İmplant Üstü Hibrit Protezler: Endikasyondan Klinik Uygulamaya Multidisipliner Bir Yaklaşım
Özet
İmplant destekli hibrit protezler, tam ve kısmi dişsizlik vakalarında fonksiyon ve estetiği birlikte sağlamayı amaçlayan sabit restorasyonlardır. Metal altyapı üzerine yerleştirilen yapay dişler ve akrilik kaide yapısından oluşan bu protezler, özellikle ileri kret rezorpsiyonu bulunan hastalarda yumuşak doku ve dudak desteğinin yeniden oluşturulmasına olanak tanır. Tedavi planlamasında interark mesafe, gülme hattı ve dudak desteği gibi estetik kriterler belirleyici rol oynar. Hibrit protezlerin altyapı üretiminde döküm tekniklerinin yerini giderek Bilgisayar Destekli Tasarım – Bilgisayar Destekli Üretim teknolojileri almakta; titanyum, krom-kobalt, zirkonya ve Polieter Eter Keton / Yüksek performanslı polimer gibi materyaller farklı biyomekanik avantajlar sunmaktadır. Üst yapı olarak akrilik, kompozit, metal-seramik veya monolitik zirkonya tercih edilebilmektedir. Klasik hibrit protez tasarımlarının yanı sıra toronto protez ve metal bar destekli monolitik zirkonya gibi farklı tasarımlar ve farklı materyal kombinasyonları kullanılabilmektedir. Hibrit protezlerde mukozitis, akrilik diş kırıkları ve vida gevşemesi gibi biyolojik ve mekanik komplikasyonların görülme sıklığı yüksektir. Bu nedenle doğru hasta seçimi, pasif uyumlu altyapı, uygun materyal seçimi ve iyi ağız hijyeni başarının temel belirleyicileridir. Hibrit protezler doğru planlandığında ileri doku kayıplarında etkili bir tedavi seçeneğidir.
Implant-supported hybrid prostheses are fixed restorations designed to provide both function and aesthetics in cases of complete and partial edentulism. Consisting of artificial teeth placed on a metal framework and an acrylic base, these prostheses enable the restoration of soft tissue and lip support, particularly in patients with advanced alveolar ridge resorption. In treatment planning, aesthetic criteria such as interarch distance, smile line and lip support play a decisive role. In the production of hybrid prosthesis frameworks, Computer-Aided Design – Computer-Aided Manufacturing (CAD-CAM) technologies are increasingly replacing casting techniques; materials such as titanium, chromium-cobalt, zirconia and Polyether Ether Ketone (PEEK) / High-performance polymers (BioHPP) offer different biomechanical advantages. For the superstructure, acrylic, composite, metal-ceramic or monolithic zirconia may be selected. In addition to classic hybrid prosthesis designs, various designs and material combinations—such as the Toronto prosthesis and metal bar-supported monolithic zirconia—can be utilised. In hybrid dentures, the incidence of biological and mechanical complications—such as mucositis, acrylic tooth fractures and screw loosening—is high. Therefore, appropriate patient selection, a passively fitted framework, suitable material selection and good oral hygiene are key determinants of success. When properly planned, hybrid dentures are an effective treatment option for advanced tissue loss.
Referanslar
Thalji G, Bryington M, De Kok IJ, et.al. Prosthodontic management of implant therapy. Dental Clinics of North America. 2014;58(1): 207-225.
Misch CE. Contemporary Implant Dentistry. Mosby Elsevier, St Louis; 2008. p. 1034-1035.
The Glossary of Prosthodontic Terms: Ninth Edition. Journal of Prosthetic Dentistry. 2017;117(5S): e1-e105.
Real-Osuna J, Almendros-Marqués N, Gay-Escoda C. Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses. Medicina Oral, Patologia Oral, Cirugia Bucal. 2012;17(1): e116-e121.
