• Archives of Plastic Surgery
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• v.39 no.5
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• pp.477-482
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• 2012

Background The bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture and size of the bone defect in alveolar cleft has been considered helpful for increasing the success rate of bone grafting because those features may vary with the cleft type. Recently, some studies have reported on the usefulness of three-dimensional (3D) computed tomography (CT) assessment of alveolar bone defect; however, no study on the possible implication of the cleft type on the difference between the presumed and actual value has been conducted yet. We aimed to evaluate the clinical predictability of such measurement using 3D CT assessment according to the cleft type. Methods The study consisted of 47 pediatric patients. The subjects were divided according to the cleft type. CT was performed before the graft operation and assessed using image analysis software. The statistical significance of the difference between the preoperative estimation and intraoperative measurement was analyzed. Results The difference between the preoperative and intraoperative values were $-0.1{\pm}0.3cm^3$ (P=0.084). There was no significant intergroup difference, but the groups with a cleft palate showed a significant difference of $-0.2{\pm}0.3cm^3$ (P<0.05). Conclusions Assessment of the alveolar cleft volume using 3D CT scan data and image analysis software can help in selecting the optimal graft procedure and extracting the correct volume of cancellous bone for grafting. Considering the cleft type, it would be helpful to extract an additional volume of $0.2cm^3$ in the presence of a cleft palate.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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• pp.238-249
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• 2003

Purpose: To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach. Materials and Methods: Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using an lateral approach from March, 1997 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn't. Radiographically B?hler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results. Results: According to Sanders classification, 19 cases of the 36 cases were classified as type II. Type III fracture were found in 12 cases and type IV in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type II and 7 cases(58.3%) in type ill, but no case in type IV. B?hler angles were improved from preoperative average 1.6?to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.8?, respectively. Among 36 cases, Computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satifactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satifactory results in 2 cases with 5mm gap or more. Conclusion: Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of B?hler angle are more important to obtain best results.

• The Journal of Korean Academy of Prosthodontics
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• v.29 no.3
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• pp.55-74
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• 1991

The purpose of this study was to investigate the influence of early functional load around osseointegrated titanium implants. 24 titanium plasma spray coated implants (ITI HS-type) were placed into the previously extracted site in the mandible of six adult dogs. The implants were divided into three groups : the control group was the implants without abutment during the experimental period; the experimental group I was loaded by connecting the contoured abutment after 6 weeks of healing; the experimental group II was loaded after 12 weeks of healing: and the mandibular second premolar and surrounding tissues were selected for natural tooth group to compare the implanted group. All dogs were injected intravenously tetracycline, alizarin red S, and calcein for bone labeling. After the experimental period of 18 weeks, the dogs were sacrificed and longitudinal sections of the bone-implant interface were cut and observed using light microscope, scanning electron microscope, and fluorescence microscope. The results of the study were as follows: 1. Light and scanning electron microscopically, all implant surfaces were well contact with bone tissue at the cortical layer, but some areas of cancellous bone were not contact directly. 2. Fluorescence microscopically, number and size of the new secondary osteons around the implant were increased than those of the natural tooth. 3. Fluorescence microscopically, linear and concentrical fluorescence was observed at or near the surface of all implants, and the bone formation and remodeling of the implants loaded after 6 week of healing were great, and unloaded implants were worst. 4. Fluorescence microscopically, endosteal bone formation was greater than periosteal bone formation at or near the implants. 5. Fluorescence microscopically, number and size of linear and concentric fluorescence was increased at the lingual side than the buccal side of the loaded implants. The result of the study indicate the possibility of the early load to the implant via a prosthesis.

