• The Journal of Korean Academy of Prosthodontics
• /
• v.30 no.4
• /
• pp.582-610
• /
• 1992

The long-term success of any dental implant is dependent upon the optimization of stresses which occur during oral function and parafunction. Especially, it has been suggested that there is an unique set of problems associated with joining an osseointegrated implant and a natural tooth with a fixed partial denture. For this particular case, although many literatures suggest different ways to avoid high stress concentrations on the bone surrounding the implant under static and dynamic loading conditions, but few studies on the biomechanical efficacy of each assertion have been reported. The purpose of this investigation was to evaluate the efficacies of clinically suggested methods on stress distribution under static load and shock absorption under dynamic load, using two dimensional finite element method. In FEM models of osseointegrated implant-natural tooth supported fixed partial dentures, calculations were made on the stresses in surrounding bone and on the deflections of abutments and superstructure, first, to compare the difference in stress distribution effects under static load by the flexure of fastening screw or prosthesis, or intramobile connector, and second, to compare the difference in the shock absorption effects under dynamic load by intramobile connector or occlusal veneering with composite resin. The results of this analysis suggest that : 1. Under static load condition, using an implant design with fastenign screw connecting implant abutment and prosthesis or increasing the flexibility of fastening screw, or increasing the flexibility of prosthesis led to the .increase in height of peak stresses in cortical bone surrounding the implant, and has little effect on stress change in bone around the natural tooth. 2. Under static load condition, intramobile connector caused the substantial decrease in stress concentration in cortical bone surrounding the implant and the slight increase in stress in bone around the natural tooth. 3. Under dynamic load condition, both intramobile connector and composite resin veneering showed shock absorption effect on bone surrounding the implant and composite resin veneering had a greater shock absorption effect than intramobile connector.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.29 no.3
• /
• pp.209-223
• /
• 2013

This study was to evaluate the stress distributions of prefabricated, customized abutments and fixtures according to their material and shape by three-dimensional finite element analysis. And to investigate the fatigue life and fracture characteristics. Mandibular models were fabricated by reconstruction of the CT scan of patients with normal occlusion. A total of six finite element models were designed, a load of 100 N was applied on the buccal cusps vertically, and 30 degree obliquely. 10 specimens each were fabricated for the more clinically widely used 4 type abutments and were loaded according to ISO 14801. Differences in stress distribution patterns were not found according to the materials of the abutments and fixtures. But a slight difference in the stress level was detected. Customized abutment groups showed lower crown stress levels. One-piece zirconia implant showed the lowest bone stress levels. In the fatigue test, highest values were measured in group 7. Prefabricated abutments showed less variation of fatigue life (P<0.05). Use of customized abutments can improve the fracture resistance of restorations. Especially, use of customized zirconia abutments reinforced by titanium screw connecting parts is recommended.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.26 no.2
• /
• pp.179-195
• /
• 2010

In the internal connection system, the loading transfer mechanism within the inner surface of the implant and also the stress distribution occuring to the mandible can be changed according to the abutment form. Therefore it is thought to be imperative to study the difference of the stress distribution occuring at the mandible according to the abutment form. The purpose of this study was to assess the loading distributing characteristics of three different abutments for GS II$^{(R)}$ implant fixture(Osstem, Korea) under vertical and inclined loading using finite element analysis. Three finite element models were designed according to three abutments; 2-piece Transfer$^{TM}$ abutment made of pure titanium(GST), 2-piece GoldCast$^{TM}$ abutment made of gold alloy(GSG), 3-piece Convertible$^{TM}$ abutment with external connection(GSC). This study simulated loads of 100N in a vertical direction on the central pit(load 1), on the buccal cusp tip(load 2) and $30^{\circ}$ inward inclined direction on the central pit(load 3), and on the buccal cusp tip(load 4). The following results were obtained. 1. Without regard to the loading condition, greater stress was concentrated at the cortical bone contacting the upper part of the implant fixture and lower stress was taken at the cancellous bone. 2. When off-axis loading was applied, high stress concentration observed in cervical area. 3. GSG showed even stress distribution in crown, abutment and fixture. GST showed high stress concentration in fixture and abutment screw. GSC showed high stress concentration in fixture and abutment. 4. Maximum von Mises stress in the surrounding bone had no difference among three abutment type. In GS II$^{(R)}$ conical implant system, different stress distribution pattern was showed according to the abutment type and the stress-induced pattern at the supporting bone according to the abutment type had no difference among them.

