• The Journal of Korean Academy of Prosthodontics
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• v.56 no.4
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• pp.330-337
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• 2018

In edentulous patients, implant - supported fixed prosthesis treatment has been proved to be useful, but involves complex treatment process. On the other hand, in the modern dentistry, digital technology has been developed day by day and it has expanded its range to the implant restoration of edentulous patients. In this case, a digital system was used for all stages of diagnosis, surgery, design and fabrication of provisional implants fixed prosthesis restoration in 66-year-old mandibular edentulous patients. In the preoperative diagnosis stage, a provisional restoration was designed based on the mucosal scan using the intraoral scanner and the stable occlusion of prefabricated complete denture of the patient. After flapless implant surgery using the surgical guide, the prefabricated interim restoration was connected to the implant and used as immediate provisional restoration. The final restoration was designed and fabricated by transferring the vertical dimension and the centric relation of the provisional restoration with stable occlusion using digital technology. We report a simple protocol of implant treatment in edentulous patients by using digital techniques to preserve the patient's vertical dimension and occlusion.

• The Journal of Korean Academy of Prosthodontics
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• v.31 no.4
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• pp.580-610
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• 1993

The purpose of this study was to analyse the deflection and stress distribution at the supporting bone and it's superstructure by the alteration of angulation between implant and it's implant abutment. For this study, the free-end saddle case of mandibular first and second molar missing would be planned to restore with fixed prosthesis. So the mandibular second premolar was prepared for abutment, and the cylinder type osseointegrated implant was placed at the site of mandibular second molar for abutment. The finite element stress analysis was applied for this study. 13 two-dimensional FEM models were created, a standard model at $0^{\circ}$ and 12 models created by changing the angulation between implant and implant abutment as increasing the angulation mesially and distally with $5^{\circ}$ unittill $30^{\circ}$. The preprocessing decording, solving and postprocessing procedures were done by using FEM analysis software PATRAN and SUN-SPARC2GX. The deflections and von Mises stresses were calculated under concentrated load (load 1) and distributed load(load 2) at the reference points. The results were as follows : 1. Observing at standard model, the amount of total deflection at the distobuccal cusp-tip of pontic under concentrated load was largest of all, and that at the apex of implant was least of all, and the amount of total deflection at the buccal cusp-tip of second premolar under distributed load was largest of all, and that at the apex of implant was least of all. 2. Increasing the angulation mesially or distally, the amounts of total deflection were increased or decreased according to the reference points. But the order according to the amount of total deflection was not changed except apex of second premolar and central fossa of implant abutment under concentrated load during distal inclination. 3. Observing at standard model, the von Mises stress at the distal joint of pontic under concentrated load was largest of all, and that at the apex of implant was least of all. The von Mises stress at the distal margin of second premolar under distributed load was largest of all, and that at the apex of Implant was least of ail. 4. Increasing the angulation of implant mesially, the von Mises stresses at the mesial crest of implant were increased under concentrated load and distributed load, but those were increased remarkably under distributed load and so that at $30^{\circ}$ mesial inclination was largest of all. 5. Increasing the angulation of implant distally, the von Mises stresses at the distal crest of implant were increased remarkably under concentrated load and distributed load, and so those at $30^{\circ}$ distal inclination were largest of all.

• The Journal of Korean Academy of Prosthodontics
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• v.42 no.4
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• pp.425-442
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• 2004

Statement of problem: A difficulty in achieving a passive-fitting prosthesis can be overcome by individual crown restoation of multiple implants. But individualized crown has another difficulty in control of contact tightness and stress distribution. Purpose: This in vitro study is to evaluate the stress distribution and the magnitude in the supporting tissues around Endopore implants with different crown lengths, interproximal contact tightness, and the splinting effects. Material & methods: Three Endopore implants($4.1{\times}9mm$) were placed in the mandibular posterior edentulous area distal to the canine and photoelastic model was made with PL-2 resin(Measurements Group, Raleigh, USA). Restorations were fabricated in two crown lengths: 9, 13 mm. For non-splinted restorations, individual crowns were fabricated on three custom-milled titanium abutments. After the units were cemented, 4 levels of interproximal contact tightness were evaluated: open, ideal($8{\mu}m$ shim stock drags without tearing), medium($40{\mu}m$), and heavy($80{\mu}m$). For splinted restorations, 3-unit fixed partial dentures were fabricated. This study was examined under simulated non-loaded and loaded conditions(6.8 kg). Photoelastic stress analysis was carried out to measure the fringe order around the implant supporting structure. Results: 1. When restorations were not splinted, the more interproximal contact tightness was increased among the three implants, the more stress was shown in the cervical region of each implant. When crown length was increased, stresses tended to increase in the apex of implants but there were little differences in stress fringes. 2. When nonsplinted restorations were loaded on the first or third implant, stresses were increased in the apex and cervical region of loaded implant. Regardless of interproximal contact tightness level, stresses were not distributed among the three implants. But with tighter interproximal contact, stresses were increased in the cervical region of loaded first or third implant. 3. When the nonsplinted restorations were not loaded, there were little stresses on the supporting structure of implants, but low level stresses were shown in the splinted restorations even after sectioning and soldering. 4. With splinted restorations, there were little differences in stresses between different crown lengths. When splinted restorations were loaded, stresses were increased slightly on the loaded implant, but relatively even stress distribution occurred among the three implants. Conclusions: Splinting the crowns of adjacent implants is recommended for Endopore implants under the overloading situation.

