Geriatride Protetik Yaklaşımlar
Özet
Yaşlanma süreciyle birlikte geriatrik hastalarda alveol kemiği, dişler, ağız mukozası, tükürük salgısı ve temporomandibular eklem gibi yapılarda fizyolojik ve patolojik değişimler meydana gelmektedir. Bu bireylerde kronik periodontitis kaynaklı diş kayıpları sıklıkla görülmekte, osteoporoz ve hatalı protez kullanımı gibi etkenler ise kemik rezorpsiyonunu hızlandırarak dikey boyut kaybı ve mesnetsiz kret gibi protetik zorluklara yol açmaktadır. Ayrıca diyabet gibi sistemik hastalıklar yara iyileşmesini geciktirip implant başarısını olumsuz etkilerken, xerostomia (ağız kuruluğu) protez tutuculuğunu azaltmakta ve mukozal hassasiyeti artırmaktadır. Yaşlı hastaların tedavisinde bölümlü, kantilever köprü, overdenture, tam ve implant üstü protezler gibi çeşitli protetik yaklaşımlar uygulanmakta olup, tedavi planlamasında hastanın sistemik anamnezi, psikolojik durumu, nörolojik adaptasyon yeteneği ve anatomik faktörleri dikkate alınmalıdır. Genç hastalardan farklı olmamakla birlikte, geriatrik bireylerde temizliği ve tamiri en kolay olan, hastanın yaşam kalitesini ve çiğneme fonksiyonunu optimize edecek protetik yöntemlerin tercih edilmesi başarının anahtarıdır.
Aging leads to physiological and pathological alterations in the alveolar bone, teeth, oral mucosa, salivary secretion, and temporomandibular joint of geriatric patients. Tooth loss due to chronic periodontitis is frequently observed in these individuals, and factors such as osteoporosis and ill-fitting dentures accelerate bone resorption, causing prosthetic challenges like loss of vertical dimension and labile ridges. Furthermore, systemic conditions such as diabetes delay wound healing and impair implant success, whereas xerostomia (dry mouth) reduces denture retention and increases mucosal sensitivity. Various prosthetic modalities, including partial, cantilever fixed, overdenture, complete, and implant-supported dentures, are utilized; nevertheless, treatment planning must evaluate the patient's systemic anamnesis, psychological status, neurological adaptation, and anatomical constraints. Although not inherently distinct from treatments for younger individuals, selecting the prosthetic design that is simplest to clean and repair while optimizing quality of life and masticatory function remains the key to clinical success in geriatric cases.
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