• Clinics in Shoulder and Elbow
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• 제24권3호
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• pp.141-146
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• 2021

Background: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model. Methods: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to the study group (spine base fixation with a four long screws, three with both long superior and long posterior screws). Results: The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. Conclusions: The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.

• 대한치과교정학회지
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• 제37권2호
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• pp.89-97
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• 2007

교정용 스크류의 적절한 식립 토오크는 스크류와 골과의 경계에 적절히 작용하여 실패를 최소화 할 수 있는데, 너무 낮은 식립 토오크는 안정성이 없으며 반면에 너무 강한 식립 토오크는 열, 기계적 손상으로 골 괴사를 야기할 수도 있다. 본 연구에는 임상적으로 스크류의 길이와 직경 및 형태 등을 달리하여 식립 토오크를 측정해서 스크류의 각 부분에 대한 세분화된 토오크의 변화를 분석하고자 하였다. 연구결과 1.5 mm 두께의 인공피질골 블록에서 cylindrical type 스크류와 taper type 스크류 두 형태 모두에서 스크류 길이가 길수록 최대 식립 토오크 값도 함께 증가하였다. 특히 cylindrical type 스크류에서 길이에 따른 토오크 변화에 대해 통계적으로 유의한 차이가 관찰되었다 (p<0.05). 미니스크류의 연속적인 식립 토오크 분석 결과 cylindrical type 스크류는 연속적인 그래프 형태를 보이면서 불완전 나사부에서 식립 토오크가 크게 증가하였으며, taper type 스크류는 나사선의 마지막 경사진 부분에서 식립 토오크가 크게 증가하였다. 외경이 커질수록 최대 식립 토오크 값은 증가하였는데, 통계적으로 유의한 차이를 보였다 (p<0.05). 형태와 외경, 길이는 모두 토오크 값에 유의한 영향을 미치는데, 식립 토오크에 가장 큰 영향을 미치는 것은 외경, 형태, 길이 순서였다. 본 연구 결과 스크류의 식립 토오크에 가장 큰 영향을 미치는 것은 스크류의 외경이며 각각의 해부학적 구조물에 대한 피질골의 두께를 고려하여 적합한 스크류의 두께 및 나사산의 형태를 선택하는 것이 스크류의 초기 고정력을 얻는데 유리하다고 판단된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권6호
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• pp.393-402
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• 2020

Objectives: Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites. Materials and Methods: This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05. Results: Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035). Conclusion: We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.

• 대한치과기공학회지
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• 제42권2호
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• pp.99-105
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• 2020

Purpose: A study analysed the stress distribution of abutment screw and supporting bone of fixture by the tightening torque force of the abutment screw within clinical treatment situation for the stability of the dental implant prosthesis. Methods: The finite element analysis was targeted to the mandibular molar crown model, and the implant was internal type 4.0 mm diameter, 10.0 mm length fixture and abutment screw and supporting bone. The occlusal surface was modeled in 4 cusps and loaded 100 N to the buccal cusps. The connection between the abutment and the fixture was achieved by combining three abutment tightening torque forces of 20, 25, and 30 Ncm. Results: The results showed that the maximum stress value of the supporting bone was found in the buccal cortical bone region of the fixture in all models. The von Mises stress value of each model showed 184.5 MPa at the 20 Ncm model, 195.3 MPa in the 25 Ncm model, and 216.5 MPa in the 30 Ncm model. The contact stress between the abutment and the abutment screw showed the stress value in the 20 Ncm model was 201.2 MPa, and the 245.5 MPa in the 25 Ncm model and 314.0 MPa in the 30 Ncm model. Conclusion: The increase of tightening force within the clinical range of the abutment screw of the implant dental prosthesis was found to have no problem with the stability of the supporting bone and the abutment screw.

• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.376-381
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• 2019

Objective : To define optimal method that calculate the safe direction of cervical pedicle screw placement using computed tomography (CT) image based three dimensional (3D) cortical shell model of human cervical spine. Methods : Cortical shell model of cervical spine from C3 to C6 was made after segmentation of in vivo CT image data of 44 volunteers. Three dimensional Cartesian coordinate of all points constituting surface of whole vertebra, bilateral pedicle and posterior wall were acquired. The ideal trajectory of pedicle screw insertion was defined as viewing direction at which the inner area of pedicle become largest when we see through the biconcave tubular pedicle. The ideal trajectory of 352 pedicles (eight pedicles for each of 44 subjects) were calculated using custom made program and were changed from global coordinate to local coordinate according to the three dimensional position of posterior wall of each vertebral body. The transverse and sagittal angle of trajectory were defined as the angle between ideal trajectory line and perpendicular line of posterior wall in the horizontal and sagittal plane. The averages and standard deviations of all measurements were calculated. Results : The average transverse angles were $50.60^{\circ}{\pm}6.22^{\circ}$ at C3, $51.42^{\circ}{\pm}7.44^{\circ}$ at C4, $47.79^{\circ}{\pm}7.61^{\circ}$ at C5, and $41.24^{\circ}{\pm}7.76^{\circ}$ at C6. The transverse angle becomes more steep from C3 to C6. The mean sagittal angles were $9.72^{\circ}{\pm}6.73^{\circ}$ downward at C3, $5.09^{\circ}{\pm}6.39^{\circ}$ downward at C4, $0.08^{\circ}{\pm}6.06^{\circ}$ downward at C5, and $1.67^{\circ}{\pm}6.06^{\circ}$ upward at C6. The sagittal angle changes from caudad to cephalad from C3 to C6. Conclusion : The absolute values of transverse and sagittal angle in our study were not same but the trend of changes were similar to previous studies. Because we know 3D address of all points constituting cortical shell of cervical vertebrae. we can easily reconstruct 3D model and manage it freely using computer program. More creative measurement of morphological characteristics could be carried out than direct inspection of raw bone. Furthermore this concept of measurement could be used for the computing program of automated robotic screw insertion.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권1호
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• pp.52-59
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• 2006

Purpose: The purpose of this study was to evaluate the influence of apical-coronal implant position on the stress distribution after occlusal and oblique loading. Materials and Methods: The cortical and cancellous bone was assumed to be isotropic, homogeneous, and linearly elastic. The implant was apposed to cortical bone in the crestal region and to cancellous bone for the remainder of the implant-bone interface. The cancellous core was surrounded by 2-mm-thick cortical bone. An axial load of 200 N was assumed and a 200-N oblique load was applied at a buccal inclination of 30 degrees to the center of the pontic and buccal cusps. The 3-D geometry modeled in Iron CAD was interfaced with ANSYS. Results: When only the stress in the bone was compared, the minimal principal stress at load Points A and B, with a axial load applied at 90 degrees or an oblique load applied at 30 degrees, for model 5. The von Mises stress in the screw of model 5 was minimal at Points A and B, for 90- and 30-degree loads. When the von Mises stress of the abutment screw was compared at Points A and B, and a 30-degree oblique load, the maximum principal stress was seen with model 2, while the minimum principal stress was with model 5. In the case of implant, the model that received maximum von Mises stress was model 1 with the load Point A and Point B, axial load applied in 90-degree, and oblique load applied in 30-degree. Discussion and Conclusions: These results suggests that implantation should be done at the supracrestal level only when necessary, since it results in higher stress than when implantation is done at or below the alveolar bone level. Within the limited this study, we recommend the use of supracrestal apical-coronal positioning in the case of clinical indications.

• 대한치과보철학회지
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• 제30권4호
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• pp.582-610
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• 1992

The long-term success of any dental implant is dependent upon the optimization of stresses which occur during oral function and parafunction. Especially, it has been suggested that there is an unique set of problems associated with joining an osseointegrated implant and a natural tooth with a fixed partial denture. For this particular case, although many literatures suggest different ways to avoid high stress concentrations on the bone surrounding the implant under static and dynamic loading conditions, but few studies on the biomechanical efficacy of each assertion have been reported. The purpose of this investigation was to evaluate the efficacies of clinically suggested methods on stress distribution under static load and shock absorption under dynamic load, using two dimensional finite element method. In FEM models of osseointegrated implant-natural tooth supported fixed partial dentures, calculations were made on the stresses in surrounding bone and on the deflections of abutments and superstructure, first, to compare the difference in stress distribution effects under static load by the flexure of fastening screw or prosthesis, or intramobile connector, and second, to compare the difference in the shock absorption effects under dynamic load by intramobile connector or occlusal veneering with composite resin. The results of this analysis suggest that : 1. Under static load condition, using an implant design with fastenign screw connecting implant abutment and prosthesis or increasing the flexibility of fastening screw, or increasing the flexibility of prosthesis led to the .increase in height of peak stresses in cortical bone surrounding the implant, and has little effect on stress change in bone around the natural tooth. 2. Under static load condition, intramobile connector caused the substantial decrease in stress concentration in cortical bone surrounding the implant and the slight increase in stress in bone around the natural tooth. 3. Under dynamic load condition, both intramobile connector and composite resin veneering showed shock absorption effect on bone surrounding the implant and composite resin veneering had a greater shock absorption effect than intramobile connector.