• The Journal of Korean Academy of Prosthodontics
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• v.59 no.1
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• pp.79-87
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• 2021

The digital workflow of optical impressions by the intraoral scanner and CADCAM manufacture of dental prostheses is actively developing. The complex process of traditional impression taking, definite cast fabrication, wax pattern making, and casting has been shortened, and the number of patient's visits can also be reduced. Advances in intraoral scanner technology have increased the precision and accuracy of optical impression, and its indication is progressively widened toward the long span fixed dental prosthesis. This case report describes the long span implant case, and the operator fully utilized digital workflow such as computer-guided implant surgical template and CAD-CAM produced restoration after the digital impression. The provisional restoration and customized abutments were prepared with the optical impression taken on the same day of implant surgery. Moreover, the final prosthesis was fabricated with the digital scan while utilizing the same customized abutment from the provisional restoration. During the data acquisition step, stl data of customized abutments, previously scanned at the time of provisional restoration delivery, were imported and automatically aligned with digital impression data using an 'A.I. abutment matching algorithm' the intraoral scanner software. By using this algorithm, it was possible to obtain the subgingival margin without the gingival retraction or abutment removal. Using the digital intraoral scanner's advanced functions, the operator could shorten the total treatment time. So that both the patient and the clinician could experience convenient and effective treatment, and it was possible to manufacture a prosthesis with predictability.

• The Journal of Korean Academy of Prosthodontics
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• v.42 no.4
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• pp.412-424
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• 2004

Statement of problem: Several prosthetic options are available for the restoration of multiple adjacent implants. A passively fitting prosthesis has been considered a prerequisite for the success and maintenance of osseointegration. Passivity is a particular concern with multiple implants because of documented inaccuracies in the casting and soldering process. One way to avoid this problem is to restore the implants individually, however, the restorations of individual adjacent impants requires careful adjustment of interproximal contacts. Purpose: The purpose of this study was to compare the stress distribution pattern and amount surrounding Bicon implants with individual crowns and splinted restorations. Material and method: A photoelastic model of a human partially edentulous left mandible with 3 Bicon implants($4{\times}11mm$) was fabricated. For non-splinted restorations, individual crowns were fabricated on 3 abutments ($4{\times}0.65mm,\;0^{\circ}$, 2.0 mm post, Bicon Inc., Boston, USA) After the units were cemented, 4 levels of interproximal contact tightness were evaluated: open, ideal ($8{\mu}m$ shim stock drags without tearing), medium($40{\mu}m)$), and heavy($80{\mu}m$). Splinted 3-unit fixed partial dentures were fabricated and cemented to the model. Changes in stress distribution under simulated non-loaded and loaded conditions(7.5, 15, 30 lb) were analyzed with a circular polaricope. Results: 1. Stresses were distributed around the entire body of fin in Bicon implants. 2. Splinted restorations were useful for distribution of stress around implants especially with higher loads. 3. By increasing the contact tightness between the individually restored three implants, the stress increased in the coronal portion of implants. Conclusions: Ideal adjustment of the contact tightness was important to reduce the stresses around individually restored Bicon implants.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.149-155
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• 2017

Cerebral palsy is a non-progressive disorder resulting from central nervous system damage caused by multiple factors. Almost all cerebral palsy patients have a movement disorder that makes dental treatment difficult. Oral hygiene management is difficult and the risks for periodontitis, dental caries and loss of multiple teeth are high. Placement of dental implants for multiple missing teeth in cerebral palsy patients needs multiple rounds of general anesthesia, and the prognosis is poor despite the expense. Therefore, making the decision to perform multiple dental implant treatments on cerebral palsy patients is difficult. A 33-year-old female patient with cerebral palsy and mental retardation was scheduled for multiple implant treatments. She underwent computed tomography (CT) under sedation and the operation of nine dental implants under general anesthesia. Implant-supported fixed prosthesis treatment was completed. During follow-up, she had the anterior incisors extracted and underwent the surgery of 3 additional dental implants, completing the prosthetic treatment. Although oral parafunctions existed due to cerebral palsy, no implant failure was observed 9 years after the first implant surgery.

