• 구강회복응용과학지
• /
• 제31권4호
• /
• pp.340-348
• /
• 2015

임플란트주위염(peri-implantitis)은 기능중인 골유착 임플란트 주위의 조직에서 생기는 사이트 별 감염성 질환이며 임플란트 후기 실패(late failure)의 원인으로 가장 높은 비율을 차지한다. 여러 연구들을 통해 미생물 침착이 임플란트주위염에 미치는 영향이 보고된 바 있으며 세균막의 제거는 임플란트주위염의 치료 시 필수조건이 된다. 최근에 여러 연구들을 통해 티타늄 임플란트에 레이저를 사용하여 표면을 살균, 정화 시키는 방법에 대한 실험이 많이 보고되고 있다. 본 논문에서는 임플란트주위염 처치에 있어 레이저가 갖는 효능에 대한 최근 연구 결과들을 문헌고찰을 통해 되짚어보고자 한다.

• The Journal of Advanced Prosthodontics
• /
• 제8권2호
• /
• pp.131-136
• /
• 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.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제42권
• /
• pp.13.1-13.6
• /
• 2020

Background: The aim of this study was to evaluate the factors that may affect implant fixture fractures. Methods: Patients who experienced implant fixture removal at Seoul National University Bundang Hospital from 2007 to 2015 due to implant fixture fracture were included. Implant/crown ratio, time of implant fracture, clinical symptoms before implant fracture, treatment of fractured implants, and the success and survival rate of the replaced implants were evaluated retrospectively. Results: Thirteen implants were fractured in 12 patients. Patient mean age at the time of fracture was 59.3 years. Of the 13 implants, 7 implants were placed at our hospital, and 6 were placed at a local clinic. The mean crown/implant ratio was 0.83:1. The clinical symptoms before fracture were screw loosening in five implants, marginal bone loss in five implants, and the presence of peri-implant diseases in five implants. All the fractured implants were removed, and 12 out of the 13 sites were re-implanted. Parafunctions were observed in two patients: one with bruxism and one with attrition due to a strong chewing habit. Conclusions: Several clinical symptoms before the fracture of an implant can predict implant fixture failure. Therefore, if these clinical symptoms are observed, appropriate treatments can be taken before more serious complications result.

• Journal of Periodontal and Implant Science
• /
• 제46권3호
• /
• pp.176-196
• /
• 2016

Purpose: We sought to evaluate the effectiveness of bone substitutes in circumferential periimplant defects created in the rabbit tibia. Methods: Thirty rabbits received 45 implants in their left and right tibia. A circumferential bone defect (6.1 mm in diameter/4 mm depth) was created in each rabbit tibia using a trephine bur. A dental implant ($4.1mm{\times}8.5mm$) was installed after the creation of the defect, providing a 2-mm gap. The bone defect gaps between the implant and the bone were randomly filled according to the following groups: blood clot (CO), particulate Bio-Oss$^{(R)}$ (BI), and Bio-Oss$^{(R)}$ Collagen (BC). Ten animals were euthanized after periods of 15, 30, and 60 days. Biomechanical analysis by means of the removal torque of the implants, as well as histologic and immunohistochemical analyses for protein expression of osteocalcin (OC), Runx2, OPG, RANKL, and TRAP were evaluated. Results: For biomechanics, BC showed a better biological response ($61.00{\pm}15.28Ncm$) than CO ($31.60{\pm}14.38Ncm$) at 30 days. Immunohistochemical analysis showed significantly different OC expression in CO and BC at 15 days, and also between the CO and BI groups, and between the CO and BC groups at 60 days. After 15 days, Runx2 expression was significantly different in the BI group compared to the CO and BC groups. RANKL expression was significantly different in the BI and CO groups and between the BI and BC groups at 15 days, and also between the BI and CO groups at 60 days. OPG expression was significantly higher at 60 days postoperatively in the BI group than the CO group. Conclusions: Collectively, our data indicate that, compared to CO and BI, BC offered better bone healing, which was characterized by greater RUNX2, OC, and OPG immunolabeling, and required greater reversal torque for implant removal. Indeed, along with BI, BC presents promising biomechanical and biological properties supporting its possible use in osteoconductive grafts for filling peri-implant gaps.