• Journal of the Korean Society for Precision Engineering
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• v.25 no.2
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• pp.148-155
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• 2008

The aim of the study is to interpret the distribution of occlusal force by 3-dimensional finite element analysis of ISP(Implant Supported Prosthesis) supported by minimum number of implant to restore the edentulous patients. For this study, the Astra Tech implant system is used. Geometric modeling for 6 and 4 fixture ISP group is performed with respect to the bone, implant and one piece superstructure, respectively. Implants are arbitrarily placed according to the anatomical limit of lower jaw and for the favorable distribution of occlusal force, which is applied at the end of cantilever extension of ISP with 30mm. Element type is tetrahedral for finite element model and the typical mechanical properties, Young's modulus and Poisson's ratio of each material, cortical, cancellous bone and implant material are utilized for the finite element analysis. From this study, we can see the distribution of equivalent stress equal to real situation and speculate the difference in the stress distribution in the whole model and at each implant fixture, From the analysis, the area of maximum stress is distributed on distal contact area between bone and fixture in the crestal bone. The maximum stress is 53MPa at the 0.2mm area from the bone-implant interface in the maximum side for 300N load condition for 4 fixture case, which is slightly less than the stress calculated from allowable strain. This stress has not been deduced to directly cause the loss of crestal bone around implant fixture, but the stress can be much reduced as the old peoples may have lower chewing force. Thus, clinical trial may be performed with this treatment protocol to use 4 fixtured ISP for old patients.

• The Journal of Korean Academy of Prosthodontics
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• v.44 no.5
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• pp.584-593
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• 2006

Statement of problem : Dental implant which has been developed gradually through many experiments and clinical applications is presently used to various dental prosthetic treatments. To conduct a successful function of implant prosthesis in oral cavity for a long time, it is important that not only structure materials must have the biocompatibility, but also the prosthesis must be designed for the stress, which is occurred in occlusion, to scatter adequately of load support. Therefore, it is essential to give the consideration about the stress analysis of supporting tissues for higher successful rates. Purpose : Recently, many implant manufacturing company produce various taper design of root form implant, the fixture is often selected. However, the stress analysis of taper form fixture still requires more studies. Material and method : This study we make the element models that five implant fixture; Branemark system(Nobel Biocare, Gothenberg, Sweden), Camlog system(Altatec, Germany), Astra system(Astra Tech, Sweden), 3i system(Implant Innovations Inc, USA), Avana system(Osstem, Korea) were placed in the area of mandibular first premolar and prosthesis fabricated, which we compared with stress distribution using the three-dimension finite element analysis under two loading condition. Results : This study compares the aspect of stress distribution of each system with the standard of Von mises stress, among many resulted from finite element analysis so that this research gets the following results. 1. In all implant system, oblique loading of maximum Von mises stress of implant, alveolar bone and crown is higher than vertical loading of those. 2. Regardless of loading conditions and type of system, cortical bone which contacts with implant fixture top area has high stress, and cancellous bone has a little stress. under the vertical loading, maximum Von mises stress is more higher in order of Branemark, Camlog, Astra, 3i, Avana. under the horizontal loading, maximum Von mises is more higher in order of Camlog, Branemark, Astra, 3i, Avana.

• The Journal of Advanced Prosthodontics
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• v.6 no.5
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• pp.361-371
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• 2014

PURPOSE. In case of large horizontal discrepancy of alveolar ridge due to severe resorption, cantilevered crown is usually an unavoidable treatment modality. The purpose of this study was to evaluate the clinical criteria for the placement of the aforementioned implant crown. MATERIALS AND METHODS. The mandible model with 2 mm thick cortical bone and cancellous bone was fabricated from CT cross-section image. An external connection type implant was installed and cantilevered crowns with increasing offset of 3, 4, 5, 6, and 7 mm were connected. Vertical load and $30^{\circ}$ oblique load of 300 N was applied and stress around bone and implant component was analyzed. A total of 14 cases were modeled and finite element analysis was performed using COSMOS Works (Solid works Inc, USA). RESULTS. As for the location of the vertical load, the maximum stress generated on the lingual side of the implant became larger according to the increase of offset distance. When the oblique load was applied at $30^{\circ}$, the maximum stress was generated on the buccal side and its magnitude gradually decreased as the distance of the offset load increased to 5 mm. After that point, the magnitude of implant component's stress increased gradually. CONCLUSION. The results of this study suggest that for the patient with atrophied alveolar ridge following the loss of molar teeth, von-Mises stress on implant components was the lowest under the $30^{\circ}$ oblique load at the 5 mm offset point. Further studies for the various crown height and numbers of occusal points are needed to generalize the conclusion of present study.