• 대한치과보철학회지
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• 제43권2호
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• pp.248-257
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• 2005

Statement of problem. Cortical bone plays an important role in the primary implant stability, which is essential to immediate/early loading. However, immediate load-bearing capacity and primary implant stability according to the change of the cortical bone thickness have not been reported. Purpose. The objectives of this study were (1) to measure the immediate load-bearing capacity of implant and primary implant stability according to the change of cortical bone thickness, and (2) to evaluate the correlation between them. Material and methods.48, screw-shaped implants (3.75 mm$\times$7 mm) were placed into bovine rib bone blocks with different upper cortical bone thickness (0-2.5 mm) and resonance frequency (RF) values were measured subsequently. After fastening of healing abutment. implants were subjected to a compressive load until tolerated micromotion threshold known for the osseointegration and load values at threshold were recorded. Thereafter, RF measurement after loading, CT taking and image analysis were performed serially to evaluate the cortical bone quality and quantity. Immediate load-bearing capacity and RF values were analyzed statistically with ANOVA and post-hoc method at 95% confidence level (P<0.05). Regression analysis and correlation test were also performed. Results. Existence and increase of cortical bone thickness increased the immediate load-bearing capacity and RF value (P<0.05) With the result of regression analysis, all parameter's of cortical bone thickness to immediate load-bearing capacity and resonance frequency showed significant positive values (P<0.0001). A significant high correlation was observed between the cortical bone thickness and immediate load-beating capacity (r=0.706, P<0.0001), between the cortical bone thickness and resonance frequency (r=0.753, P<0.0001) and between the immediate load-bearing capacity and resonance frequency (r=0.755, P<0.0001). Conclusion. In summary, cortical bone thickness change affected the immediate load-baring capacity and the RF value. Although RF analysis (RFA) is based on the measurement of implant/bone interfacial stiffness, when the implant is inserted stably, RFA is also considered to reflect implant/bone interfacial strength of immediately after placement from high correlation with the immediate load-baring capacity. RFA and measuring the cortical bone thickness with X-ray before and during surgery could be an effective diagnosis tool for the success of immediate loading of implant.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.568-573
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• 2018

Objective : Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons. Methods : We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1-6) with classical position (anesthesiologist and monitor were placed near to patient's head. Surgeons were standing classically near to patient's body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient's belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1-2 mm penetration, 2-4 mm penetration and >4 mm penetration. Results : Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003). Conclusion : Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon's position standing near to patient's head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1469-1475
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• 2000

Objective : The goal of this study was to evaluate the clinical outcome of the posterior C1-2 transarticular screw fixation without C1-2 sublaminar wiring in atlantoaxial instability. Methods : Between Apr. 1995 and Feb. 2000, we used this technique in treat randomly selected 17 patients (11 men, 6 women) who had atlantoaxial instability. The causes of instability were : type II-A odontoid process fracture(10 cases) ; type II-P odontoid process fracture(1 case) ; Os odontoideum(2 cases) ; transverse ligament laxity due to rheumatoid disease(1 case) ; and, transverse ligament injury without bone fracture(3 cases). All cases were operated with posterior C1-2 transarticular screw fixation with 3.5mm cortical screw and interlaminar iliac graft without sublaminar wire fixation. The mean follow-up period was 28 months(5 to 58 months) and the mean age at the time of operation was 41 years(15 to 68 years). All Patients were allowed to ambulate with Philadelphia neck collar on the first post-operation day. Results : Bony fusion was successfully achieved in all cases demonstrated at 3-month follow-up studies. There was no operative mortality or morbidity. Conclusion : The authors conclude that the posterior transarticular screw fixation without C1-2 sublaminar wiring provide adequate stability with high bony union rate in atlantoaxial instability of various causes.