• The Journal of Advanced Prosthodontics
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• 제4권4호
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• pp.227-234
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• 2012

PURPOSE. The aims of this pilot study were to introduce implant loading devices designed for animal study and to evaluate the validity of the load transmission ability of the loading devices. MATERIALS AND METHODS. Implant loading devices were specially designed and fabricated with two implant abutments and cast metal bars, and orthodontic expansion screw. In six Beagles, all premolars were extracted and two implants were placed in each side of the mandibles. The loading device was inserted two weeks after the implant placement. According to the loading protocol, the load was applied to the implants with different time and method, simulating early, progressive, and delayed loading. The implants were clinically evaluated and the loading devices were removed and replaced to the master cast, followed by stress-strain analysis. Descriptive statistics of remained strain (${\mu}{\varepsilon}$) was evaluated after repeating three cycles of the loading device activation. Statistic analysis was performed using nonparametric, independent t-test with 5% significance level and Friedman's test was also used for verification. RESULTS. The loading devices were in good action. However, four implants in three Beagles showed loss of osseointegration. In stress-strain analysis, loading devices showed similar amount of increase in the remained strain after applying 1-unit load for three times. CONCLUSION. Specialized design of the implant loading device was introduced. The loading device applied similar amount of loads near the implant after each 1-unit loading. However, the direction of the loads was not parallel to the long axis of the implants as predicted before the study.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권1호
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• pp.30-35
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• 2011

Introduction: Dental implants are used routinely with high success rates in generally healthy individuals. By contrast, their use in patients with diabetes mellitus is controversial because altered bone healing around implants has been reported. This study examined the bone healing response around titanium implants placed immediately in rats with controlled and uncontrolled diabetes. Materials and Methods: Twenty rats 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. A titanium implant ($1.2{\times}3\;mm$) was placed in the extraction socket of the maxillary first molar and bone block was harvested at 1, 2 and 4 weeks. Results: Bone formation around the implants was consistently (from 1 to 4 week post-implantation) slower for the diabetic group than the control and insulin-treated group. Bone morphogenesis in the diabetic rats was characterized by fragmented bone tissues and extensive soft tissue intervention. Conclusion: The immediate placement of titanium implants in the maxilla of diabetic rats led to an unwanted bone healing response. These results suggest that immediate implant insertion in patients with poorly controlled diabetes might be contraindicated.

• Imaging Science in Dentistry
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• 제44권2호
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• pp.129-135
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• 2014

Purpose: The objective of this study was to assess the trabecular bone changes that occurred around functional endosseous dental implants by means of radiographic image analysis techniques. Materials and Methods: Immediate preoperative and postoperative periapical radiographs of de-identified implant patients at the University Dental Hospital of Manchester were retrieved, screened for specific inclusion criteria, digitized, and quantified for structural elements of the trabecular bone around the endosseous implants, by using image analysis techniques. Data were analyzed using SPSS version 11.5. P values of less than 0.05 were considered statistically significant. Results: A total of 12 implants from 11 patients were selected for the study, and 26 regions of interest were obtained. There was a significant increase in the bone area in terms of the mean distance between nodes (p=0.006) and a significant decrease in the marrow area in terms of the bone area (p=0.006) and the length of marrow spaces (p=0.032). Conclusion: It appeared that the bone around the implant underwent remodeling that resulted in a net increase in bone after implant placement.

• 대한심미치과학회지
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• 제32권1호
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• pp.16-22
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• 2023

