• The Journal of Korean Academy of Prosthodontics
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• v.61 no.1
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• pp.63-72
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• 2023

When oral restoration is performed with a full mouth implant-supported fixed restoration in an edentulous patient, it is very important to determine the shape and position of the definitive prosthesis in consideration of the anatomical state and the relationship with the antagonist, and the process of placing multiple implants in the planned direction and angle is very important. In this case, implants were ideally planned based on an upper prosthesis through a computer-guided surgical procedure for an edentulous maxillary patient who visited due to discomfort in the existing denture. Through this, we would like to report this because we obtained satisfactory functional and esthetic results for both the patient and the operator with the treatment of oral restoration by manufacturing a fixed prosthesis for maxillary and full jaw implants.

• The Journal of Korean Academy of Prosthodontics
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• v.62 no.1
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• pp.38-46
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• 2024

In order to treat edentulous patients with fixed implant prosthesis, the final prosthesis form should be predetermined based on the anatomic structures of the arch, the opposing dentition, and the occlusal plane. The design and occlusion of the interim prosthesis can provide useful information when fabricating the definitive prosthesis. In this case report, scan data of the edentulous region and the interim prosthesis were superimposed through an intraoral scanning digital workflow. In this way, the interim prosthesis information was incorporated into the design of the final prosthesis. Furthermore, the interim prosthesis data acquired through intraoral scanning was utilized to plan the positions and angles of the implants based on the final prosthesis design. Surgical guides were used to accurately place the implants in the planned three-dimensional positions. In this case report, satisfactory esthetic and functional clinical outcomes were achieved through application of digital techniques.

• Journal of Dental Rehabilitation and Applied Science
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• v.33 no.4
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• pp.278-283
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• 2017

Purpose: The aim of this study was to evaluate the interdental distances of anterior, premolar, and molar teeth at the cementoenamel junction (CEJ) and 2 mm below the CEJ in healthy natural dentition with cone-beam computerized tomography (cone-beam CT) in order to provide valuable data for ideal implant positioning relative to mesiodistal bone dimensions. Materials and Methods: Two hundred patients who visited Dental Hospital, Wonkwang University, who had natural dentition with healthy interdental papillae, and who underwent cone-beam CT were selected. The cone-beam CT images were converted to digital imaging and communication in medicine (DICOM) files and reconstructed in three-dimensional images. To standardize the cone-beam CT images, head reorientation was performed. All of the measurements were determined on the reconstructed panoramic images by three professionally trained dentists. Results: At the CEJ, the mean maxillary interdental distances were 1.84 mm (anterior teeth), 2.07 mm (premolar), and 2.08 mm (molar), and the mean mandibular interproximal distances were 1.55 mm (anterior teeth), 2.20 mm (premolar), and 2.36 mm (molar). At 2mm below the CEJ, the mean maxillary interdental distances were 2.19 mm (anterior teeth), 2.51 mm (premolar), and 2.60 mm (molar), and the mean mandibular interproximal distances were 1.86 mm (anterior teeth), 2.53 mm (premolar), and 3.01 mm (molar). Conclusion: The interdental distances in the natural dentition were larger at the posterior teeth than at the anterior teeth and also at 2 mm below the CEJ level compared with at the CEJ level. The distances between mandibular incisors were the narrowest and the distances between mandibular molars were the widest in the entire dentition.

• The Journal of Korean Academy of Prosthodontics
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• v.52 no.2
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• pp.128-135
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• 2014

Treatment options for partially edentulous patients are fixed partial denture, removable partial denture and implant supported fixed partial denture. In case of a patient with a few remaining teeth, removable partial denture and implant supported fixed prosthesis are available. For implant fixed prothesis, enough implant fixtures are required and the patient's general condition, local factors and economic status must be considered. When the condition of the abutments and the residual ridge is favorable and the prosthesis is well designed, removable partial denture can be an option. In removable partial denture, the bilateral support is important. If the teeth remain unilateral, harmful stress is put on the abutments by the fulcrum line. In this situation, strategic implantation and implant-retained or assisted removable partial denture is beneficial to the retention and support of the denture. And this can be cost-effective, functional and esthetic choice of treatment. This article describes the prosthodontic rehabilitation of Maxillary Kennedy class I partially edentulous patients. In these two cases, the patients had a small number of teeth and they were restored by the combination of a removable partial denture and dental implants.

