated or have moderate stability.
3. The implant is removed by applying reverse torque with special internal wrenches.
4. Trephine Drills for Implant Removal:
5. Bone and implant are removed together in a cylinder shape, slightly wider than the implant diameter.
6. Bone grafting can then be applied to the defect area.
7. Can be used especially for removing fractured implant bodies.
8. Implant Removal with Piezosurgery:
9. Piezosurgery allows us to make much more controlled incisions on the bone.
10. In implants close to sensitive anatomical structures like nerves or sinuses, piezosurgery allows for much safer removal.

Tar éis Tagerlann na Plandáil a bhaint i ndiaidh, d'fhéadfadh an riochtcnúilcnúilcnúil cnultúrcnúil an chíche a bheith oiriúnach go pras do thagairt nua, nó is féidir an cinneadh a dhéanamh chun "cnámh a chruthú ar dtús, ansin an t-uar a chur isteach." Braitheann sé seo ar CBCT agus do fhaireachas eallaigh.

Mar a déarfá, i gcontaetha a Mhargann in Bursa, i gcásanna ina mbainimid an sean-tagrantán agus athdhearbhaímid an gáirdín an othar ó bhonn le targar agus pleanáil digiteach, is cuma má bhíonn sé mar chuid den seisiún céanna nó ina dhiaidh de réir tréimhse haidhme mhaoinithe.

4. An Céim Thábhachtach Is mó I gCistí Athbhreithnithe: Pleanáil Digiteach agus Measúnacht 3D

Cé gur shocraíodh cinntí uair amháin le scannánanna panóramacha, inniu, buíochas le CBCT (tomagrafaíocht 3D) agus bogearraí pleanála digiteacha, is féidir linn:

1. Tomhas trastomhnacht cnámh le cruinneas micrin.
2. Féidearthacht soiléir ar struchtúir cosúil leis an urlabhra na sinuas agus an zygoma (gnúiseanna).
3. Pleanáil an seasamh, na huillinní, agus na faid na n-uar in oiriún an fhíorúil.

Léiríonn sé seo gur féidir linn i ndiaidh na n-athbhreithníte,

1. Bain den t-uar gan aon chailliúntas cnámh neamh-riachtanach.
2. Más féidir, cuir an t-uar nua in oiriúint níos fearr i rith na seisiún céanna.
3. Déan mi-aimhleasa fadatréimhse na fórsaí béal le haghaidh "plúchán uirbe + fiacla dôite" pleanáilte do othair.

Déantar oibríocht athbhreithnithe linn ar Dhentál Milim, go mór má bhíonn na hailt seo:

1. Tá othair againn a rinneadh suas le linn am.
2. Tá triail déanta ag go leor áiteanna ach níor éirigh leo na torthaí is fearr a bhaint amach.
3. Tá cailliúint cnámh agus dúradh linn, "Ní fhéadfaidh tú níos mó tarraigeanna a chur isteach.'

5. Réiteach don Caillteanas Cnámh Throm: Cad iad na Zygomatic Implants?

Tagann cuid mhór othar chugainn linn le ráiteas ar nós:

1. "Níl cnám ar bith fágtha i mo ghéaga uachtarach; cuirtear i láthair dom ach palate (fiacla réamh-mheasta)."
2. "Rinne mé ardú sinus, agus theip é; duirt siad nach féidir le implants a bheith "
3. "Cuirtear graftáil cnámh i bhfeidhm i gcónaí, ach ní dhéanaimid aon toradh."

Seo áit nach mór don zygomatic implant teacht i gcás.

Cad é Zygomatic Implant?

1. Cuirtear implants clasaiceach i bhfeidhm san mbonn alveolar den ghéaga uachtarach (maxilla),
2. Tá implants Zygomatic níos faide, deartha go speisialta, agus scriú isteach san cnámh súl (cnámh zygomatic).
3. Cuirtear deis eile ar fáil chun fiacla shocrúla a dhéanamh, go háirithe do dhaoine le caillteanas cnámh dian san ghéaga uachtarach, daoine a ndearna siad níos mó oibríochtaí sinus, nó iad siúd a raibh taithí rathúil orthu roimhe.

