• The Journal of Korean Academy of Prosthodontics
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• v.43 no.2
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• pp.158-175
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• 2005

Statement of problem. Every effort has been continually made to obtain objectivity in measuring the longevity of fixed restorations, such as by establishing unified judgement standard for deciding success and adopting statistical method that analyzes the data of successful and failed cases at the same time. In Korea, however desired level of development has not to be made in this field yet. Purpose. This study, adopting California Dental Association (CDA) quality evaluation system, established objective standard for deciding success, and inferred the longevity of fixed restorations and their failure analysis through adopting Kaplan-Meier survival analysis. Material and method. In order to assess the longevity of flxed restorations serviced in Korea and causes of failure, a total of 1109 individuals (aged 15-74, 716 women and 393 men loaded with 2551 unit fixed restorations, and 1934 abutments) who lived in Kyung-In Province were examined and the findings were as follows : Results. 1. Length of service of fixed restorations serviced in Korea was 6.86$\pm$0.15 yr (mean), 5.5 yr (median), and the rate of success was 65.82% in 5 year survival, and 21.15% in 10 year survival. 2. When there was patient's need for replacing old prosthetics, longevity of fixed restorations was 7.51$\pm$0.27 yr (mean), 7 yr (median), and the rate of success was 61.08% in 5 year survival, and 17.57% in 10 year survival. 3. Longevity of fixed restorations was longest in the over-sixty age group(9.21$\pm$0.66) and that of the teen age group(3.39$\pm$0.28) was shortest (p<0.05). 4. Longevity of fixed restorations of women (7.38$\pm$0.18 years) was longer than that of men (6.00$\pm$0.26) (p<0.05). 5. As for the provider factor (such as unlicensed performers, university hospitals, and private clinic), there was no statistically significant difference in longevity of fixed restorations. 6. Defective margin (34.78%). periodontal disease (12.15%), periapical involvement (11.73%), was the most frequent causes of failure and poor esthetics group showed the longest life above all (p<0.05). Actual frequent causes of failure after removing old prosthetics were defective margin, periapical involvement, periodontal disease and uncemented restoration. In 75.67% of the cases, abutment state after removing old prosthetics was good enough for loading another prosthetics. 7. There was found to have statistically significant influence between longevity of single crown (6.35$\pm$0.20 yr) and that of 3 unit fixed restorations (7.60$\pm$0.30 y) (p<0.05). In each case the most frequent cause of failure was defective margin. 8. The number of cantilever pontic, pontic/abutment ratio, oral hygiene status were found to have no statistically significant influence on longevity of fixed restorations in all groups (p>0.05). 9. Longevity of fixed restorations made of non precious metal was longest (9.60$\pm$0.40 yr) semi precious and precious trailing behind(p<0.05). 10. Group function group (37.04%) and partial group function group (44.62%) were predominant in frequency but showed no correlation between them and among different types of occlusal plane and different types of occlusal surface (p>0.05). 11. Longevity of fixed restorations was longest in the centric interference group(9.35$\pm$0.62) (p<0.05) among different types of occlusal interference. Conclusion. We found that longevity of fixed restorations serviced in Korea is affected by age, gender and type of material, and that most frequent cause of failure is defective margin. In order to assess the accurate longevity of axed restorations, unified research design. overcoming inter-observer difference and establishing the objective research items are needed. Furthermore, it is thought that prospective approach through thorough study and regular follow-ups is needed just from the start of research. Nationwide detailed studies on length of service of fixed restorations manufactured in Korea are hoped to be conducted hereafter.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.4
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• pp.424-434
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• 2009