상악 전치부 임플란트 수복의 성공에 있어서 심미적인 요소는 매우 중요한 부분입니다. 하지만 심미적인 결과를 얻는 것은 쉬운 일이 아니며 특히 치주염으로 인해 치조골 소실이 심하게 발생한 경우라면 더욱 그러합니다. 상악 전치부의 경우, 발치 직후부터 시작되는 치주 조직의 위축이 심미적 수복을 방해하므로 이를 최소화하기 위해 발치 즉시 임플란트를 시행하기도 합니다. 하지만 치조골 소실이 심한 경우 발치 즉시 식립은 심미적 실패를 가져올 가능성이 있고, 이런 결과는 돌이킬 수 없는 문제를 야기합니다. 그래서 치조제 보존술(Alveolar ridge preservation)을 시행하고 이후에 임플란트를 식립하는 방법으로 접근하기도 합니다. 2019년 JCP에 발치 후 임플란트 식립 시기와 발치와 처치에 대한 유럽치주학회의 consensus가 수록되어 있는데 여기서도 '심미적으로 중요한 부위에서 순측 치조골의 소실이 심하게 발생한 경우 치조제 보존술을 고려해야 한다고 언급하고 있습니다. 치조제 보존술을 하게 되면 primary closure가 어렵기 때문에 open membrane technique으로 이차치유를 유도하거나 FGG, CT graft를 시행하게 됩니다. 하지만 이차 치유 과정은 골재생에 부정적인 영향을 줄 수 있고, 연조직 이식은 환자와 술자에게 부담이 될 수 있습니다. 반면 치조골 결손이 심한 발치와에 있는 육아 조직(Granulation tissue)을 이용하게 되면 연조직 이식 없이도 primary closure를 얻을 수 있습니다. 또한 육아 조직에 조직 재생에 도움이 될 수 있는 줄기세포가 함유되어 있다는 연구들이 있습니다. 이를 근거로 치조골 및 연조직 결손이 심한 상악 전치부 치아를 육아 조직을 이용한 치조제 보존술을 통해 임플란트 수복을 시행하였습니다. 결손이 심한 발치와임에도 불구하고 비교적 심미적인 임플란트 수복 결과를 얻을 수 있었습니다.

• 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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• 제9권5호
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• pp.381-386
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• 2017

PURPOSE. To integrate extra-oral facial scanning information with CAD/CAM complete dentures to immediately rehabilitate terminal dentition. MATERIALS AND METHODS. Ten patients with terminal dentition scheduled for total extraction and immediate denture placement were recruited for this study. The patients were submitted to a facial scanning procedure using the in-office PritiMirror scanner with bite registration records in-situ. Definitive stone cast models and bite records were subsequently submitted to a lab scanning procedure using the lab scanner (iSeries DWOS; Dental Wings). The scanned models were used to create a virtual teeth setup of a complete denture. Using the intra-oral bite records as a reference, the virtual setup was incorporated in the facial scan thereby facilitating a virtual clinical evaluation (teeth try-in) phase. After applying necessary adjustments, the virtual setup was submitted to a CAM procedure where a 5-axis industrial milling machine (M7 CNC; Darton AG General) was used to fabricate a full-milled PMMA immediate provisional prosthesis. RESULTS. Total extractions were performed, the dentures were immediately inserted, and subjective clinical fit was evaluated. The immediate provisional prostheses were inserted and clinical fit, occlusion/articulation, and esthetics were subjectively assessed; the results were deemed satisfactory. All provisional prostheses remained three months in function with no notable technical complications. CONCLUSION. Ten patients with terminal dentition were treated using a complete digital approach to fabricate complete dentures using CAD/CAM technology. The proposed technique has the potential to accelerate the rehabilitation procedure starting from immediate denture to final implant-supported prosthesis leading to more predictable functional and aesthetics outcomes.

• 대한치과보철학회지
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• 제49권1호
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• pp.29-37
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• 2011

