{"id":802,"date":"2024-03-18T12:50:24","date_gmt":"2024-03-18T12:50:24","guid":{"rendered":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/?post_type=chapter&#038;p=802"},"modified":"2024-03-20T15:24:29","modified_gmt":"2024-03-20T15:24:29","slug":"engellemeler","status":"publish","type":"chapter","link":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/chapter\/engellemeler\/","title":{"raw":"Engellemeler","rendered":"Engellemeler"},"content":{"raw":"A\u011f\u0131z i\u00e7inde baz\u0131 b\u00f6lgelerde protezin kolayca tak\u0131l\u0131p \u00e7\u0131kar\u0131lmas\u0131n\u0131 ve dolay\u0131s\u0131yla giri\u015f yolunu \u00f6nleyecek engellemeler yer alabilir. Engelleme b\u00f6lgeleri i\u00e7in farkl\u0131 \u00e7\u00f6z\u00fcm yollar\u0131 mevcutur:\r\n<ul>\r\n \t<li>\u00c7ekim veya cerrahi operasyonla elimine etmek,<\/li>\r\n \t<li>M\u00f6lleme, doldurma veya restorasyon,<\/li>\r\n \t<li>Planlaman\u0131n de\u011fi\u015ftirilmesi yoluyla bu b\u00f6lgelerden ka\u00e7\u0131nmak,<\/li>\r\n \t<li>Mevcut and\u0131rkat\u0131 protez tutuculu\u011fu i\u00e7in kullanarak, avantajl\u0131 duruma getirmek.<\/li>\r\n<\/ul>\r\n<strong>Yumu\u015fak doku engelleri:<\/strong>\r\n\r\n\u00d6zellikle, mandibular molar di\u015flerin \u00e7ekimini takiben meydana gelen atrofik de\u011fi\u015fiklikler sonucunda, a\u015f\u0131r\u0131 a\u00e7\u0131l\u0131 ve belirgin olarak \u015fekillenen mylohyoid kret b\u00f6lgesi (\u015eekil 7-5), maksiller molar di\u015flerin \u00e7ekimini takiben bukkal kemi\u011fin lateral y\u00f6nde geni\u015flemesi veya do\u011fal yap\u0131s\u0131 sonucu a\u015f\u0131r\u0131 belirgin hale gelen t\u00fcber b\u00f6lgesi (\u015eekil 7-6) ve mandibulan\u0131n mental alan\u0131nda, bu tip engellere rastlan\u0131r.\r\n\r\n[caption id=\"attachment_803\" align=\"alignnone\" width=\"300\"]<a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5.jpg\"><img class=\"size-medium wp-image-803\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5-300x300.jpg\" alt=\"\u015eekil 7-5. Belirgin mylohyoid kret b\u00f6lgesi.\" width=\"300\" height=\"300\" \/><\/a> <strong>\u015eekil 7-5.<\/strong> Belirgin mylohyoid kret b\u00f6lgesi.[\/caption]\r\n\r\n[caption id=\"attachment_804\" align=\"alignnone\" width=\"300\"]<a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6.jpg\"><img class=\"size-medium wp-image-804\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6-300x293.jpg\" alt=\"\u015eekil 7-6. T\u00fcber b\u00f6lgesi a\u015f\u0131r\u0131 belirgin oldu\u011funda, protez flanj\u0131 giri\u015f yoluna uygun olarak yeterince geni\u015f tutulamaz.\" width=\"300\" height=\"293\" \/><\/a> <strong>\u015eekil 7-6.<\/strong> T\u00fcber b\u00f6lgesi a\u015f\u0131r\u0131 belirgin oldu\u011funda, protez flanj\u0131 giri\u015f yoluna uygun olarak yeterince geni\u015f tutulamaz.[\/caption]\r\n\r\nGenelde premolar b\u00f6lgedeki kemik, molar b\u00f6lgede oldu\u011fu kadar geni\u015f de\u011fildir ve apikal b\u00f6lgede, kret tepesine g\u00f6re daha ince \u015fekillenmi\u015ftir. Bu durumda protezin bukkal flanj\u0131n\u0131n and\u0131rkat alan\u0131na g\u00f6re uyumland\u0131r\u0131lmas\u0131na dikkat edilir.