• The Journal of Advanced Prosthodontics
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• v.11 no.5
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• pp.271-279
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• 2019

PURPOSE. The newest technologies for digital implant impression (DII) taking are developing rapidly and showing acceptable clinical results. However, scientific literature is lacking data from clinical studies about the accuracy of DII. The aim of this study was to compare digital and conventional dental implant impressions (CII) in a clinical environment. MATERIALS AND METHODS. Twenty-four fixed zirconia restorations supported by 2 implants were fabricated using conventional open-tray impression technique with splinted transfers (CII group) and scan with Trios 3 IOS (3Shape) (DII group). After multiple verification procedures, master models were scanned using laboratory scanner D800 (3Shape). 3D models from conventional and digital workflow were imported to reverse engineering software and superimposed with high resolution 3D CAD models of scan bodies. Distance between center points, angulation, rotation, vertical shift, and surface mismatch of the scan bodies were measured and compared between conventional and digital impressions. RESULTS. Statistically significant differences were found for: a) inter-implant distance, b) rotation, c) vertical shift, and d) surface mismatch differences, comparing DII and CII groups for mesial and distal implant scan bodies ($P{\leq}.05$). CONCLUSION. Recorded linear differences between digital and conventional impressions were of limited clinical significance with two implant-supported restorations.

• The korean journal of orthodontics
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• v.45 no.6
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• pp.289-298
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• 2015

Objective: To evaluate and compare the effects of two appliances on the en masse retraction of the anterior teeth anchored by temporary skeletal anchorage devices (TSADs). Methods: The sample comprised 46 nongrowing hyperdivergent adult patients who planned to undergo upper first premolar extraction using lingual retractors. They were divided into three groups, based on the lingual appliance used: the C-lingual retractor (CLR) group (group 1, n = 16) and two antero-posterior lingual retractor (APLR) groups (n = 30, groups 2 and 3). The APLR group was divided by the posterior tube angulation; posterior tube parallel to the occlusal plane (group 2, n = 15) and distally tipped tube (group 3, n = 15). A retrospective clinical investigation of the skeletal, dental, and soft tissue relationships was performed using lateral cephalometric radiographs obtained pretreatment and post en masse retraction of the anterior teeth. Results: All groups achieved significant incisor and canine retraction. The upper posterior teeth did not drift significantly during the retraction period. The APLR group had less angulation change in the anterior dentition, compared to the CLR group. By changing the tube angulation in the APLR, the intrusive force significantly increased in the distally tipped tube of group 3 patients and remarkably reduced the occlusal plane angle. Conclusions: Compared to the CLR, the APLR provides better anterior torque control and canine tipping while achieving bodily translation. Furthermore, changing the tube angulation will affect the amount of incisor intrusion, even in patients with similar palatal vault depth, without the need for additional TSADs.

• Journal of Dental Rehabilitation and Applied Science
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• v.36 no.2
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• pp.88-94
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• 2020

Purpose: The purpose of this study was to analyze the sagittal root position of maxillary anterior teeth and report the frequency of each classification in Korean for immediate implant placement. Materials and Methods: A retrospective review of cone-beam computed tomography (cone-beam CT) images was conducted on 120 patients (60 male and 60 female) who fulfilled the inclusion criteria. After reorientation of the axis, cone-beam CT images were evaluated and the relationship of the sagittal root position (SRP) of the maxillary anterior teeth to its associated osseous housing was recorded. Class I, II, and III were classified respectively when the root was positioned on the labial, central, and palatal aspect of the alveolar bone. Class IV was the position that at least two thirds of the root is engaging both the labial and palatal cortical plates. Then, the angulation of the root axis and the alveolar bone axis was measured. Descriptive statistics and Kruskal-Wallis test were used to compare the angulation according to the root position and SRP class. Results: The frequency distribution of sagittal root position of maxillary anterior teeth indicated that 81.1%, 10.3%, 1.9%, and 6.7% were classified as Class I, II, III, and IV, respectively. The sagittal angulation at approximately 77.5% of central incisor, lateral incisor, and canine was < 20 degrees, but the angle at more than 42.7% of canine was ≥ 20 degrees. Within the class, the angulation was statistically significantly greater in Class I (16.19) compared to Class II (8.72) and Class III (9.93), and smaller in Class IV (3.79). Conclusion: Within the limitation of this study, a majority of the maxillary anterior roots were positioned close to the buccal cortical plate. However, some roots have very thin alveolar bone and sagittal angulation larger than 30 degrees. Therefore, cone-beam CT analyses of the sagittal root position and the sagittal angulation are recommended for the selection of the appropriate dental implant treatment approach.

