• Journal of Periodontal and Implant Science
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• v.31 no.2
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• pp.371-388
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• 2001

A novel glucanhydrolase(DXAMase) from a mutant of Lipomyces starkeyi(KSM 22) has been shown effective in hydrolysis of mutan, reduction of mutan formation by Streptococcus mutans and removal pre-formed sucrose-dependentadherent microbial film and DXAMase has been strongly bound to hydroxyapatitie. These in vitro properties of Lipomyces starkeyi DXAMase are desirable for its application as a dental plaque control agent. This study was performed to determine the adjunctive oral hygiene benefits and safety of dextranase(Lipomyces starkeyi KSM 22 DXAMase)-containing mouthwash when used alongside normal tooth-brushing. This 6-month clinical trial was placebo-controlled double-blind design evaluating 1U/ml dextranase mouthwash and 0.12% chlorhexidine mouthwash. A total 39 systemically healthy subjects, who had moderate levels of plaque and gingivitis were included. At baseline, 1, 3 and 6 months, subjects were scored for plaque accumulation(Turesky modification of Quingley-Hein's plaque index), gingivitis status($L\ddot{o}e$ and Silness gingival index), and tooth stain(Area and severity index system by Lang et al). Additionally, oral mucosal examinations were performed and subjects questioned for adverse symptoms. Two weeks after pre-experiment examinations and a professional prophylaxis, the subjects provided with allocated mousewash and instructed to use 20-ml volumes for 30s twice daily after toothbrushing. All the groups showed significant increase in plaque accumulation since 1 month of experiment. During 6 months' period, the Dextranase mouthwash group showed the least increase in plaque accumulation, compared to the Chlorhexidine mouthwash and placebo groups. As for gingival inflammation, all the groups showed significant increase during 6 months of experiment. The Experimental group(Dextranase mouthwash) also showed the least increase in gingival index score, compared to the Positive control(Chlorhexidine mouthwash)as well as the Negative control(placebo)groups. Whereas the tooth stain was increased significantly in the Positive control group, compared to the baseline score and the Negative controlgroup since 3 months of mouthrinsing. It was significantly increased after 6 months in the Experimental group, still less severe than the Positive control group. As for the oral side effect, the Experimental group showed less tongue accumulation, bad taste, compared to the Positive control group. From these results, mouthrinsing with Lipomyces starkeyi KSM 22 dextranase provided adjunctive benefits to toothbrushing, comparable to 0.12% chlorhexidine mouthwash in inhibition of plaque accumulation and gingival inflammation and local side effects were if anything less frequent and less intense than chlorhexidine, with long-term use of the mouthwash. All data had provided positive evidence for Lipomyces starkeyi KSM 22 dextranase as an antiplaque agent and suggested that further development of dextranase formulations for plaque control are warranted.

• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.4
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• pp.343-358
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• 2011

As implant treatment has become popular, lots of different shapes and materials of the implant upper component have been supplied. And there are also diverse reports about failures including loosening of the abutment screw which is one of the most common reason. Purpose : The purpose of this study is to find out how different screw tightening orders and methods influence on screw loosening according to the different connection systems. The upper component was fabricated by casting method. After fabricating master models that are precisely attached to the upper component, 5 experimental models each for the external connection system and internal connection system were fabricated using splinting impression technique. First, to find out the influence of the screw tightening order, screws were tightened in 3 orders; 1-2-3-4, 2-3-1-4, 2-4-3-1. After tightening, removal torque values (RTV) of each group was measured. And also to find out the influence of screw tightening method, a model with 2-3-1-4 screw tightening order was tightened with 30 Ncm at one time(1-step method) and the RTV was compared with the same order group (2-3-1-4) in the 2 step method. In the external connection system, RTV appeared significantly lower in group 2-3-1-4 than group 2-4-3-1 (p<0.05). And also in the internal connection system, the RTV of group 2-3-1-4 appeared significantly lower than that of group 2-4-3-1 and 1-2-3-4 (p<0.05). When comparing the tightening number of the screw without considering the screw tightening order, the first tightened screw appeared significantly higher RTV than the second one in the external connection system (p<0.05), however there was no significant difference from the first tightened screw to the last tightened screw in the internal connection system. And there was no statistically significant difference between the two screw tightening methods in both internal and external connection system. In the comparison of external and internal connection system, each RTV appeared 16.27 Ncm and 14.25 Ncm and appeared as a statistically significant difference (p<0.05). There was a significant difference in RTV measured according to the screw tightening order. The lowest RTV appeared in the groups started tightening from the middle. There was also a significant difference in RTV between the two connection system groups. A further study is needed to find out the influence factors in RTV and also a study is required related to the load condition.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.2
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• pp.125-135
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• 2009