• Journal of Periodontal and Implant Science
• /
• v.40 no.4
• /
• pp.194-200
• /
• 2010

Purpose: There is no consensus regarding the relationship between the width of keratinized mucosa and the health of periimplant tissues, but clinicians prefer to provide enough keratinized mucosa around dental implants for long-term implant maintenance. An apically positioned flap during second stage implant surgery is the chosen method of widening the keratinized zone in simple procedures. However, the routine suture techniques used with this method tend to apply tension over the provisional abutments and decrease pre-existing keratinized mucosa. To overcome this shortcoming, a pre-fabricated implant-retained stent was designed to apply vertical pressure on the labial flap and stabilize it in a bucco-apical direction to create a wide keratinized mucous zone. Methods: During second stage implant surgery, an apically displaced, partial thickness flap with a lingualized incision was retracted. A pre-fabricated stent was clipped over the abutments after connecting to the provisional abutment. Vertical pressure was applied to displace the labial flap. No suture was required and the stent was removed after 10 days. Results: A clinically relevant amount of keratinized mucosa was achieved around the dental implants. Buccally displaced keratinized mucosa was firmly attached to the underlying periosteum. A slight shrinkage of the keratinized zone was noted after the healing period in one patient, but no discomfort during oral hygiene was reported. Clinically healthy gingiva with enough keratinized mucosa was achieved in both patients. Conclusions: The proposed technique is a simple and time-effective technique for preserving and providing keratinized tissue around dental implants.

• Journal of Periodontal and Implant Science
• /
• v.49 no.3
• /
• pp.171-184
• /
• 2019

Purpose: To evaluate the effects of intra-alveolar socket grafting, subepithelial connective tissue grafts, and individualized abutments on peri-implant hard and soft tissue outcomes following immediate implant placement. Methods: This randomized experimental study employed 5 mongrel dogs, with 4 sites per dog (total of 20 sites). The mesial roots of P3 and P4 were extracted in each hemimandible and immediate dental implants were placed. Each site was randomly assigned to 1 of 4 different treatment groups: standardized healing abutment (control group), alloplastic bone substitute material (BSS) + standardized healing abutment (SA group), BSS + individualized healing abutment (IA group), and BSS + individualized healing abutment + a subepithelial connective tissue graft (IAG group). Clinical, histological, and profilometric analyses were performed. The intergroup differences were calculated using the Bonferroni test, setting statistical significance at P<0.05. Results: Clinically, the control and SA groups demonstrated a coronal shift in the buccal height of the mucosa ($0.88{\pm}0.48mm$ and $0.37{\pm}1.1mm$, respectively). The IA and IAG groups exhibited an apical shift of the mucosa ($-0.7{\pm}1.15mm$ and $-1.1{\pm}0.96mm$, respectively). Histologically, the SA and control groups demonstrated marginal mucosa heights of $4.1{\pm}0.28mm$ and $4.0{\pm}0.53mm$ relative to the implant shoulder, respectively. The IA and IAG groups, in contrast, only showed a height of 2.6mm. In addition, the height of the mucosa in relation to the most coronal buccal bone crest or bone substitute particles was not significantly different among the groups. Volumetrically, the IA group ($-0.73{\pm}0.46mm$) lost less volume on the buccal side than the control ($-0.93{\pm}0.44mm$), SA ($-0.97{\pm}0.73mm$), and IAG ($-0.88{\pm}0.45mm$) groups. Conclusions: The control group demonstrated the most favorable change of height of the margo mucosae and the largest dimensions of the peri-implant soft tissues. However, the addition of a bone substitute material and an individualized healing abutment resulted in slightly better preservation of the peri-implant soft tissue contour.