• Imaging Science in Dentistry
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• v.38 no.1
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• pp.49-56
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• 2008

Purpose: Diagnostic estimation of destruction and formation of bone has the typical limit according to capacity of x-ray generator and image detector. So the aim of this study was to find out how much it can reproduce the shape and the density of bone in the case of using recently developed dental type of cone beam computed tomography, and which image is applied by new detector and mathematic calculation. Materials and Methods: Cone beam computed tomography (PSR 9000N, Asahi Roentgen Ind. Co., Ltd., Japan) and soft x-ray radiography were executed on dry mandible that was already decalcified during 5 hours, 10 hours, 15 hours, 20 hours, and 25 hours. Estimating and comparing of those came to the following results. Results: The change of inferior border of mandible and anterior border of ramus in the region of cortical bone was observed between first 5 and 10 hours of decalcification. The reproduction of shape and density in the region of cortical bone and cancellous bone can be hardly observed at cone beam computed tomography compared with soft x-ray radiography. The difference of decrease of bone density according to hours of decalcification increase wasn't reproduced at cone beam computed tomography compared with soft x-ray radiography. Conclusion: CBCT images revealed higher spatial resolution. However, contrast resolution in region of low contrast sensitivity is the inferiority of images' property.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.2
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• pp.108-118
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• 2010

Introduction: Maxillary posterior region, compared to the mandible or maxillary anterior region, has a thin cortical bone layer and is largely composed of cancellous bone, and therefore, it is often difficult to achieve primary stability. In such cases, sinus elevation with bone graft is necessary. Materials and Methods: In this research, 121 patients who had implant placement after bone graft were subjected to a follow-up study of 5 years from the moment of the initial surgery. The total survival rate, 5-year cumulative survival rate and the influence of the following factors on implant survival were evaluated; the condition of the patient (sex, age, general body condition), the site of implant placement, diameter and length of the implant, sinus elevation technique, closure method for osseous window, type of prosthesis and opposing teeth. Results: 1. The 5-year cumulative survival rate of total implants was 90.5%, there was no significant difference between sex, age, the site of implant placement, diameter and length of the implant, sinus elevation technique, and the type of opposing teeth. 2. Patients with diabetes mellitus < osteoporosis and smooth-surfaced machined group < hydroxyapatite (HA)-treated group and homogenous demineralized freeze dried allogenic bone (DFDB) bone graft only group had significantly lower survival rate. 3. With less than 4 mm of residual alveolar ridge height, lateral approach without closing the osseous window resulted in a significantly lower survival rate. 4. Restoration of a single implant showed a significantly lower survival rate, compared to cases where the superstructure was joined with several implants in the area. Conclusion: Patients with diabetes or osteoporosis need longer period of time for osseointegration compared to the normal, and the dentists must be prudent when choosing a surface treatment type and the bone graft material. Also, as the vertical dimension of the residual alveolar ridge can influence the result, staged implant placement should be considered when it seems difficult for the implant to gain primary stability from the residual bone with less than 4 mm of vertical dimension. It is recommended to obdurate the bone window and that the superstructure be connected with several impants in the peripheral area.

