Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Influence of Peri-Implant Bone Defect Type on Insertion Torque and Resonance Frequency Analysis: An in Vitro Study
Peri-İmplant Kemik Defekti Tipinin Yerleştirme Torku ve Rezonans Frekans Analizi Üzerine Etkisi: İn Vitro Çalışma
Nurettin DİKERa, Burcu DİKERb
a Department of Oral and Maxillofacial Surgery, Bezmiâlem Vakıf University Faculty of Dentistry, İstanbul, Türkiye
b Department of Prosthodontics, Bezmiâlem Vakıf University Faculty of Dentistry, İstanbul, Türkiye
Turkiye Klinikleri J Dental Sci. 2022;28(4):763-71
doi: 10.5336/dentalsci.2022-90409
Article Language: EN
Full Text
ABSTRACT
Objective: The aim of the present study is to investigate the effects of different peri-implant bone defects on primary stability and the correlation between insertion torque (IT) and resonance frequency analysis (RFA) measurements. Material and Methods: Fourty implant beds were prepared in artificial bone blocks using the 3D surgical guide. Implant osteotomies were divided into 5 groups (n=8) according to defect type: i) no peri-implant bone defect (control), ii) a dehiscence defect, iii) a fenestration defect on the middle part, iv) a fenestration defect on the apical part and v) a circumferential defect. Implants were inserted by using a surgical drilling unit with torque control and RFA measurement were done. Results: IT values for the control group were significantly higher than the other groups (p<0.001). The results of IT measurements for dehiscence defect group were significantly greater when compared to fenestration and circular defect groups (p<0.01). Implant stability quotient (ISQ) values for the control group were significantly higher than other groups (p<0.05). In addition, the ISQ values for the dehiscence defect group were significantly lower when compared to fenestration defect groups (p<0.001), and ISQ values for the circular defect group were significantly lower than any other groups (p<0.001). IT values and, ISQ values are moderately correlated (p=0.013, r=0.388). Conclusion: The location of peri-implant bone defect affects RFA measurements more than IT. However, IT seems to be correlated with bone implant contact. Therefore, in the case of peri-implant bone defect, IT measurement may be preferred for evaluation of primary stability.

Keywords: Resonance frequency analysis; dental implants
ÖZET
Amaç: Bu çalışmanın amacı, farklı tipteki peri-implant kemik defektlerinin primer stabilite üzerindeki etkilerinin ve implantların yerleştirme torku (YT) ölçümleri ile rezonans frekans analizi (RFA) ölçümleri arasındaki korelasyonu incelemektir. Gereç ve Yöntemler: 3 boyutlu cerrahi kılavuz kullanılarak yapay kemik bloklarının içerisine 40 adet implant boşluğu hazırlandı. Farklı tipte peri-implant defektler oluşturulduktan sonra implant boşlukları defekt tipine göre 5 gruba (n=8) ayrıldı: i) implant çevresinde kemik defekti yok (kontrol), ii) dehisens defekti, iii) implantın orta kısımda fenestrasyon defekti, iv) implantın apikal kısmında fenestrasyon defekti ve v) sirküler kemik defekti. İmplantlar tork kontrollü cerrahi motor kullanılarak yerleştirildi ve RFA ölçümleri yapıldı. Bulgular: Kontrol grubunda ölçülen YT değerleri diğer gruplara göre istatistiksel anlamlı olarak daha yüksekti (p<0,001). Dehisens tipi defektleri olan grupların YT ölçümlerinin sonuçları, fenestrasyon ve sirküler kemik defekti grupları ile karşılaştırıldığında istatistiksel anlamlı olarak daha yüksekti (p<0,01). Kontrol grubu için implant stabilite katsayısı [implant stability quotient (ISQ)] değerleri diğer gruplara göre istatistiksel anlamlı olarak yüksekti (p<0,05). Ayrıca dehisens tipi defekt grubu için ISQ değerleri, fenestrasyon tipi defekti olan gruplar ile karşılaştırıldığında anlamlı derecede daha düşüktü (p<0,001). Bunun yanında sirküler kemik defekti grubu için ISQ değerleri diğer gruplara göre anlamlı derecede daha düşüktü (p<0,001). YT değerleri ile ISQ değerlerinin orta düzeyde korelasyon gösterdiği tespit edilmiştir (p=0,013, r=0,388). Sonuç: Periimplant kemik defektinin lokalizasyonu, RFA ölçümlerini YT ölçümlerinden daha fazla etkilemektedir. Bununla birlikte YT'nin kemik implant teması ile daha güçlü bir ilişkisi olduğu görülmektedir. Bu nedenle peri-implant kemik defekti varlığında, primer stabilitenin değerlendirilmesi için YT ölçümü tercih edilebilir.

