• 대한치과의사협회지
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• 제54권3호
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• pp.198-205
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• 2016

The purpose of this paper was to investigate the significance of splinted and non-splinted implant-supported restorations with an internal connection for multiple consecutively missing teeth. Upon examination of the effects of fixture-abutment connection, the distribution of occlusal load was favorable in splinted implant-prosthesis with an external connection, but effect of strain distribution was not significant in splinted implant-prosthesis with an internal connection. In splinted implant-prostheses for short implants, strain distribution was not affected by the method of retention. For cement-retained prostheses, the effect of strain distribution due to splinting was not significant. In clinical studies, non-splinted prostheses with an internal connection for multiple consecutively missing teeth showed high survival rate, mild marginal bone loss, and stable periodontal condition. However, failure to achieve optimal proximal contact between single-unit prostheses may lead to food impaction, and veneer fracture may be inevitable when the framework provides inadequate support in the proximal region. In conclusion, splinted implant-prosthesis is not an indication in all cases, and clinical consideration of its use should be based on the patient's oral condition, such as location and number of implants, formation of proximal contact, canine guidance, existence of parafunctional habit, and oral hygiene, when multiple consecutively missing teeth are replaced by internal connection type implant.

• 구강회복응용과학지
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• 제21권2호
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• pp.169-182
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• 2005

The purpose of this study was to compare the stress distribution around the surrounding bone according to the splinted and non-splinted conditions on the finite element models of the two implant crowns with the different vertical bone level. The finite element model was designed with the parallel placement of the two fixtures ($4.0mm{\times}11.5mm$) with reverse buttress thread on the mandibular 1st and 2nd molars. As the bone quality, the inner cancellous bone and the outer 2 mm cortical bone were designed, and the cortical and cancellous bone were assumed to be perfectly bonded to the implant fixture. The splinted model(Model 1) had 2 mm contact surface and the non-splinted model(Model 2) had $8{\mu}m$ gap between two implant crowns. Two group (Splinted and non-splinted) was loaded with 200 N magnitude in the vertical and oblique directions on the loading point position on the central position of the crown, the 2 mm and 4 mm buccal offset point from the central position. Von Mises stress value was recorded and compared in the fixture-bone interface in the bucco-lingual and mesio-distal sections. The results were as follows; 1. In the vertical loading condition of central position, the stress was distributed on the cortical bone and the cancellous bone around the thread of the fixture in the splinted and non-splinted models. In the oblique loading condition, the stress was concentrated toward the cortical bone of the fixture neck, and the neck portion of 2nd molar in the non-splinted model was concentrated higher than that of 1st molar compared to the splinted model. 2. In the 2 mm buccal offset position of the vertical loading compared to the central vertical loading, stress pattern was shifted from apical third portion of the fixture to upper third portion of that. In the oblique loading condition, the stress was distributed over the fixture-bone interface. 3. In the 4 mm buccal offset position of the vertical loading, stress pattern was concentrated on the cortical bone around the buccal side of the fixture thread and shifted from apical third portion of the fixture to upper third portion of that in the splinted and non-splinted models. In the oblique loading, stresses pattern was distributed to the outer position of the neck portion of the fixture thread on the mesio-distal section in the splinted and non-splinted models. Above the results, it was concluded that the direction of loading condition was a key factor to effect the pattern and magnitude of stress over the surrounding bone of the fixture under the vertical and oblique loading conditions, although the type with or without proximal contact did not effect to the stress distribution.

• 대한치과보철학회지
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• 제32권3호
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• pp.445-454
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• 1994