Egilmez F, Ergun G, Cekic-Nagas I, et.al. Implant-supported hybrid prosthesis: Conventional treatment method for borderline cases. European Journal of Dentistry. 2015;9(03): 442-448.
Salama A. Fixed Detachable Prosthesis/Hybrid prosthesis: Literature Review. MSA Dental Journal. 2023;2(2): 42-48.
Law C, Bennani V, Lyons K, et.al. Influence of implant framework and mandibular flexure on the strain distribution on a Kennedy class II mandible restored with a longspan implant fixed restoration: A pilot study. The Journal of Prosthetic Dentistry. 2014;112(1): 31-37.
Hatakeyama W, Takafuji K, Kihara H, et.al. A review of the recent literature on maxillary overdenture with dental implants. Journal of Oral Science. 2021;63(4): 301-305.
Kaya N. Maksiller Defektlerde Dental Implant Uygulamalari ve Yaşam Kalitesine Olan Etkisi: Literatür Derlemesi. Selcuk Dental Journal. 2022;9: 316-326
Drago C, Gurney L. Maintenance of implant hybrid prostheses: clinical and laboratory procedures. Journal of Prosthodontics. 2013;22(1): 28-35.
Gönüldaş F, Yılık B. Tam dişsizliklerde hibrit protezler. İmplant Üstü Protezlerin Yapım Teknikleri. Türkiye Klinikleri. 2021;1: 34-42.
Resnik RR. Misch’s Contemporary Implant Dentistry. 4th ed. Elsevier; 2020. p.1–1267.
Carpentieri J, Greenstein G, Cavallaro J. Hierarchy of restorative space required for different types of dental implant prostheses. Journal of the American Dental Association. 2019;150: 695–706.
Krishnan V, Manju V, Thampi A, et.al. Prosthetıc Rehabılıtatıon Of Surgıcally Reconstructed Mandıble Wıth Increased Crown Heıght Space. Journal of Prosthetic and Implant Dentistry. 2021;4: 148-157.
Sertgöz A, Güvener S. Finite element analysis of the effect of cantilever and implant length on stress distribution in an implant-supported fixed prosthesis. Journal of Prosthetic Dentistry. 1996;76(2): 165-169.
Kim Y, Oh TJ, Misch CE, et.al. Occlusal considerations in implant therapy: Clinical guidelines with biomechanical rationale. Clinical Oral Implants Research. 2005;16: 26–35.
Shackleton JL, Carr L, Slabbert JC, et.al. Survival of fixed implant-supported prostheses related to cantilever lengths. Journal of Prosthetic Dentistry. 1994;71(1): 23-26.
Zarb G JT. Prosthodontic procedures. In: Branemark PI ZG, Albrektsson T editor. Tissue Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence; 1985: 250-251.
Drago C, Howell K. Concepts for designing and fabricating metal implant frameworks for hybrid implant prostheses. Journal of Prosthodontics. 2012; 21: 413-424.
Bural C, Geçkili O. Hibrit Protezler. Turkiye Klinikleri Prosthodontics. 2015;1: 45-52.
Örtorp A, Jemt T, Bäck T, et.al. Comparisons of precision of fit between cast and CNC-milled titanium implant frameworks for the edentulous mandible. International Journal of Prosthodontics 2003;16: 194-200.
Al-Fadda SA, Zarb GA, Finer Y. İmplant-protez iskeletlerinin yapımında kullanılan 2 yöntemin uyum doğruluğunun karşılaştırılması. International Journal of Prosthodontics. 2007;20: 125–131.
Cevik P, Schimmel M, Yilmaz B. New generation CAD‐CAM materials for implant‐supported definitive frameworks fabricated by using subtractive technologies. BioMed Research İnternational. 2022(1): 3074182.
Güneş F, Kocacıklı M, Korkmaz T. Dental İmplantolojide Polietereterketon (PEEK): Geleneksel Derleme. Selcuk Dental Journal. 2023;10(3): 611-617.