Anahtar Kelimeler: Rezonans frekans analizi; diş implantları
REFERENCES:
  1. De Bruyn H, Raes S, Ostman PO, Cosyn J. Immediate loading in partially and completely edentulous jaws: a review of the literature with clinical guidelines. Periodontol 2000. 2014;66(1):153-87. [Crossref]  [PubMed] 
  2. Cobo-Vázquez C, Reininger D, Molinero-Mourelle P, González-Serrano J, Guisado-Moya B, López-Quiles J. Effect of the lack of primary stability in the survival of dental implants. J Clin Exp Dent. 2018;10(1):e14-e9. [PubMed]  [PMC] 
  3. Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. J Biomed Mater Res. 1998;43(2):192-203. [Crossref]  [PubMed] 
  4. Rues S, Schmitter M, Kappel S, Sonntag R, Kretzer JP, Nadorf J. Effect of bone quality and quantity on the primary stability of dental implants in a simulated bicortical placement. Clin Oral Investig. 2021;25(3):1265-72. [Crossref]  [PubMed]  [PMC] 
  5. Lombardi T, Bernardello F, Berton F, Porrelli D, Rapani A, Camurri Piloni A, et al. Efficacy of alveolar ridge preservation after maxillary molar extraction in reducing crestal bone resorption and sinus pneumatization: a multicenter prospective case-control study. Biomed Res Int. 2018;2018:9352130. [Crossref]  [PubMed]  [PMC] 
  6. Mercan U, Bilhan H, Meral DG, Kazokoglu S, Aykol-Sahin G, Geckili O. Influence of the localization of frontal bone defects on primary stability values of 2 different implant designs: an in vitro study. Implant Dent. 2017;26(1):87-94. [Crossref]  [PubMed] 
  7. de Araújo Nobre M, Lopes A, Antunes E. The 10 year outcomes of implants inserted with dehiscence or fenestrations in the rehabilitation of completely edentulous jaws with the all-on-4 concept. J Clin Med. 2022;11(7):1939. [Crossref]  [PubMed]  [PMC] 
  8. Turkyilmaz I, Sennerby L, Yilmaz B, Bilecenoglu B, Ozbek EN. Influence of defect depth on resonance frequency analysis and insertion torque values for implants placed in fresh extraction sockets: a human cadaver study. Clin Implant Dent Relat Res. 2009;11(1):52-8. [Crossref]  [PubMed] 
  9. Atsumi M, Park SH, Wang HL. Methods used to assess implant stability: current status. Int J Oral Maxillofac Implants. 2007;22(5):743-54. [PubMed] 
  10. Javed F, Romanos GE. The role of primary stability for successful immediate loading of dental implants. A literature review. J Dent. 2010;38(8):612-20. [Crossref]  [PubMed] 
  11. Shokri M, Daraeighadikolaei A. Measurement of primary and secondary stability of dental implants by resonance frequency analysis method in mandible. Int J Dent. 2013;2013:506968. [Crossref]  [PubMed]  [PMC] 
  12. Baldi D, Lombardi T, Colombo J, Cervino G, Perinetti G, Di Lenarda R, et al. Correlation between insertion torque and implant stability quotient in tapered implants with knife-edge thread design. Biomed Res Int. 2018;2018:7201093. [Crossref]  [PubMed]  [PMC] 
  13. Kuchler U, Chappuis V, Bornstein MM, Siewczyk M, Gruber R, Maestre L, et al. Development of implant stability quotient values of implants placed with simultaneous sinus floor elevation - results of a prospective study with 109 implants. Clin Oral Implants Res. 2017;28(1):109-15. [Crossref]  [PubMed] 
  14. Trisi P, Berardi D, Paolantonio M, Spoto G, D'Addona A, Perfetti G. Primary stability, insertion torque, and bone density of conical implants with internal hexagon: is there a relationship? J Craniofac Surg. 2013;24(3):841-4. [Crossref]  [PubMed] 
  15. Lages FS, Douglas-de Oliveira DW, Costa FO. Relationship between implant stability measurements obtained by insertion torque and resonance frequency analysis: a systematic review. Clin Implant Dent Relat Res. 2018;20(1):26-33. [Crossref]  [PubMed] 
  16. Meredith N, Alleyne D, Cawley P. Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis. Clin Oral Implants Res. 1996;7(3):261-7. [Crossref]  [PubMed] 