Statement of problem: Loosening or fracture of the abutment screw is one of the common problems related to the dental implant. Generally, in order to make the screw joint stable, the preload generated by tightening torque needs to be increased within the elastic limit of the screw. However, additional tensile forces can produce the plastic deformation of abutment screw when functional loads are superimposed on preload stresses, and they can elicit loosening or fracture of the abutment screw. Therefore, it is necessary to find the optimum tightening torque that maximizes a fatigue life and simultaneously offer a reasonable degree of protection against loosening. Purpose: The purpose of this study was to present the influence of tightening torque on the implant-abutment screw joint stability with the 3 dimensional finite element analysis. Material and methods: In this study, the finite element model of the implant system with external butt joint connection was designed and verified by comparison with additional theoretical and experimental results. Four different amount of tightening torques(10, 20, 30 and 40 Ncm) and the external loading(250 N, $30^{\circ}$) were applied to the model, and the equivalent stress distributions and the gap distances were calculated according to each tightening torque and the result was analyzed. Results: Within the limitation of this study, the following results were drawn; 1) There was the proportional relation between the tightening torque and the preload. 2) In case of applying only the tightening torque, the maximum stress was found at the screw neck. 3) The maximum stress was also shown at the screw neck under the external loading condition. However in case of applying 10 Ncm tightening torque, it was found at the undersurface of the screw head. 4) The joint opening was observed under the external loading in case of applying 10 Ncm and 20 Ncm of tightening torque. 5) When the tightening torque was applied at 40 Ncm, under the external loading the maximum stress exceeded the allowable stress value of the titanium alloy. Conclusion: Implant abutment screw must have a proper tightening torque that will be able to maintain joint stability of fixture and abutment.

• The Journal of Korean Academy of Prosthodontics
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• v.48 no.4
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• pp.280-286
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• 2010

Purpose: This study evaluated the detorque values of screws in a multiple implant-supported superstructure using stone casts made with 2 different impression techniques. Material and methods: A fully edentulous mandibular master model and a metal framework directly connected to four implants (Br${\aa}$nemark $System^{(R)}$; Nobel Biocare AB) with a passive fit to each other were fabricated. Six experimental stone casts (Group 1) were made with 6 non-splinted impressions on a master cast and another 6 experimental casts (Group 2) were made with 6 acrylic resin splinted impressions. The detorque values of screws ($TorqTite^{(R)}$ GoldAdapt Abutment Screw; Nobel Biocare AB) were measured twice after the metal framework was fastened onto each experimental stone cast with 20 Ncm torque. Detorque values were analyzed using the mixed model with the fixed effect of screw and reading and the random effect of model for the repeated measured data at a .05 level of ignificance. Results: The mean detorque values were 7.9 Ncm (Group 1) and 8.1 Ncm (Group 2), and the mean of minimum detorque values were 6.1 Ncm (Group 1) and 6.5 Ncm (Group 2). No statistically significant differences between 2 groups were found and no statistically significant differences among 4 screws were found for detorque values. No statistically significant differences between 2 groups were also found for minimum detorque values. Conclusion: In a multiple external hexagon implant-supported prosthesis, no significant differences between 2 groups were found for detorque values and for minimum detorque values. There seems to be no significant differences in screw joint stability between 2 stone cast groups made with 2 different impression techniques.

• Journal of Dental Rehabilitation and Applied Science
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• v.30 no.3
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• pp.206-214
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• 2014

This study is to evaluate how different bearing surface angles of abutment screw affect the mechanical stability of the joint in the conical seal design implant system. Materials and Methods: Internal connection type regular implants, two-piece cemented type abutments and tungsten carbide/carbon-coated titanium alloy abutment screws were selected. Titanium alloy screws with conical ($45^{\circ}$) and flat ($90^{\circ}$) head designs which fit on to abutment were fabricated. The abutments were tightened to implants with 30 Ncm by digital torque gauge. The loading was applied once to the central axis of abutment. The mean axial displacement was measured using micrometer before and after the tightening and loading (n = 5). The abutment was tightened to implants with 30 Ncm and T-shape stainless steel crown was cemented. Then the change in the amount of reverse-torque was measured after the repeated loading to the central axis, and the place 5 mm away from the central axis. Compressive bending and fatigue strength were measured at the place 5 mm away from the central axis (n = 5). Results: Both groups showed the largest axial displacement when abutment screw tightening and total displacement was greater in the flat head group compared to conical head group (P < 0.05). However, there were no significant differences in reverse torque value, compressive bending and fatigue strength (P > 0.05). Conclusion: Within the limitations of this study, the abutment screw head design had no effect on two groups regarding the joint stability, however the conical head design affected the settlement of abutment resulting in the reduced total displacement.

