• 대한치과보철학회지
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• 제31권4호
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• pp.661-678
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• 1993

The purpose of this study was to analyze the stress distribution at supporting bone according to the types of endosseous implants. This investigation evaluated the stress patterns in rectangular photoelastic models produced by four different types of dental implants such as $Br\ddot{a}nemark$, screw type of Steri-Oss, blade type of Steri-Oss, IMZ with IMC and resin tooth using the techniques of quasi-three dimensional photoelasticity. All prostheses were casted in the same nonprecious alloy and were cemented or screwed on their respective implants and abutments. 20 kg of vertical load was applied on the central fossa of casted crown and 16 kg of inclined had was applied on the top third of distal surface of casted crown respectively. The results were as follows : 1. Under the vertical load, screw implants of Steri-Oss and $Br\ddot{a}nemark$ showed increasing stress condition between and around the screw threads along the implant lateral surface and cylindrical implant of IMZ showed the less stress condition along the lateral surface with concentration of stress mostly near the root apex. 2. Under the vertical load, the stress of Steri-Oss blade was distributed uniformly at the alveolar bone under the broad blade. 3. Under the inclined load, the stress concentration of Steri-Oss screw and $Br\ddot{a}nemark$ was developed highly around the mesiocervical bone area on the contralateral side to force application. The stress of $Br\ddot{a}nemark$ with flexible gold glod was more concentrated in the cervical bone area than that of Steri-Oss with stiff screw. 4. Under the inclined load, the stress of Steri-Oss blade broadly was distributed around the mesioceivical bone area and the lower and mesial bone area of the blade. 5. Under the Inclined load, IMZ implant showed the gap between c개wn and fixture due ta deformation of the IMC and IMZ was lower in stress concentration developed around the mesiocervical bone area than $Br\ddot{a}nemark$ and Steri-Oss screw. 6. Under the inclined load, the stress magnitude induced in the mesiocervical bone area of implants was in order of $Br\ddot{a}nemark$, Steri-Oss strew, IMZ and Stsri-Oss blade. 7. Tilting forces as compared to axial forces exerted greater magnitude of stress in the cervical bone area of the implant. 8. In respect of stress distribution, Steri-Oss blade was superior than any other implants and in respect of the stability by horizontal lone, IMB and $Br\ddot{a}nemark$ was inferior than any other implants.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.353-358
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• 2012

Objective : The purpose of this study was to determine the efficacy of bone cement-augmented short segment fixation using percutaneous screws for thoracolumbar burst fractures in a background of severe osteoporosis. Methods : Sixteen patients with a single-level thoracolumbar burst fracture (T11-L2) accompanying severe osteoporosis treated from January 2008 to November 2009 were prospectively analyzed. Surgical procedures included postural reduction for 3 days and bone cement augmented percutaneous screw fixation at the fracture level and at adjacent levels without bone fusion. Due to the possibility of implant failure, patients underwent implant removal 12 months after screw fixation. Imaging and clinical findings, including involved vertebral levels, local kyphosis, canal encroachment, and complications were analyzed. Results : Prior to surgery, mean pain score (visual analogue scale) was 8.2 and this decreased to a mean of 2.2 at 12 months after screw fixation. None of the patients complained of pain worsening during the 6 months following implant removal. The percentage of canal compromise at the fractured level improved from a mean of 41.0% to 18.4% at 12 months after surgery. Mean kyphotic angle was improved significantly from $19.8^{\circ}$ before surgery to 7.8 at 12 months after screw fixation. Canal compromise and kyphotic angle improvements were maintained at 6 months after implant removal. No significant neurological deterioration or complications occurred after screw removal in any patient. Conclusion : Bone cement augmented short segment fixation using a percutaneous system can be an alternative to the traditional open technique for the management of selected thoracolumbar burst fractures accompanied by severe osteoporosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권6호
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• pp.332-336
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• 2012

Objectives: This study sought to evaluate fixation methods and determine the best method for the postoperative stabilization of maxillary osteotomy. For our analysis we performed a three-dimensional finite element analysis of stress distribution on the plate, screw, and surrounding bone, as well as displacement onto the plate. Materials and Methods: We generated a model using synthetic skull scan data; an initital surface model was changed to a solid model using software. Modified anterior segmental osteotomy (using Park's method) was made using the program, and four different types of fixation methods were used. An anterior load of 100 N was applied on the palatal surface of two central incisors. Results: The Type 1 (L-shaped) fixation method gave stresses of 187.8 MPa at the plate, 45.8 MPa at the screw, and 15.4 MPa at the bone around the plate. The Type 2 (I-shaped) fixation method gave stresses of 186.6 MPa at the plate, 75.7 MPa at the screw, and 13.8 MPa at the bone around the plate. The Type 3 (inverted L-shaped) fixation method gave stresses of 28.6 MPa at the plate, 29.9 MPa at the screw, and 15.3 MPa at the bone around the plate. The Type 4 (I-shaped) fixation method gave stresses of 34.8 MPa at the plate, 36.9 MPa at the screw, and 14.9 MPa at the bone around the plate. The deflection of the plates for the four fixation methods was 0.014 mm, 0.022 mm, 0.017 mm, and 0.018 mm, respectively. Conclusion: The Type 3 (inverted L-shaped) fixation method offers more stability than the other fixation methods. We therefore recommend this method for the postoperative stabilization of maxillary osteotomy.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.88-107
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• 2024

