• 구강회복응용과학지
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• 제28권4호
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• pp.423-439
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• 2012

NobelGuide$^{TM}$ 임플란트 시스템은 골량과 골질을 수술 전에 판단하여 점막을 젖히지 않고 미리 계획된 스텐트와 보철물을 이용하여 즉시하중을 부여하는 CAD/CAM 기반의 임플란트 보철 치료방법이다. 환자의 불편감을 최소화하여 미리 예측 가능한 위치에 임플란트를 식립함으로써 술 후 합병증 및 보철과정을 간소화 할 수 있는 장점이 있다. 본 증례의 환자는 56세 남성으로 상,하악 부분 무치악 상태였으며, 상악전치부 보철물 탈락과 하악 전치가 흔들린다는 주소로 내원하였다. 이에 상악 잔존치 모두와 하악 4전치 발거 및 치주치료를 실시한 뒤 임시 의치를 6개월간 사용하여 발치와 치유 및 의치 적응여부를 평가하였다. 골량은 충분하다고 판단되었고 환자의 협조도와 경제적인 여건, 전신건강 등 여러 사항이 양호하여 CAD/CAM 기반의 수술템플렛을 이용한 무판막 수술을 통해, 미리 제작된 임시 고정성 보철물로 즉시하중을 부여하는 상악 NobelGuide$^{TM}$ 임플란트 시스템을 계획하였다. 사용중인 임시의치를 이용하여 제작한 방사선 스텐트로 CT를 촬영하고, computer based planning (Procera$^{(R)}$ software)을 통해 3차원적인 골형상과 각 부위별 단면상을 참고하여 상악에 8개의 임플란트 식립체를 생역학적 관점 및 골조건을 고려하여 분산 배치하였다. 미리 제작된 임시 고정성 보철물을 임플란트 수술 후 즉시 장착 및 하중을 부여하여 기능하도록 하였으며 6개월 후 골유착 정도를 평가한 뒤 금속구조물을 이용한 최종 보철물을 제작하였다. 하악의 경우 전치부 도재전장주조금속관과 우측 구치부 임플란트 보철물 제작을 통해 상, 하악 치료를 마무리하였다.

• Journal of Periodontal and Implant Science
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• 제53권2호
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• pp.99-109
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• 2023

Purpose: The aim of this systematic review was to evaluate the effectiveness of the socket shield technique (SST), an innovative surgical method introduced in 2010, for reducing buccal bone plate resorption. Methods: The review was conducted following the PRISMA guidelines. Clinical studies conducted in humans and investigating the SST were searched on PubMed (MEDLINE), Embase, Web of Knowledge, and Google Scholar in November and December 2021. The implant survival rate, percentage of complications, and clinical parameters (marginal bone loss [MBL], pink esthetic score [PES], and buccal bone plate resorption [BBPR]) were analyzed using the collected data. Results: The initial search resulted in 132 articles. After article screening, the full texts of 19 studies were read and 17 articles were finally included in the review. In total, 656 implants were installed with the SST. Nine of the 656 implants experienced failure, resulting in an implant survival rate of 98.6%. The percentage of complications was about 3.81%. The analysis of clinical parameters (MBL, PES, and BBPR), showed favorable results for the SST. The mean MBL in implants placed with the SST was 0.39±0.28 mm versus 1.00±0.55 mm in those placed without the SST. PES had a better outcome in the SST group, with an average of 12.08±1.18 versus 10.77±0.74. BBPR had more favorable results in implants placed with the SST (0.32±0.10 mm) than in implants placed with the standard technique (1.05±0.18 mm). Conclusions: The SST could be considered beneficial for preserving the buccal bone plate. However, since only 7 of the included studies were long-term randomized controlled trials comparing the SST with the standard implant placement technique, the conclusions drawn from this systematic review should be interpreted with caution.

• Journal of Periodontal and Implant Science
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• 제38권3호
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• pp.445-452
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• 2008

Purpose: The purpose of this study was comparison of survival rate of implant as two sinus elevation techniques and when window opening procedure had done it was comparison of survival rate of implant between the procedure of implantation after 6 month of sinus elevation to allow healing period and that of implantation with sinus elevation simultaneously. Material and Methods: All 79 of patients treated at DanKook University Dental Hospital Dept. of Periodontics for 164 implantation of maxillary posterior edentulous area with sinus elevation. Sinus elevation technique was divided of the technique : Osteotome technique and window opening technique. Result: 14 implants among 96 implants was failed implants of using osteotome for sinus elevation whereas one implant of 68 implants was failed of using window opening technique. Conclusion: Window opening technique had higher survival rate than osteotome technique. In case of window opening, there was no significant difference of immediate implantation and delayed implantation.

