• 대한치과보철학회지
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• 제54권2호
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• pp.93-102
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• 2016

목적: 본 연구의 목적은 내부육각 연결형 임플란트에서 두 가지 지르코니아 지대주와 티타늄 지대주의 변연 및 내면 적합도를 비교하고자 하였다. 재료 및 방법: 티타늄 지대주와 두 종류의 지르코니아 지대주를 내부육각연결 구조형 임플란트(TSV, Zimmer)에 체결하였다. 기성 티타늄 지대주(Hex-Lock, Zimmer)를 대조군으로 하여, 기성 지르코니아 지대주(ZirAce, Acucera)와 copy milling 시스템(Zirkonzahn Max, Zirkonzahn)으로 제작한 맞춤형 지르코니아 지대주를 비교하였다. 임플란트 고정체에 30 Ncm의 토크로 지대주를 연결하였으며, 각 실험군 당 8개의 시편을 제작하였다. 아크릴 레진에 포매하여 절단시편을 제작한 후 주사전자현미경으로 고정체-임플란트 계면에서 변연간극과 내부육각 내면간극을 측정하고, 지대주 나사와 지대주 나사받침 사이 계면에서 수직 및 수평간극을 측정했다. 측정치는 일원배치분산분석과 Scheffe test로 통계 처리하였다(${\alpha}=0.05$). 결과: 맞춤형 지르코니아 지대주의 변연 간극은 두 가지 기성 지대주에 비해 컸다. 내부육각 내면간극은 맞춤형 지르코니아 지대주와 기성 지르코니아 지대주 사이에 유의차를 보이지 않았고 기성 티타늄 지대주보다 컸다. 기성 지르코니아 지대주의 지대주 나사 수직간극과 수평간극은 기성 티타늄 지대주보다 컸다. 맞춤형 지르코니아 지대주의 경우. 지대주 나사 수평간극은 두 가지 기성 지대주보다 컸으며, 지대주 나사 수직간극을 측정할 수 없었다. 기성 지르코니아 지대주는 나사받침이 명확하게 형성되어 있었으나, 나사받침의 형태가 지대주 나사와 조화되지 않았다. 맞춤형 지르코니아 지대주의 경우에는 나사받침이 명확하게 형성되어 있지 않았다. 결론: 내부육각 연결형 임플란트에서 기성 티타늄 지대주가 두 종류의 지르코니아 지대주보다 적합도가 좋았다. 맞춤형 지르코니아 지대주는 두가지 기성 지대주에 비해 변연간극이 크고 나사와 나사받침 사이의 적합도가 낮았다.

• 대한치과의사협회지
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• 제54권3호
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• pp.191-197
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• 2016

In the past, restoration of implant crown, ready-made abutment produced by implant manufacturer could only be used. Using straight, angled abutment, there was a limit in adaptation multiple implants. Recently, with the development of implant and CAD/CAM technology, CAD/CAM customized abutment use has become possible which is different from the past when restoration was possible with only prefabricated abutment. Not only it makes emergence profile possible which is similar to natural teeth, but also it makes insertion path possible on CAD in multiple implant restorations. However, on anterior teeth which dental esthetics is very important, another restorations which are formed with natural colored gingiva area could be required. Titanium-based zirconia prostheses which have titanium connection and zirconia structure from 1mm above fixture platform are alternative. Therefore, the purpose of this review is to analyze the characteristics, advantages and disadvantages of the abutment which is used in multiple implant restorations, and to choose right abutment when clinical trials.

• The Journal of Advanced Prosthodontics
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• 제9권4호
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• pp.271-277
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• 2017

PURPOSE. This in vitro study aimed to evaluate the effect of implant connection design (external vs. internal) on the fit discrepancy and torque loss of zirconia and titanium abutments. MATERIALS AND METHODS. Two regular platform dental implants, one with external connection ($Br{\aa}nemark$, Nobel Biocare AB) and the other with internal connection (Noble Replace, Nobel Biocare AB), were selected. Seven titanium and seven customized zirconia abutments were used for each connection design. Measurements of geometry, marginal discrepancy, and rotational freedom were done using video measuring machine. To measure the torque loss, each abutment was torqued to 35 Ncm and then opened by means of a digital torque wrench. Data were analyzed with two-way ANOVA and t-test at ${\alpha}=0.05$ of significance. RESULTS. There were significant differences in the geometrical measurements and rotational freedom between abutments of two connection groups (P<.001). Also, the results showed significant differences between titanium abutments of internal and external connection implants in terms of rotational freedom (P<.001). Not only customized internal abutments but also customized external abutments did not have the exact geometry of prefabricated abutments (P<.001). However, neither connection type (P=.15) nor abutment material (P=.38) affected torque loss. CONCLUSION. Abutments with internal connection showed less rotational freedom. However, better marginal fit was observed in externally connected abutments. Also, customized abutments with either connection could not duplicate the exact geometry of their corresponding prefabricated abutment. However, neither abutment connection nor material affected torque loss values.