Statement of problem: Problems such as loosening and fractures of retained screws and fracture of implant fixture have been frequently reported in implant prosthesis. Purpose: Implant has weak mechanical properties against lateral loading compared to vertical occlusal loading, and therefore, stress analysis of implant fixture depending on its material and geometric features is needed. Material and methods: Total 28 of external hexed implants were divided into 7 of 4 groups; Group A (3i, FULL $OSSEOTITE^{(R)}$Implant), Group B (Nobelbiocare, $Br{\aa}nemark$ $System^{(R)}$Mk III Groovy RP), Group C (Neobiotec, $SinusQuick^{TM}$ EB), Group D (Osstem, US-II). The type III gold alloy prostheses were fabricated using adequate UCLA gold abutments. Fixture, abutment screw, and abutment were connected and cross-sectioned vertically. Hardness test was conducted using MXT-$\alpha$. For fatigue fracture test, with MTS 810, the specimens were loaded to the extent of 60-600 N until fracture occurred. The fracture pattern of abutment screw and fixture was observed under scanning electron microscope. A comparative study of stress distribution and fracture area of abutment screw and fixture was carried out through finite element analysis Results: 1. In Vicker's hardness test of abutment screw, the highest value was measured in group A and lowest value was measured in group D. 2. In all implant groups, implant fixture fractures occurred mainly at the 3-4th fixture thread valley where tensile stress was concentrated. When the fatigue life was compared, significant difference was found between the group A, B, C and D (P<.05). 3. The fracture patterns of group B and group D showed complex failure type, a fracture behavior including transverse and longitudinal failure patterns in both fixture and abutment screw. In Group A and C, however, the transverse failure of fixture was only observed. 4. The finite element analysis infers that a fatigue crack started at the fixture surface. Conclusion: The maximum tensile stress was found in the implant fixture at the level of cortical bone. The fatigue fracture occurred when the dead space of implant fixture coincides with jig surface where the maximum tensile stress was generated. To increase implant durability, prevention of surrounding bone resorption is important. However, if the bone resorption progresses to the level of dead space, the frequency of implant fracture would increase. Thus, proper management is needed.

• Progress in Medical Physics
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• v.23 no.4
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• pp.269-278
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• 2012

Aquaplast Thermoplastic (AT) is a tissue-equivalent oral compensator that has been developed to improve dose uniformity at the common boundary and around the treated area during radiotherapy in patients with head and neck cancer. In order to assess the usefulness of AT, the degree of improvement in dose distribution and physical properties were compared to those of oral compensators made using paraffin, alginate, and putty, which are materials conventionally used in dental imprinting. To assess the physical properties, strength evaluations (compression and drop evaluations) and natural deformation evaluations (volume change over time) were performed; a Gafchromic EBT2 film and a glass dosimeter inserted into a developed phantom for dose verification were used to measure the common boundary dose and the beam profile to assess the dose delivery. When the natural deformation of the oral compensators was assessed over a two-month period, alginate exhibited a maximum of 80% change in volume from moisture evaporation, while the remaining tissue-equivalent properties, including those of AT, showed a change in volume that was less than 3%. In a free-fall test at a height of 1.5 m (repeated 5 times as a strength evaluation), paraffin was easily damaged by the impact, but AT exhibited no damage from the fall. In compressive strength testing, AT was not destroyed even at 8 times the force needed for paraffin. In dose verification using a glass dosimeter, the results showed that in a single test, the tissue-equivalent (about 80 Hounsfield Units [HU]) AT delivered about 4.9% lower surface dose in terms of delivery of an output coefficient (monitor unit), which was 4% lower than putty and exhibited a value of about 1,000 HU or higher during a dose delivery of the same formulation. In addition, when the incident direction of the beam was used as a reference, the uniformity of the dose, as assessed from the beam profile at the boundary after passing through the oral compensators, was 11.41, 3.98, and 4.30 for air, AT, and putty, respectively. The AT oral compensator had a higher strength and lower probability of material transformation than the oral compensators conventionally used as a tissue-equivalent material, and a uniform dose distribution was successfully formed at the boundary and surrounding area including the mouth. It was also possible to deliver a uniformly formulated dose and reduce the skin dose delivery.

• Restorative Dentistry and Endodontics
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• v.24 no.2
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• pp.408-415
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• 1999

When a zinc-oxide eugenol type sealer was placed in root canals treated previously with calcium hydroxide, acceleration of its setting and the yellowish discoloration were observed clinically. The purpose of this study was to evaluate the properties of calcium hydroxide-eugenol compound. Some physical properties of calcium hydroxide-eugenol compound were compared with a manufactured zinc-oxide eugenol based root canal sealer, Tubli-seal$^{(R)}$ in terms of water solubility, water sorption, film thickness and microleakage. Solubility and water sorption were determined by the use of the method described in American Dental Association Specification(ADAS) no. 57. Ten samples of each material were prepared into disks 20mm in diameter and 1.5mm in thickness. The samples were immersed in 50ml of distilled water at $37{\pm}1^{\circ}C$ for 7 days. The samples were then removed and placed in a desiccator. The values for solubility and water sorption were calculated using differences between the weights of same sample. Film thickness was determined by the use of the method described in ADAS no. 57 too. A small quantity of mixed cement was placed between two glass plates of which thickness was measured previously. 15Kg loading was applied and total thickness of the glass plates and the cement film was measured. The thickness difference was recorded as the material's film thickness. Microleakage was determined with a dye penetration method. Experimental materials were placed between the dentin surface of bovine tooth and the acrylic rod. These units were immersed in Pelican ink (W-Germany) for three days. Dye-penetrated dentin surfaces of bovine tooth were measured using the NIB Image 1.60 Macintosh program. The results are as follows: 1. Water solubility value of calcium hydroxide-eugenol compound (20.98${\pm}$2.94%) was statistically higher than those of Tubli-seal$^{(R)}$(2.52${\pm}$0.49%)(p<0.05). 2. Water sorption value of calcium hydroxide-eugenol compound (59.72${\pm}$17.75%) was statistically higher than those of Tubli-seal$^{(R)}$(3.15${\pm}$0.76%)(p<0.05). 3. Film thickness value of calcium hydroxide-eugenol compound (0.36${\pm}$0.03mm) was statistically higher than those of Tubli-seal$^{(R)}$(0.12${\pm}$0.1mm)(p<0.05). 4. Dye penetration value after 3 days-immersion of calcium hydroxide-eugenol compound(57.63${\pm}$25.85%) was statistically higher than those of Tubli-seal$^{(R)}$(28.05${\pm}$23.46%)(p<0.05).

