• The Journal of Korean Academy of Prosthodontics
• /
• v.46 no.5
• /
• pp.443-454
• /
• 2008

Statement of problem: A clinically successful color match is one of the important factor to get an esthetic dental restoration. Dental shade guides are commonly used to evaluate tooth color in restorative procedure. But numerous reports have indicated that common shade guides do not provide sufficient spectral coverage of the natural tooth colors. To address issues associated with the shade guide, distinct avenues have been pursued objective spectrophotometric / colorimetric assessment. Purpose: This study compared the accuracy of tooth color selection of spectrophotometer with that of human visual determination. Three main factors were investigated, namely, the effect of light, the individual variation and the experience of the observer. Material and methods: At the first experiment, on ten patients, one operator independently selected the best matching shade to the unrestored maxillary central incisor, using a Vita Classical Shade Guide in the morning, at noon and in the afternoon. The same teeth were measured by means of a reflectance spectrophotometer. At the second experiment, on ten patients, ten operators (5 experts, 5 novices) selected and measured by the same method above at noon. At the third experiment, the results of the second experiment were divided into two groups, expert and novice, and analyzed. Results: 1. There was significant difference between visual and spectrophotometric assessment (mean ${\Delta}E$ values) in experiment 1, 2, 3 (P < .05). 2. There was no significant difference between experts and novices group, when comparing with each visual and spectrophotometric assessment (mean ${\Delta}E$ values). Conclusion: Spectrophotometer could be used to analyze the shade of natural tooth objectively. Thereby, this method offers the potential tominimize considerably the need for corrections or even remakesafter intraoral try-in of restoration. Furthermore, to achieve its advantage, both the shade-matching environment and communication between dentist and technician should be optimized with use of visual and instrumental shade-matching systems.

• The Journal of Korean Academy of Prosthodontics
• /
• v.46 no.5
• /
• pp.470-478
• /
• 2008

Statement of problem: Use of all-ceramic prostheses fabricated with CAD/CAM systems is increasing in the dentistry. Marginal fidelity in production of all-ceramic restoration has important clinical implications and is a key consideration issue in CAD/CAM production as well. Purpose: The objective of this study was to analyse marginal fidelities of $Procera^{(R)}$ Allceram Crown. Material and methods: On 56 patients treated with $Procera^{(R)}$ system Allceram Crown at Dankook Dental Hospital, marginal discrepancies of 101 abutments were measured by stereomicroscope at coping and final restoration stages. Paired t-test and one-way analysis of variance on marginal discrepancy data were conducted to determine the presence of significant differences between measurement and measuring point stages. Results: Marginal discrepancies of final restoration ($45.82{\pm}30.84\;{\mu}m$) were lower than alumina coping ($53.84{\pm}38.83\;{\mu}m$). Furthermore, the differences were found to be statistically significant at 95% confidence level. Anterior marginal discrepancies were lower than posterior marginal discrepancies, but they were not statistically significant. Lingual marginal discrepancies were higher than other measurement sites, and the differences were found to be statistically significant at 95% confidence level. Conclusion: Within the conditions of this study, marginal fidelities of $Procera^{(R)}$ Allceram Crown were acceptable, and after porcelain build-up, marginal fitness improved over alumina coping. More careful scanning is needed for better results.

• The Journal of Korean Academy of Prosthodontics
• /
• v.46 no.5
• /
• pp.479-489
• /
• 2008