\r\n\r\n<strong>Sert doku engelleri:<\/strong> Her iki \u00e7enede migrasyona u\u011fram\u0131\u015f, devrilmi\u015f veya rotasyona u\u011fram\u0131\u015f di\u015fler mevcut olup, protezin en ideal \u015fekilde planlanmas\u0131na engel olabilir. Bunlar, linguale veya meziale e\u011fimli mandibular di\u015fler (\u015eekil 7-7) ile bukkale devrilmi\u015f maksiller, premolar ve molar di\u015flerdir (\u015eekil 7-8).\r\n\r\n[caption id=\"attachment_805\" align=\"alignnone\" width=\"300\"]<a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7.jpg\"><img class=\"size-medium wp-image-805\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7-300x167.jpg\" alt=\"\u015eekil 7-7. Mandibular di\u015fler linguale do\u011fru a\u015f\u0131r\u0131 e\u011fimli oldu\u011funda, lingual bar\u0131n uygun \u015fekilde yerle\u015ftirilmesine engel olaca\u011f\u0131ndan, model analizinde tespit edilmelidir.\" width=\"300\" height=\"167\" \/><\/a> <strong>\u015eekil 7-7.<\/strong> Mandibular di\u015fler linguale do\u011fru a\u015f\u0131r\u0131 e\u011fimli oldu\u011funda, lingual bar\u0131n uygun \u015fekilde yerle\u015ftirilmesine engel olaca\u011f\u0131ndan, model analizinde tespit edilmelidir.[\/caption]\r\n\r\n[caption id=\"attachment_806\" align=\"alignnone\" width=\"300\"]<a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8.jpg\"><img class=\"size-medium wp-image-806\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8-300x182.jpg\" alt=\"\u015eekil 7-8. Maksiller di\u015flerin bukkale do\u011fru a\u015f\u0131r\u0131 miktarda a\u00e7\u0131lmas\u0131, protez plan\u0131nda problem yaratabilir.\" width=\"300\" height=\"182\" \/><\/a> <strong>\u015eekil 7-8.<\/strong> Maksiller di\u015flerin bukkale do\u011fru a\u015f\u0131r\u0131 miktarda a\u00e7\u0131lmas\u0131, protez plan\u0131nda problem yaratabilir.[\/caption]\r\n\r\nAyr\u0131ca, do\u011fal \u015fekilleri veya ark \u00fczerindeki atipik konumlar\u0131 nedeniyle, baz\u0131 di\u015flerin y\u00fczeylerinde ideal kro\u015fe planlamas\u0131na ters d\u00fc\u015fen alanlar bulunabilir.\r\n\r\nS\u0131kl\u0131kla kar\u015f\u0131la\u015f\u0131lan problem, baz\u0131 destek di\u015flerin normal d\u0131\u015f\u0131 ekvator hatt\u0131 seviyesine sahip olarak, kro\u015felerin g\u00f6vde ve omuz k\u0131s\u0131mlar\u0131n\u0131n okluzale yak\u0131n konumlanmas\u0131na neden olmas\u0131d\u0131r. Bu tip di\u015f y\u00fczeyleri genelde maksiller premolar di\u015flerin distobukkal k\u00f6\u015feleri, maksiller molarlar\u0131n meziobukkal k\u00f6\u015feleri ile mandibular molar di\u015flerin daha s\u0131kl\u0131kla meziolingual ve nadiren de meziobukkal k\u00f6\u015felerinde g\u00f6r\u00fcl\u00fcr.\r\n\r\nAlt \u00e7enede, anterior lingual b\u00f6lgedeki kemik \u00e7\u0131k\u0131nt\u0131lar\u0131 ve linguale e\u011fimli olan premolar di\u015fler, lingual bar i\u00e7in engel olu\u015fturan ba\u015fl\u0131ca fakt\u00f6rlerdir.\r\n\r\nEngelleme \u00e7ift tarafl\u0131 oldu\u011funda, cerrahi i\u015flem veya lingual di\u015f y\u00fczeylerinin yeniden \u015fekillendirilmesi ka\u00e7\u0131n\u0131lmazd\u0131r. Ancak bu engelleme b\u00f6lgeleri tek tarafl\u0131 ise \u00e7o\u011funlukla, modelin \u201clateral y\u00f6nde\u201d e\u011fimlendirilmesi \u00e7\u00f6z\u00fcm yarat\u0131r. Engellemeden kurtulmak i\u00e7in giri\u015f yolunun de\u011fi\u015ftirilmesinde, rehber d\u00fczlem ve tutucu alanlar i\u00e7in belirlenen model pozisyonu kaybedilebilir. Bu durumda, engel b\u00f6lgesinin giderilmesi veya rehber d\u00fczlem ve tutucu alanlar\u0131n tekrar g\u00f6zden ge\u00e7irilmesi aras\u0131nda bir karar vermek gerekir.