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.4
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• pp.342-349
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• 2019

Purpose: The purpose of this study was to retrospectively investigate the survival and success rate of implant-supported fixed prosthesis according to the materials in the posterior area. Other purposes were to observe the complications and evaluate the factors affecting failure. Materials and methods: Patients who had been restored implant prosthesis in the posterior area by the same prosthodontist in the department of prosthodontics, dental hospital, Chonbuk National University, in the period from January 2011 to June 2018 were selected for the study. The patient's sex, age, material, location, type of prosthesis and complications were examined using medical records. The KaplanMeier method was used to analyze the survival and success rate. The Log-rank test was conducted to compare the differences between the groups. Cox proportional hazards model was used to assess the association between potential risk factors and success rate. Results: A total of 364 implants were observed in 245 patients, with an average follow-up of 17.1 months. A total of 5 implant prostheses failed and were removed, and the 3 and 5 year cumulative survival rate of all implant prostheses were 97.5 and 91.0, respectively. The 3 and 5 year cumulative success rate of all implant prostheses were 61.1% and 32.9%, respectively. Material, sex, age, location and type of prosthesis did not affect success rate (P>.05). Complications occurred in the order of proximal contact loss (53 cases), retention loss (17 cases), peri-implant mucositis (12 cases), infraocclusion (4 cases) and so on. Conclusion: Considering a high cumulative survival rate of implant-supported fixed prostheses, regardless of the materials, implant restored in posterior area can be considered as a reliable treatment to tooth replacement. However, regular inspections and, if necessary, repairs and adjustments are very important because of the frequent occurrence of complications.

• Proceedings of the KACD Conference
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• 2008.05a
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• pp.169-176
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• 2008

The purpose of this study was to evaluate the effect of thickness, filling methods and curing methods on the polymerization of dual cured core materials by means of microhardness test. Two dual cured core materials, MultiCore Flow (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Bis-Core (Bisco Inc., Schaumburg, IL, USA) were used in this study. 2 mm (bulky filled), 4 mm (bulky filled), 6 mm (bulky and incrementally filled) and 8 mm (bulky and incrementally filled)-thickness specimens were prepared with light cure or self cure mode. After storage at $37^{\circ}C$ for 24 hours, the Knoop hardness values (KHN) of top and bottom surfaces were measured and the microhardness ratio of top and bottom surfaces was calculated. The data were analyzed using one-way ANOVA and Scheffe multiple comparison test, with ${\alpha}=0.05$. The effect of thickness on the polymerization of dual cured composites showed material specific results. In 2, 4 and 6 mm groups, the KHN of two materials were not affected by thickness. However, in 8 mm group of MultiCore Flow, the KHN of the bottom surface was lower than those of other groups (p < 0.05). The effect of filling methods on the polymerization of dual cured composites was different by their thickness or materials. In 6 mm thickness, there was no significant difference between bulk and incremental filling groups. In 8 mm thickness, Bis-Core showed no significant difference between groups. However, in MultiCore Flow, the microhardness ratio of bulk filling group was lower than that of incremental filling group (p < 0.05). The effect of curing methods on the polymerization of dual cured composites showed material specific results. In Bis-Core, the KHN of dual cured group were higher than those of self cured group at both surfaces (p < 0.05). However, in MultiCore Flow, the results were not similar at both surfaces. At the top surface, dual cured group showed higher KHN than that of self cured group (p < 0.05). However, in the bottom surface, dual cured group showed lower value than that of self cured group (p < 0.05).