• Biomolecules & Therapeutics
• /
• 제22권6호
• /
• pp.563-569
• /
• 2014

Materials with differing surfaces have been developed for clinical implant therapy in dentistry and orthopedics. This study was designed to evaluate bone response to titanium alloy containing Ti-32Nb-5Zr with nanostructure, anodic oxidation, heat treatment, and ibandronate coating. Rats were randomly assigned to two groups for implantation of titanium alloy (untreated) as the control group and titanium alloy group coated with ibandronate as the experimental group. Then, the implants were inserted in both tibiae of the rats for four weeks. After implantation, bone implant interface, trabecular microstructure, mechanical fixation was evaluated by histology, micro-computed tomography (${\mu}CT$) and the push-out test, respectively. We found that the anodized, heat-treated and ibandronate-coated titanium alloy triggered pronounced bone implant integration and early bone formation. Ibandronate-coated implants showed elevated values for removal torque and a higher level of BV/TV, trabecular thickness and separation upon analysis with ${\mu}CT$ and mechanical testing. Similarly, higher bone contact and a larger percentage bone area were observed via histology compared to untreated alloy. Furthermore, well coating of ibandronate with alloy was observed by vitro releasing experiment. Our study provided evidences that the coating of bisphosphonate onto the anodized and heat-treated nanostructure of titanium alloy had a positive effect on implant fixation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제42권6호
• /
• pp.345-351
• /
• 2016

Objectives: This study compared the impact of implant surface treatment on the stability and osseointegration of implants in dog mandibles. Materials and Methods: Six adult dogs received a total of 48 implants that were prepared using four different surface treatments; resorbable blast media (RBM), hydroxyapatite (HA), hydrothermal-treated HA, and sand blasting and acid etching (SLA). Implants were installed, and dogs were separated into 2- and 4-week groups. Implant stability was evaluated via Periotest M, Osstell Mentor, and removal torque analyzers. A histomorphometric analysis was also performed. Results: The stability evaluation showed that all groups generally had satisfactory values. The histomorphometric evaluation via a light microscope revealed that the HA surface implant group had the highest ratio of new bone formation on the entire fixture. The hydrothermal-treated HA surface implant group showed a high ratio of bone-to-implant contact in the upper half of the implant area. Conclusion: The hydrothermal-treated HA implant improved the bone-to-implant contact ratio on the upper fixture, which increased the implant stability.

• 대한심미치과학회지
• /
• 제16권2호
• /
• pp.7-18
• /
• 2007

There is now an increased demand for harmony between the peri-implant gingiva and adjacent dentition. In the event of a pending loss of a single tooth in the aesthetic zone with healthy periodontium, expectation for optimal gingival and prosthodontic aesthetics are often very high. Unfortunately, bone resorption is common following the removal of an anterior tooth, compromising the gingival tissue levels for the eventual implant restoration. Also, improper implant placement and inadequate osseous-gingival support potentially deleterious aesthetic result. The creation of an esthetic implant restoration with gingival architecture that harmonizes with the adjacent dentitionis formidable challenge. The predictability of the peri-implant esthetic outcome may ultimately be determined by the patient's own presenting anatomy rather than the clinician's ability to manage state-of-the-art procedures. To more accurately predict the peri-implant esthetic outcome before removing a failing tooth, a considering of diagnostic keys is essential. This presentation addresses the useful diagnostic keys that affect the predictability of peri-implant gingival aesthetics and the overcoming of the risk factors in anterior single-tooth replacement; it also describes a surgical and prosthodontic technique in achieving a long term successful esthetic outcome. Proper diagnosis and understanding of the biological and periodontal variables of failing dentition and their response to surgical and prosthodontic procedures are the essence of predictability. Using a smart protocol that alters the periodontium toward less risk and more favorable assessment of the diagnostic keys before implant placement will provide the most predictable esthetic outcome. Simple diagnostic keys suggested this presentation are useful method to evaluate the overcoming of the risk factors in anterior single implant restoration.

