• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권1호
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• pp.41-52
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• 2012

Purpose: Triangulation is the process of determining the location of a point by measuring angles to it from known points at either end of a fixed baseline. This point can be fixed as the third point of a triangle with one known side and two known angles. The aim of this study was to find a clinically adaptable method for applying an optical tracking navigation system to orthognathic surgery and to estimate its accuracy of measuring the bone displacement by use of triangulation methods. Methods: In orthognathic surgery, the head position is not fixed as in neurosurgery, so that a head tracker is needed to establish the reference point on the head surface byusing an optical tracking system. However, the operation field is interfered by its bulkiness that makes its clinical use difficult. To solve this problem, we designed a method using an Aquaplast splinting material and a mini-screw in applying a head tracker on a patient's forehead. After that, we estimated the accuracy of measuring displacements of the ball marker by an optical tracking system with a conventional head tracker (Group A) and with a newly designed head tracker (Group B). Measured values of ball markers' displacements by each optical tracking system were compared with values obtained from fusion CT images for an estimation of accuracy. Results: The accuracy of the optical tracking system with a conventional head tracker (Group A) is not suitable for clinical usage. Measured and predictable errors are larger than 10 mm. The optical tracking system with a newly designed head tracker (Group B) shows 1.59 mm, 6.34 mm, and 9.52 mm errorsin threeclinical cases. Conclusion: Most errors were brought on mainly from a lack of reproducibility of the head tracker position. The accuracy of the optical tracking system with a newly designed head tracker can be a useful method in further orthognathic navigation surgery even though the average error is higher than 2.0 mm.

• Composites Research
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• 제25권4호
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• pp.98-104
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• 2012

본 논문에서는 척추체 간 유합용 케이지의 응력방패현상을 감소시키기 위하여 강성 차이에 대한 연구를 수행하였다. 최근 의료 임플란트 분야에서는 탄소섬유강화 폴리머를 이용하여 좋은 결과를 보여 왔다. 그러나 생체 역학적으로 이 재료에 대하여 요추체의 안정성과 골 이식재가 받는 응력에 관련한 연구는 없었다. 따라서 이전에 유효화한 요추체 (L2-L5) 비선형 유한 요소 모델을 이용하여 L4-L5 분절의 케이지의 강성 차이에 따른 효과를 알아보기 위하여 탄소섬유강화 폴리머와 티타늄 케이지를 이용한 후방 요추체 유합 모델을 만들었다. 자가골 보다 강성이 작은 탄소 섬유강화폴리머 케이지는 인접 분절의 하종판에 응력이 적게 걸리며, 골 이식재에 응력은 증가시켰다. 위의 결과로 탄소섬유강화 폴리머 케이지는 응력 방패 현상을 감소시킬 수 있을 뿐만 아니라 골 유합률을 증가시킬 수 있다.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.163-169
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• 2013

Purpose: This study was conducted to confirm the anatomic conformity of the new periarticular locking plates designed by Zimmer on Korean adult bones and to identify the structures at risk during the application of these implants. Methods: The study was performed on the humerus, radius, and tibia of 10 adult cadavers(6 males and 4 females) procured from the cadaveric lab of our hospital. Anteroposterior (AP) and lateral X-rays were taken to confirm that the cadavers were free of any unusual lesions or anatomic variations. We used the 3.5-mm proximal humerus plate, 2.7-mm distal radius plate, 3.5- and 5.0-mm proximal tibia plates, and 3.5-mm distal tibia plate developed by Zimmer, Inc. (Zimmer periarticular locking plate). The longest plate from each group was used to confirm anatomical conformity. Standard approaches were used for each area, and soft tissue was retracted in order to pass the plate beneath the muscle. The position of the plate was confirmed using standard AP and lateral view X-rays. After this procedure had been completed, the region was dissected along the length of the implant to determine the conformity of the implant to bone and the penetrations of screws into the articular surface or violations of any vital structures, such as nerves, blood vessels, or tendons. Results: Excellent anatomical conformity was observed with Zimmer periarticular locking plates for Korean adults. The tibial nerve and the posterior tibial artery were found to be structures at risk when applying a distal tibial plate. Conclusion: Additional posterolateral fixation is recommended when dealing with cases of tibial plateau fracture when the fracture line extends to the posterolateral cortex. We recommend taking proper views using 10~15 degrees of internal rotation to ensure correct screw length and, thus, avoid penetration of vital structures and tendons.