• The Journal of Advanced Prosthodontics
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• v.8 no.2
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• pp.131-136
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• 2016

PURPOSE. The aim of this study was to observe stress concentration in the implant, the surrounding bone, and other components under the pull-out force during the crown removal. MATERIALS AND METHODS. Two 3-dimensional models of implant-supported conventional metal ceramic crowns were digitally constructed. One model was designed as a vertically placed implant ($3.7mm{\times}10mm$) with a straight abutment, and the other model was designed as a 30-degree inclined implant ($3.7mm{\times}10mm$) with an angled abutment. A pull-out force of 40 N was applied to the crown. The stress values were calculated within the dental implant, the abutment, the abutment screw, and the surrounding bone. RESULTS. The highest stress concentration was observed at the coronal portion of the straight implant (9.29 MPa). The stress concentrations at the cortical bone were lower than at the implants, and maximum stress concentration in bone structure was 1.73 MPa. At the abutment screws, the stress concentration levels were similiar (3.09 MPa and 3.44 MPa), but the localizations were different. The stress at the angled abutment was higher than the stress at the straight abutment. CONCLUSION. The pull-out force, applied during a crown removal, did not show an evident effect in bone structure. The higher stress concentrations were mostly observed at the implant and the abutment collar. In addition, the abutment screw, which is the weakest part of an implant system, also showed stress concentrations. Implant angulation affected the stress concentration levels and localizations. CLINICAL IMPLICATIONS. These results will help clinicians understand the mechanical behavior of cement-retained implant-supported crowns during crown retrieval.

• The Journal of the Korean dental association
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• v.58 no.2
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• pp.83-92
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• 2020

In the anterior maxillary area, dental implants for tooth replacement are challenging due to the need to satisfy high esthetic level as well as functionality. Immediate implant placement and provisionalization can dramatically reduce the edentulous period, and then fulfill patient's demand for esthetics. The aim of present case report is to demonstrate two cases that successfully restored single tooth with immediate implant placement and provisionalization in the anterior maxillary area. A 47 years old female was scheduled to replace her maxillary right central incisor due to crown-root fracture by trauma. Another 54-year-old female was planned to place dental implant following tooth extraction of maxillary right lateral incisor owing to continuous pus discharge despite repetitive treatments including apicoectomy. In these two cases, surgical and prosthetic procedures progressed in a similar way. After minimal flap elevation, atraumatic tooth extraction was performed. Implant was placed in proper 3-dimensional position and angulation with primary stability. Bone graft or guided bone regeneration for peri-implant bone defect was conducted simultaneously. Provisionalization without occlusal loading was carried out at the same day. Each definitive crown was delivered at 7 and 5 months after the surgery. Two cases have been followed uneventfully for 2 to 5 years of loading time. In conclusion, Immediate implant placement and provisionalization could lead to esthetic outcome for single tooth replacement with dental implant under proper case selection.

