• The Journal of Korean Academy of Prosthodontics
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• v.43 no.2
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• pp.158-175
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• 2005

Statement of problem. Every effort has been continually made to obtain objectivity in measuring the longevity of fixed restorations, such as by establishing unified judgement standard for deciding success and adopting statistical method that analyzes the data of successful and failed cases at the same time. In Korea, however desired level of development has not to be made in this field yet. Purpose. This study, adopting California Dental Association (CDA) quality evaluation system, established objective standard for deciding success, and inferred the longevity of fixed restorations and their failure analysis through adopting Kaplan-Meier survival analysis. Material and method. In order to assess the longevity of flxed restorations serviced in Korea and causes of failure, a total of 1109 individuals (aged 15-74, 716 women and 393 men loaded with 2551 unit fixed restorations, and 1934 abutments) who lived in Kyung-In Province were examined and the findings were as follows : Results. 1. Length of service of fixed restorations serviced in Korea was 6.86$\pm$0.15 yr (mean), 5.5 yr (median), and the rate of success was 65.82% in 5 year survival, and 21.15% in 10 year survival. 2. When there was patient's need for replacing old prosthetics, longevity of fixed restorations was 7.51$\pm$0.27 yr (mean), 7 yr (median), and the rate of success was 61.08% in 5 year survival, and 17.57% in 10 year survival. 3. Longevity of fixed restorations was longest in the over-sixty age group(9.21$\pm$0.66) and that of the teen age group(3.39$\pm$0.28) was shortest (p<0.05). 4. Longevity of fixed restorations of women (7.38$\pm$0.18 years) was longer than that of men (6.00$\pm$0.26) (p<0.05). 5. As for the provider factor (such as unlicensed performers, university hospitals, and private clinic), there was no statistically significant difference in longevity of fixed restorations. 6. Defective margin (34.78%). periodontal disease (12.15%), periapical involvement (11.73%), was the most frequent causes of failure and poor esthetics group showed the longest life above all (p<0.05). Actual frequent causes of failure after removing old prosthetics were defective margin, periapical involvement, periodontal disease and uncemented restoration. In 75.67% of the cases, abutment state after removing old prosthetics was good enough for loading another prosthetics. 7. There was found to have statistically significant influence between longevity of single crown (6.35$\pm$0.20 yr) and that of 3 unit fixed restorations (7.60$\pm$0.30 y) (p<0.05). In each case the most frequent cause of failure was defective margin. 8. The number of cantilever pontic, pontic/abutment ratio, oral hygiene status were found to have no statistically significant influence on longevity of fixed restorations in all groups (p>0.05). 9. Longevity of fixed restorations made of non precious metal was longest (9.60$\pm$0.40 yr) semi precious and precious trailing behind(p<0.05). 10. Group function group (37.04%) and partial group function group (44.62%) were predominant in frequency but showed no correlation between them and among different types of occlusal plane and different types of occlusal surface (p>0.05). 11. Longevity of fixed restorations was longest in the centric interference group(9.35$\pm$0.62) (p<0.05) among different types of occlusal interference. Conclusion. We found that longevity of fixed restorations serviced in Korea is affected by age, gender and type of material, and that most frequent cause of failure is defective margin. In order to assess the accurate longevity of axed restorations, unified research design. overcoming inter-observer difference and establishing the objective research items are needed. Furthermore, it is thought that prospective approach through thorough study and regular follow-ups is needed just from the start of research. Nationwide detailed studies on length of service of fixed restorations manufactured in Korea are hoped to be conducted hereafter.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.2
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• pp.137-147
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• 2008

Statement of problem: Dental implant procedure has been recognized as a very effective treatment to rehabilitate fully or partially edentulous patients. However, mechanical failures such as screw loosening, screw fracture have been still reported frequently. Purpose: The purpose of this study was to evaluate the influence of tungsten carbide/carbon coating, which has superior hardness and frictional wear resistance, on implant-abutment screw loosening of three different joint connections after one million cyclic loading. Material and methods: The values of detorque before and after loading were measured in three different joint connections (Osstem Implant, Korea), one external butt joint, US II implant system and two internal cones, SS II and GS II system. The values of detorque before loading was analyzed by one-way ANOVA, and two-way ANOVA and Scheffe' test were performed for the value of detorque after loading. Results: 1. The values of initial detorque of tungsten carbide/carbon coated Ti alloy screw were smaller those of Ti alloy screw (P<.01), and there were no differences among implant systems in each screw (P>.05). 2. In comparison of loss rate of detorque value after cyclic loading, US II system was greater than SS II and GS II system but there was no difference between SS II and GS II system (P<.01). 3. Loss rates of detorque value after cyclic loading decreased consistently at tungsten carbide/carbon coated Ti alloy screw comparing with Ti alloy screw in all implant systems (P<.01), and there were no differences among three systems in reduction of loss rates by using tungsten carbide/carbon coated Ti alloy screw (P>.05). Conclusion: Tungsten carbide/carbon coating to increase preload with reduction of friction resistance was a effective way to decrease screw loosening by functional loading.

• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.2
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• pp.125-140
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• 2011

The remnant of temporary cement on the intaglio surface of cast restoration may have a negative effect on the retentive strength of permanent cement. This study was to evaluate the effect of temporary cement cleaning methods on the retentive strength of cementation type implant prostheses. Prefabricated implant abutments - height 5.5mm, diameter 4.5mm, 6 degree axial wall taper with chamfer margins were used. Forty copings-abutment specimens were divided into four groups(each n=10) according to the cleaning methods for temporary cement(Temp-$Bond^{(R)}$) as follows : no temporary cementation(the control group), orange solvent, ultrasonic cleaning, air borne-particle abrasion. After the application of temporary cement and the separation, the cleaning procedure was performed according to the protocol of each group. The specimens were cemented with $Premier^{(R)}$ Implant $Cement^{TM}$. After the permanent cementation, the specimens were subjected to thermocycling and pulled out from the specimens with a universal testing machine at a cross-head speed of 0.5mm/min. After the retentive strength test, all the specimens were cleaned using ultrasonic cleaning, abraded with air borne-particles, and steam-cleaned. Likewise, the specimens were temporarily cemented(Temp-$Bond^{(R)}$ NE), cleaned according to the protocol of each group, cemented with $Premier^{(R)}$ Implant $Cement^{TM}$ and subjected to thermocycling and measurement of their retentive strength. The mean of group with orange solvent were significantly lower than those of other groups(p<0.05). There was no significance between group with ultrasonic cleaning and group with air borne-particle abrasion. Group with ultrasonic cleaning and group with air-particle abrasion were no significance at control group. There was no significance between group cemented with Temp-$Bond^{(R)}$ and group cemented with Temp-$Bond^{(R)}$ NE. Within the limitation of this study, it can be concluded that the temporary cement cleaning method with only orange solvent may have a negative effect on the retentive strength of permanent cement. Ultrasonic cleaning and air borne-particle abrasion methods are recommended for the temporary cement cleaning method on cementation type implant prostheses.

• The Journal of Korean Academy of Prosthodontics
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• v.50 no.1
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• pp.36-43
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• 2012

Purpose: To analyze the stress distribution of the implant and its supporting structures through 3D finite elements analysis for implants with different hexagon heights and to make the assessment of the mechanical stability and the effect of the elements. Materials and methods: Infinite elements modeling with CAD data was designed. The modeling was done as follows; an external connection type ${\phi}4.0mm{\times}11.5mm$ Osstem$^{(R)}$ USII (Osstem Co., Pusan, Korea) implant system was used, the implant was planted in the mandibular first molar region with appropriate prosthetic restoration, the hexagon (implant fixture's external connection) height of 0.0, 0.7, 1.2, and 1.5 mm were applied. ABAQUS 6.4 (ABAQUS, Inc., Providence, USA) was used to calculate the stress value. The force distribution via color distribution on each experimental group's implant fixture and titanium screw was studied based on the equivalent stress (von Mises stress). The maximum stress level of each element (crown, implant screw, implant fixture, cortical bone and cancellous bone) was compared. Results: The hexagonal height of the implant with external connection had an influence on the stress distribution of the fixture, screw and upper prosthesis and the surrounding supporting bone. As the hexagon height increased, the stress was well distributed and there was a decrease in the maximum stress value. If the height of the hexagon reached over 1.2mm, there was no significant influence on the stress distribution. Conclusion: For implants with external connections, a hexagon is vital for stress distribution. As the height of the hexagon increased, the more effective stress distribution was observed.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.5
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• pp.528-534
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• 2008