• The Journal of Korean Academy of Prosthodontics
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• v.56 no.3
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• pp.212-217
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• 2018

Purpose: This study was to assess clinically the incidence of abutment screw loosening of posterior implant-supported fixed prosthesis and its affecting factors. Materials and methods: 391 implant-supported crowns restored from January 2013 to January 2016 were included in this study. All restorations were fabricated with either a single crowns or a splinted crown, and cemented with temporary cement. The incidence of abutment screw loosening is investigated and gender, restoration position, opposing teeth, restoration type, abutment connection type were assessed as possible factors affecting abutment screw loosening. Results: During the observation period (2 - 5 years), abutment screw loosening was found in 29 restorations (7.4%). It took 3 to 48 months (means 19.5 months) to loose the screw, and three of these implants were fractured. Among the factors considered, there were statistically significant differences at abutment screw loosening rate between molar group (9.4%) and premolar group (2.6%) (P<.019). According to the type of opposing teeth, there were statistically significant differences between nature teeth (74.7%) and implant (25.0%), removable denture (3%) (P<.019). The other possible factors did not have a significant effect on loosening of the abutment. Conclusion: The incidence of abutment screw loosening in posterior restoration was 7.4%. Abutment screw loosening were more likely to occur in molars group than premolar group, and according to the opposing teeth, there were the greatest frequency in nature teeth than implant and removal denture. There was a statistically significant difference.

• Journal of Periodontal and Implant Science
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• v.50 no.5
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• pp.340-354
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• 2020

Purpose: This pilot study was conducted to evaluate the cleaning efficacy of an angled implant brush for home oral hygiene of full-arch fixed-implant prostheses. Methods: Forty-one patients treated with a full-arch implant rehabilitation in the maxilla or mandible (164 implants) for at least 4 months were enrolled. The screw-retained fixed prostheses were removed and baseline (T0) parameters were recorded, including plaque index (PI), probing depth (PD), and bleeding on probing (BOP). All patients completed a 5-item questionnaire on hygiene maintenance and received an implant brush for home hygiene. After 1 month (T1) PI, PD, and BOP were recorded again and patients completed a 7-item questionnaire to evaluate their satisfaction with the implant brush. One-way repeated-measures analysis of variance was conducted to evaluate the significance of changes in PI, PD, and BOP. A P value <0.05 was considered to indicate statistical significance. Results: A statistically significant reduction of BOP (0.62±0.6 at T0 vs. 0.5±0.5 at T1; P=0.032) was found, while no statistically significant changes in PD (1.74±0.5 mm at T0 vs. 1.77±0.5 mm at T1; P=0.050) or PI (1.9±0.7 at T0 vs. 1.7±0.7 at T1; P=0.280) occurred. According to the 7-item questionnaire, patients reported no difficulty in using the angled brush (63.4%) and deemed it highly (46.3%) or very highly (4.8%) effective in improving their home oral hygiene. Conclusions: Within the limits of the present pilot study, the patients experienced a reduction of BOP 1 month after being instructed to use the angled implant brush. The angled implant brush appeared to be a well-accepted device for home-care hygiene of full-arch fixed-implant rehabilitations.

• The Journal of Korean Academy of Prosthodontics
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• v.58 no.4
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• pp.342-348
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• 2020

Anatomical changes in the facial and alveolar bones occur after multiple teeth are extracted. In the maxilla, the alveolar bone is absorbed in the direction and inclination of the root, and the remaining alveolar bone becomes shorter, reducing the diameter of the arch. In addition, as the nasolabial angle increases, the support of the lips and the aesthetics of the face are lost. This case reports a functional and aesthetically satisfactory results of full mouth rehabilitation with the implant-supported fixed prosthesis using a zirconia framework.

• The Journal of Advanced Prosthodontics
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• v.14 no.1
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• pp.22-31
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• 2022

PURPOSE. The purpose of this study was to investigate the misfit and screw preload at the implant abutment connection of implant supported fixed dental prosthesis with cantilever (ICFDP) manufactured using different digital manufacturing techniques and to compare the screw preload before and after cyclic loading. MATERIALS AND METHODS. Mandibular jaw model with four intra-foraminal implants was scanned using digital scanner. Stereolithography file was used to design a framework with nonengaging (NE) abutments and 10 mm cantilever distal to one terminal implant. Five frameworks were constructed using combined digital-conventional techniques (CAD-cast), and five frameworks were constructed using three-dimensional printing (3DP). Additional CAD-cast framework was constructed in a way that ensures passive fit (PF) to use as control. Scanning electron microscope (SEM) measured the implant abutment connection misfit. Sixty screws were used on the corresponding frameworks. Screws were torqued and pre-cyclic loading reverse torque value (RTV) was recorded. Frameworks were subjected to 200,000 loading cycles with a loading point 9 mm from the center of terminal implants adjacent to the cantilever and post-cyclic loading RTVs were recorded. RESULTS. Microscopic readings showed significant differences between frameworks. PF demonstrated the lowest measurements of 16.04 (2.6) ㎛ while CAD-cast demonstrated the highest measurements of 29.2 (3.1) ㎛. In all groups, RTVs were significantly lower than the applied torque. Post-cyclic loading RTV was significantly lower than pre-cyclic loading RTV in PF and 3DP frameworks. Differences in RTVs between the three manufacturing techniques were insignificant. CONCLUSION. Although CAD-cast and three-dimensionally printed (3DP) both produce frameworks with clinically acceptable misfit, 3DP might not be the technique of choice for maintaining screw's preload stability under an aggressive loading situation.