Statement of the problem: Under anatomical limitations on maxillary posterior region, a poor crown-to root ratio acting on dental implants can result in undesirable stress in surrounding bone, which in turn can cause bone defects and eventual failure of implants. Purpose: The purpose is to compare stress distribution due to different crown-root ratio and effect of splinting between natural teeth and implants in maxillary molar area under different loads. Material and methods: Analysis of stress arising supporting bone of the natural teeth and the implant was made with 3-dimensional finite element method. The model simulated naturel teeth was made with 2nd premolar and 1st molar in the maxillary molar region (Model T). The model simulated implants placed on same positions with two parallel implants of Straumann Dental Implant cemented abutment (Model I). Each model was designed in different crown-root ratio (0.7:1, 1:1, 1.25:1) and set cement type gold crown to make it non-splinted or splinted. After that, 300 N force was loaded to each model in five ways (Load 1: middle of occlusal table, Load 2: middle of buccal cusp, Load 3: middle of lingual cusp, Load 4: horizontal load to buccal cusp of anterior abutment only, Load 5: horizontal load to middle of buccal cusp of each abutment), and stress distribution was analyzed. Results and conclusion: On all occasions, stress was concentrated at the cervical region of the implant. Under load 1, 2 and 3, stress was not increased even when crown-root ratio increases, but under load 4 and 5, when crown-root ratio increases, stress also increased. There was difference in stress values between natural teeth and implants when crown-root ratio gradually increases; In case of natural teeth, splinting decreased stress under vertical and horizontal loads. In case of implants, splinting decreased stress under vertical loads 1,2 and 3, but increased maximal stress under loads 2 and 3. Under horizontal loads, splinting decreased stress, however the effect of splinting decreased under load 5 than load 4. Furthermore, the stress was increased, when crown-root ratio is 1.25:1. Clinical implications: This limited finite element study suggests that the stress on supporting bone may be increased under non-axial loads and poor crown-root ratio. Under poor crown-root ratio, excessive stress was generated at the cervical region of the implant, and decreased splinting effect for stress distribution, which can be related to clinical failure.

• The Journal of Korean Academy of Prosthodontics
• /
• v.46 no.5
• /
• pp.490-499
• /
• 2008

Statement of problem: Bioactive materials must have the ability to spontaneously form a bone like apatite layer on their surface and induce direct biochemical bonding to bone. A simple chemical treatment via alkali and heat has been revealed to induce bioactivity in titanium. Purpose: The purpose of this study was to evaluate the surface characteristics and stability of alkali and heat treated implants. Material and methods: Specimens were divided into three groups; group 1 was the control group with machined surface implants, groups 2 and 3 were treated with alkali solutions and heat treated in the atmosphere and vacuum conditions respectively. The surface characteristics were observed with FESEM, XPS, TF-XRD and AFM. Stability was evaluated with the resonance frequency analysis, periotest and removal torque values. One-way ANOVA and Duncan test were used for statistical analysis. Results: 1. Groups treated with alkali and heat showed similar characteristics. Groups 2 and 3 showed high compositions of Na ions on the surface with sub-micron sized pores compared to group 1. Group 2 showed mixed compositions of anatase and rutile with superior contents of rutile. 2. Resonance frequency analysis : The ISQ of group 2 showed significantly higher values than that of groups 1 and 3 at 12 weeks. The ISQ of groups 1 and 2 showed significant increase after 4 weeks, and the ISQ of group 3 increased significantly after 2 and 4 weeks respectively (P < .05). 3. Periotest: The PTV of groups 1 and 2 showed significant decrease after 4 weeks, and the PTV of group 3 showed significant decrease after 2 and 4 weeks respectively (P < .05). 4. Removal torque analysis: The removal torque value of group 2 was significantly higher than those of groups 1 and 3 at 2, 4 and 8 weeks. The removal torque values of groups 1 and 3 showed increase at 4 and 12 weeks, but the removal torque value of group 2 showed increase after 4 weeks (P < .05). Conclusion: An oxide layer with appropriate crystal structure and amorphous sodium titanate layer can be obtained on titanium implants through alkali and heat treatment in the atmosphere, and even alkali and heat treatment in vacuum conditions, provided a bioactive surface containing sodium. These surface layers can be considered to be effective for enhancement of osseointegration and reduction of healing period for implant treatment.

• The Journal of Korean Academy of Prosthodontics
• /
• v.46 no.5
• /
• pp.511-519
• /
• 2008

Statement of problem: An incompatibility between the initiator systems of self-curing composite resins and light-curing adhesives was supposed recently. Purpose: The purpose of the study was to evaluate the influence of activators for self/dual bonding on dentin shear bonding strengths. Material and methods: Fifty human molars were divided into 5 groups. A flat dentin surface was created for each tooth. A self-curing composite resin (Luxacore) was bonded with the following adhesives (n = 10); One-Step, Prime&Bond NT, AdheSE, Prime&Bond NT and AdheSE were also used in combination with activators. Shear bond strengths were measured after 24 hours of water storage. The specimens were loaded in shear in the Instron until failure at a 1 mm/min crosshead speed. Data were compared using one-way ANOVA and Tukey HSD test (${\alpha}$= 0.05). Results: The dentin adhesive systems in order of decreasing median bond strength were One-Step > Prime&Bond NT with activator, AdheSE with activator > Prime&Bond NT, AdheSE. Among adhesives, One-Step had the highest bond strength. Prime&Bond NT with activator had higher bond strengths than Prime&Bond NT that was used alone, and so was AdheSE. Conclusion: Shear bond strengths were increased in Prime&Bond NT and AdheSE when these were used with activators comparing used without activators. But using activators was not effective clinically comparing One-Step.