Aboelnagga M, El Sadat O. The effect of BioHPP versus Zirconia CAD/CAM-fabricated fixed-detachable prosthesis rehabilitating single maxillary arches on the peri-implant bone level changes. Egyptian Journal of Oral and Maxillofacial Surgery. 2022;13(1): 35-45.
Taş N, Eğilmez F. İmplant Destekli Hibrit Protezlerin Yapımında Kullanılan Materyaller ve Üretim Yöntemleri (Materials and Manufacturing Methods Used in the Construction of Implant-Supported Hybrid Prostheses). Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2021;31: 305-315.
Özdoğan MS. İmplant destekli hibrit protezlerde endikasyon-kontraendikasyon ve malzeme seçimi. Bidge Yayınları. 2025:130-152
Johansson A, Omar R, Carlsson GE. Bruxism and prosthetic treatment: a critical review. Journal of Prosthodontic Research. 2011;55(3): 127-136
Heintze SD, Zellweger G, Grunert I, et.al. Laboratory methods for evaluating the wear of denture teeth and their correlation with clinical results. Dental Materials Journal. 2012;28: 261-72.
Bidra AS. Complete Arch Monolithic Zirconia Prosthesis Supported By Cobalt Chromium Metal Bar: A Clinical Report. Journal of Prosthodontics. 2020;29(7): 558-563.
Goodacre CJ, Bernal G, Rungcharassaeng K, et.al. Clinical complications with implants and implant prostheses. Journal of Prosthetic Dentistry. 2003;90: 121-132
Grover RK, Jain S, Sharma R, et.al. Restoring Function and Esthetics in Complete Edentulism: A Case Report of Implant-Supported Hybrid Denture. Cureus. 2024;16(10): e71399.
Hirani M, Devine M, Obisesan O, et.al. The use of three implants to support a fixed prosthesis in the management of the edentulous mandible: a systematic review. International Journal of Implant Dentistry. 2022;8(1): 28.
Kiraz MS, Çevik P. Tam Dişsiz Maksillanın Toronto Altyapı Tasarımına Sahip Hibrit Protez ile Rehabilitasyonuna Dijital ve Konvansiyonel Yaklaşım: Olgu Sunumu. ADO Klinik Bilimler Dergisi. 2022;11(2): 166-171.
Pelekanos S, Ntovas P, Rizou V, et.al. Translucent monolithic zirconia titanium-supported FP1 full-arch prosthesis: A novel proof of concept to address esthetic, functional, and biologic challenges. Journal of Esthetic and Restorative Dentistry. 2024;36(1): 197-206.
Froimovici FO, Butnărașu CC, Montanari M, et.al. Fixed Full-Arch Implant-Supported Restorations: Techniques Review and Proposal for Improvement. Dentistry journal (Basel). 2024;12(12): 408.
Pjetursson BE, Thoma D, Jung R, et.al. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clinical Oral Implants Research. 2012;23(6): 22-38.
Zitzmann NU, Marinello CP. A review of clinical and technical considerations for fixed and removable implant prostheses in the edentulous mandible. International Journal of Prosthodontics. 2002;15(1): 65-72.
Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported by Brånemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup. International Journal of Oral & Maxillofacial Implants. 1991;6: 270-276.
Purcell BA, McGlumphy EA, Holloway JA et.al. Prosthetic complications in mandibular metal-resin implant-fixed complete dental prostheses: a 5-to 9-year analysis. International Journal of Oral & Maxillofacial Implants. 2008;23: 847-857.
Referanslar
Thalji G, Bryington M, De Kok IJ, et.al. Prosthodontic management of implant therapy. Dental Clinics of North America. 2014;58(1): 207-225.
Misch CE. Contemporary Implant Dentistry. Mosby Elsevier, St Louis; 2008. p. 1034-1035.