• Journal of Periodontal and Implant Science
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• v.44 no.2
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• pp.79-84
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• 2014

Purpose: While single-species biofilms have been studied extensively, we know notably little regarding multispecies biofilms and their interactions. The purpose of this study was to develop and evaluate an in vitro multispecies dental biofilm model that aimed to mimic the environment of chronic periodontitis. Methods: Streptococcus gordonii KN1, Fusobacterium nucleatum ATCC23726, Aggregatibacter actinomycetemcomitans ATCC33384, and Porphyromonas gingivalis ATCC33277 were used for this experiment. The biofilms were grown on 12-well plates with a round glass slip (12 mm in diameter) with a supply of fresh medium. Four different single-species biofilms and multispecies biofilms with the four bacterial strains listed above were prepared. The biofilms were examined with a confocal laser scanning microscope (CLSM) and scanning electron microscopy (SEM). The minimum inhibitory concentrations (MIC) for four different planktonic single-species and multispecies bacteria were determined. The MICs of doxycycline and chlorhexidine for four different single-species biofilms and a multispecies biofilm were also determined. Results: The CLSM and SEM examination revealed that the growth pattern of the multispecies biofilm was similar to those of single-species biofilms. However, the multispecies biofilm became thicker than the single-species biofilms, and networks between bacteria were formed. The MICs of doxycycline and chlorhexidine were higher in the biofilm state than in the planktonic bacteria. The MIC of doxycycline for the multispecies biofilm was higher than were those for the single-species biofilms of P. gingivalis, F. nucleatum, or A. actinomycetemcomitans. The MIC of chlorhexidine for the multispecies biofilm was higher than were those for the single-species biofilms of P. gingivalis or F. nucleatum. Conclusions: To mimic the natural dental biofilm, a multispecies biofilm composed of four bacterial species was grown. The 24-hour multispecies biofilm may be useful as a laboratory dental biofilm model system.

• Proceedings of the Korean Institute of Surface Engineering Conference
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• 2003.10a
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• pp.134-135
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• 2003

The dental implant materials required good mechanical properties, such as fatigue strength, combined with a high resistance to corrosion. For increasing fatigue resistance and delaying onset of stress corrosion cracking, shot peening has been used for > 50 years to extend service life of metal components. However, there is no information on the electrochemical behavior of shot peened and hydroxyapatite(HA) coated Ti-6Al-4V alloys. To increase fatigue strength, good corrosion resistance, and biocompatibility, the electrochemical characteristics of Ti/TiN/HA coated and shot peened Ti-6Al-4V alloys by electron beam physical vapor deposition(EB-PVD) have been researched by various electrochemical method in 0.9%NaCl. Ti-6Al-4V alloys were prepared under the condition of hydrogen and vacuum arc furnace. The produced materials were quenched at 1000$^{\circ}C$ under high purity dried Ar atmosphere and were hold at 500$^{\circ}C$ for 2 hrs to achieve the fatigue strength(1140㎫) of materials. Ti-6Al-4V alloys were prepared under the condition of hydrogen and vacuum arc furnace. Shot peening(SP) and sand blasting treatment was carried out for 1, 5, and 10min. On the surface of Ti-6Al-4V alloys using the steel balls of 0.5mm and alumina sand of 40$\mu\textrm{m}$ size. Ti/TiN/HA multilayer coatings were carried out by using electron-beam deposition method(EB-PVD) as shown Fig. 1. Bulk Ti, powder TiN and hydroxyapatite were used as the source of the deposition materials. Electrons were accelerated by high voltage of 4.2kV with 80 - 120mA on the deposition materials at 350$^{\circ}C$ in 2.0 X 10-6 torr vacuum. Ti/TiN/HA multilayer coated surfaces and layers were investigated by SEM and XRD. A saturated calomel electrode as a reference electrode, and high density carbon electrode as a counter electrode, were set according to ASTM GS-87. The potentials were controlled at a scan rate of 100 mV/min. by a potentiostat (EG&G Co.273A) connected to a computer system. Electrochemical tests were used to investigate the electrochemical characteristics of Ti/TiN/HA coated and shot peened materials in 0.9% NaCl solution at 36.5$^{\circ}C$. After each electrochemical measurement, the corrosion surface of each sample was investigated by SEM.