• The Journal of Korean Academy of Prosthodontics
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• v.38 no.4
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• pp.552-560
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• 2000

Purpose : The purpose of this study was to determine proper position and angulation of an implant for immediate implantation. Materials and Method : From the years 1997 to 2000. 52 Denta $scan^R$ views, 22 upper and 32 lower jaw with an average age of 43 and 40 respectively, were investigated, which comprise intact upper and lower 6 anterior teeth and premolars. On the Denta $scan^R$, the optimal placement for the immediated implantation was simulated. The measuring methods included 1) Angulation difference between tooth long axis and alveolar bone process. 2) Angulation difference of long axis between tooth and installing fixture 3) Distance between center of tooth at cervical area and center of fixture. 4) Distance from root apex to the bone limit of vital structure. One sample t-test was used for statistical analysis. Result : The results were as follows. 1) At the maxillary central incisor and lateral incisor, angulation difference of long axis between tooth and installing fixture was respectively 0.5 and 3.2 degrees with the fixture center's palatally positioned 2mm apart from tooth center. 2) At the lower anterior 6 teeth, that was about $-2.8^{\circ}\;to\;-4.6^{\circ}$ with the fixture center's lingually positioned 1mm apart from tooth center. 3) At the maxillary canine and premolar, that was respectively $11.8^{\circ}\;and \;7.2^{\circ}$ with the fixture center palatally positioned $2\sim2.4mm$ apart from tooth center. 4) At the lower premolar area, that was about $0^{\circ}\;to\;2^{\circ}$ with the fixture center's lingually positioned $0.5{\sim}1mm$ apart from tooth center. 5) Distance from root apex to the bone limit of vital structure, at the maxillary anterior and premolars. was the range of 10 to 12mm, and at the mandibular anterior teeth and the 1st premolar, that was the range of 18 to 20mm. Conclusion : The proper implant position of maxillary anterior and premolar teeth is as paralleled as or more buccally angulated than long axis of tooth with the fixture center's palatally positioned. In mandiblular anterior region, long axis of implants is lingully angulated compared with long axis of tooth and in premolar, almost parelleled with long axis of tooth and alveolar process.

• Imaging Science in Dentistry
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• v.42 no.3
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• pp.139-146
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• 2012

Purpose: An individual surgical stent fabricated from computed tomography (CT) data, called a CT-guided stent, would be useful for accurate installation of implants. The purpose of the present study was to introduce a newly developed CT-guided stent with a simple design and evaluate the accuracy of the stent placement. Materials and Methods: A resin template was fabricated from a hog mandible and a specially designed plastic plate, with 4 metal balls inserted in it for radiographic recognition, was attached to the occlusal surface of the template. With the surgical stent applied, CT images were taken, and virtual implants were placed using software. The spatial positions of the virtually positioned implants were acquired and implant guiding holes were drilled into the surgical stent using a specially designed 5-axis drilling machine. The surgical stent was placed on the mandible and CT images were taken again. The discrepancy between the central axis of the drilled holes on the second CT images and the virtually installed implants on the first CT images was evaluated. Results: The deviation of the entry point and angulation of the central axis in the reference plane were $0.47{\pm}0.27$ mm, $0.57{\pm}0.23$ mm, and $0.64{\pm}0.16^{\circ}$, $0.57{\pm}0.15^{\circ}$, respectively. However, for the two different angulations in each group, the $20^{\circ}$ angulation showed a greater error in the deviation of the entry point than did the $10^{\circ}$ angulation. Conclusion: The CT-guided template proposed in this study was highly accurate. It could replace existing implant guide systems to reduce costs and effort.