  17. Satwalekar P, Nalla S, Reddy R, Chowdary SG. Clinical evaluation of osseointegration using resonance frequency analysis. J Indian Prosthodont Soc. 2015;15(3):192-9. [Crossref]  [PubMed]  [PMC] 
  18. Akça K, Kökat AM, Cömert A, Akkocaoğlu M, Tekdemir I, Cehreli MC. Torque-fitting and resonance frequency analyses of implants in conventional sockets versus controlled bone defects in vitro. Int J Oral Maxillofac Surg. 2010;39(2):169-73. [Crossref]  [PubMed] 
  19. Shin SY, Shin SI, Kye SB, Chang SW, Hong J, Paeng JY, et al. Bone cement grafting increases implant primary stability in circumferential cortical bone defects. J Periodontal Implant Sci. 2015;45(1):30-5. [Crossref]  [PubMed]  [PMC] 
  20. Shin SY, Shin SI, Kye SB, Hong J, Paeng JY, Chang SW, et al. The effects of defect type and depth, and measurement direction on the implant stability quotient value. J Oral Implantol. 2015;41(6):652-6. [Crossref]  [PubMed] 
  21. Akkocaoglu M, Uysal S, Tekdemir I, Akca K, Cehreli MC. Implant design and intraosseous stability of immediately placed implants: a human cadaver study. Clin Oral Implants Res. 2005;16(2):202-9. [Crossref]  [PubMed] 
  22. Venkatakrishnan CJ, Bhuminathan S, Chandran CAR. Dental implant insertion torque and bone density-short review. Biomed Pharmacol J. 2017;10(3):1305-9. [Crossref] 
  23. Degidi M, Perrotti V, Strocchi R, Piattelli A, Iezzi G. Is insertion torque correlated to bone-implant contact percentage in the early healing period? A histological and histomorphometrical evaluation of 17 human-retrieved dental implants. Clin Oral Implants Res. 2009;20(8):778-81. [Crossref]  [PubMed] 
  24. Liu C, Tsai MT, Huang HL, Chen MY, Hsu JT, Su KC, et al. Relation between insertion torque and bone-implant contact percentage: an artificial bone study. Clin Oral Investig. 2012;16(6):1679-84. [Crossref]  [PubMed] 
  25. Ramakrishna R, Nayar S. Clinical assessment of primary stability of endosseous implants placed in the incisor region, using resonance frequency analysis methodology: an in vivo study. Indian J Dent Res. 2007;18(4):168-72. [Crossref]  [PubMed] 
  26. Park JH, Lim YJ, Kim MJ, Kwon HB. The effect of various thread designs on the initial stability of taper implants. J Adv Prosthodont. 2009;1(1):19-25. [Crossref]  [PubMed]  [PMC] 
  27. Turkyilmaz I, Sennerby L, McGlumphy EA, Tözüm TF. Biomechanical aspects of primary implant stability: a human cadaver study. Clin Implant Dent Relat Res. 2009;11(2):113-9. [Crossref]  [PubMed] 
  28. Kahraman S, Bal BT, Asar NV, Turkyilmaz I, Tözüm TF. Clinical study on the insertion torque and wireless resonance frequency analysis in the assessment of torque capacity and stability of self-tapping dental implants. J Oral Rehabil. 2009;36(10):755-61. [Crossref]  [PubMed] 
  29. Levin BP. The correlation between immediate implant insertion torque and implant stability quotient. Int J Periodontics Restorative Dent. 2016;36(6):833-40. [Crossref]  [PubMed] 
  30. Nkenke E, Hahn M, Weinzierl K, Radespiel-Tröger M, Neukam FW, Engelke K. Implant stability and histomorphometry: a correlation study in human cadavers using stepped cylinder implants. Clin Oral Implants Res. 2003;14(5):601-9. [Crossref]  [PubMed] 
  31. Abrahamsson I, Linder E, Lang NP. Implant stability in relation to osseointegration: an experimental study in the Labrador dog. Clin Oral Implants Res. 2009;20(3):313-8. [Crossref]  [PubMed] 
  32. Capparé P, Vinci R, Di Stefano DA, Traini T, Pantaleo G, Gherlone EF, et al. Correlation between Initial BIC and the insertion torque/depth integral recorded with an instantaneous torque-measuring implant motor: an in vivo study. Clin Implant Dent Relat Res. 2015;17 Suppl 2:e613-20. [Crossref]  [PubMed] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com