\r\n\r\nKemik and\u0131rkatlar\u0131n\u0131n varl\u0131\u011f\u0131nda, yine modele yeni bir lateral e\u011fim vermek veya protez kaidesinin plan\u0131n\u0131 de\u011fi\u015ftirerek, bukkal, labial veya distolingual flanjlar\u0131n k\u0131salt\u0131lmas\u0131 d\u00fc\u015f\u00fcn\u00fclebilir. Ancak m\u00fcmk\u00fcn oldu\u011fu kadar fazla miktarda alan\u0131n \u00f6rt\u00fclerek, protez deste\u011finin artt\u0131r\u0131lmas\u0131 gere\u011fi de g\u00f6z \u00f6n\u00fcnde tutulmal\u0131d\u0131r.\r\n\r\n\u00dcst \u00e7enede ana ba\u011flay\u0131c\u0131n\u0131n yerle\u015ftirilmesini zorla\u015ft\u0131ran engellere nadiren rastlan\u0131r. Bukkale e\u011fimli posterior di\u015fler veya di\u015fsiz bo\u015flu\u011fun bukkal b\u00f6lgesinde rastlanan kemik \u00e7\u0131k\u0131nt\u0131lar\u0131n\u0131n varl\u0131\u011f\u0131nda, \u00f6ncelikle ana ba\u011flay\u0131c\u0131n\u0131n plan\u0131n\u0131n de\u011fi\u015ftirilmesi \u00fczerinde d\u00fc\u015f\u00fcn\u00fcl\u00fcr; ancak bu \u015fekilde \u00e7\u00f6z\u00fcm yarat\u0131lamad\u0131\u011f\u0131nda, modelin giri\u015f yolu de\u011fi\u015ftirilir ve yine rehber d\u00fczlem ve tutucu di\u015f alanlar\u0131 yeniden g\u00f6zden ge\u00e7irilir.\r\n\r\nMin\u00f6r ba\u011flay\u0131c\u0131n\u0131n veya kro\u015fe kollar\u0131n\u0131n ge\u00e7ece\u011fi destek di\u015f y\u00fczeyleri de engel olu\u015fturma ihtimalleri a\u00e7\u0131s\u0131ndan de\u011ferlendirilmelidir. Dikey min\u00f6r ba\u011flay\u0131c\u0131lar i\u00e7in engel te\u015fkil eden b\u00f6lgeler doldurma i\u015flemiyle giderilmeye \u00e7al\u0131\u015f\u0131lsa da, bu durum hastan\u0131n dilini rahats\u0131z eder ve g\u0131da birikimine neden olur. Ayr\u0131ca, min\u00f6r ba\u011flay\u0131c\u0131lar\u0131n dikey kollar\u0131n\u0131n m\u00fcmk\u00fcn oldu\u011funca yard\u0131mc\u0131 rehber d\u00fczlemler olarak kullan\u0131lmas\u0131 \u00f6nerilir. \u00c7ok fazla miktarda doldurma i\u015flemini gerektiren bir di\u015f and\u0131rkat\u0131 mevcut oldu\u011funda, giri\u015f yolunda \u00e7ok hafif bir de\u011fi\u015fiklik yap\u0131larak veya a\u011f\u0131z haz\u0131rl\u0131\u011f\u0131 esnas\u0131nda azalt\u0131l\u0131p, giderilebilir.\r\n\r\nKro\u015felerin stabilizasyon kollar\u0131n\u0131n ge\u00e7ece\u011fi di\u015f y\u00fczeyleri de incelenerek, ekvator hatt\u0131n\u0131n \u00fczerinde kalan b\u00f6lgenin kro\u015fe kolu i\u00e7in yeterli olup olmad\u0131\u011f\u0131 de\u011ferlendirilir. Destek di\u015fin lingual y\u00fczeyinin okluzal 1\/3 b\u00f6lgesine yerle\u015ftirilen stabilizasyon kollar\u0131 di\u015fin okluzal boyutunu ve dolay\u0131s\u0131yla da okluzal y\u00fck\u00fcn\u00fc artt\u0131r\u0131r. Bu nedenle stabilizasyon kollar\u0131n\u0131n di\u015fin lingual y\u00fczeyinin orta ve gingival 1\/3 b\u00f6lgeleri aras\u0131na yerle\u015ftirilmesi daha avantajl\u0131d\u0131r.