The aim of this systematic review was to collect evidence on the following 10 technical aspects of glenoid baseplate fixation in reverse total shoulder arthroplasty (rTSA): screw insertion angles; screw orientation; screw quantity; screw length; screw type; baseplate tilt; baseplate position; baseplate version and rotation; baseplate design; and anatomical safe zones. Five literature libraries were searched for eligible clinical, cadaver, biomechanical, virtual planning, and finite element analysis studies. Studies including patients >16 years old in which at least one of the ten abovementioned technical aspects was assessed were suitable for analysis. We excluded studies of patients with: glenoid bone loss; bony increased offset-reversed shoulder arthroplasty; rTSA with bone grafts; and augmented baseplates. Quality assessment was performed for each included study. Sixty-two studies were included, of which 41 were experimental studies (13 cadaver, 10 virtual planning, 11 biomechanical, and 7 finite element studies) and 21 were clinical studies (12 retrospective cohorts and 9 case-control studies). Overall, the quality of included studies was moderate or high. The majority of studies agreed upon the use of a divergent screw fixation pattern, fixation with four screws (to reduce micromotions), and inferior positioning in neutral or anteversion. A general consensus was not reached on the other technical aspects. Most surgical aspects of baseplate fixation can be decided without affecting fixation strength. There is not a single strategy that provides the best outcome. Therefore, guidelines should cover multiple surgical options that can achieve adequate baseplate fixation.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2004년도 추계학술대회 논문집
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• pp.1198-1201
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• 2004

To investigate the bone remodeling phenomenon around screw tooth of the implant for osteointegration, a finite element model of the screw was developed. Strain energy density was chosen for the indicator for remodeling process. The modified mathematical equation for remodeling process was applied to 2-dimensional tibia and implant model under static bending state Caculated results show reliable remodeling process compared with histology data.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 추계학술대회
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• pp.248-248
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• 2009

• 구강회복응용과학지
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• 제23권1호
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• pp.31-42
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• 2007

The purpose of this study was to compare the stress distribution according to the splinting condition and non-splinting conditions on the finite element models of the two units implant prostheses. The finite element model was designed with the parallel placement of two fixtures ($4.0mm{\times}11.5mm$) on the mandibular 1st and 2nd molars. A cemented abutment and gold screw were used for superstructures. A FEA models assumed a state of optimal osseointegration, as the bone quality, inner cancellous bone and outer 2 mm compact bone was designed. This concluded that the cortical and trabecular bone were assumed to be perfectly bonded to the implant. Splinting condition had 2 mm contact surface and non-splinting condition had $8{\mu}m$ gap between two implant prosthesis. Two group (Splinting and non-splinting) were loaded with 200 N magnitude in vertical axis direction and were divided with subdivision group. Subdivision group was composed of three loading point; Center of central fossa, the 2 mm and 4 mm buccal offset point from the central fossa. Von Mises stress value were recorded and compared in the fixture-bone interface and bucco-lingual sections. The results were as follows; 1. In the vertical loading condition of central fossa, splinting condition had shown a different von Mises stress pattern compared to the non-splinting condition, while the maximum von Mises stress was similar. 2. Stresses around abutment screw were more concentrated in the splinting condition than the non-splinting condition. As the distance from central fossa increased, the stress concentration increased around abutment screw. 3. The magnitude of the stress in the cortical bone, fixture, abutment and gold screw were greater with the 4 mm buccal offset loading of the vertical axis than with the central loading.