• Journal of Korean Dental Science
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• 제4권2호
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• pp.59-66
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• 2011

Purpose: This research sought to determine the resorption rate of bone grafted to the maxillary sinus according to the grafted material's type, patient's age, systemic disease, implant size, site of implant placement, and residual ridge height. Materials and Methods: This research targeted 24 patients who had immediate Osstem$^{(R)}$ implant (US Plus$^{(R)}$) placement after bone graft. The panorama was taken before the surgery, after the surgery, and 6 months after the surgery. Vertical height change and resorption rate of the grafted bone were measured with the same X-rays and compared. The influence of the following factors on the grafted bone material's resorption rate was evaluated: grafted material type, patient's age, systemic disease, implant size, site of implant placement, and residual ridge height. Results: Patients in their 40s had $34.0{\pm}21.1%$ resorption rate, which was significantly higher compared to the other age groups (P<0.05). There was no significant relationship between systemic disease and grafted bone resorption. There was no significant relationship between implant size (diameter, length) and grafted bone resorption. There was no significant relationship between the site of implant placement and grafted bone resorption. The ramal bone-grafted site was significantly more resorbed than the ramal bone/Bio-Oss$^{(R)}$-grafted site, maxillary tuberosity bone/Bio-Oss$^{(R)}$-grafted site, and ramal bone/maxillary tuberosity bone/Bio-Oss$^{(R)}$-grafted site (P<0.05). There was no significant difference in the grafted bone resorption rate in the sinus between more than 4 mm and less than 4 mm residual ridge heights. After an average of 6 months, a second surgery was done; given an average follow-up of 1.9 years, the success rate and survival rate of the implant were 96.9% and 98.4%, respectively. Conclusion: These results indicate that the bone resorption rate of grafted bone among patients in their 40s is higher compared to patients in their 50s and over, and that only autogenous bone (ramus) shows higher resorption rate than the mixed graft of autogenous bone and xenogenous graft (Bio-oss) after maxillary sinus graft.

• 대한치과교정학회지
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• 제38권3호
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• pp.149-158
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• 2008

본 연구는 미니 임플란트 식립 후 교정력 부하시기와 관련하여 임플란트 주위골의 치유과정을 조사하였다. 성견 8마리의 하악 협측골에 교정용 미니 임플란트(ORLUS, Ortholution CO, Korea) 48개를 식립한 후 교정력을 주지 않은 대조군과 식립 후 즉시 교정력을 준 즉시 부하군, 그리고 식립 후 3주간의 치유기간을 두고 교정력을 준 지연 부하군으로 나누어 각각의 군에 대해 3주, 6주, 12주가 경과된 시점에 임플란트 주위골의 변화를 조직 계측학적으로 관찰하였다. 골 접촉률은 즉시 부하군에서 시기에 따른 유의한 변화가 없었으며 지연 부하군은 3주에 비해 12주에서 유의하게 증가하였다(p<0.05). 각 시점에서 군간의 골 접촉률을 비교했을 때 12주째 지연 부하군이 즉시 부하군 보다 유의하게 높았다(p<0.05). 골 면적비율은 즉시 부하군의 경우, 시기에 따른 유의한 변화가 없었으며, 지연 부하군과 대조군은 6주에 비해 12주째 유의한 증가를 보였으며 (p<0.05), 12주째 실험군 간에 유의한 차이는 관찰되지 않았다(p>0.05). 동요도는 12주째 즉시 부하군과 지연 부하군 간에 유의한 차이는 없었다(p>0.05). 위의 결과에서 즉시 부하가 self drilling형 미니 임플란트 주위골의 안정성에 부정적인 영향을 주지 않았으므로 식립 즉시 교정력을 부여하여 사용하는 데 임상적으로 문제가 없을 것으로 판단된다.

• Restorative Dentistry and Endodontics
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• 제33권1호
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• pp.39-44
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• 2008

심미적으로 중요한 전치부에서 단일치아 임플란트를 이용한 보철수복은 임상의에게 새로운 도전과제중의 하나가 되었다. 그러나 전치부에서 single-unit implant는 식립할 부위의 치조골 상태가 양호해야 하는데 치은연하 파절로 인해 치아 주위에 골 손실이 있는 경우 immediate implant는 심미적으로 문제를 야기 할 수 있다. 따라서 본 증례는 "orthodontic extrusive remodeling"을 통해 파절치와 주위 조직을 교정적으로 정출시켜 임플란트 식립을 위한 연조직과 경조직을 증대시킨 후 임플란트 식립을 통해 상악측절치에서 성공적 인 심미수복을 이룬 증례에 관한 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권4호
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• pp.204-211
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• 2012