\r\n\r\nKro\u015fe kollar\u0131n\u0131n ideal bir \u015fekilde yerle\u015ftirilmesine engel olan b\u00f6lgeler genellikle di\u015f y\u00fczeylerinin a\u011f\u0131z haz\u0131rl\u0131\u011f\u0131 esnas\u0131nda yeniden \u015fekillendirilmesi ile giderilir. Ancak bu i\u015flem i\u00e7in a\u015f\u0131r\u0131 miktarda di\u015f modifikasyonu gerekti\u011finde, giri\u015f yolunda az miktarda de\u011fi\u015fiklik yapmak veya kro\u015fe plan\u0131n\u0131 de\u011fi\u015ftirmek daha avantajl\u0131d\u0131r.\r\n\r\nEn \u00e7ok rastlanan engel b\u00f6lgeleri premolar destek di\u015flerin distal k\u00f6\u015feleri ile molar desteklerin mezial k\u00f6\u015feleridir. Bu b\u00f6lgeler genellikle \u00e7evresel kro\u015fe kollar\u0131n\u0131n ba\u015flang\u0131\u00e7 k\u0131s\u0131mlar\u0131 ile \u00e7at\u0131\u015f\u0131rlar. Bu durumda yap\u0131lacak olan alternatifler \u015fu \u015fekildedir:\r\n<ul>\r\n \t<li>Doldurma i\u015flemi yap\u0131labilir. Ancak bu y\u00f6ntem pek sa\u011fl\u0131kl\u0131 de\u011fildir; \u00e7\u00fcnk\u00fc kro\u015fenin \u015flang\u0131\u00e7 k\u0131sm\u0131 di\u015ften uzakta konumlan\u0131r; ki bu durum dil ve duda\u011f\u0131 rahats\u0131z ederken, n\u0131 zamanda g\u0131da birikimine neden olur.<\/li>\r\n \t<li>Bar kro\u015fe kolu kullan\u0131larak, tutucu alana gingival b\u00f6lgeden yakla\u015f\u0131labilir. Destek di\u015f zeyindeki and\u0131rkat sahas\u0131 \u00e7ok y\u00fcksek olmad\u0131\u011f\u0131nda veya bar kro\u015fe kolunun rle\u015ftirilmesini engelleyecek bir yumu\u015fak doku engeli olmad\u0131\u011f\u0131nda bu \u00e7\u00f6z\u00fcm genellikle \u015far\u0131l\u0131 olur.<\/li>\r\n \t<li>A\u011f\u0131z haz\u0131rl\u0131\u011f\u0131 esnas\u0131nda di\u015f konturu azalt\u0131labilir. Bu durum gerekli oldu\u011funda, k\u0131rm\u0131z\u0131 kalemle gereken miktar ve b\u00f6lgesi i\u015faretlenmelidir.<\/li>\r\n<\/ul>\r\nDestek di\u015f y\u00fczeyindeki and\u0131rkat sahas\u0131 \u00e7ok yukar\u0131da veya \u00e7ok a\u015f\u0131r\u0131 miktarda oldu\u011funda, yine tutucu kro\u015fe kolunun yerle\u015ftirilmesine engel olabilir.","rendered":"<p>A\u011f\u0131z i\u00e7inde baz\u0131 b\u00f6lgelerde protezin kolayca tak\u0131l\u0131p \u00e7\u0131kar\u0131lmas\u0131n\u0131 ve dolay\u0131s\u0131yla giri\u015f yolunu \u00f6nleyecek engellemeler yer alabilir. Engelleme b\u00f6lgeleri i\u00e7in farkl\u0131 \u00e7\u00f6z\u00fcm yollar\u0131 mevcutur:<\/p>\n<ul>\n<li>\u00c7ekim veya cerrahi operasyonla elimine etmek,<\/li>\n<li>M\u00f6lleme, doldurma veya restorasyon,<\/li>\n<li>Planlaman\u0131n de\u011fi\u015ftirilmesi yoluyla bu b\u00f6lgelerden ka\u00e7\u0131nmak,<\/li>\n<li>Mevcut and\u0131rkat\u0131 protez tutuculu\u011fu i\u00e7in kullanarak, avantajl\u0131 duruma getirmek.<\/li>\n<\/ul>\n<p><strong>Yumu\u015fak doku engelleri:<\/strong><\/p>\n<p>\u00d6zellikle, mandibular molar di\u015flerin \u00e7ekimini takiben meydana gelen atrofik de\u011fi\u015fiklikler sonucunda, a\u015f\u0131r\u0131 a\u00e7\u0131l\u0131 ve belirgin olarak \u015fekillenen mylohyoid kret b\u00f6lgesi (\u015eekil 7-5), maksiller molar di\u015flerin \u00e7ekimini takiben bukkal kemi\u011fin lateral y\u00f6nde geni\u015flemesi veya do\u011fal yap\u0131s\u0131 sonucu a\u015f\u0131r\u0131 belirgin hale gelen t\u00fcber b\u00f6lgesi (\u015eekil 7-6) ve mandibulan\u0131n mental alan\u0131nda, bu tip engellere rastlan\u0131r.