Osseointegrated implant prostheses are to provide normal function without compromising the unique interaction between the tissue and the implant. The essential requirement for the osseointegrated implant prostheses is passive fit of abutment. Therefore, the impression must be accurate and reproduciable since the resultant master cast precisely duplicates the clinical condition. The purpose of this study was to compare the accuracy of the master casts obtained from five impression techniques. Group 1 : To take impression with indirect technique and Impregum F. Group 2 : To take impression with unsplinted direct technique and Impregum F. Group 3 : To take impression with splinted direct technique and Impregum F. Group 4 : To take impression with unsplinted direct technique and Xanthano. Group 5 : To take impression with splinted dierct technique and Xanthano. The results were as follow : 1. In taking impression of Impregum F, there was no significant difference between to use of indirect technique and unsplinted direct technique.(p<0.05) 2. Unsplinted direct technique with Impregum F is less accurate than splinted direct technique with Impregum F or Xanthano and unsplinted direct technique with Xanthano.(p<0.05). 3. There was no significant difference between splinted direct technique with Impregum F and unsplinted direct technique with Xanthano.(p<0.05) 4. Splinted direct technique reproduce more accurate than unsplinted direct technique.(p<0.05) 5. Impression plaster produced less distortion than polyether.(p<0.05) As a result, splinted direct technique with Xanthano was the most accurate technique. As a result, splinted direct technique with Xanthano was the most accurate technique in this study. In addition to dimensinal changes in the materials used, positional errors were also attributed to the mechanical components used in the transfer porocess. Although the errors measured were relatively small, this study demonstrates the potential for distortions with the transfer technique used. Further study is indicated that ?the technique will be able to reproduce the intraoral relationship of implant fixtures reliably and predictably.

• The Journal of Advanced Prosthodontics
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• 제14권4호
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• pp.223-235
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• 2022

PURPOSE. To compare the clinical outcomes of two types of implant restoration for posterior edentulous area, 3-unit bridge supported by 2 implants and 3 implant-supported splinted crowns. MATERIALS AND METHODS. The data included 127 implant-supported fixed restorations in 85 patients: 37 restorations of 3-unit bridge supported by 2 implants (2-IB), 37 restorations of 3 implant-supported splinted crowns (3-IC), and 53 single restorations (S) as controls. Peri-implantitis and mechanical complications that occurred for 14 years were analyzed by multivariable Cox regression model. Kaplan-Meier curves and the multivariable Cox regression model were used to analyze the success and survival of implants. RESULTS. Peri-implantitis occurred in 28.4% of 2-IB group, 37.8% of 3-IC group, and 28.3% of S control group with no significant difference. According to the implant position, middle implants (P2) of the 3-IC group had the highest risk of peri-implantitis. The 3-IC group showed a lower mechanical complication rate (7.2%) than the 2-IB (16.2%) and S control group (20.8%). The cumulative success rate was 52.8% in S (control) group, 62.2% in 2-IB group, and 60.4% in 3-IC group. The cumulative survival rate was 98.1% in S (control) group, 98.6% in 2-IB group, and 95.5% in 3-IC group. There was no significant difference in the success and survival rate according to the restoration type. CONCLUSION. The restoration type was not associated with the success and survival of implants. The risk of mechanical complications was reduced in 3 implant-supported splinted crowns. However, the middle implants of the 3 implant-supported splinted crowns had a higher risk of peri-implantitis.

• 대한치과보철학회지
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• 제43권3호
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• pp.352-362
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• 2005

Statement of problem. Accurate impression is essential to success of implant prostheses. But there have been few studies about the accuracy of fixture-level impression techniques in internal connection implant systems. Purpose. The purpose of this study was to compare the accuracy of two fixture-level impression techniques in two conditions (parallel and divergent) and to assess the effect of tightening sequences and forces on stresses generated on superstructures in internal connection implant system (Astra Tech). Material and methods. Two metal master frameworks made from two abutments (Cast-to Abutment ST) each and a corresponding, passively fitting, dental stone master cast with four fixture replicas (Fixture Replica ST) were fabricated. Ten dental stone casts for each impression techniques (direct unsplinted & splinted technique) were made with vinyl polysiloxane impressions from the master cast. Strain gauges for each framework were fixed midway between abutments to measure the degree of framework deformation on each stone cast. Pairs of strain gauges placed opposite each other constituted one channel (half Wheatstone bridge) to read deformation in four directions (superior, inferior, anterior, and posterior). Deformation data were analyzed using one-way ANOVA and the Tukey test at the .01 level of significance. And the effect of tightening sequences (right-to-left and left-to-right) and forces (10 Ncm and 20 Ncm) were assessed with ten stone casts made from parallel condition by the splinted technique. Deformation data were analyzed using paired t-test at the .01 level of significance. Conclusions. Within the limitations of this study, the following conclusions could be drawn. 1. Frameworks bent toward the inferior side on all casts made by both direct unsplinted and splinted impression techniques in both parallel and divergent conditions. 2. There was no statistically significant difference of accuracy between the direct unsplinted and splinted impression techniques in both parallel and divergent conditions (P>.01). 3. There was no statistically significant difference of stress according to screw tightening sequences in casts made by the splinted impression technique in parallel condition (P>.01). 4. Greater tightening force resulted in greater stress in casts made by the splinted impression technique in parallel condition (P<.01).