Purpose: Marginal fit is one of the important components for the successful prosthodontic restoration. Poor fitting margin of the restoration causes hypersensitivity, secondary caries, and plaque accumulation, which later result in prosthodontic failure. CAD/CAM zirconia all-ceramic restorations, such as $LAVA^{(R)}$ (3M ESPE, St.Paul, MN) and $EVEREST^{(R)}$ (KaVo Dental GmbH, Biberach, Germany) systems were recently introduced in Korea. It is clinically meaningful to evaluate the changes of the marginal fit of the CAD/CAM zirconia systems before and after build-up. The purposes of this study are to compare the marginal fit of the two CAD/CAM all-ceramic systems with that of the ceramometal restoration, before and after porcelain build-up Material and methods: A maxillary first premolar dentiform tooth was prepared with 2.0 mm occlusal reduction, 1.0 mm axial reduction, chamfer margin, and 6 degree taperness in the axial wall. The prepared dentiform die was duplicated into the metal abutment die. The metal die was placed in the dental study model, and the full arch impressions of the model were made. Twenty four copings of 3 groups which were $LAVA^{(R)}$, $EVEREST^{(R)}$, and ceramometal restorations were fabricated. Each coping was cemented on the metal die with color-mixed Fit-checker $II^{(R)}$ (GC Cor., Tokyo, Japan). The marginal opening of each coping was measured with $Microhiscope^{(R)}$ system (HIROX KH-1000 ING-Plus, Seoul, Korea. X300 magnification). After porcelain build-up, the marginal openings of $LAVA^{(R)}$, $EVEREST^{(R)}$,and ceramometal restorations were also evaluated in the same method. Statistical analysis was done with paired t-test and one-way ANOVA test. Results: In coping states, the mean marginal opening for $EVEREST^{(R)}$ restorations was $52.00{\pm}11.94\;{\mu}m$ for $LAVA^{(R)}$ restorations $56.97{\pm}10.00\;{\mu}m$, and for ceramometal restorations $97.38{\pm}18.54\;{\mu}m$. After porcelain build-up, the mean marginal opening for $EVEREST^{(R)}$ restorations was $61.69{\pm}19.33\;{\mu}m$, for $LAVA^{(R)}$ restorations $70.81{\pm}12.99\;{\mu}m$, and for ceramometal restorations $1115.25{\pm}23.86\;{\mu}m$. Conclusion: 1. $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations in comparison with ceramometal restorations showed better marginal fit, which had significant differences (P < 0.05) in coping state and also after porcelain build-up . 2. The mean marginal opening values between $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations did not showed significant differences after porcelain build-up as well as in coping state (P > .05). 3. $EVEREST^{(R)}$, $LAVA^{(R)}$ and ceramometal restorations showed a little increased marginal opening after porcelain build-up, but did not show any statistical significance (P > .05).

• The Journal of Korean Academy of Prosthodontics
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• v.36 no.1
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• pp.26-49
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• 1998

The purpose of this study was to confirm the formation of hybrid layer and resin tags in dentin tissue and the possibility of bonding between luting cements used for the prosthesis and the resinous surface coated with resin bonding agents to prevent the dentin hypersensitivity after abutment preparation. Some resin bonding agents, which may have the possibility of bonding with polyacrylic acid as a liquid ingredient of polycarboxylate and glass ionomer cements, were selected. All-Blond desensitizer containing NTG-GMA and BPDM, Scotch-Bond Multipurpose plus containing HEMA, and XR-bond containing organophosphate were selected as a coating agent. Dental cements were zinc phosphate, polycarboxylate, and glass ionomer cement. After the exposed dentin surface of premolars was ethced with 10% phosphoric acid and coated with resin bonding agents, the morphology of treated surfaces and the resin tags and hybrid layers on sectioned surfaces were observed by SEM. Shear bond strength between the resin bonding agents and 3 kinds of cements was measured 24 hours after bonding. On the debonded surfaces of the shear bond strength tested specimens, the cement tags and the bonding sites between the resin materials and cements were examined by SEM. Following conclusions were drawn : 1. Coating of dentin with resin bonding agents had no effect on the shear bond strength of zinc phosphate cement. 2. Both of polycarboxylate and glass ionomer cements showed the increased shear bond strength by the dentinal coating with Scotch-Bond Multipurpose plus containing HEMA. However, in the case of dentinal coating with some agents containing NTG-GMA and BPDM or organophosphate, polycarboxylate cement exhibited the lowered shear bond strength, and glass ionomer cement showed the unchanged shear bond strength. 3. Complete obstructions of dentinal tubules were observed on the dentin coated with All-Bond desensitizer or XR-bond, but distinct shape of the orifices of dentinal tubules was observed consistently on the dentin coated with Scotch-Bond Multipurpose plus. 4. The hybrid layer was thickest on the dentin coated with All-Bond desensitizer, and the length of resin tags was longest on the dentin coated with Scotch-Bond Multipurpose plus. 3. On the debonded specimens which had been bonded with polycarboxylate cement or glass ionomer cement after coating with Scotch-Bond Multipurpose plus, the cement tags and the bonding sites between the resinous surface and the cements could be examined.