• 대한치과보철학회지
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• 제35권4호
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• pp.627-646
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• 1997

In order to find the degree of osseointegration at bone-implant interface of clinically successful implants, models including the 3.75mm wide, 10mm long screw type $Br{\aa}nemark$ implant as a standard and cylinder, 15mm long, 5.0mm wide, two splinted implants, and implants installed in various cancellous bone density were designed. Also, the amount of load and material of prostheses were changed. The stress and minimum contact fraction were analyzed on each model using three-dimensional finite element method(I-DEAS and ABAQUS version 5.5). The results of this study were as follows. 1. 10mm long, 3.75mm diameter-screw type implant had $36.5{\sim}43.7%$ of minimum contact fraction. 2. Cylinder type implant showed inferior stress distribution and higher minimum contact fraction than screw type. 3. As implant length was increased, minimum contact fraction was increased a little, however, maximum principal stress was decreased. 4. Implants with a large diameter had lower stress value with slightly higher minimum contact fraction than standard screw type. 5. Two splinted implants showed no change of minimum contact fraction. 6. The higher bone density, the lower stress value. 7. The material of occlusal surface had no effect on the stress of the bone-implant interface.

• Hip & pelvis
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• 제30권4호
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• pp.269-275
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• 2018

Purpose: The purpose of this study is to describe a method of inserting cement in the femoral head before fixation with dynamic hip screw to prevent screw cut out due to osteoporosis and to evaluate its clinical outcome in these patients. Materials and Methods: In this prospective study, 30 patients aged 60 years and older with intertrochanteric fracture were included. Bone mineral density was measured. After reaming of the femoral head and neck with a triple reamer and polymethyl methacrylate, bone cement was introduced into the femoral head using a customized nozzle and a barrel fitted on a cement gun. A Richard screw was inserted and the plate was fixed over the femoral shaft. Patients were mobilized and clinical outcomes were rated using the Salvati and Wilson's scoring system. Results: More patients included in this study were between 66 and 70 years old than any other age group. The most common fracture according to the Orthopaedic Trauma Association classification was type 31A2.2 (46.7%). The T-score was found to be $-2.506{\pm}0.22$ (mean${\pm}$standard deviation); all patients were within the range of -2.0 to -2.8. The duration of radiological union was $13.67{\pm}1.77$ weeks. Salvati and Wilson's scoring at 12 months of follow up was $30.96{\pm}4.97$. The majority of patients were able to perform their normal routine activities; none experienced implant failure or screw cut out. Conclusion: Bone cement augmentation may effectively prevent osteoporosis-related hardware complications like screw cut out in elderly patients experiencing intertrochanteric fractures.

• 대한정형외과학회지
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• 제55권5호
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• pp.405-410
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• 2020

목적: 퇴행성 요추부 척추 질환에 대한 수술적 치료로 척추 경 나사못(pedicle screw) 삽입술이 전통적으로 사용되어왔다. 이에 대한 대안으로 제시된 피질골 궤도 나사못(cortical-bone trajectory screw)은 덜 침습적인 후방 요추부 고정이 가능한 점과 몇몇의 생체 역학 연구에서 보고한 우수한 기계적 안정성을 장점으로 가지고 있다. 본 연구의 목적은 후방 감압술 후 후방 고정술 및 유합을 시행한 환자에 있어 피질골 궤도 나사못 고정술의 초기 실패에 관한 사례의 임상적 및 방사선적 결과를 알아보고자 함에 있다. 대상 및 방법: 요추의 퇴행성 척추 협착 및 척추 전방 전위에 대한 전통적인 척추 경 나사못 고정을 대안하여 피질골 궤도 나사못을 사용하여 2013년부터 2018년까지 수술적 치료를 시행한 311명의 환자를 대상으로 하였다. 수술 후 조기 고정 실패는 수술 후 6개월째, 외래 추시에서 시행한 컴퓨터 단층촬영(computed tomography) 및 방사선 사진상 나사못의 이완, 이탈 및 파손과 같은 고정 실패가 일어날 시로 정의하였다. 결과: 조기 고정 실패는 311예 중 46예(14.8%), 나사못 이완이 46예(14.8%), 이탈이 12예(3.9%), 파손이 4예(1.3%)에서 발생하였다. 해당 고정 실패가 일어난 부위 분석 시, L1이 7예(15.2%), L2가 3예(6.5%), L3가 4예(8.7%), L4가 4예(8.7%), L5가 4예(8.7%), 그리고 S1이 24예(52.2%)였다. 주로 말단 피질골 궤도 나사못 중에서도 S1 나사못에서 이완, 이탈 및 파손과 같은 고정 실패가 주로 발생하였다. 결론: 피질골 궤도 나사못 고정은 기존의 척추 경 나사못 고정과 비교했을 때 동등한 임상 결과 또는 적은 합병증을 나타낼 수 있는 하나의 대안이 될 수 있으나 골다공증이 있거나 특히 L5-S1 유합부위에서 전방지지구조가 되지 않는 조건일 때, 이완, 이탈, 파손 등의 조기 고정 실패가 나타나는 결과가 있었다.