• Journal of Periodontal and Implant Science
• /
• v.36 no.4
• /
• pp.879-889
• /
• 2006

The early exposure of cover screws is a common complication of 2-stage implant technique. The exposure of cover screws between stage I and IT surgery may cause inflammation in the soft tissues surrounding the implants, and lead to peri-implantitis or marginal bone loss. The purpose of this study was to evaluate the effect of the early exposure of cover screws on implants placed using 2-stage technique. Two hundred and nineteen implants in 77 patients were examined for cumulative survival rate, radiographic marginal bone level change, cause and frequency of the early exposure. The results were as follows: 1. Twenty-five implants showed early exposure of cover screws with a frequency of 11.4%. 2. Cumulative survival rate of the implants with early cover screw exposure was 88.0%, and that of the implants without cover screw exposure was 96,9%. 3. At the time of stage IT surgery and 1 year after loading, the marginal bone loss was greater around the implants with early exposure of cover screws than around the implants without cover screw exposure(p <0.05), 4, There was no statistically significant difference in the frequency of the early exposure according to the implant diameter, gender, and smoking(p >0,05).

• 대한치주과학회:학술대회논문집
• /
• 2006.11a
• /
• pp.139-139
• /
• 2006

• The Journal of Korean Academy of Prosthodontics
• /
• v.45 no.3
• /
• pp.321-328
• /
• 2007

Statement of problem. To work the economic limitation of dental implant usage, some types of domestic implant have been developing. But, there have been seldom reported about the clinical success rate of them as yet. Purpose. The aim of this retrospective multicenter study was to evaluate the performance of CSM implants(CSM company, Daegu, Korea). Material and methods. Thirty-five patients were rehabilitated with 150 CSM implants in this multicenter study. Results. The success rate was 96.2%. CSM Titanium fixtures can obtain slightly higher success rate when a cover screw was not used for implant installation than when used. However it doesn't show significant difference(p=.7615, Fisher's Exact test). Conclusion. This multicenter retrospective study demonstrated the efficacy of the CSM implant in the treatment of variety of clinical manifestation of tooth loss. And it can be assumed that whether a cover screw is used or not should no influence on the osseointegration.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.29 no.2
• /
• pp.175-182
• /
• 2013

The purpose of this study was to observe and analyze the initial marginal bone resorption changes according to the patterns of cover screw exposures during healing period followed by implants installation. Total 64 fixtures(TiUniteTM, NobelBiocare, Sweden) were installed in partially edentulous jaws of 28 patients, who were selected retrospectively and were shown at least one cover screw exposure. Cover screw exposures were defined at 1 month recall. According to the patterns of exposures, groups were categorized into group 1 (No exposure), group 2 (pin-point exposure), group 3 (less than 1/2 of cover screw), group 4 (more than 1/2 of cover screw), group 5 (total exposure). Periapical radiographs were taken in purpose of changes of marginal bone level between installation and 2 month recall. Healing abutments were secured on the exposure groups at 2 month recall. Results were as follows: 1. Marginal bone resorptions were identified whenever cover screws were exposed. 2. Group 2 and 3 were shown significantly increased bone loss more than other group (P <.05). 3. Group 4 and 5 were shown significantly increased bone loss more than group 1, however, less than other groups ( P <.05). Conclusionally, cover screw exposure may cause marginal bone resorptions, therefore, early connection of healing abutment is clinically helpful.

• Clinics in Shoulder and Elbow
• /
• v.27 no.1
• /
• pp.88-107
• /
• 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.

• The Journal of Korean Academy of Prosthodontics
• /
• v.37 no.2
• /
• pp.256-268
• /
• 1999

Submerged implants require secondary surgical uncovering of implants after healing period of 3-6 months. In surgical methods, there are surgical scalpel, tissue punch, electro-surgical, and laser-used uncovering, and so forth The objectives of this study are investigation and assessment of 1) thermal change in clinical application for uncovering of HA-coated implant and pure titanium implant irradiated by pulsed Nd-YAG, $CO_2$, and Er-YAG laser. 2) surface change of cover screws aaer irradiation using laser energy. The temperature of apex & side wall of implants were recorded at 10sec, 20sec, 30sec after 30sec irradiation to implant healing screw; 1) pulsed Nd-YAG laser; 2W, 20pps, contact mode 2) $CO_2$ laser; water-infused & non-water infused state, 2.5-3.5W, contibuous mode, noncontact mode 3) $CO_2$ laser ; non-water infused state, 3W, superpulse, noncontact. mode 4) Er-YAG laser; (1) non-water infused state, 10pps, 60mj, contact mode (2) water-infused state, 10pps, 60mj, 80mj, 101mj, contact mode. According to the results of this study, pulsed Nd-YAG laser is not indicated because of increased thermal change and pitting of metal surface of implant cover screw. By contrast, $CO_2$ laser & Er-YAG laser are presumed to indicate because of narrow range of thermal change & near abscence of thermal damage of metal surface. Dental laser is thought to be much helpful to surgical procedure when it is used as optimal power and time condition considering characteristics and indications of each laser. Further research is needed to verify that these techniques are safe and beneficial to implant success.

