• The Journal of Korean Academy of Prosthodontics
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• v.54 no.2
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• pp.93-102
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• 2016

Purpose: The aim of this study was to evaluate the fit accuracy of two zirconia and titanium abutments in internal hexagonal implants. Materials and methods: One titanium abutment and two zirconia abutments were tested in internal hexagonal implants (TSV, Zimmer). Prefabricated zirconia abutments (ZirAce, Acucera) and customized zirconia abutments milled by the Zirkonzahn system (Zirkonzahn Max, Zirkonzahn) were selected and prefabricated titanium abutments (Hex-Lock, Zimmer) were used as a control. Eight abutments per group were connected to implants with 30 Ncm torque. The marginal gaps at abutment-implant interface, the internal gaps at internal hex, vertical and horizontal gaps between screws and screw seats in abutments were measured after sectioning the embedded specimens using a scanning electron microscope. Data analysis included one-way analysis of variance and the Scheffe test (n=16, ${\alpha}=0.05$). Results: The mean marginal gap of customized zirconia abutment was higher than those of two prefabricated zirconia and titanium abutments. The internal gaps at internal hex showed no significant differences between customized and prefabricated abutments and were higher than those of prefabricated titanium abutments. The mean vertical and horizontal gaps at screw in prefabricated zirconia abutment were higher than those of prefabricated titanium abutment. In the case of customized zirconia abutment, the mean horizontal gap at screw was higher than those of both the prefabricated zirconia and the titanium abutment but the mean vertical gap was not even measureable. The screw seats were clearly formed but did not match with abutment screws in prefabricated zirconia abutments. They were not, however, precisely formed in the case of customized zirconia abutments. Conclusion: Within the limitations of this study, the prefabricated titanium abutments showed better fit than the zirconia abutments, regardless of customized or prefabricated. Also, the customized zirconia abutments showed significantly higher marginal gaps and the fit was less accurate between screws and screw seats than the prefabricated abutments, titanium and zirconia.

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.3
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• pp.209-223
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• 2013

This study was to evaluate the stress distributions of prefabricated, customized abutments and fixtures according to their material and shape by three-dimensional finite element analysis. And to investigate the fatigue life and fracture characteristics. Mandibular models were fabricated by reconstruction of the CT scan of patients with normal occlusion. A total of six finite element models were designed, a load of 100 N was applied on the buccal cusps vertically, and 30 degree obliquely. 10 specimens each were fabricated for the more clinically widely used 4 type abutments and were loaded according to ISO 14801. Differences in stress distribution patterns were not found according to the materials of the abutments and fixtures. But a slight difference in the stress level was detected. Customized abutment groups showed lower crown stress levels. One-piece zirconia implant showed the lowest bone stress levels. In the fatigue test, highest values were measured in group 7. Prefabricated abutments showed less variation of fatigue life (P<0.05). Use of customized abutments can improve the fracture resistance of restorations. Especially, use of customized zirconia abutments reinforced by titanium screw connecting parts is recommended.

• Journal of Dental Rehabilitation and Applied Science
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• v.30 no.1
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• pp.81-92
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• 2014

It is so hard to obtain optimal anterior esthetics in the implant prosthesis. This is not only because of hard and soft tissue problem such as alveolar bone resorption and interdental papilla loss but also because of prosthetic limitation related to marginal exposure of metal abutment and metal ceramics and low transillumination. In this case, guided soft tissue healing is obtained using a long term provisional restoration with soft and hard tissue augmentation or immediate implantation. Then, this healed tissue is transferred to final master model using a customized impression coping and the implant is restored with a customized zirconia abutment and a all ceramics. This case presents satisfying result esthetically and functionally.