• The Journal of Korean Academy of Prosthodontics
• /
• v.60 no.1
• /
• pp.19-28
• /
• 2022

In removable partial dentures, abutment teeth are essential for support, maintenance, and stability of partial dentures, and are an important factor in the fabrication of functional dentures. If the number of periodontally sound abutments is sufficient and they are located on both sides, it will be easy to manufacture functional dentures with good support, maintenance, and stability. But on the contrary, if the number of teeth is insufficient or if they are located on one side, it is biomechanically disadvantageous and relatively difficult to make functional denture. On the other hand, recently, implant-supported removable dentures, which reinforce the three elements of maintenance, support, and stability by using implant surveyed crown, have been frequently selected as treatment plans. In particular, by adding an implant surveyed crown when only a small number of residual teeth remain, mastication efficiency, esthetics, patient comfort, and pronunciation can be improved. In this case, bilateral posterior extension partial denture was fabricated using implant surveyed crown as abutments by placing implants in the premolars area opposite to the residual tooth unilaterally in the mandible. As a result, the asymmetry of the abutment was resolved, and the maintenance and stability of the denture was achieved.

• Journal of the Korean Ceramic Society
• /
• v.41 no.7
• /
• pp.508-512
• /
• 2004

For abutment of dental implants, (Y, Nb)-TZP/Alumina composites were prepared by addition of 10-90 vol% alumina at an interval of 10 vol％ into tetragonal zirconia solid solution which consists of 90.24 mol% Zr $O_2$, 5.31 mol% Y$_2$ $O_3$, and 4.45 mol% Nb$_2$O$\_$5/. Biaxial flexure strength and fracture toughness of composite were optimized by adding 10 vol% alumina, which resulted in 900 MPa and 8.9 MPam$\^$1/2/, respectively. The composite did not undergo low temperature degradation even after autoclave treatment at 200$^{\circ}C$ for 10 h. 65 of (Y, Nb)-TZP/Alumina composite abutments were employed into 40 patients and any adverse reaction, screw loosing, or fracture of abutments was not observed for the span of 2 years, indicating that the ceramic abutments can be safely used for restorations.

• Structural Engineering and Mechanics
• /
• v.74 no.4
• /
• pp.567-576
• /
• 2020

Considerable controversy surrounds the choice of the best abutment type for implant prosthetics. The two most common structures are hex and non-hex abutments. The non-hex abutment typically furnishes a larger contact area between itself and the implant than that provided by a hex structure. However, when a hex abutment is loaded, the position of its contact area may be deeper than that of a non-hex abutment. Hence, the purpose of this study is to determine the different biomechanical behaviors of an internal bone-level implant based on the abutment type-hex or non-hex-and clinical crown length under static and cyclic loadings using finite element analysis (FEA). The hex structure was found to increase the implant and abutment stability more than the nonhex structure among several criteria. The use of the hex structure resulted in a smaller volume of bone tissues being at risk of hypertrophy and fatigue failure. It also reduced micromovement (separation) between the implant components, which is significantly related to the pumping effect and possible inflammation. Both static and fatigue analyses, used to examine short- and long-term stability, demonstrated the advantages of the hex abutment over the non-hex type for the stability of the implant components. Moreover, although its impact was not as significant as that of the abutment type, a large crown-implant ratio (CIR) increased bone strain and stress in the implant components, particularly under oblique loading.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.36 no.4
• /
• pp.289-295
• /
• 2020

Improving implant esthetics is very difficult, especially in cases where unaesthetic problems are related to implants in the maxillary anterior dentition. A 69-year old male patient was referred by a prosthodontist for periodic pus discharge and an unaesthetic implant prosthesis (maxillary right lateral incisor). The implant was placed too deeply and showed soft tissue volume deficiency and a long clinical crown. After a clinical and radiographic examination, implant submergence and alveolar ridge augmentation were performed to enhance the aesthetics instead of an explantation. The treatment plan was as follows: extraction the adjacent teeth with tooth mobility, secondary caries, and poor prognosis; placement an additional dental implant with hard and soft tissue grafting; fabrication a fixed bridge using implant abutments. A fixed esthetic prosthesis using implants was fabricated, and the patient was satisfied with the prosthesis. A ridge augmentation with implant submergence may be an alternative for solving the problems of unaesthetic implant restorations in the esthetic zone.

• The Journal of Advanced Prosthodontics
• /
• v.6 no.3
• /
• pp.233-240
• /
• 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.