• Archives of Plastic Surgery
• /
• v.32 no.3
• /
• pp.293-298
• /
• 2005

Osseointegrated prosthetic auricular reconstruction can be classified as either direct or indirect. In the $Br{\aa}nemark $ system of direct osseointegration, implants are placed into the mastoid process of the temporal bone. In the Epitec system of indirect osseointegration, implants are inserted into a three-dimensional carrier plate that is fixed to the mastoid by means of screws. We experienced forty-four cases using the indirect system and seventeen cases using the direct system. We compared with two systems by complications, such as skin reaction, implant loosening, implant loss. There were no specific differences in the skin reaction around the implants and abutments in relation to age or system used. The degree of skin reaction was different according to the conditions around the implant: in cases of virgin microtia, a skin flap was used to cover the implant, in contrast to grafted skin coverage for failed autogenous reconstruction. In both systems, the skin reaction was more severe and frequent in skin flap than in grafted skin. Loosening of the implant was more frequent in the direct system; however, accidental detachment of the implant from the abutment was more frequent in the indirect system. To reduce complications of skin reaction in osseointegrated prosthetic auricular reconstruction, it is important for soft tissue around implant to immobilize. Therefore, grafted skin is better than skin flap as soft tissue around implant. And immobilization of soft tissue around implant by wound dressing is major facter.

• Archives of Reconstructive Microsurgery
• /
• v.17 no.2
• /
• pp.82-86
• /
• 2008

Purpose: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. Materials and Methods: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 $cm^2$. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. Results: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. Conclusion: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.37
• /
• pp.34.1-34.14
• /
• 2015

Background: Over the past 30-40 years, various carbon implant materials have become more interesting, because they are well accepted by the biological environment. The traditional carbon-based polymers give rise to many complications. The polymer complication may be eliminated through carbon fibres bound by pyrocarbon (carbon/carbon). The aim of this study is to present the long-term clinical results of carbon/carbon implants, and the results of the scanning electron microscope and energy dispersive spectrometer investigation of an implant retrieved from the human body after 8 years. Methods: Mandibular reconstruction (8-10 years ago) was performed with pure (99.99 %) carbon implants in 16 patients (10 malignant tumours, 4 large cystic lesions and 2 augmentative processes). The long-term effect of the human body on the carbon/carbon implant was investigated by comparing the structure, the surface morphology and the composition of an implant retrieved after 8 years to a sterilized, but not implanted one. Results: Of the 16 patients, the implants had to be removed earlier in 5 patients because of the defect that arose on the oral mucosa above the carbon plates. During the long-term follow-up, plate fracture, loosening of the screws, infection or inflammations around the carbon/carbon implants were not observed. The thickness of the carbon fibres constituting the implants did not change during the 8-year period, the surface of the implant retrieved was covered with a thin surface layer not present on the unimplanted implant. The composition of this layer is identical to the composition of the underlying carbon fibres. Residual soft tissue penetrating the bulk material between the carbon fibre bunches was found on the retrieved implant indicating the importance of the surface morphology in tissue growth and adhering implants. Conclusions: The surface morphology and the structure were not changed after 8 years. The two main components of the implant retrieved from the human body are still carbon and oxygen, but the amount of oxygen is 3-4 times higher than on the surface of the reference implant, which can be attributed to the oxidative effect of the human body, consequently in the integration and biocompatibility of the implant. The clinical conclusion is that if the soft part cover is appropriate, the carbon implants are cosmetically and functionally more suitable than titanium plates.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.40
• /
• pp.35.1-35.7
• /
• 2018

Background: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. Case presentation: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors' clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect. Another 62-year-old female patient visited the authors' clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. Conclusions: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.