• The Journal of Korean Academy of Prosthodontics
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• v.56 no.3
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• pp.212-217
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• 2018

Purpose: This study was to assess clinically the incidence of abutment screw loosening of posterior implant-supported fixed prosthesis and its affecting factors. Materials and methods: 391 implant-supported crowns restored from January 2013 to January 2016 were included in this study. All restorations were fabricated with either a single crowns or a splinted crown, and cemented with temporary cement. The incidence of abutment screw loosening is investigated and gender, restoration position, opposing teeth, restoration type, abutment connection type were assessed as possible factors affecting abutment screw loosening. Results: During the observation period (2 - 5 years), abutment screw loosening was found in 29 restorations (7.4%). It took 3 to 48 months (means 19.5 months) to loose the screw, and three of these implants were fractured. Among the factors considered, there were statistically significant differences at abutment screw loosening rate between molar group (9.4%) and premolar group (2.6%) (P<.019). According to the type of opposing teeth, there were statistically significant differences between nature teeth (74.7%) and implant (25.0%), removable denture (3%) (P<.019). The other possible factors did not have a significant effect on loosening of the abutment. Conclusion: The incidence of abutment screw loosening in posterior restoration was 7.4%. Abutment screw loosening were more likely to occur in molars group than premolar group, and according to the opposing teeth, there were the greatest frequency in nature teeth than implant and removal denture. There was a statistically significant difference.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.25 no.1
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• pp.35-49
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• 2016

With the increasing demand for aesthetic implant dentistry, the importance of implant restoration is emphasized not only in the functional aspect but also in the aesthetic aspect. The aesthetic restoration of dental implants in the anterior maxilla is a challenge for clinicians because it requires proper harmony in three following conditions; reconstruction of hard tissue, soft tissue, and aesthetic prosthesis. The soft tissue aesthetics are dependent upon the condition of the supporting hard tissue because the osseous structure provides a framework for the development of a healthy and aesthetic soft tissue interface. Therefore, the augmentation of hard tissue is a first step and especially, optimal 3-dimensional position of implant is the most important factor in aesthetic implant restoration. The management of soft tissue is a second step, and the final step is a restoration of harmonic prosthesis using provisional restoration with proper emergence profile. This clinical report describes the procedure of bone augmentation in labial dehiscence defect, Vascularized Interpositional Periosteal-Connective Tissue (VIP-CT) flap for aesthetic anterior soft tissue, and the importance of provisional restoration and impression taking stage with customized impression coping.

• Journal of Dental Rehabilitation and Applied Science
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• v.37 no.3
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• pp.147-156
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• 2021

There are various treatment options such as conventional complete denture, hybrid prosthesis and implant-supported fixed prosthesis for fully edentulous patients. In case of implant-supported fixed prosthesis, compared to removable prosthesis, it is difficult to place the implant in the correct position considering the anatomical contours of the final prosthesis. In this case, a full mouth rehabilitation with implant-supported fixed prosthesis was performed for a patient who required extraction of all remaining teeth due to dental caries and chronic periodontitis. In the implant placement stage, the implant was placed in the desired position using a surgical guide fabricated considering the anatomical contours of the final prosthesis, and the function and esthetics were evaluated through correction and re-fabrication of the fixed provisional restoration. A final restoration of porcelain fused to gold prosthesis was delivered to the patient based on the provisional restoration. To cope with complications such as loosening of screws and fracture of porcelain, a screw-retained type prosthesis was fabricated for the posterior part and a screw-cement-retained type prosthesis for the anterior part. As a result, the patient showed an improved prognosis in terms of functional and esthetics after the final prosthesis was delivered.