• The Journal of Korean Academy of Prosthodontics
• /
• v.46 no.1
• /
• pp.1-11
• /
• 2008

Statement of problem: Over the past decade, increased demand for esthetically pleasing restorations has led to the development of all-ceramic systems. Recent reports suggest that the all-ceramic crowns have excellent physical properties, wear resistance, and color stability. In addition, numerous ceramics have excellent biocompatibility, a natural appearance, and improved physical bonding with resin composite luting agents. However, the brittle nature of ceramics has been a major factor in their restriction for universal usage. Functional occlusal loading can generate stress in the luting agent, and the stress distribution may be affected by the marginal geometry at the finish line. Tooth preparation for fixed prosthodontics requires a decision regarding the marginal configuration. The design dictates the shape and bulk of the all ceramic crowns and influences the fit at the margin. Purpose: The purpose of this study was to evaluate the stress distribution within marginal configurations of all- ceramic crowns (90-degree shoulder, 110-degree shoulder, 135-degree shoulder). Material and methods: The force is applied from a direction of 45 degrees to the vertical tooth axis. Three-dimensional finite element analysis was selected to determine stress levels and distributions. Results and conclusion: The result of stress level for the shoulder marginal configuration was more effective on stress distribution at 135-degree shoulder margin. But the stresses concentrated around at 135-degree shoulder margin. The stress decreased apically at the surface between cements and alumina core, and increased apically at the surface between alumina core and veneering porcelain.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.25 no.4
• /
• pp.375-390
• /
• 2009

Statement of problem: Implant supported overdenture is accepted widely as a way to restore edentulous ridge providing better retention and support of dentures. Various types of attachment for overdenture have been developed. Purpose: The purpose of this study was to investigate the influence of attachment type in implant overdentures on the biomechanical stress distribution in the surrounding bone, prosthesis and interface between implant and bone. Material and methods: Finite element analysis method was used. Average CT image of mandibular body(Digital $Korea^{(R)}$, KISTI, Korea) was used to produce a mandibular model. Overdentures were placed instead of mandibular teeth and 2mm of mucosa was inserted between the overdenture and mandible. Two implants($USII^{(R)}$, Osstem, Korea) were placed at both cuspid area and 4 types of overdenture were fabricated ; ball and socket, Locator, magnet and bar type. Load was applied on the from second premolar to second molar tooth area. 6 times of finite element analyses were performed according to the direction of the force $90^{\circ}$, $45^{\circ}$, $0^{\circ}$ and unilateral or bilateral force applied. The stress at interface between implants and bone, and prosthesis and the bone around implants ware compared using von Mises stress. The results were explained with color coded graphs based on the equivalent stress to distinguish the force distribution pattern and the site of maximum stress concentration. Results: Unilateral loading showed that connection area between implant fixture and bar generated maximum stress in bar type overdentures. Bar type produced 100 Mpa which means the most among 4 types of attachments. Bilateral loading, however, showed that bar type was more stable than other implants(magnet, ball and socket). 26 Mpa of bar type was about a half of other types on overdenture under $90^{\circ}$ bilateral loading. Conclusions: In any directions of stress, bar type was proved to be the most vulnerable type in both implants and overdentures. Interface stress did not show any significant difference in stress distribution pattern.

• The Journal of Korean Academy of Prosthodontics
• /
• v.47 no.3
• /
• pp.348-355
• /
• 2009