The Glossary of Prosthodontic Terms: Ninth Edition. Journal of Prosthetic Dentistry. 2017;117(5S): e1-e105.
Real-Osuna J, Almendros-Marqués N, Gay-Escoda C. Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses. Medicina Oral, Patologia Oral, Cirugia Bucal. 2012;17(1): e116-e121.
Egilmez F, Ergun G, Cekic-Nagas I, et.al. Implant-supported hybrid prosthesis: Conventional treatment method for borderline cases. European Journal of Dentistry. 2015;9(03): 442-448.
Salama A. Fixed Detachable Prosthesis/Hybrid prosthesis: Literature Review. MSA Dental Journal. 2023;2(2): 42-48.
Law C, Bennani V, Lyons K, et.al. Influence of implant framework and mandibular flexure on the strain distribution on a Kennedy class II mandible restored with a longspan implant fixed restoration: A pilot study. The Journal of Prosthetic Dentistry. 2014;112(1): 31-37.
Hatakeyama W, Takafuji K, Kihara H, et.al. A review of the recent literature on maxillary overdenture with dental implants. Journal of Oral Science. 2021;63(4): 301-305.
Kaya N. Maksiller Defektlerde Dental Implant Uygulamalari ve Yaşam Kalitesine Olan Etkisi: Literatür Derlemesi. Selcuk Dental Journal. 2022;9: 316-326
Drago C, Gurney L. Maintenance of implant hybrid prostheses: clinical and laboratory procedures. Journal of Prosthodontics. 2013;22(1): 28-35.
Gönüldaş F, Yılık B. Tam dişsizliklerde hibrit protezler. İmplant Üstü Protezlerin Yapım Teknikleri. Türkiye Klinikleri. 2021;1: 34-42.
Resnik RR. Misch’s Contemporary Implant Dentistry. 4th ed. Elsevier; 2020. p.1–1267.
Carpentieri J, Greenstein G, Cavallaro J. Hierarchy of restorative space required for different types of dental implant prostheses. Journal of the American Dental Association. 2019;150: 695–706.
Krishnan V, Manju V, Thampi A, et.al. Prosthetıc Rehabılıtatıon Of Surgıcally Reconstructed Mandıble Wıth Increased Crown Heıght Space. Journal of Prosthetic and Implant Dentistry. 2021;4: 148-157.
Sertgöz A, Güvener S. Finite element analysis of the effect of cantilever and implant length on stress distribution in an implant-supported fixed prosthesis. Journal of Prosthetic Dentistry. 1996;76(2): 165-169.
Kim Y, Oh TJ, Misch CE, et.al. Occlusal considerations in implant therapy: Clinical guidelines with biomechanical rationale. Clinical Oral Implants Research. 2005;16: 26–35.
Shackleton JL, Carr L, Slabbert JC, et.al. Survival of fixed implant-supported prostheses related to cantilever lengths. Journal of Prosthetic Dentistry. 1994;71(1): 23-26.
Zarb G JT. Prosthodontic procedures. In: Branemark PI ZG, Albrektsson T editor. Tissue Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence; 1985: 250-251.
Drago C, Howell K. Concepts for designing and fabricating metal implant frameworks for hybrid implant prostheses. Journal of Prosthodontics. 2012; 21: 413-424.
Bural C, Geçkili O. Hibrit Protezler. Turkiye Klinikleri Prosthodontics. 2015;1: 45-52.
Örtorp A, Jemt T, Bäck T, et.al. Comparisons of precision of fit between cast and CNC-milled titanium implant frameworks for the edentulous mandible. International Journal of Prosthodontics 2003;16: 194-200.
Al-Fadda SA, Zarb GA, Finer Y. İmplant-protez iskeletlerinin yapımında kullanılan 2 yöntemin uyum doğruluğunun karşılaştırılması. International Journal of Prosthodontics. 2007;20: 125–131.