• 대한치과보철학회지
• /
• 제44권5호
• /
• pp.594-605
• /
• 2006

Statement of problem: Modification of titanium implant surface has potential to ensure clinically favorable performance that several surface modification technologies have been introduced. Among the methods. anodizing method and sol-gel hydroxyapatite coating method have gained much interest due to its roughness and chemical composition of the coating layer, but more of its biocompatibility result is required. Purpose : The purpose of this study was to compare bone-implant interface shear strength of four different surface treated implants as time elapsed. Resonance frequency analysis(RFA) and removal torque measurement methods were employed to measure implant stability at one week and six week after implantation. Material and method: A total of 80 screw-shaped implant [20 machined, 20 resorbable media blasted(RBM), 20 anodized, and 20 anodized+hydroxyapatite sol-gel coated] were prepared, and one of each group was implanted in the tibia of a New Zealand white rabbit that total 20 of them were used. In order to test the implant stability and implant-tissue interface contact changing in the bone bed, each 10 rabbit were sacrificed 1 week and 6 week later while resonance frequency and removal torque were measured. One-way analysis of variance and the Tukey test were used for statistical analysis. Results : The results were as follows. 1. There was no statistically significant difference of implant stability quotients(ISQ) value in RFA between individual groups after 1 week of implantation and 6 weeks(p>0.05). But, there was statistically significant increase of ISQ value in 6 weeks group compared to 1 week group(p<0.05). 2. There was no statistically significant difference in removal torque analysis between individual groups after 1 week of implantation and 6 weeks(p>0.05). but there was statistically significant increase in all 4 groups after 6 weeks compared to 1 week later(p<0.05). 3. There was no statistically significant difference in removal torque analysis between anodized group and HA coating after anodic oxidation 6 weeks later(p>0.05), but significant difference was appeared in both groups compared to RBM group and smooth-machined group(p<0.05). Conclusions : It can be suggested that changes in surface characteristics affect bone reactions. Anodized and anodized+hydroxyapatite sol-gel coating showed significantly improved bone tissue response to implants, but further study on the effect of hydroxyapatite dissolution is needed.

• The Journal of Advanced Prosthodontics
• /
• 제10권6호
• /
• pp.415-421
• /
• 2018

PURPOSE. This study investigated the effects of abutment screw lengths on screw loosening and removal torque in external connection implants after oblique cyclic loading. MATERIALS AND METHODS. External connection implants were secured with abutment screws to straight abutments. The abutment-implant assemblies were classified into seven groups based on the abutment screw length, with each group consisting of five assemblies. A cyclic load of 300 N was applied at a $30^{\circ}$ angle to the loading axis until one million cycles were achieved. Removal torque values (RTVs) before and after loading, and RTV differences were evaluated. The measured values were analyzed using repeated measures of analysis of variance with the Student-Newman-Keuls multiple comparisons. RESULTS. All assemblies survived the oblique cyclic loading test without screw loosening. There was a significant decrease in the RTVs throughout the observed abutment screw lengths when the abutment-implant assemblies were loaded repeatedly (P<.001). However, the abutment screw length did not show significant difference on the RTVs before and after the experiment when the abutment screw length ranged from 1.4 to 3.8 mm (P=.647). CONCLUSION. Within the limit of this experiment, our results indicate that the abutment screw length did not significantly affect RTV differences after oblique cyclic loading when a minimum length of 1.4 mm (3.5 threads) was engaged. These findings suggest that short abutment screws may yield stable clinical outcomes comparable to long screws in terms of load resistance.

• The Journal of Advanced Prosthodontics
• /
• 제5권1호
• /
• pp.21-28
• /
• 2013

PURPOSE. This study examined the effects of the abutment types and dynamic loading on the stability of implant prostheses with three types of implant abutments prepared using different fabrication methods by measuring removal torque both before and after dynamic loading. MATERIALS AND METHODS. Three groups of abutments were produced using different types of fabrication methods; stock abutment, gold cast abutment, and CAD/CAM custom abutment. A customized jig was fabricated to apply the load at $30^{\circ}$ to the long axis. The implant fixtures were fixed to the jig, and connected to the abutments with a 30 Ncm tightening torque. A sine curved dynamic load was applied for $10^5$ cycles between 25 and 250 N at 14 Hz. Removal torque before loading and after loading were evaluated. The SPSS was used for statistical analysis of the results. A Kruskal-Wallis test was performed to compare screw loosening between the abutment systems. A Wilcoxon signed-rank test was performed to compare screw loosening between before and after loading in each group (${\alpha}$=0.05). RESULTS. Removal torque value before loading and after loading was the highest in stock abutment, which was then followed by gold cast abutment and CAD/CAM custom abutment, but there were no significant differences. CONCLUSION. The abutment types did not have a significant influence on short term screw loosening. On the other hand, after $10^5$ cycles dynamic loading, CAD/CAM custom abutment affected the initial screw loosening, but stock abutment and gold cast abutment did not.