Statement of problem: Although the use of colorimeter to improve the accuracy of tooth color measurement has increased, it is real situation that there is almost no comparative study about the accuracy among various colorimeters. Purpose: The purpose of this study is to compare the accuracy of porcelain color reproducibility using ShadeEye-Ncc dental chroma meter (Shofu Inc., Kyoto, Japan) and Shadepilot$^{TM}$ system (Degudent Inc., Hanau, Germany). Material and methods: Color of 2M2 and 3M2 shade tap of Vitapan 3D Master shade guide were measured using the above two colorimeters. Porcelain specimens were fabricated through this data. The porcelain systems used were Vintage Halo Porcelain system with ShadeEye-Ncc dental chroma meter, and VitaOmega900 Porcelain system with Shadepilot$^{TM}$ system. Colors of shade tap models and porcelain specimen were measured with spectrophotometer, and calculated delta E based on the results. Results: The following results were obtained. 1. Shadepilot$^{TM}$ system showed more suitable porcelain color reproducibility compared to ShadeEye-Ncc dental chroma meter (P <.05). 2. The result showed the difference of porcelain color reproducibility according to shade of Shade tap which is model. More suitable porcelain color reproducibility was shown at 3M2 shade tap than at 2M2 shade tap (P <.05). 3. The average of ${\Delta}E*$ of porcelain specimens which was made by the two colorimeters was 4.44-6.14, so the difference of shade was shown through the naked eye. Conclusion: Shadepilot$^{TM}$ system showed more suitable porcelain color reproducibility. When using ShadeEye-Ncc dental chromameter, it will be necessary to improve accuracy through coloring various parts of the whole tooth.

• The Journal of Korean Academy of Prosthodontics
• /
• v.47 no.3
• /
• pp.320-327
• /
• 2009

Statement of Problem: Although many efforts have been continually made to estimate long term prognosis of removable partial dentures, the complication of removable partial dentures was still found because of inaccurate fabrication procedure and improper maintenance care. Purpose: The purpose of this study was to evaluate the clinical status of removable partial dentures. Material and methods: A total of 112 individuals with 153 removable partial dentures (35 - 87 years, 64 women and 48 men) were examined by intra-oral examination, diagnostic cast and radiographic examination. Results and conclusion: The results of this study were as follows: 1. Length of service of removable partial dentures was $5.3{\pm}4.3$ years (mean), 4.0 years (median). 2. A total of 45 removable partial dentures were considered failures. The loss of 18 abutments of 369 was founded. 3. Type of arch, Kennedy classification and type of opposite dentition were found to have no influence on longevity and success rate of removable partial dentures (P > .05). 4. Most common major connector was the palatal plate in maxilla and the number of lingual bar and linguoplate designed in mandible were similar. 5. The circumferential type retainer was the most commonly used retainer. 6. Sixty-three percent of the class I and II removable partial dentures incorporated indirect retention into the design. 7. Approximately 81% of the removable partial dentures had at least one defect. Excessive wear of posterior teeth (27.9%), lack of integrity (23.2%), lack of stability (22.6%) were frequent defects of removable partial dentures.

• The Journal of Korean Academy of Prosthodontics
• /
• v.47 no.3
• /
• pp.312-319
• /
• 2009

Statement of problem: Delamination of veneering porcelain from underlying ceramic substructures has been reported for zirconia-ceramic restorations. Colored zirconia cores for esthetics have been reported that their bond strength with veneered porcelain is weaker compared to white zirconia cores. Purpose: This study aimed to investigate the shear bond strength by manufacturing the veneering porcelain on the colored zirconia core, using the layering technique and heat-pressing technique, and to evaluate the clinical stability by comparing the result of this with that of conventional metal ceramic system. Material and methods: A Metal ceramic (MC) system was tested as a control group. The tested systems were Katana zirconia with CZR (ZB) and Katana Zirconia with NobelRondo Press (ZP). Thirty specimens, 10 for each system and control, were fabricated. Specimen disks, 3 mm high and 12 mm diameter, were fabricated with the lost-wax technique (MC) and the CAD-CAM (ZB and ZP). MC and ZB specimens were prepared using opaque and dentin veneering ceramics, veneered, 3 mm high and 2.8 mm in diameter, over the cores. ZP specimens were prepared using heat pressing ingots, 3 mm high and 2.8mm in diameter. The shear bond strength test was performed in a Shear bond test machine. Load was applied at a cross-head speed of 0.50 mm/min until failure. Mean shear bond strengths (MPa) were analyzed with the One-way ANOVA. After the shear bond test, fracture surfaces were examined by SEM. Results: The mean shear bond strengths (SD) in MPa were MC control 29.14 (2.26); ZB 29.48 (2.30); and ZP 29.51 (2.32). The shear bond strengths of the tested systems were not significantly different (P > .05). All groups presented cohesive and adhesive failures, and showed predominance of cohesive failures in ceramic veneers. Conclusion: 1. The shear bond strengths of the tested groups were not significantly different from the control group (P >.05). 2. There was no significant different between the layering technique and the heat pressing technique in the veneering methods on the colored zirconia core. 3. All groups presented cohesive and adhesive failures, and showed predominance of cohesive failures in ceramic veneers.