• The Journal of Advanced Prosthodontics
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• v.13 no.6
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• pp.343-350
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• 2021

PURPOSE. The success of an implant-prosthetic rehabilitation is influenced by good implant health and an excellent implant-prosthetic coupling. The stability of implant-prosthetic connection is influenced by the rotational tolerance between anti-rotational features on the implant and those on the prosthetic component. The aim of this study is to investigate the rotational tolerance of a conical connection implant system and its titanium abutment counterpart, in various conditions. MATERIAL AND METHODS. 10 preparable titanium abutments, having zero-degree angulation (MegaGen, Daegu, Korea) with an internal 5-degree conical connection, and 10 implants (MegaGen, Daegu, Korea) were used. Rotational tolerance between the connection of implant and titanium abutments was measured through the use of a tridimensional optics measuring system (Quick Scope QS250Z, Mitutoyo, Kawasaki, Japan) in the as-received condition (Time 0), after securing with a titanium screw tightening at 35 Ncm (Time 1), after tightening 4 times at 35 Ncm (Time 2), after tightening one more time at 45 Ncm (Time 3), and after tightening another 4 times at 45 Ncm (Time 4). RESULTS. The group "Time 0" had the lowest values of rotational freedom (0.22 ± 0.76 degrees), followed by the group Time 1 (0.46 ± 0.83 degrees), the group Time 2 (1.01 ± 0.20 degrees), the group Time 3 (1.30 ± 0.85 degrees), and the group Time 4 (1.49 ± 0.17 degrees). CONCLUSION. The rotational tolerance of a conical connection is low in the "as received" condition but increases with repetitive tightening and with application of a torque greater than 35 Ncm.

• The Journal of the Korean dental association
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• v.57 no.3
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• pp.149-160
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• 2019

Atrophic alveolar ridge of maxillary anterior area is commonly observed after the extraction of teeth in patients with severely compromised periodontal disease, causing difficulties with implant placement. Successful esthetics and functional implant rehabilitation rely on sufficient bone volume, adequate bone contours, and ideal implant positioning and angulation. The present case report categorized the ridge augmentation techniques using guided bone regeneration (GBR) on the maxillary anterior site by Seibert classification. Case I patient presented for implant placement in the position of tooth #11. The alveolar ridge was considered a Seibert classification I ridge defect. Simultaneous implant placement and GBR were performed. Eight months after implantation, clinical and radiological examinations were performed. Case III patient presented with discomfort due to mobility of the upper maxillary anterior site. Due to severe destruction of alveolar bone, teeth #11 and #12 were extracted. After three months, the alveolar ridge was considered a Seibert classification III ridge defect. A GBR procedure was performed; implantation was performed 6 months later. Approximately 1-year after implantation, clinical and radiological examinations were performed. During the whole treatment period, healing was uneventful without membrane exposure, severe swelling, or infection in all cases. Radiographic and clinical examinations revealed that atrophic hard tissues and buccal bone contour were restored to the acceptable levels for implant placement and esthetic restoration. In conclusion, severely resorbed alveolar ridge of the maxillary anterior area can be reconstructed with ridge augmentation using the GBR procedure so that dental implants could be successfully placed.

• Journal of Dental Rehabilitation and Applied Science
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• v.36 no.1
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• pp.29-40
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• 2020

Purpose: The purpose of this study was to compare the accuracy of impression taking method using the encoded healing abutment, scan body and pick-up impression coping with different implant angulations. Materials and Methods: Master model was fabricated by 3D printer and three implants were placed into the model with 0°, 10° and 20° mesial angulation. The abutments were secured to each implants and master model was scanned to make a reference model. Group P model was fabricated using pick-up impression copings and model was scanned after securing the abutments. Encoded healing abutment (Group E) and scan body (Group S) were secured on the master model and digital impression was taken using intraoral scanner 15 times each. Each STL files of test groups were superimposed with reference model using best fit alignment and root mean square (RMS) value was analyzed. Results: The RMS values were lowest in Group P, followed by Group S and Group E. Group P showed significant difference with Group S and E (P < 0.05) while there was no significant difference between Group S and E. Correlation between implant angulation and RMS value was significant in Group E (P < 0.05). Conclusion: The pick-up impression coping method showed higher accuracy and there was no significant difference in accuracy between the healing abutment and the scan body. The clinical use of the encoded healing abutment is possible, but it should be used with caution in the case of angulated implant.