• 구강회복응용과학지
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• 제29권3호
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• pp.209-223
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• 2013

하악 제 1대구치에 티타늄과 지르코니아 소재의 기성 지대주와 맞춤형 지대주를 이용해 지르코니아 크라운으로 수복한 경우를 3차원 유한요소법을 통해 응력 분포를 분석해 보고, 피로 파절 강도 및 파절 형태를 고찰해 보았다. 정상교합자의 CT scan을 재구성한 하악골 모형상에 제 1대구치 임플란트 지지 지르코니아 크라운으로 수복한 6가지 유한요소 모형을 제작하고, 협측 교두 중앙에 수직과 30도 각도로 100 N의 하중을 가하는 조건으로 응력분포를 분석하였다. 현재 임상적으로 사용되고 있는 4가지 지대주를 이용하여, 군당 10개의 시편을 제작하고, ISO 14801에 따라 피로파절 실험을 실시하였다. 지대주나 고정체의 재질에 따른 응력분포의 차이는 없었고 형태에 따른 응력크기의 차이만 보였다. 맞춤형 지대주 군이 전반적으로 낮은 크라운 응력을 나타내었으며, 지대주 일체형 지르코니아 임플란트는 계면 골조직의 응력이 가장 낮게 나타났다. 피로수명의 평균값은 7군이 가장 높았고, 1군, 2군, 3군의 순서로 낮게 나타났으며(P<0.05), 기성 지대주 군은 피로수명의 편차가 적게 나타났다. 구치부의 임플란트 수복 시에는 맞춤형 지대주의 사용이 상부 보철물의 파절저항성 향상에 유리하며, 심미적 요구도가 높은 경우에는 고정체와의 접합부를 티타늄으로 제작한 지르코니아 맞춤형 지대주의 사용을 고려해 볼 만 하다.

• 대한치과보철학회지
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• 제45권6호
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• pp.717-723
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• 2007

Statement of problem. Unreasonable distal cantilevered implant-supported prosthesis can mask functional problems of reconstruction temporarily, but it can cause serious strain and stress around its supported implant and surrounding alveolar bone. Purpose. The purpose of this study was to evaluate strain of implants supporting distal cantilevered fixed prosthesis with two different cantilevered length under distal cantilevered static load. Material and methods. A partially edentulous mandibular test model was fabricated with auto-polymerizing resin (POLYUROCK; Metalor technologies, Stuttgart, Swiss) and artificial denture teeth (Endura; Shofu inc., Kyoto, Japan). Two implants-supported 5-unit screw-retained cantilevered fixed prosthesis was made using standard methods with Type III gold alloy (Harmony C&B55; Ivoclar-vivadent, Liechtenstein, Germany) for superstructure and reinforced hard resin (Tescera; Ivoclar-vivadent, Liechtenstein, Germany) for occlusal material. Two strain gauges (KFG-1-120-C1-11L1M2R; KYOWA electronic instruments, Tokyo, Japan) were then attached to the mesial and the distal surface of each standard abutment with adhesive (M-bond 200; Tokuyama, Tokyo, Japan). Total four strain gauges were attached to test model and connected to dynamic signal conditioning strain amplifier (CTA1000; Curiotech inc., Paju, Korea). The stepped $20{\sim}100$ N in 25 N increments, cantilevered static load 8mm apart (Group I) or 16mm apart (Group II), were applied using digital push-pull gauge (Push-Pull Scale & Digital Force Gauge, Axis inc., Seoul, Korea). Each step was performed ten times and every strain signal was monitored and recorded. Results. In case of Group I, the strain values were surveyed by $80.7{\sim}353.8{\mu}m$ in Ch1, $7.5{\sim}47.9{\mu}m/m$ in Ch2, $45.7{\sim}278.6{\mu}m/m$ in Ch3 and $-212.2{\sim}718.7{\mu}m/m$ in Ch4 depending on increasing cantilevered static load. On the other hand, the strain values of Group II were surveyed by $149.9{\sim}612.8{\mu}m/m$ in Ch1, $26.0{\sim}168.5{\mu}m/m$ in Ch2, $114.3{\sim}632.3{\mu}m/m$ in Ch3, and $-323.2{\sim}-894.7{\mu}m/m$ in Ch4. Conclusion. A comparative statistical analysis using paired sample t-test about Group I Vs Group II under distal cantilevered load shows that there are statistical significant differences for all 4 channels (P<0.05).