• The Journal of Korean Academy of Prosthodontics
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• v.49 no.2
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• pp.168-176
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• 2011

Purpose: This study aims at investigating the influence of various insertion torques on thermal changes of bone. A proper insertion torque is derived based on the thermal analysis with two different implant designs. Materials and methods: For implant materials, bovine scapula bone of 15 - 20 mm thickness was cut into 35 mm by 40 - 50 mm pieces. Of these, the pieces having 2 - 3 mm thickness cortical bone were used as samples. Then, the half of the sample was immersed in a bath of $36.5^{\circ}C$ and the other half was exposed to ambient temperature of $25^{\circ}C$, so that the inner and surface temperatures reached $36.5^{\circ}C$ and $28^{\circ}C$, respectively. Two types of implants ($4.5{\times}10\;mm$ Br${\aa}$nemark type, $4.8{\times}10\;mm$ Microthread type) were inserted into bovine scapula bone and the temperature was measured by a thermocouple at 0.2 mm from the measuring point. Finite element method (FEM) was used to analyze the thermal changes at contacting surface assuming that the sample is a cube of $4\;cm{\times}4\;cm{\times}2\;cm$ and a layer up to 2 mm from the top is cortical bone and below is a cancellous bone. Boundary conditions were set on the basis of the shape of cavity after implants. SolidWorks was used as a CAD program with the help of Abaqus 6.9-1. Results: In the in-vitro experiment, the Microhead type implant gives a higher maximum temperature than that of the Br${\aa}$nemark type, which is attributed to high frictional heat that is associated with the implant shape. In both types, an Eriksson threshold was observed at torques of 50 Ncm (Br${\aa}$nemark) and 35 Ncm (Microthread type), respectively. Based on these findings, the Microthread type implant is more affected by insertion torques. Conclusion: This study demonstrate that a proper choice of insertion torque is important when using a specific type of implant. In particular, for the Microthread type implant, possible bone damage may be expected as a result of frictional heat, which compensates for initial high success rate of fixation. Therefore, the insertion torque should be adjusted for each implant design. Furthermore, the operation skills should be carefully chosen for each implant type and insertion torque.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.4
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• pp.365-375
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• 2009

Statement of problems: Stress analysis on implant components of the combined screw- and cement-retained implant prosthesis has not investigated yet. Purpose: The purpose of this study was to assess the load distribution characteristics of implant prostheses with the different prosthodontic retention types, such as cement-type, screw-type and combined type by using 3-dimensional finite element analysis. Material and methods: A 3-dimensional finite element model was created in which two SS II implants (Osstem Co. Ltd.) were placed in the areas of the first premolar and the first molar in the mandible, and three-unit fixed partial dentures with four different retention types were fabricated on the two SS II implants. Model 1 was a cement-retained implant restoration made on two cement-retained type abutments (Comocta abutment; Osstem Co. Ltd.), and Model 2 was a screw-retained implant restoration made on the screw-retained type abutments (Octa abutment; Osstem Co. Ltd.). Model 3 was a combined type implant restoration made on the cement-retained type abutment (Comocta abutment) for the first molar and the screw-retained type abutment (Octa abutment) for the first premolar. Lastly, Model 4 was a combined type implant restoration made on the screw-retained type abutment (Octa abutment) for the first molar and the cement-retained type abutment (Comocta abutment) for the first premolar. Average masticatory force was applied on the central fossa in a vertical direction, and on the buccal cusp in a vertical and oblique direction for each model. Von-Mises stress patterns on alveolar bone, implant body, abutment, abutment screw, and prosthetic screw around implant prostheses were evaluated through 3-dimensional finite element analysis. Results: Model 2 showed the lowest von Mises stress. In all models, the von Mises stress distribution of cortical bone, cancellous bone and implant body showed the similar pattern. Regardless of loading conditions and type of abutment system, the stress of bone was concentrated on the cortical bone. The von-Mises stress on abutment, abutment screw, and prosthetic screw showed the lower values for the screw-retained type abutment than for the cement-retained type abutment regardless of the model type. There was little reciprocal effect of the abutment system between the molar and the premolar position. For all models, buccal cusp oblique loading caused the largest stress, followed by buccal cusp vertical loading and center vertical loading. Conclusion: Within the limitation of the FEA study, the combined type implant prosthesis did not demonstrate more stress around implant components than the cement type implant prosthesis. Under the assumption of ideal passive fit, the screw-type implant prosthesis showed the east stress around implant components.