<\/p>\n<figure id=\"attachment_803\" aria-describedby=\"caption-attachment-803\" style=\"width: 300px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-803\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5-300x300.jpg\" alt=\"\u015eekil 7-5. Belirgin mylohyoid kret b\u00f6lgesi.\" width=\"300\" height=\"300\" srcset=\"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5-300x300.jpg 300w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5-150x150.jpg 150w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5-65x65.jpg 65w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5-225x226.jpg 225w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5-350x351.jpg 350w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-5.jpg 414w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-803\" class=\"wp-caption-text\"><strong>\u015eekil 7-5.<\/strong> Belirgin mylohyoid kret b\u00f6lgesi.<\/figcaption><\/figure>\n<figure id=\"attachment_804\" aria-describedby=\"caption-attachment-804\" style=\"width: 300px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-804\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6-300x293.jpg\" alt=\"\u015eekil 7-6. T\u00fcber b\u00f6lgesi a\u015f\u0131r\u0131 belirgin oldu\u011funda, protez flanj\u0131 giri\u015f yoluna uygun olarak yeterince geni\u015f tutulamaz.\" width=\"300\" height=\"293\" srcset=\"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6-300x293.jpg 300w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6-65x63.jpg 65w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6-225x220.jpg 225w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6-350x342.jpg 350w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-6.jpg 414w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-804\" class=\"wp-caption-text\"><strong>\u015eekil 7-6.<\/strong> T\u00fcber b\u00f6lgesi a\u015f\u0131r\u0131 belirgin oldu\u011funda, protez flanj\u0131 giri\u015f yoluna uygun olarak yeterince geni\u015f tutulamaz.<\/figcaption><\/figure>\n<p>Genelde premolar b\u00f6lgedeki kemik, molar b\u00f6lgede oldu\u011fu kadar geni\u015f de\u011fildir ve apikal b\u00f6lgede, kret tepesine g\u00f6re daha ince \u015fekillenmi\u015ftir. Bu durumda protezin bukkal flanj\u0131n\u0131n and\u0131rkat alan\u0131na g\u00f6re uyumland\u0131r\u0131lmas\u0131na dikkat edilir.<\/p>\n<p><strong>Sert doku engelleri:<\/strong> Her iki \u00e7enede migrasyona u\u011fram\u0131\u015f, devrilmi\u015f veya rotasyona u\u011fram\u0131\u015f di\u015fler mevcut olup, protezin en ideal \u015fekilde planlanmas\u0131na engel olabilir. Bunlar, linguale veya meziale e\u011fimli mandibular di\u015fler (\u015eekil 7-7) ile bukkale devrilmi\u015f maksiller, premolar ve molar di\u015flerdir (\u015eekil 7-8).<\/p>\n<figure id=\"attachment_805\" aria-describedby=\"caption-attachment-805\" style=\"width: 300px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-805\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7-300x167.jpg\" alt=\"\u015eekil 7-7. Mandibular di\u015fler linguale do\u011fru a\u015f\u0131r\u0131 e\u011fimli oldu\u011funda, lingual bar\u0131n uygun \u015fekilde yerle\u015ftirilmesine engel olaca\u011f\u0131ndan, model analizinde tespit edilmelidir.