Cé a bhfuil sé oiriúnach dó?

1. Vacsaillí le caillteanas cnámh dian san ghéaga uachtarach.
2. Cásanna ina bhfuil roinnt implants caillte, agus tá folament cnámh ag insint go dtí urlár sinus.
3. Vacsaillí a duirt siad, "Ní féidir ach fiacla réamh-mheasta a bheith agat" ach ní mian leo fiacla shocrúla a fhágáil.
4. Dáiríre atá daoine a bhfuil a n-amhábhar córasach ceadaíocht do chlinicí ghinearálta agus atá ceachtar cnámh an zygoma go leor i dteagmháil leis an limistéal.

Cé atá dócha go bhféadfadh sé nach mbeadh oiriúnach dó?

1. Vacsaillí ar shláinte ghinearálta dian nach bhfuil oiriúnach do shùru vóta mór.
2. Cásanna le toirt chinéiteach nó patalót ar an zygoma.

6. Conas a úsáidtear Zygomatic Implants i bSeiceáil Athshlánaithe?

Dearfaighimid sa ghlún uachtarach:

1. Tá sean-implántaithe agat.
2. Tá cuid de na haimplántaithe seo caillte, tá cuid díobh ar líne, tá cuid ar an bhuaireamh.
3. Tá oibríochtaí déanta sa limistéar na beleza agus tá do chnámh tiubhú laghdaithe go suntasach.

Sa chás seo, d’fhéadfadh go mbeadh bealach clasaiceach de "dul chun cinn arís coscáin na sinusa + grafting cnámh + implant ar chách" ann:

1. Notreamh fada i bhfad.
2. Ilchríoch sonraí biaíochta.
3. Próiseas doille agus ag críochnú sna blianta.

Seo ar nós an zygomatic implant a thagann i bhfeidhm i bseiceáil athshlánaithe:

1. Bainistíocht na sean-implántaithe:
2. Tá implants EFI anteriormente in ócáid AR a bhaint go cúramach.
3. Glantóir na hábhair taobh istigh den suíomh sinus, más gá.
4. 3D Measúnacht ar Chnámh Uachtarach agus cnámha Zygoma:
5. Measctar fad, coffa, agus dlúthdnacht na cnámh zygoma le CBCT.
6. Tá na pointí ina gcónaí le haghaidh na n-implántaithe Zygomatic á phleanáil i dtimpeallacht fhíorúil.
7. Pleanáil Fiacla Cosanta i Seisiún Aonair (All-on-4 / All-on-6 + Zygomatic Implant Combinations):
8. In am some cases, fixed teeth can be made with a combination of two zygomatic implants in the upper jaw + 2–4 classic implants in the anterior region.
9. Thus, function and aesthetics can be achieved in a shorter time without classic bone grafting surgeries.
10. Surgical Procedure:
11. Can be performed under general anesthesia or deep sedation.
12. It is preferred to be performed by an experienced oral and maxillofacial surgeon in a hospital setting.
13. If adequate primary stability is achieved after the zygomatic implants are placed, temporary fixed teeth can be fitted on the same day or shortly thereafter (immediate loading concept).
14. Healing and Final Prosthesis Process:
15. The biological integration of the zygomatic implants with the bone is monitored for the first few months.
16. Then, permanent fixed teeth, custom-designed for the individual, are prepared and screwed in.

In Bursa, as Dr. Ali Direnç Ulaşan at Milim Dental, we have numerous cases where we have been able to restore fixed teeth with the combination of revision surgery + zygomatic implants in patients who were previously told ”it's impossible” multiple times and experienced unsuccessful attempts at different centers.

7. What are the Advantages of Revision Surgery?

A correctly planned revision surgery:

1. Provides teeth that are more aesthetically harmonious with your face and smile.
2. Functionally ensures better chewing and balanced load distribution.
3. Facilitates long-term maintenance with designs that allow for easier hygiene.
4. Especially in zygomatic implant combinations, fixed, screw-retained teeth can be offered to patients who were previously told they would be confined to a removable denture.