연구 목적: 양악 총의치를 사용 중인 환자를 대상으로 하악에 4개의 작은 직경의 임플란트를 식립하여 implant supported overdenture로 전환 시 환자의 만족도 (저작, 유지, 발음, 심미, 사회적 문제, 심리적 문제)를 평가하였다. 연구 재료 및 방법: 60세 이상의 완전 무치악 환자 중 상하악 총의치를 장착한 환자를 대상으로 하였다. 수술 전에 진단 스텐트를 이용한 방사선 사진 (CT, panorama) 촬영을 시행하고 현재 사용하고 있는 의치에 대한 만족도에 대해 조사하였다. 그 후 하악 이공 전방부에 4개의 mini dental implant 식립 및 immediate loading 후 방사선 사진 촬영을 하였다. 식립 1달 후와 3달 후에 방사선 사진을 촬영하였으며 수술 전과 동일한 설문지를 통한 overdenture 사용 시 만족도 조사하였다. 결과: 현재 9명의 환자를 대상으로 시행하였다. 1. 총 36개의 임플란트를 식립하였으며 이중 1개의 임플란트가 실패하여 97.2%의 생존률을 보였다. 2. 임플란트 식립 전, 후 만족도 비교는 oral health impact profile 49를 이용한 설문 조사를 통해 이루어 졌다. 저작 시 불편감, 유지, 발음, 심미, 사회적 활동시 불편감, 심리적 불편감 등으로 비교 분석하였으며 5점 기준으로 불편감이 심할 수록 낮은 점수를 부여하였다. 그 결과 전반적으로 만족도가 상승하였다. 그 중 유지력 면에서 가장 크게 만족도가 상승하였으며 사회활동시 불편감, 심리적 불편감, 저작시 불편감, 심미, 발음 순으로 개선되었다. 결론: 이번 연구를 통하여 mini dental implant를 이용한 의치를 사용시 환자의 만족도가 높아진 것을 볼 수 있었다. 추 후 좀 더 많은 환자를 통해 장기간 연구를 할 예정이며 추가적인 방사선 사진을 촬영하여 임플란트 주위 골 소실 여부를 관찰할 예정이다.

• 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.

• 대한심미치과학회지
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• 제26권1호
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• pp.17-23
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• 2017

임플란트 식립시기가 심미적인 부분에 영향을 미치는 것에 대한 연관성을 평가하기 위해 전치부 영역에 식립된 34개의 임플란트 (27명 환자)를 후향적으로 조사했다. 즉시, 조기 및 지연식립으로 시기별로 그룹을 나누고 모든 환자를 보철완료 1년후에 연조직 평가를 시행했다. 통계적으로 그룹별 유의한 의미는 없었다. 식립 시기에 상관없이 만족할 만한 최종결과를 위해 다양한 골이식술과 연조직 이식술이 이루어졌다. 즉, 식립시기로 그 결과를 결정지을 수 없다는 점은 다각적인 면에서 고려사항이 요구된다는 점을 시사한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.27.1-27.9
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• 2019

Background: Implants are becoming the first choice of rehabilitation for tooth loss. Even though they have a high success rate, failures still occur for many reasons. The objective of this study is to analyze the reasons for recurring failure at the same site and the results of re-implantation. Methods: Thirteen patients (11 males and 2 females, mean age 60 ± 9.9 years) who experienced implant surgery failure at the same site (same tooth extraction area) two or more times in the Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, between 2004 and 2017 were selected. The medical records on a type, sites, diameter, and length of implants; time and estimated cause of failure; and radiographs were reviewed. Data were collected and analyzed retrospectively, and the current statuses were evaluated. Results: A total of 14 implants experienced failure in the same site more than two times. Twelve implants were placed in the maxilla, while 2 implants were placed in the mandible. The maxillary molar area was the most common site of failure (57.1%), followed by the mandibular molar, anterior maxilla, and premolar areas (14.3% each). The first failure occurred most commonly after prosthetic treatment (35.7%) with an average period of failure of 3.8 months after loading. Ten cases were treated as immediate re-implantation, while the other 4 were delayed reimplantation after an average of 3.9 months. The second failure occurred most commonly after prosthetic treatment (42.9%), with an average of 31 months after loading; during the healing period (42.9%); and during the ongoing prosthetic period (14.3%). In 3 cases (21.4%), the treatment plan was altered to an implant bridge, while the other 11 cases underwent another implant placement procedure (78.6%). Finally, a total of 9 implants (64.3%) survived, with an average functioning period of 60 months. Conclusions: Implants can fail repeatedly at the same site due to overloading, infection, and other unspecified reasons. The age and sex of the patient and the location of implant placement seem to be associated with recurring failure. Type of implant, bone augmentation, and bone materials used are less relevant.