\" width=\"300\" height=\"167\" srcset=\"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7-300x167.jpg 300w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7-768x429.jpg 768w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7-65x36.jpg 65w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7-225x126.jpg 225w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7-350x195.jpg 350w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-7.jpg 905w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-805\" class=\"wp-caption-text\"><strong>\u015eekil 7-7.<\/strong> Mandibular di\u015fler linguale do\u011fru a\u015f\u0131r\u0131 e\u011fimli oldu\u011funda, lingual bar\u0131n uygun \u015fekilde yerle\u015ftirilmesine engel olaca\u011f\u0131ndan, model analizinde tespit edilmelidir.<\/figcaption><\/figure>\n<figure id=\"attachment_806\" aria-describedby=\"caption-attachment-806\" style=\"width: 300px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-806\" src=\"http:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8-300x182.jpg\" alt=\"\u015eekil 7-8. Maksiller di\u015flerin bukkale do\u011fru a\u015f\u0131r\u0131 miktarda a\u00e7\u0131lmas\u0131, protez plan\u0131nda problem yaratabilir.\" width=\"300\" height=\"182\" srcset=\"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8-300x182.jpg 300w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8-768x466.jpg 768w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8-65x39.jpg 65w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8-225x137.jpg 225w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8-350x212.jpg 350w, https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-content\/uploads\/sites\/25\/2024\/03\/7-8.jpg 921w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-806\" class=\"wp-caption-text\"><strong>\u015eekil 7-8.<\/strong> Maksiller di\u015flerin bukkale do\u011fru a\u015f\u0131r\u0131 miktarda a\u00e7\u0131lmas\u0131, protez plan\u0131nda problem yaratabilir.<\/figcaption><\/figure>\n<p>Ayr\u0131ca, do\u011fal \u015fekilleri veya ark \u00fczerindeki atipik konumlar\u0131 nedeniyle, baz\u0131 di\u015flerin y\u00fczeylerinde ideal kro\u015fe planlamas\u0131na ters d\u00fc\u015fen alanlar bulunabilir.<\/p>\n<p>S\u0131kl\u0131kla kar\u015f\u0131la\u015f\u0131lan problem, baz\u0131 destek di\u015flerin normal d\u0131\u015f\u0131 ekvator hatt\u0131 seviyesine sahip olarak, kro\u015felerin g\u00f6vde ve omuz k\u0131s\u0131mlar\u0131n\u0131n okluzale yak\u0131n konumlanmas\u0131na neden olmas\u0131d\u0131r. Bu tip di\u015f y\u00fczeyleri genelde maksiller premolar di\u015flerin distobukkal k\u00f6\u015feleri, maksiller molarlar\u0131n meziobukkal k\u00f6\u015feleri ile mandibular molar di\u015flerin daha s\u0131kl\u0131kla meziolingual ve nadiren de meziobukkal k\u00f6\u015felerinde g\u00f6r\u00fcl\u00fcr.<\/p>\n<p>Alt \u00e7enede, anterior lingual b\u00f6lgedeki kemik \u00e7\u0131k\u0131nt\u0131lar\u0131 ve linguale e\u011fimli olan premolar di\u015fler, lingual bar i\u00e7in engel olu\u015fturan ba\u015fl\u0131ca fakt\u00f6rlerdir.<\/p>\n<p>Engelleme \u00e7ift tarafl\u0131 oldu\u011funda, cerrahi i\u015flem veya lingual di\u015f y\u00fczeylerinin yeniden \u015fekillendirilmesi ka\u00e7\u0131n\u0131lmazd\u0131r. Ancak bu engelleme b\u00f6lgeleri tek tarafl\u0131 ise \u00e7o\u011funlukla, modelin \u201clateral y\u00f6nde\u201d e\u011fimlendirilmesi \u00e7\u00f6z\u00fcm yarat\u0131r. Engellemeden kurtulmak i\u00e7in giri\u015f yolunun de\u011fi\u015ftirilmesinde, rehber d\u00fczlem ve tutucu alanlar i\u00e7in belirlenen model pozisyonu kaybedilebilir. Bu durumda, engel b\u00f6lgesinin giderilmesi veya rehber d\u00fczlem ve tutucu alanlar\u0131n tekrar g\u00f6zden ge\u00e7irilmesi aras\u0131nda bir karar vermek gerekir.