Objectives: Dental implants installation in patients with diabetes remains controversial as altered bone healing around implants has been reported. And little is known about the biological factors involved in bone healing around implants. The present study aimed to investigate the biological markers around immediately placed implants in rats with controlled and uncontrolled diabetes. Materials and Methods: Twenty rats (40 sites) were divided into the control, insulin-treated and diabetic groups. The rats received streptozotocin (60 mg/kg) to induce diabetes; animals in the insulin-treated group also received three units of subcutaneous slow-release insulin. Two threaded titanium alloy implant ($1.2{\times}3mm$) were placed in the extraction socket of the both maxillary first molars and allowed for healing. Bone blocks including implant were harvested at 3 days, 1, 2 and 4 weeks. The levels of bone morphogenetic protein (BMP)-4, transforming growth factor (TGF)-${\beta}1$, osteocalcin (OC) and osteonectin (ON) were measured in the peri-implant osseous samples by RT-PCR. Results: The BMP-4 level increased immediately in all groups by day 3, then decreased abruptly in the control and the insulin-treated groups. However, by week 4, all groups showed mostly the same amount of BMP-4 expression. The level of TGF-${\beta}1$ also instantly increased by day 3 in the insulin-treated group. This level elevated again reaching the same values as the control group by week 4, but was not as high as the diabetic group. In addition, the expression of OC and ON in the control and insulin-treated groups was higher than that of the diabetic group at 2 weeks and 4 weeks, indicating active bone formation in these groups. Conclusion: The immediate placement of titanium implants in the maxilla of diabetic rat led to an unwanted bone healing response. Conclusively, the results of this study suggest that immediate implant insertion in patients with poorly controlled diabetes might be contraindicated.

• Journal of Periodontal and Implant Science
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• 제45권4호
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• pp.128-135
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• 2015

Purpose: The aim of this study was to determine the effect of overlaying titanium mesh (TM) with an adjunctive collagen membrane (CM) for preserving the buccal bone when used in association with immediate implant placement in dogs. Methods: Immediate implant placements were performed in the mesial sockets of the third premolars of five dogs. At one site the TM was attached to the fixture with the aid of its own stabilizers and then covered by a CM (CM group), while the contralateral site received only TM (TM group). Biopsy specimens were retrieved for histologic and histomorphometric analyses after 16 weeks. Results: All samples exhibited pronounced buccal bone resorption, and a high rate of TM exposure was noted (in three and four cases of the five samples in each of the TM and CM groups, respectively). A dense fibrous tissue with little vascularity or cellularity had infiltrated through the pores of the TM irrespective of the presence of a CM. The distances between the fixture platform and the first bone-implant contact and the bone crest did not differ significantly between the TM and CM groups. Conclusions: Our study suggests that the additional use of a CM over TM does not offer added benefit for mucosal healing and buccal bone preservation.

• 대한치과보철학회지
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• 제61권1호
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• pp.26-32
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• 2023

활동이 많은 소아 청소년 시기에는 치아의 외상이 흔하게 발생한다. 그 중 탈구로 인해 유착이 일어날 경우 임상검사를 통한 진단이 중요하며 성인이 된 후 심미적인 보철 수복을 위해서는 진단에 따른 치료가 중요하다. 본 증례는 외상으로 인해 유착된 치아를 치관절제술과 임플란트 식립을 통한 상악 전치부 심미 보철 수복 증례이다. 치관절제술 후 치관을 이용하여 보철 수복을 위한 공간 유지를 시행하였다. 성인이 된 후 guide surgery를 이용하여 정교한 임플란트 식립과 심미적인 보철 수복을 가능하게 하였으며, 상악 전치부임을 고려하여 원발성 안정성(primary stability) 확인 후 즉시 부하(immediate loading)를 시행하였다. 연조직 지지를 위해 임시치아의 윤곽 변화를 주며 임시치아를 교체하였고 digital wax-up 하여 최종 보철물을 수복하였다.

• The Journal of Advanced Prosthodontics
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• 제8권5호
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• pp.363-371
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• 2016

PURPOSE. On maxillofacial tumor patients, oral implant placement prior to postoperative radiotherapy can shorten the period of prosthetic reconstruction. There is still lack of research on effects of post-implant radiotherapy such as healing process or loading time, which is important for prosthodontic treatment planning. Therefore, this study evaluated the effects of post-implant local irradiation on the osseointegration of implants during different healing stages. MATERIALS AND METHODS. Custom-made implants were placed bilaterally on maxillary posterior edentulous area 4 weeks after extraction of the maxillary first molars in Forty-eight Sprague-Dawley rats. Experimental group (exp.) received radiation after implant surgery and the other group (control) didn't. Each group was divided into three sub-groups according to the healing time (2, 4, and 8 week) from implant placement. The exp. group 1, 2 received 15-Gy radiation 1 day after implant placement (immediate irradiation). The exp. group 3 received 15-Gy radiation 4 weeks after implant placement (delayed irradiation). RESULTS. The bone mineral density (BMD) was significantly lower in the immediate irradiation groups. BMD was similar in the delayed irradiation group and the control group. The irradiated groups exhibited a lower bone-to-implant contact ratio, although the difference was not statistically significant. The irradiated groups also exhibited a significantly lower bone volume and higher empty lacuna count than the control groups. No implant failure due to local irradiation was found in this study. CONCLUSION. Within the limits of this study, the timing of local irradiation critically influences the bone healing mechanism, which is related to loading time of prostheses.