• 구강회복응용과학지
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• 제30권1호
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• pp.81-92
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• 2014

상악 전치부에 임플란트를 이용해 심미적으로 수복 하는 것은 많은 어려움이 따른다. 이는 치조골 흡수와 치간 유두 수축 등과 같은 임플란트 주변 경, 연조직 문제와 금속지대주 및 금속도재관의 변연노출과 낮은 광투과도 등의 보철적 한계 때문이다. 이에 본 증례에서는 경, 연조직의 증대술 및 성형술, 발치 후 즉시 식립 등과 함께 임시수복물의 장기간 사용 및 수정으로 임플란트 주위 연조직의 형태와 건강을 형성한 후, 맞춤형 인상 코핑을 사용하여 이를 최종 모형에 재현하였다. 또한 맞춤형 지르코니아 지대주와 완전 도재관을 이용해 최종 수복함으로써 기능적이고 심미적인 결과를 얻었기에 이를 보고하고자 한다.

• The Journal of Advanced Prosthodontics
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• 제6권3호
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• pp.233-240
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• 2014

PURPOSE. To evaluate the effects of different abutment geometries in combination with varying luting agents and the effectiveness of different cleaning methods (prior to re-cementation) regarding the retentiveness of zirconia copings on implants. MATERIALS AND METHODS. Implants were embedded in resin blocks. Three groups of titanium abutments (pre-fabricated, height: 7.5 mm, taper: $5.7^{\circ}$; customized-long, height: 6.79 mm, taper: $4.8^{\circ}$; customized-short, height: 4.31 mm, taper: $4.8^{\circ}$) were used for luting of CAD/CAM-fabricated zirconia copings with a semi-permanent (Telio CS) and a provisional cement (TempBond NE). Retention forces were evaluated using a universal testing machine. Furthermore, the influence of cleaning methods (manually, manually in combination with ultrasonic bath or sandblasting) prior to re-cementation with a provisional cement (TempBond NE) was investigated with the pre-fabricated titanium abutments (height: 7.5 mm, taper: $5.7^{\circ}$) and SEM-analysis of inner surfaces of the copings was performed. Significant differences were determined via two-way ANOVA. RESULTS. Significant interactions between abutment geometry and luting agent were observed. TempBond NE showed the highest level of retentiveness on customized-long abutments, but was negatively affected by other abutment geometries. In contrast, luting with Telio CS demonstrated consistent results irrespective of the varying abutment geometries. Manual cleaning in combination with an ultrasonic bath was the only cleaning method tested prior to re-cementation that revealed retentiveness levels not inferior to primary cementation. CONCLUSION. No superiority for one of the two cements could be demonstrated because their influences on retentive strength are also depending on abutment geometry. Only manual cleaning in combination with an ultrasonic bath offers retentiveness levels after re-cementation comparable to those of primary luting.

• The Journal of Advanced Prosthodontics
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• 제7권3호
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• pp.183-190
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• 2015

PURPOSE. This study evaluated the fracture load of customized zirconia abutments with titanium insert according to preparation depths, with or without 5-year artificial aging. MATERIALS AND METHODS. Thirty-six identical lithium disilicate crowns (IPS e.max press) were fabricated to replace a maxillary right central incisor and cemented to the customized zirconia abutment with titanium insert on a $4.5{\times}10$ mm titanium fixture. Abutments were fabricated with 3 preparation depths (0.5 mm, 0.7 mm, and 0.9 mm). Half of the samples were then processed using thermocycling (temperature: $5-55^{\circ}C$, dwelling time: 120s) and chewing simulation (1,200,000 cycles, 49 N load). All specimens were classified into 6 groups depending on the preparation depth and artificial aging (non-artificial aging groups: N5, N7, N9; artificial aging groups: A5, A7, A9). Static load was applied at 135 degrees to the implant axis in a universal testing machine. Statistical analyses of the results were performed using 1-way ANOVA, 2-way ANOVA, independent t-test and multiple linear regression. RESULTS. The fracture loads were $539.28{\pm}63.11$ N (N5), $406.56{\pm}28.94$ N (N7), $366.66{\pm}30.19$ N (N9), $392.61{\pm}50.57$ N (A5), $317.94{\pm}30.05$ N (A7), and $292.74{\pm}37.15$ N (A9). The fracture load of group N5 was significantly higher than those of group N7 and N9 (P<.017). Consequently, the fracture load of group A5 was also significantly higher than those of group A7 and A9 (P<.05). After artificial aging, the fracture load was significantly decreased in all groups with various preparation depths (P<.05). CONCLUSION. The fracture load of a single anterior implant restored with lithium disilicate crown on zirconia abutment with titanium insert differed depending on the preparation depths. After 5-year artificial aging, the fracture loads of all preparation groups decreased significantly.