<\/p>\n<p>Kemik and\u0131rkatlar\u0131n\u0131n varl\u0131\u011f\u0131nda, yine modele yeni bir lateral e\u011fim vermek veya protez kaidesinin plan\u0131n\u0131 de\u011fi\u015ftirerek, bukkal, labial veya distolingual flanjlar\u0131n k\u0131salt\u0131lmas\u0131 d\u00fc\u015f\u00fcn\u00fclebilir. Ancak m\u00fcmk\u00fcn oldu\u011fu kadar fazla miktarda alan\u0131n \u00f6rt\u00fclerek, protez deste\u011finin artt\u0131r\u0131lmas\u0131 gere\u011fi de g\u00f6z \u00f6n\u00fcnde tutulmal\u0131d\u0131r.<\/p>\n<p>\u00dcst \u00e7enede ana ba\u011flay\u0131c\u0131n\u0131n yerle\u015ftirilmesini zorla\u015ft\u0131ran engellere nadiren rastlan\u0131r. Bukkale e\u011fimli posterior di\u015fler veya di\u015fsiz bo\u015flu\u011fun bukkal b\u00f6lgesinde rastlanan kemik \u00e7\u0131k\u0131nt\u0131lar\u0131n\u0131n varl\u0131\u011f\u0131nda, \u00f6ncelikle ana ba\u011flay\u0131c\u0131n\u0131n plan\u0131n\u0131n de\u011fi\u015ftirilmesi \u00fczerinde d\u00fc\u015f\u00fcn\u00fcl\u00fcr; ancak bu \u015fekilde \u00e7\u00f6z\u00fcm yarat\u0131lamad\u0131\u011f\u0131nda, modelin giri\u015f yolu de\u011fi\u015ftirilir ve yine rehber d\u00fczlem ve tutucu di\u015f alanlar\u0131 yeniden g\u00f6zden ge\u00e7irilir.<\/p>\n<p>Min\u00f6r ba\u011flay\u0131c\u0131n\u0131n veya kro\u015fe kollar\u0131n\u0131n ge\u00e7ece\u011fi destek di\u015f y\u00fczeyleri de engel olu\u015fturma ihtimalleri a\u00e7\u0131s\u0131ndan de\u011ferlendirilmelidir. Dikey min\u00f6r ba\u011flay\u0131c\u0131lar i\u00e7in engel te\u015fkil eden b\u00f6lgeler doldurma i\u015flemiyle giderilmeye \u00e7al\u0131\u015f\u0131lsa da, bu durum hastan\u0131n dilini rahats\u0131z eder ve g\u0131da birikimine neden olur. Ayr\u0131ca, min\u00f6r ba\u011flay\u0131c\u0131lar\u0131n dikey kollar\u0131n\u0131n m\u00fcmk\u00fcn oldu\u011funca yard\u0131mc\u0131 rehber d\u00fczlemler olarak kullan\u0131lmas\u0131 \u00f6nerilir. \u00c7ok fazla miktarda doldurma i\u015flemini gerektiren bir di\u015f and\u0131rkat\u0131 mevcut oldu\u011funda, giri\u015f yolunda \u00e7ok hafif bir de\u011fi\u015fiklik yap\u0131larak veya a\u011f\u0131z haz\u0131rl\u0131\u011f\u0131 esnas\u0131nda azalt\u0131l\u0131p, giderilebilir.<\/p>\n<p>Kro\u015felerin stabilizasyon kollar\u0131n\u0131n ge\u00e7ece\u011fi di\u015f y\u00fczeyleri de incelenerek, ekvator hatt\u0131n\u0131n \u00fczerinde kalan b\u00f6lgenin kro\u015fe kolu i\u00e7in yeterli olup olmad\u0131\u011f\u0131 de\u011ferlendirilir. Destek di\u015fin lingual y\u00fczeyinin okluzal 1\/3 b\u00f6lgesine yerle\u015ftirilen stabilizasyon kollar\u0131 di\u015fin okluzal boyutunu ve dolay\u0131s\u0131yla da okluzal y\u00fck\u00fcn\u00fc artt\u0131r\u0131r. Bu nedenle stabilizasyon kollar\u0131n\u0131n di\u015fin lingual y\u00fczeyinin orta ve gingival 1\/3 b\u00f6lgeleri aras\u0131na yerle\u015ftirilmesi daha avantajl\u0131d\u0131r.