• 대한치과보철학회지
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• 제45권6호
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• pp.780-786
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• 2007

Statement of problem. The performance and maintenance of implant-supported prostheses are primarily dependent upon load transmission both at the bone-to-implant interface and within the implant-abutment-prosthesis complex. The design of the interface between components has been shown to have a profound influence on the stability of screw joints. Purpose. The Purpose of this study was to compare the strength and the fatigue resistance of 1-piece and 2-piece abutment connected to oral implant, utilizing an internal conical interface. Material and methods. Twenty $Implatium^{(R)}$ tapered implants were embedded to the top of the fixture in acrylic resin blocks. Ten $Combi^{(R)}$(1-piece) and $Dual^{(R)}$(2-piece) abutments of the same dimension were assembled to the implant, respectively. The assembled units were mounted in a testing machine. A load was applied perpendicular to the long axis of the assemblies and the loading points was at the distance of 7mm from the block surface. Half of 1-piece and 2-piece abutment-implant units were tested for the evaluation of the bending strength, and the others were cyclically loaded for the evaluation of the fatigue resistance until plastic deformation occurred. Nonparametric statistical analysis was performed for the results. Results. Mean plastic and maximum bending moment were $1,900{\pm}18Nmm,\;3,609{\pm}106Nmm$ for the 1-piece abutment, and $1,250{\pm}31Nmm,\;2,688{\pm}166Nmm$ for the 2-piece abutment, respectively. Mean cycles and standard deviation when implant-abutment joint showed a first plastic deformation were $238,610{\pm}44,891$. cycles for the 1-piece abutment and $9,476{\pm}3,541$ cycles for the 2-piece abutment. A 1-piece abutment showed significantly higher value than a 2-piece abutment in the first plastic bending moment (p<.05), maximum bending moment (p<.05) and fatigue strength (p<.05). Conclusion. Both 1-piece and 2-piece conical abutment had high strength and fatigue resistance and this suggests long-term durability without mechanical complication. However, the 1-piece conical abutment was more stable than the 2-piece conical abutment in the strength and the fatigue resistance.

• 대한치과보철학회지
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• 제41권2호
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• pp.223-231
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• 2003

Statement of problem : Little is known about the effect of a counter-torque device and the internal hexagon of abutment on the tightening torque transmitted to the implant. Purpose : The purpose of this study was to examine the effect of a counter-torque device and the internal hexagon of abutment on the tightening torque transmitted to the implant. Material and Methods : In this study, three types of abutment were used, (1) two-piece conical abutment with hexagon, (2) two-piece conical abutment without hexagon, and (3) one-piece conical abutment without hexagon. The experimental groups were divided into five groups according to the type of abutment and the usage of a counter-torque device. Group I : two-piece conical abutment with internal hexagon was tightened without the use of a counter-torque device. Group II : two-piece conical abutment without internal hexagon was tightened without the use of a counter-torque device. Group III : one-piece conical abutment without internal hexagon was tightened without the use of a counter-torque device. Group IV : two-piece conical abutment with internal hexagon was tightened with the use of a counter-torque device Group V : two-piece conical abutment without internal hexagon was tightened with the use of a counter-torque device. Abutments were tightened 20Ncm torque with the use of manual torque wrench and then torque values were measured by torque-gauge. After the measurement of torque values, all groups were loosened with the use of manual torque wrench and then detorque values were measured by torque-gauge. Results : The results were as follows. 1. There were no differences in torque values among three types of abutment. 2. Regardless of the existence of the internal hexagon of abutment, a counter-torque device decreased the tightening torque transmitted to the implant about 92% 3. In group III showed the highest detorque value, however there were no differences among group I, II, IV and V. Conclusion : Within the limitations of this study, it was concluded that the internal hexagon of abutment has no effect on the tightening torque transmitted to the implant and the detorque value of abutment screw. The use of a counter-torque device is essential to prevent microfracture on the implant-bone interface but has no effect on preload.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.32.1-32.4
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• 2020