• Journal of Dental Rehabilitation and Applied Science
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• v.21 no.2
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• pp.153-167
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• 2005

The purpose of this study was to compare the v-shape thread with the square shape thread of fixture in the view of stress distribution pattern using finite element stress analysis. The finite element model was designed with the parallel placement of two standard fixtures(4.0 mm diameter ${\times}$ 11.5 mm length) on the region of mandibular 1st and 2nd molars. Three dimensional finite element model was created with the components of the implant and surrounding bone. This study simulated loads of 200 N at the central fossa in a axial direction (load A), 200 N at the buccal offset load that is 2 mm apart from central fossa in a axial direction (load B), 200 N at the buccal offset load that was 4 mm apart from central fossa in a axial direction (load C). These forces of load A',B',C' were applied to a $15^{\circ}$ inward oblique direction at that same site with 200 N. Von Mises stress values were recorded and compared in the supporting bone, fixture, and abutment screw. The following results have been made based on this study : 1. The highest stress concentration occurred at the cervical region of the implant fixture. 2. Von Mises stress value of off-site region was higher than that of central fossa region. 3. Square shape thread type showed more even stress distribution in the vertical and oblique force than V-shape thread type. 4. Stress distribution was the most effective in the case of buccal offset load (2, 4 mm distance from central fossa) in the square shape thread type. 5. V-shape thread type revealed higher von Mises stress value than square shape thread type in all environmental condition. The results from numerical analyses concluded that square shape thread type had the lower destructive stress and more stress distribution between the fixture and bone interface than V-shape thread type. Therefore, square shape thread type was regarded as optimal thread configuration in biomechanical concepts.

• The Journal of Korean Academy of Prosthodontics
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• v.58 no.4
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• pp.282-289
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• 2020

Purpose: The aim of this in vitro study was to evaluate the accuracy of three different intraoral scanners (IOSs) on digital impressions of different types of endocrown cavity preparations. Materials and methods: Two human mandibular molar teeth were prepared with different endocrown abutment designs: one with a buccal wall (Class 2) and the other without a buccal wall (Class 3). Both cavity designs were scanned using a reference desktop scanner (E3) and three different intraoral scanners: Trios3 (TRI group), Cerec Omnicam (CER group), and i500 (I5 group). The obtained Standard Tessellation Language (.stl) datasets were exported to metrology software. The precision was evaluated based on deviations among repeated scan models recorded by each IOS. The trueness was evaluated based on deviations between the reference data and repeated scans. For detecting interaction, data were statistically analyzed using a univariate analysis of variance (ANOVA) and for analyzing the comparison of the test groups data were analyzed by one-way ANOVA and post-hoc Tukey test at the significance level of .05. Results: The deviation values for both cavity designs in the I5 group were significantly lower than those in the other IOS groups in terms of trueness. For both cavity designs, the TRI group exhibited better precision than the other IOS groups. Conclusion: Different technologies of IOS device's and different endocrown prepration designs affected the accuracy of the digital scans.

• Journal of Dental Rehabilitation and Applied Science
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• v.26 no.1
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• pp.39-46
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• 2010

To assess the stress distribution of implant prosthesis induced by intentional misfit using photoelastic model. Stress was measured at the surrounding bone after applying vertical load to the implant. Three implants were placed in each of three photoelastic resin blocks. No misfits were used for the control group, while for the experimental group $100{\mu}m$ misfit after cutting the crown was used. The photoelastic stress analysis was performed. In control group, stress concentration was not shown when the load was not applied, whereas stress concentration was shown only in the loaded part even when load was applied and the stress was distributed in anterior-posterior direction when applying a load in the middle. When intentional misfits were given, stress around the fixture was incurred when tightening the screw even if load was not applied. If the load was applied, stress was concentrated around the implants including areas where the load was applied. In particular, the prosthesis made of UCLA showed more stress concentration as compared with a conical abutment. In the UCLA case, concentration was shown from the apex following through the axis to the cervical area. Prosthesis with misfit makes the stress concentrated though the load was not applied and it induces even more severe stress concentration when the load was applied. This founding demonstrates the importance of the correct prosthesis production.

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.3
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• pp.272-279
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• 2013

The concept of implant stability was basically originated from the relative condition of bone-implant interface and has some meanings for evaluation of that interface. In addtion, it has been used for the investigation of initial bone healing process after fixture installation because a degree of micromotion around interface can affect unfavorable clinical results. The purpose of this study is to investigate the mode of initial bone healing from fixture installation through prospective trial. Thirty fixtures were consecutively installed in mandibles of 26 patients with single tooth loss area and then healing abutment were secured for one-stage surgery meothod. Resonance frequency analysis was performed with one week interval during 12 weeks and periapical radiographs were taken at each month. Although marginal bone level change was not shown through observation period (P>0.05), statistical difference of implant stability was shown through 4 and 6 week (P<0.05) and was not shown after 6 week (P>0.05) according to the bone quality. Initial bone healing process is a successive process of bone resorption and favorable bone healing result might be postulated at 4 week interval after installation through RFA.