<\/p>\n<p>Kro\u015fe kollar\u0131n\u0131n ideal bir \u015fekilde yerle\u015ftirilmesine engel olan b\u00f6lgeler genellikle di\u015f y\u00fczeylerinin a\u011f\u0131z haz\u0131rl\u0131\u011f\u0131 esnas\u0131nda yeniden \u015fekillendirilmesi ile giderilir. Ancak bu i\u015flem i\u00e7in a\u015f\u0131r\u0131 miktarda di\u015f modifikasyonu gerekti\u011finde, giri\u015f yolunda az miktarda de\u011fi\u015fiklik yapmak veya kro\u015fe plan\u0131n\u0131 de\u011fi\u015ftirmek daha avantajl\u0131d\u0131r.<\/p>\n<p>En \u00e7ok rastlanan engel b\u00f6lgeleri premolar destek di\u015flerin distal k\u00f6\u015feleri ile molar desteklerin mezial k\u00f6\u015feleridir. Bu b\u00f6lgeler genellikle \u00e7evresel kro\u015fe kollar\u0131n\u0131n ba\u015flang\u0131\u00e7 k\u0131s\u0131mlar\u0131 ile \u00e7at\u0131\u015f\u0131rlar. Bu durumda yap\u0131lacak olan alternatifler \u015fu \u015fekildedir:<\/p>\n<ul>\n<li>Doldurma i\u015flemi yap\u0131labilir. Ancak bu y\u00f6ntem pek sa\u011fl\u0131kl\u0131 de\u011fildir; \u00e7\u00fcnk\u00fc kro\u015fenin \u015flang\u0131\u00e7 k\u0131sm\u0131 di\u015ften uzakta konumlan\u0131r; ki bu durum dil ve duda\u011f\u0131 rahats\u0131z ederken, n\u0131 zamanda g\u0131da birikimine neden olur.<\/li>\n<li>Bar kro\u015fe kolu kullan\u0131larak, tutucu alana gingival b\u00f6lgeden yakla\u015f\u0131labilir. Destek di\u015f zeyindeki and\u0131rkat sahas\u0131 \u00e7ok y\u00fcksek olmad\u0131\u011f\u0131nda veya bar kro\u015fe kolunun rle\u015ftirilmesini engelleyecek bir yumu\u015fak doku engeli olmad\u0131\u011f\u0131nda bu \u00e7\u00f6z\u00fcm genellikle \u015far\u0131l\u0131 olur.<\/li>\n<li>A\u011f\u0131z haz\u0131rl\u0131\u011f\u0131 esnas\u0131nda di\u015f konturu azalt\u0131labilir. Bu durum gerekli oldu\u011funda, k\u0131rm\u0131z\u0131 kalemle gereken miktar ve b\u00f6lgesi i\u015faretlenmelidir.<\/li>\n<\/ul>\n<p>Destek di\u015f y\u00fczeyindeki and\u0131rkat sahas\u0131 \u00e7ok yukar\u0131da veya \u00e7ok a\u015f\u0131r\u0131 miktarda oldu\u011funda, yine tutucu kro\u015fe kolunun yerle\u015ftirilmesine engel olabilir.<\/p>\n","protected":false},"author":3,"menu_order":4,"template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-802","chapter","type-chapter","status-publish","hentry"],"part":217,"_links":{"self":[{"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/pressbooks\/v2\/chapters\/802","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/wp\/v2\/users\/3"}],"version-history":[{"count":1,"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/pressbooks\/v2\/chapters\/802\/revisions"}],"predecessor-version":[{"id":807,"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/pressbooks\/v2\/chapters\/802\/revisions\/807"}],"part":[{"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/pressbooks\/v2\/parts\/217"}],"metadata":[{"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/pressbooks\/v2\/chapters\/802\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/wp\/v2\/media?parent=802"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/pressbooks\/v2\/chapter-type?post=802"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/wp\/v2\/contributor?post=802"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/ekitap.ankara.edu.tr\/hareketli-bolumlu-protezler\/wp-json\/wp\/v2\/license?post=802"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}