Cevik P, Schimmel M, Yilmaz B. New generation CAD‐CAM materials for implant‐supported definitive frameworks fabricated by using subtractive technologies. BioMed Research İnternational. 2022(1): 3074182.
Güneş F, Kocacıklı M, Korkmaz T. Dental İmplantolojide Polietereterketon (PEEK): Geleneksel Derleme. Selcuk Dental Journal. 2023;10(3): 611-617.
Aboelnagga M, El Sadat O. The effect of BioHPP versus Zirconia CAD/CAM-fabricated fixed-detachable prosthesis rehabilitating single maxillary arches on the peri-implant bone level changes. Egyptian Journal of Oral and Maxillofacial Surgery. 2022;13(1): 35-45.
Taş N, Eğilmez F. İmplant Destekli Hibrit Protezlerin Yapımında Kullanılan Materyaller ve Üretim Yöntemleri (Materials and Manufacturing Methods Used in the Construction of Implant-Supported Hybrid Prostheses). Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2021;31: 305-315.
Özdoğan MS. İmplant destekli hibrit protezlerde endikasyon-kontraendikasyon ve malzeme seçimi. Bidge Yayınları. 2025:130-152
Johansson A, Omar R, Carlsson GE. Bruxism and prosthetic treatment: a critical review. Journal of Prosthodontic Research. 2011;55(3): 127-136
Heintze SD, Zellweger G, Grunert I, et.al. Laboratory methods for evaluating the wear of denture teeth and their correlation with clinical results. Dental Materials Journal. 2012;28: 261-72.
Bidra AS. Complete Arch Monolithic Zirconia Prosthesis Supported By Cobalt Chromium Metal Bar: A Clinical Report. Journal of Prosthodontics. 2020;29(7): 558-563.
Goodacre CJ, Bernal G, Rungcharassaeng K, et.al. Clinical complications with implants and implant prostheses. Journal of Prosthetic Dentistry. 2003;90: 121-132
Grover RK, Jain S, Sharma R, et.al. Restoring Function and Esthetics in Complete Edentulism: A Case Report of Implant-Supported Hybrid Denture. Cureus. 2024;16(10): e71399.
Hirani M, Devine M, Obisesan O, et.al. The use of three implants to support a fixed prosthesis in the management of the edentulous mandible: a systematic review. International Journal of Implant Dentistry. 2022;8(1): 28.
Kiraz MS, Çevik P. Tam Dişsiz Maksillanın Toronto Altyapı Tasarımına Sahip Hibrit Protez ile Rehabilitasyonuna Dijital ve Konvansiyonel Yaklaşım: Olgu Sunumu. ADO Klinik Bilimler Dergisi. 2022;11(2): 166-171.
Pelekanos S, Ntovas P, Rizou V, et.al. Translucent monolithic zirconia titanium-supported FP1 full-arch prosthesis: A novel proof of concept to address esthetic, functional, and biologic challenges. Journal of Esthetic and Restorative Dentistry. 2024;36(1): 197-206.
Froimovici FO, Butnărașu CC, Montanari M, et.al. Fixed Full-Arch Implant-Supported Restorations: Techniques Review and Proposal for Improvement. Dentistry journal (Basel). 2024;12(12): 408.
Pjetursson BE, Thoma D, Jung R, et.al. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clinical Oral Implants Research. 2012;23(6): 22-38.
Zitzmann NU, Marinello CP. A review of clinical and technical considerations for fixed and removable implant prostheses in the edentulous mandible. International Journal of Prosthodontics. 2002;15(1): 65-72.
Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported by Brånemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup. International Journal of Oral & Maxillofacial Implants. 1991;6: 270-276.
Purcell BA, McGlumphy EA, Holloway JA et.al. Prosthetic complications in mandibular metal-resin implant-fixed complete dental prostheses: a 5-to 9-year analysis. International Journal of Oral & Maxillofacial Implants. 2008;23: 847-857.