Background: Le Fort I osteotomy is a highly effective treatment for skeletal jaw deformities and is commonly performed. High Le Fort I osteotomy is a modified surgical procedure performed for improving the depression of the cheeks by setting the osteotomy higher than the conventional Le Fort I osteotomy. Developments in three-dimensional (3D) technology have popularized the use of 3D printers in various institutions, especially in orthognathic surgeries. In this study, we report a safe and inexpensive method of performing a high Le Fort I osteotomy using a novel 3D device and piezosurgery, which prevent tooth root injury without disturbing the operation field for patients with a short midface and long tooth roots. Results: A 17-year-old woman presented with facial asymmetry, mandibular protrusion, a short midface, and long tooth roots. We planned high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Prevention of damage to the roots of the teeth and the infraorbital nerve and accurate determination of the posterior osteotomy line were crucial for clinical success. Le Fort I osteotomy using 3D devices has been reported previously but were particularly large in size for this case. Additionally, setting the fixing screw of the device was difficult, because of the risk of damage to the roots of the teeth. Therefore, a different surgical technique, other than the conventional Le Fort I osteotomy and 3D device, was required. The left and right parts of the 3D device were fabricated separately, to prevent any interference in the surgical field. Further, the 3D device was designed to accurately cover the bone surface from the piriform aperture to the infra-zygomatic crest with two fixation points (the anterior nasal spine and the piriform aperture), which ensured stabilization of the 3D device. The device is thin and does not interfere with the surgical field. Safe and accurate surgical performance is possible using this device and piezosurgery. The roots of the teeth and the infraorbital nerve were unharmed during the surgery. Conclusions: This device is considerably smaller than conventional devices and is a simple, low-cost, and efficient method for performing accurate high Le Fort I osteotomy.

• 대한구강악안면병리학회지
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• 제42권5호
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• pp.111-118
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• 2018

Nicotine of tobacco component has a controversial impact in the clinical outcome of dental implants. Although numerous nicotine effects on bone healing around implants have been presented, it is rarely reported in vitro study about normal human osteoblast(NHost) from oral and maxillofacial area at the surface of implants. The purpose of the present study was to evaluate the effect of nicotine on the proliferation and differentiation response of NHost to plasmatic and salivary levels of nicotine reported in smokers at the surface of screw-type plasma-sprayed titanium implants. NHosts were seeded on the surface of titanium implants and cultured for 21 days in ${\alpha}-MEM$ supplemented with 10% FBS, 50mg/ml ascorbic acid, 5mM ${\beta}$-glycerophosphate and 100nM dexamethasone. Seeded implants were exposed to various nicotine concentration(0.05-0.5mg/ml) from 1 to 21 days, and characterized for cell morphology, proliferation, differentiation, alkaline phosphatase(ALP) activity and ionized calcium concentration(Cai) of medium. Continuous exposure to higher nicotine concentration(above 0.3mg/ml) induced a dose- and time-dependent vacuolation of the cytoplasm, and a tendency to detach from the implant surface. 0.05mg/ml(lower nicotine concentration) did not cause significant effects in the cell proliferation and ALP activity. 0.1-0.2mg/ml caused evident dose-dependent effects in increased cell proliferation, ALP activity and earlier onset of matrix mineralization at levels up to 0.2mg/ml, while a dose-dependent inhibitory effect at 0.3-0.5mg/ml. Cai concentration of control group was decreased at 14 days. Increased Cai concentration at 0.1-0.2mg/ml, decreased Cai concentration at 0.3mg/ml and no change at 0.5mg/ml during the culture period were seen. It suggested that nicotine concentration could paly an role in modulating NHost activity as a contributing factor associated with proliferation and differentiation of NHost at the surface of implants.

• 구강회복응용과학지
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• 제36권4호
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• pp.211-221
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• 2020

원추형 내부연결 임플란트의 독특한 생역학적 현상이 수직침하와 전하중 상실이다. 원추형 내부연결 임플란트에서 수직적 정지점의 부재로 발생하는 수직침하에 의해 나사의 전하중이 상실되고 교합이 낮아지는 현상이 유발된다. 원추형 내부연결 임플란트에 발생하는 응력은 나사가 아니라 지대주가 접촉하는 계면에 집중되므로 식립할 때는 가급적 상부직경이 두꺼운 임플란트를 선택하는 것이 중요하다. 원추형 내부연결 임플란트는 치조정보다 하방에 식립해야 하며 수복 시에는 적절한 지대주 형태와 정확한 연결을 가지는지 주의해야 한다. 최상의 임상적 결과를 얻기 위해서는 상부 직경을 잘 선택하고 적절한 위치에 식립하여 수복하는 것이 필요하다.