• 대한치과보철학회지
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• 제55권1호
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• pp.26-31
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• 2017

목적: 지르코니아 프레임워크를 이용한 시멘트 유지형 임플란트-지지 단일 크라운과 연결 크라운의 성공률과 보철적 합병증을 임상적으로 평가하는 것이다. 대상 및 방법: 67명의 환자에서 75개 수복물(단일 51개, 연결 24개)을 지르코니아 프레임워크를 이용한 시멘트 유지형 임플란트-지지 단일 크라운 혹은 연결 크라운으로 수복했다. 모든 수복물은 임시 시멘트로 합착했다. 보철적 합병증과 성공률을 조사하고, 나이, 성별, 보철물의 위치, 대합치, 보철물의 유형이 보철적 합병증에 미치는 영향을 평가했다. 결과:평균 22.2개월의 관찰 결과, 최종 누적 성공률은 66.9 (73.2 - 60.6)%였다. 유지 상실이 16개 보철물(단일 14개, 연결 2개)에서 나타났고, 지대주 나사 풀림과 비니어 도재 파절은 단일 크라운에서만 각각 2개의 보철물에서 나타났다. 단일 크라운과 연결 크라운에 대한 Kaplan-Meier 생존분석 결과, 최종 누적 성공률은 각각 58.9 (66.6 - 51.2)%, 87.5 (96.1 - 78.9)%를 보여 통계적으로 유의한 차이가 있었지만, 다른 고려 요인들은 보철적 합병증에 통계적으로 유의성이 없었다. 결론: 보철적 합병증은 유지 상실이 가장 많았고, 지대주 나사 풀림 및 비니어 도재 파절은 단일 크라운에서만 비교적 적게 관찰되었다. 나이, 성별, 보철물의 위치, 대합치에 따른 보철적 합병증에 미치는 영향은 유의한 차이가 없었지만, 상부 보철물을 연결 크라운으로 제작했을 때, 단일 크라운으로 제작한 경우보다 높은 성공률을 보였다.

• The Journal of Advanced Prosthodontics
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• 제11권2호
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• pp.112-119
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• 2019

PURPOSE. Zirconia materials have been used for implant-retained restorations, but the stress distribution of zirconia is not entirely clear. The aim of this study is to evaluate the stress distribution and risky areas caused by the different design of zirconia restorations on the atrophic bone of the posterior maxilla. MATERIALS AND METHODS. An edentulous D4-type bone model was prepared from radiography of an atrophic posterior maxilla. Monolithic zirconia and zirconia-fused porcelain implant-retained restorations were designed as splinted or non-splinted. 300-N occlusal forces were applied obliquely. Stress analyses were performed using a 3D FEA program. RESULTS. According to stress analysis, the bone between the 1) molar implant and the 2) premolar in the non-splinted monolithic zirconia restoration model was stated as the riskiest area. Similarly, the maximum von Mises stress value was detected on the bone of the non-splinted monolithic zirconia models. CONCLUSION. Splinting of implant-retained restorations can be more critical for monolithic zirconia than zirconia fused to porcelain for the longevity of the bone.