• The Journal of Korean Academy of Prosthodontics
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• v.50 no.2
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• pp.128-134
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• 2012

Purpose: The purpose of this study was to compare the screw joint stability between the CADCAM custom-made implant abutment and the prefabricated implant abutment by measuring the reverse torque value after cyclic loading. Materials and methods: Twelve screw type implants (Implantium, Dentium Co., Seoul, Korea) were embedded in aluminum cylinder with acrylic resin. The implant specimens were equally divided into 3 groups, and connected to the prefabricated titanium abutments (Implantium, Dentium Co., Seoul, Korea), CADCAM custom-made titanium abutments (Myplant, Raphabio Co., Seoul, Korea) and CADCAM custom-made zirconia abutments (Zirconia Myplant, Raphabio Co., Seoul, Korea). The CAD-CAM milled titanium crown (Raphabio Co., Seoul, Korea) was cemented on each implant abutment by resin cement. Before cyclic loading, each abutment screw was tightened to 30 Ncm and the reverse torque value was measured about 30 minutes later. After the crown specimen was subjected to the sinusoidal cyclic loading (30 to 120 N, 500,000 cycles, 2 Hz), postloading reverse torque value was measured and the reverse torque loss ratio was calculated. Kruskal-Wallis test was used for statistical analysis of the reverse torque loss ratio. Results: The CADCAM custom-made titanium abutments presented higher values in reverse torque loss ratio without statistically significant differences than the prefabricated titanium abutments ($P$>.05). Reverse torque loss ratio of the custom-made zirconia abutments was significantly higher compared to that of the prefabricated titanium abutments ($P$=.014). Conclusion: Within the limitation of the present $in-vitro$ study, it was concluded that there was no significant difference in screw joint stability between the CADCAM custom-made titanium abutments and the prefabricated titanium abutments. On the other hand, the CADCAM custom-made zirconia abutments showed lower screw joint stability than prefabricated titanium abutments.

• Journal of Dental Rehabilitation and Applied Science
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• v.28 no.2
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• pp.201-212
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• 2012

There are some similar aspects at histological and morphological characteristics between the peri-implant tissue and periodontal tissue and the direct attachment between the titanium and soft tissue around the implant called as "Functional ankylosis" can prevent the apical infiltration of inflammatory and bone resorption around implant. But, the repeated connection and disconnection of the abutment can destroy the mucosal barrier of soft tissue around the implant and can cause the marginal bone resorption. The amount of marginal bone resorption may reduced if the prosthetic abutment is placed at that time of surgery. Connection of the prosthetic abutment at surgery was limited because the low accuracy of conventional method, but by using of Cone Beam Computed Tomography(CBCT) and guide surgery, the 3-dimensional accuracy of implant placement became much higher than before and it became possible. This is a clinical case of immediate connection of prosthetic abutment and provisional restoration by using of precise CBCT diagnosis and pre-fabricated zirconia customized abutment at surgery and the alternative method is described in this article because of the clinically contentable results.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.4
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• pp.263-273
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• 2016

In the implant prosthetic procedure, the soft tissue reaction was varied with the material and surface treatment of the abutment. It may be the cause of the peri-implantitis, and hence it can affect the long-term prognosis of the implant prosthesis. Titania and zirconia abutment presented superior biocompatibility and stable soft tissue reaction, while gold alloy abutment showed unfavorable reaction sometimes. A soft tissue reaction can be differed by the surface characteristics even in the same material type. Because rougher surface induces a bacterial attachment, the part contacting a soft tissue should have smooth surface. Additional surface treatment can enhance the cellular response without increasing bacterial attachment. Repeated removal and insertion of the abutment and the shape of the abutment may affect the soft tissue reaction, also. Ultrasonic cleaning and argon plasma cleaning are effective way to clean the retained micro-dust on the customized abutment.