• 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.

• 구강회복응용과학지
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• 제28권2호
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• pp.201-212
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• 2012

임플란트 주위조직과 치아 주위조직은 조직학, 형태학적으로 유사한 면이 있다. 특히 functional ankylosis라 불리는 티타늄과 연조직의 직접적인 상피부착은 치아주위 조직의 접합상피처럼 염증세포의 치근단으로의 이행 및 그로 인한 골흡수를 막는 역할을 한다. 그러나 반복적인 지대주의 착탈은 임플란트 주위 연조직의 mucosal barrier를 파괴하여 골흡수를 야기할 수 있다. 만일 지대주의 반복적인 착탈 없이 수술 시에 보철 지대주를 채결한다면 골흡수의 양을 줄일 수 있을 것이다. 이는 기존의 수술방법으로는 한계가 있었으나 Cone Beam Computed Tomography(CBCT)를 이용한 guided surgery를 이용함으로써 임플란트 식립의 3차원적 정확성의 비약적인 향상으로 이런 술식이 가능하게 되었다. 본 증례는 정밀한 CBCT를 통한 분석 후 지르코니아 맞춤 지대주를 미리 제작하고 수술 시에 즉시 지대주와 임시보철물을 연결한 경우로 임상적으로 만족할만한 결과를 얻어 이를 보고하는 바이다.

• The Journal of Advanced Prosthodontics
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• 제10권5호
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• pp.388-394
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• 2018

PURPOSE. To measure axial displacement of different implant-abutment connection types and materials during screw tightening at the recommended torque by using a contact scanner for two-dimensional (2D) and three-dimensional (3D) analyses. MATERIALS AND METHODS. Twenty models of missing mandibular left second premolars were 3D-printed and implant fixtures were placed at the same position by using a surgical guide. External and internal fixtures were used. Three implant-abutment internal connection (INT) types and one implant-abutment external connection (EXT) type were prepared. Two of the INT types used titanium abutment and zirconia abutment; the other INT type was a customized abutment, fabricated by using a computer-controlled milling machine. The EXT type used titanium abutment. Screws were tightened at $10N{\cdot}cm$, simulating hand tightening, and then at the manufacturers' recommended torque ($30N{\cdot}cm$) 10 min later. Abutments and adjacent teeth were subsequently scanned with a contact scanner for 2D and 3D analyses using a 3D inspection software. RESULTS. Significant differences were observed in axial displacement according to the type of implant-abutment connection (P<.001). Vertical displacement of abutments was greater than overall displacement, and significant differences in vertical and overall displacement were observed among the four connection types (P<.05). CONCLUSION. Displacement according to connection type and material should be considered in choosing an implant abutment. When adjusting a prosthesis, tightening the screw at the manufacturers' recommended torque is advisable, rather than the level of hand tightening.

• 대한치과기공학회지
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• 제39권2호
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• pp.75-82
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• 2017

Purpose: This study provided the basic data for selection the zirconia block and CAM by means of marginal fitness observations, flexural strength test and hardness test. Methods: Three dental zirconia blocks(ABCera, NaturaZ, ST98) and two dental milling machines(CAD/CAM MS, DWX-50) were used in this study. Metal abutment(diameter 10 mm, height 5 mm, inclined angle $3^{\circ}$ taper, 1 mm chamfer margin) was fabricated by Ti customized abutment, and then zirconia copings were fabricated for each ten specimens. Silicone replica technique was used to observe the marginal fitness of cross-sections with a stereomicroscope at ${\times}50$ magnification. The dental zirconia blocks was cut into 10 pieces each having a size of $25mm{\times}5mm{\times}1mm$, and fabricated according to the manufacturer's instructions, and flexural strength was measured using a universal testing machine. For hardness test, a micro Vickers hardness tester was used as it was in the flexural strength test. Statistical analysis was performed by one way ANOVA and post-test was performed by Scheffe test. Results: For marginal fitness of bucco-lingual axial, ZU group($59.7{\pm}10.3{\mu}m$) was the lowest, followed by RA, ZA, ZD, RD, RU. For marginal fitness of mesio-distal axial, ZU group($59.3{\pm}10.2{\mu}m$) was the lowest, followed by RA, ZA, RD, ZD, RU. One-way ANOVA showed statistically significant difference between groups(p<0.05). For flexural strength, ABCera block($718.0{\pm}57.2MPa$) was the highest, followed by NaturaZ, ST98. For hardness, ABCera block($1550.3{\pm}19.8Hv$) was the highest, followed by ST98, NaturaZ. There was no significant difference in flexural strength and hardness between blocks(p>0.05). Conclusion: Based on the results of this study, the type of dental zirconia block did influence the marginal fitness, and all dental zirconia blocks are expected to be suitable for clinical application. The highest flexural strength and hardness were ABCera block, and no statistically significant difference was observed.