• Journal of Dental Rehabilitation and Applied Science
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• v.38 no.4
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• pp.249-256
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• 2022

The implant prosthesis of anterior maxilla requires careful consideration in planning. In order to satisfy both esthetic and functional needs of a patient, fusion of intra-oral scan in Cone-beam computed tomography (CBCT) and facial scan can be considered. Bony structures and soft tissues captured in CBCT and occlusal surfaces of intra oral scan were incorporated into personal characteristics from facial scan. The patient had insufficient buccal bone on maxillary anterior area. The maxillary implants could not be placed on the most ideal position. However, the "top down" approach completed by computer-generated arranging of teeth in implant planning and surgery with surgical guide resulted in esthetically and functionally satisfying result regardless of the limitation. Careful diagnosis with digital technique and the usage of surgical guide resulted in successful surgery and esthetic restoration. The temporary fixed prostheses were designed, restored and evaluated. The patient was not satisfied with the first design of temporary prosthesis, which showed uneven space distribution between teeth due to the position of maxillary implant. The design was modified by changing proximal emergence contours and line angle to alter the perceived since of incisors. The patient was satisfied with the new design of provisional restoration. A digital occlusion analyzer (Arcus Digma II, KaVo, Leutkirch, Germany) was used to measure inherent condylar guidance and anterior guidance of a patient to provide a definitive prosthesis.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.32 no.2
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• pp.54-68
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• 2023

Treatment planning of edentulous patient with digital method is materialized by designing the surgical guide. When designing the surgical guide, we first implement the shape of the final prosthesis in the virtual space and then materialize the implantation plan based on this. However, it is challenging to make surgical guides for edentulous patients as their lack of both the reference for the arrangement of teeth and interocclusal relationship makes it hard to envision the shape of the final prosthesis. If there exists good partial or complete dentures or residual teeth, its teeth arrangement can be used as a reference for the virtual final prosthesis and the subsequent surgical guide. If such a reference is absent or unsatisfactory, a process of manufacturing a complete denture for diagnostic purposes and verifying it on patient's mouth is necessary and use it as a new reference for the virtual final prosthesis. But even if a surgical guide is produced through the reference from the thorough reflection of the virtual final prosthesis, when we use it in the surgical field, the intraoral condition of the patient may make the implants deviated from planned in the surgical guide. In the worst case, if the positioning of the surgical guide on the mouth is incorrect, it can lead to a catastrophic error that displaces all the implant, in which case the guided surgery would be much worse than the non-guided one. In this article, we will discuss how to obtain references of tooth arrangements in a timely manner and align or register them into a unified coordinate system in digital space, and also introduce how to transfer such an implantation plan from the virtual world into the patient's mouth of real world with minimum error. And lastly, I would like to express my opinion on the establishment of a rational and systematic protocol of guided surgery of the edentulous patients.

• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.3
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• pp.267-275
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• 2011

This prospective study was designed to compare clinical outcomes of immediately loaded implant with delayed loaded implant in partially posterior edentulous patients. For test group, 42 GS III (Osstem, Korea) implants in 17 patients were loaded within 48 hours after the placement. Control group was 27 implants in 15 patients loaded at $2.6{\pm}1.7months$ from the placement surgery. Before loading, primary stability was evaluated by ISQ value. Clinical symptoms, mobility, soft tissue state was evaluated at baseline, 3 months, 6 months and 12 months of loading. Marginal bone level change was also measured with periapical radiographs. Mann-Whitney test (${\alpha}$=0.05) and repeated measured ANOVA (${\alpha}$=0.05) was used for marginal bone level change between two groups. At the baseline, mean ISQ value of test group and control group was $80.3{\pm}7.1$ and $69{\pm}17$ respectively. Test group showed 95.23% of success rate and 100% of control group was successful. At 3 and 6months of loading, significantly more bone resorption was observed in test group than in control group (p<0.05). However, there was no significant difference in the bone level change at 12months of loading between two groups (p>0.05). Marginal bone level change showed no significant difference with gender and location (p>0.05). Within the limitation of this study, when primary stability was obtained, immediate loading of GS III implant at posterior region could be predictable treatment option.