• Journal of Dental Rehabilitation and Applied Science
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• v.33 no.4
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• pp.299-306
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• 2017

In this case report, immediate loading of an implant-supported single-tooth prosthesis through complete digital workflow. A patient presented for restoration of missing a single tooth in the mandibular first molar. The digital impression was made with intraoral scanner and implant was placed using surgical guide pre-fabricated with pre-operative computed tomography (CT) and scan data. After 1 week later, prefabricated customized abutment and provisional restoration were connected for immediate loading. After 8 weeks later, abutment level impression was taken by intraoral scanner. At 3 months later from implant installation, monolithic zirconia crown were fabricated. This clinical report presents satisfying result in accuracy and patient satisfaction. A completely modeless digital procedure met expectations regarding precision, esthetics, and functionality.

• The Journal of Korean Academy of Prosthodontics
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• v.62 no.2
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• pp.157-164
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• 2024

A variety of digital technologies are being used throughout the entire implant treatment process of diagnosis, surgery, impression, design, and fabrication of prostheses. In this case, using a digital surgical guide, sinus floor elevation was performed without complications, and the implants were placed in the planned position. After the healing period for osseointegration, CAD-CAM (Computer-aided design-Computer-aided manufacturing) customized abutments and provisional prostheses were delivered. While using the provisional prosthesis, occlusal change was observed. To transfer the intermaxillary relationship and abutment position that reflect occlusal change and axial displacement, double scanning and abutment-level digital impressions were taken. Abutment superimposition was used to capture the subgingival margin without gingival retraction. Then, the definitive prosthesis was designed and fabricated with digital system. We report a case applying digital system, to achieve the predictable result as well as the efficient treatment process from implant surgery to fabricating prosthesis in the posterior area.

• The Journal of Korean Academy of Prosthodontics
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• v.60 no.3
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• pp.254-262
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• 2022

When treating partial edentulous patients, it is important to use an appropriate restorative materials. Inappropriate restorative materials can adversely affect the outcome of prosthetic restorations. Zirconia and dental metal, which are currently and widely used materials, have a higher elastic modulus than cortical bone, so when an external force is generated, a harmful force can be applied to the implant and the bone around the implant. Polyetherketoneketone (PEKK), a recently introduced material, has a elastic modulus similar to that of cortical bone, and has many advantages in terms of physical properties and biocompatibility. This case report describes that implant-supported fixed prosthetic treatment using PEKK was performed, and functional and esthetic satisfactory results were obtained.

• The Journal of Korean Academy of Prosthodontics
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• v.56 no.3
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• pp.206-211
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• 2018

Purpose: Recently, a method of forming a slot in the prosthesis lingual has been introduced to solve the occlusal and aesthetic disadvantages of screw-retained prosthesis in the manufacture of implant-fixed prosthesis and to ensure retrievability in cement retained prostheses. The purpose of this study is to investigate the effect of the internal gap on the removal of the prosthesis in the preparation of cement-retained implant prostheses with lingual slots. Materials and methods: Titanium abutment and internal gap of the zirconia prosthesis to be attached to the upper part were set to 30, 35, and $50{\mu}m$, respectively. Three for each type total 15 were produced for each type. The zirconia prosthesis formed a retrievable cement-type slot with a space of 1 mm at the location where the titanium abutment meets the shelf area. Autocatalytic resin cement was used for bonding of abutment and zirconia prosthesis, and the maximum removal stress value was measured in units of Ncm by using the customized equipment of the cemented specimen. The Kruskal-Wallis test was used to compare the three groups by statistical analysis (${\alpha}=.05$), modified by post hoc test the Mann-Whitney U-test and the Bonferroni correction method were used to compare the two methods (${\alpha}=.017$). Results: There was no statistically significant difference in removal stress between the $30{\mu}m$ group and the $35{\mu}m$ group in the internal gap (P = .032), and there was a significant difference between the $30{\mu}m$ group and the $50{\mu}m$ group, between the $35{\mu}m$ group and the $50{\mu}m$ group (P < .017). Conclusion: Thus, the internal gap of computer-aided design affected the retention between the zirconia prosthesis and the titanium abutment.