• 대한치과보철학회지
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• 제33권2호
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• pp.241-268
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• 1995

Splint therapy, the immobilization of teeth, has been done for patient's masticatory comforts and an adjunctive aid in periodontal therapy. Mandibular premolars are frequently splinted in many distal extension removable partial denture cases. But splinting is an extensive restoration that may not be conservative of tooth structure and may prove to be quite costly to the patient. The two dimensional finite element analysis method was used to determine the magnitude and mode of distribution of the stresses of the periodontal ligament and supporting alveolar bone when abutments with different periodontal supports were splinted and distal-extension removable partial denture was subjected to different loading schemes. The results were as follows : 1. When abutments were splinted, stresses moved from apico-distal to apico-mesial of terminal abutment on a vertical force and from disto-alveolar crest to apex on a distally directed force. But stresses were generally diminished on a mesially directed force. 2. As vertical bone loss was proceeding, most of stresses were transmitted to residual ridge and the rest of stresses were concentrated on apex of distal abutment. But these apical stresses were minimized when abutments were splinted. 3. As mesially inclined bone loss was proceeding, it seemed to be dangerous that many stresses were concentrated on the distal alveolar crest, especially in the distally directed load case. Abutments splinting decreased the alveolar crestal stresses but not enough. 4. For all vertical stresses were effectively decreased on splinting, stresses were concentrated as highly on apico-mesial area of distal abutment in distally directed load cases as the distal inclination of bone level was severe. 5. The directions and magnitudes of abutment movements were decreased with teeth splinting.

• The Journal of Advanced Prosthodontics
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• 제3권4호
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• pp.177-185
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• 2011

PURPOSE. The aim of this study was to evaluate the effect of dimensional stability of splinting material on the accuracy of master casts. MATERIALS AND METHODS. A stainless steel metal model with 6 implants embedded was used as a master model. Implant level impressions were made after square impression copings were splinted using 5 different techniques as follows. (1) Splinted with autopolymerizing resin and sectioned, reconnected to compensate polymerization shrinkage before the impression procedure. (2) Splinted with autopolymerizing resin just before impression procedure. (3) Primary impression made with impression plaster and secondary impression were made over with polyether impression material. (4) Splinted with impression plaster. (5) Splinted with VPS bite registration material. From master model, 5 impressions and 5 experimental casts, total 25 casts were made for each of 5 splinting methods. The distortion values of each splinting methods were measured using coordinate measuring machine, capable of recordings in the x-, y-, z- axes. A one-way analysis of variance (ANOVA) at a confidence level of 95% was used to evaluate the data and Tukey's studentized range test was used to determine significant differences between the groups. RESULTS. Group 1 showed best accuracy followed by Group 3 & 4. Group 2 and 5 showed relatively larger distortion value than other groups. No significant difference was found between group 3, 4, 5 in x-axis, group 2, 3, 4 in y-axis and group 1, 3, 4, 5 in z-axis (P<.0001). CONCLUSION. Both Splinting impression copings with autopolymerizing resin following compensation of polymerization shrinkage and splinting method with impression plaster can enhance the accuracy of master cast and impression plaster can be used simple and effective splinting material for implant impression procedure.

• 대한치과보철학회지
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• 제35권3호
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• pp.486-503
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• 1997

The purpose of this study was to evaluate the stress patterns developed in abutment and residual ridge according to removable denture design in case of remaining mandibular canines. The removable denture designs in this study were as foolows : 1. Removable partial denture with non-splinted abutment 2. Removable partial denture with splinted abutment 3. Overdenture with telescopic crown 4. Overdenture with O-Ring attachment 5. Overdenture with combination bar attachment Photoelastic stress analysis was used to record the isochromatic fringe patterns and to calculate principal stress components at measuring points. The results were as follows : 1. In case of removable partial denture with non-splinted abutment, stress of root area at the loaded side was the largest. No significant differences in stress of root area were observed between loaded side and unloaded side. 2. No significant differences in stress of residual ridge at the loaded side were observed between removable partial denture with splinted abutment and removable partial denture with non-splinted abutment. 3. In case of combination bar attachment retained overdenture, stress of root area was the largest and in case of telescopic crown retained overdenture, stress of root area was the lowest. 4. In case of attachment retained overdenture, stress of residual ridge was lower but stress of root area was larger than in case of removable partial denture.