Psychologically, it is also important: Seeing a patient who was told ”There is no solution for you anymore” being able to confidently bite and smile again is a great source of motivation for both the patient and the clinician.

8. Risks of Revision Surgery and Precautions

Like any surgical procedure, revision surgery has risks. Especially operations performed in areas like the sinus and zygoma require experience and a fully equipped team.

Possible risks:

1. Swelling, bruising, temporary pain.
2. Temporary complaints in the sinus area.
3. Infection (rare).
4. The necessity of additional surgeries in very advanced cases.

These risks can be minimized with detailed surgical planning, proper medication use, and regular check-ups.

Therefore, patients considering revision surgery must choose:

1. A team experienced in oral and maxillofacial surgery.
2. A clinician with case experience in implant and zygomatic implant procedures.

9. How Do We Answer the Question, ”Is it suitable for me?”

Whether you live in Bursa or come from out of town, the process when you apply for revision surgery at Milim Dental usually progresses as follows:

1. Detailed examination and panoramic film.
2. CBCT (3D tomography) for bone analysis.
3. Individual evaluation of your existing implants.
4. Discussion of your expectations (aesthetics, function, time, budget).
5. Creation of multiple treatment alternatives:
6. Only wound control and maintenance.
7. Revision with classic implants.
8. An advanced plan involving zygomatic implants if needed.
9. Clearly explaining the duration, cost, advantages, and disadvantages of each option.

After this stage, we proceed with a plan that we decide on together. Because this journey is a process that both the clinician and the patient walk through together.

10. Frequently Asked Questions (FAQ)

1) Can I have all my old implants removed and start from scratch?

Yes, it is possible in most cases. However, we do not remove every implant simply because it is "old." We first look at which implants can be preserved and which must be removed through detailed examination and CBCT. Some of your implants may be preserved while certain areas are completely revised.

2) Is revision surgery a very painful process?

The surgery itself is performed under local anesthesia, sedation, or general anesthesia; you will not feel pain during the procedure. Afterward, there may be mild-to-moderate pain, swelling, and bruising that can last for a few days. We usually manage this period quite comfortably with appropriate medication.

3) Can a zygomatic implant be applied to everyone?

No. A zygomatic implant is advanced surgery and is not necessary or suitable for every patient. It becomes a very valuable option, especially for patients with severe bone loss in the upper jaw, those who have undergone multiple sinus and implant attempts, and those who cannot use a removable denture. The suitability decision is absolutely made with 3D tomography and a detailed examination.

4) If I get a zygomatic implant, can I get my teeth on the same day?

In some patients, temporary fixed teeth can be fitted in the same session along with zygomatic implants (immediate loading). This decision is made based on the initial stability the implant provides in the bone, your overall bone quality, and the distribution of your chewing forces. It may not be possible for every patient, but it is a very comfortable solution in suitable cases.

5) I have undergone several unsuccessful implant and bone graft operations before; will I fail again?

Every case is unique. Past failures can stem from many reasons, such as planning errors, inadequate techniques, systemic conditions, or lack of maintenance. Modern approaches we use today, such as digital planning, piezosurgery, and zygomatic implants, increase the chance of success. However, there is no 100% guarantee in any treatment. The important thing is to clearly know the risks and embark on the journey with a realistic plan.

11. Conclusion: The phrase "Implants are no longer an option for you" is not always the final word.

If:

1. You are dissatisfied with your old implants.
2. You have complaints such as pain, swelling, gum recession, or bad odor around your implants.
3. You were told, "The bone has melted, a removable denture is your only option."
4. You have previously undergone several unsuccessful sinus and implant operations.

As Dr. Ali Direnç Ulaşan, an oral and maxillofacial surgeon in Bursa, and the Milim Dental team, we can evaluate revision surgery and, if necessary, zygomatic implant options for you.

With correct analysis, proper planning, and an experienced surgical team, many cases that were once considered impossible can now regain fixed teeth.

Remember: This article is for general informational purposes. The most accurate treatment plan for you will be finalized after an in-person examination and imaging. If you are wondering, "Can I replace my old implants, and are zygomatic implants suitable for me?" I would be happy to see you in my practice as an oral and maxillofacial surgeon.