• Journal of Periodontal and Implant Science
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• v.43 no.6
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• pp.269-275
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• 2013

Purpose: In this study, the effect of calcium sodium phosphosilicate (NovaMin) desensitizing agent, which is a powder-based system, and hydroxyethyl methacrylate and glutaraldehyde (Gluma desensitizer), which is liquid-based system, on dentinal tubule occlusion was analyzed by scanning electron microscope. The effects of the above two along with one control group were compared to determine the more effective method of sealing the dentinal tubules after initial application. Methods: Twenty specimens were allocated to each of 3 groups: Control, Gluma desensitizer, and NovaMin. Two additional samples were also prepared and treated with Gluma and NovaMin; these samples were longitudinally fractured. The specimens were prepared from extracted sound human premolars and were stored in 10% formalin at room temperature. The teeth were cleaned of gross debris and then sectioned to provide one to two dentin specimens. The dentin specimens were etched with 6% citric acid for 2 minutes and rinsed in distilled water. Control discs were dried, and the test discs were treated with the desensitizing agents as per the manufacturer's instructions. The discs as well as longitudinal sections were later analyzed under the scanning electron microscope. The proportions of completely occluded, partially occluded, and open tubules within each group were calculated. The ratios of completely and partially occluded tubules to the total tubules for all the groups was determined, and the data was statistically analyzed using nonparametric tests and statistical significance was calculated. Results: NovaMin showed more completely occluded tubules ($0.545{\pm}0.051$) while Gluma desensitizer showed more partially occluded tubules ($0.532{\pm}0.075$). The differences among all the groups were statistically significant ($P{\leq}0.05$). Conclusion: Both materials were effective in occluding dentinal tubules but NovaMin appeared more promising in occluding tubules completely after initial application.

• Journal of Periodontal and Implant Science
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• v.48 no.5
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• pp.274-283
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• 2018

Purpose: Numerous indices have been proposed to analyse wound healing in oral soft tissues, but each has specific shortcomings. A new method of analysis, the Early Wound Healing Score (EHS), was evaluated in the present study. The aim was to assess more accurately early healing by primary intention of surgical incisions in periodontal soft tissues. Methods: Twenty-one patients were treated with different surgical procedures comprising 1 or 2 vertical releasing incisions as part of a surgical access flap. Twenty-four hours after surgery, early wound healing at the vertical releasing incisions was assessed using the EHS. This score assessed clinical signs of re-epithelialization (CSR), clinical signs of haemostasis (CSH), and clinical signs of inflammation (CSI). Since complete wound epithelialization was the main outcome, the CSR score was weighted to be 60% of the total final score. Accordingly, a score of 0, 3, or 6 points was possible for the assessment of CSR, whereas scores of 0, 1, or 2 points were possible for CSH and CSI. Higher values indicated better healing. Accordingly, the score for ideal early wound healing was 10. Results: Thirty vertical releasing incisions were assessed in 21 patients. At 24 hours after incision, 16 vertical releasing incisions (53.33%) received the maximum score of CSR, while 6 cases (20%) received an EHS of 10. None of the cases received 0 points. Conclusion: The EHS system may be a useful tool for assessing early wound healing in periodontal soft tissue by primary intention after surgery.

• The korean journal of orthodontics
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• v.44 no.2
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• pp.88-95
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• 2014

Objective: The purpose of this study was to compare the treatment duration and dentoskeletal changes between two different anchorage systems used to treat maxillary dentoalveolar protrusion and to examine the effectiveness of en-masse retraction using two miniscrews placed in the midpalatal suture. Methods: Fifty-seven patients (9 men, 48 women), who had undergone level anchorage system treatment at Aichi-Gakuin University Dental Hospital (Nagoya, Japan) were divided into two groups according to the method of maxillary posterior anchorage reinforcement: midpalatal miniscrews (25 patients, mean age 22 years) and conventional anchorage (32 patients, mean age 19 years). The en-masse retraction period, overall treatment duration, pre-treatment effective ANB angle, and change in the effective ANB angle were compared with an independent-samples t -test. Results: Compared to the headgear group, the duration of en-masse retraction was longer by approximately 4 months in the miniscrew group (p < 0.001). However, we found no significant difference in the total treatment duration between the groups. Moreover, a greater change in the effective ANB angle was observed in patients treated with miniscrews than in those treated with the conventional method (p < 0.05). Conclusions: The level anchorage system treatment using miniscrews placed in the midpalatal area will allow orthodontists more time to control the anterior teeth during en-masse retraction, without increasing the total treatment duration. Furthermore, it achieves better dentoskeletal control than does the conventional anchorage method, thereby improving the quality of the treatment results.