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.4
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• pp.406-415
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• 2009

Purpose: The purpose of this study was to compare the marginal fitness and fracture load of the zirconia copings according to the design with different thickness and coloration. Material and methods: The evaluation was based on 80 zirconia copings. Zirconia copings were fabricated in design with different thicknesses using CAD/CAM system (Everset, KAVO dental GmbH, Biberach, Germany). The designs of copings were divided into four groups. The first group consisted of copings with uniform thickness of 0.3 mm. The thickness in the second group was 0.3 mm on the buccal surface and 0.6 mm on the lingual surface. The third group consisted of coping with uniform thickness of 0.6 mm. The thickness in the fourth group was 0.6 mm on the buccal surface and 1mm on the lingual surface. Each group consisted of 10 colored and 10 uncolored copings. Half of the copings (40) processed with a milling system according to the specific design were sent to be given a color (A3) through saturation in special dye by a manufacturing company. Just after sintering, the marginal discrepancies of copings were measured on the buccal, lingual, mesial and distal surfaces of metal die, under a Video Microscope System (sv-35, Sometech, Seoul, Korea) at a magnification of $\times$ 100. It was remeasured after the adjusting of the inner surface. Next, all copings were luted to the metal dies using reinforced cement {GC FujiCEM (GC Corp. Tokyo, Japan)} and mounted on the testing jig in a Universal Testing Machine (Instron 4467, Norwood, MA, USA). The results were analyzed statistically using the one-way ANOVA test. Results: The obtained results were as follow: 1. The measured value of marginal discrepancy right after sintering was the greatest in the contraction of the buccal area in all groups, except for group I2. 2. There was no significant difference of marginal fitness among the groups in the colored zirconia group (P<.05). 3. When the marginal fitness among the groups in the uncolored zirconia group was considered, group II2 had the smallest marginal discrepancy. 4. When the colored and uncolored groups with the same design were compared, there was a significant difference between I1 and II1 groups. In group 2, 3, and 4, the uncolored zirconia had the greatest marginal fitness (P<.05). 5. After adjustment of inner surface, there was no significant difference in the marginal fitness in all groups when color and design of the zirconia coping were compared. 6. The fracture load of CAD/CAM zirconia copings showed significant difference in group 1, 2, 3, and 4. I4 and II4 had the strongest fracture load. 7. When groups with different color and same design were compared, all colored groups showed greater fracture load (P>.05), with no significance. Conclusion: There was difference in the marginal fitness according to the design and coloration of zirconia copings right after sintering, but it was decided that the copings may well be used clinically if the inner surface are adjusted. The copings should be thick enough for the reinforcement of fracture strength. But considering the esthetics of the visible surfaces (labial and buccal surface), the thickness of copings may be a little thin, without giving any significant effect on the fracture strength. This type of design may be considered when giving priority to preservation of tooth or esthetics.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.4
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• pp.365-375
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• 2009

Statement of problems: Stress analysis on implant components of the combined screw- and cement-retained implant prosthesis has not investigated yet. Purpose: The purpose of this study was to assess the load distribution characteristics of implant prostheses with the different prosthodontic retention types, such as cement-type, screw-type and combined type by using 3-dimensional finite element analysis. Material and methods: A 3-dimensional finite element model was created in which two SS II implants (Osstem Co. Ltd.) were placed in the areas of the first premolar and the first molar in the mandible, and three-unit fixed partial dentures with four different retention types were fabricated on the two SS II implants. Model 1 was a cement-retained implant restoration made on two cement-retained type abutments (Comocta abutment; Osstem Co. Ltd.), and Model 2 was a screw-retained implant restoration made on the screw-retained type abutments (Octa abutment; Osstem Co. Ltd.). Model 3 was a combined type implant restoration made on the cement-retained type abutment (Comocta abutment) for the first molar and the screw-retained type abutment (Octa abutment) for the first premolar. Lastly, Model 4 was a combined type implant restoration made on the screw-retained type abutment (Octa abutment) for the first molar and the cement-retained type abutment (Comocta abutment) for the first premolar. Average masticatory force was applied on the central fossa in a vertical direction, and on the buccal cusp in a vertical and oblique direction for each model. Von-Mises stress patterns on alveolar bone, implant body, abutment, abutment screw, and prosthetic screw around implant prostheses were evaluated through 3-dimensional finite element analysis. Results: Model 2 showed the lowest von Mises stress. In all models, the von Mises stress distribution of cortical bone, cancellous bone and implant body showed the similar pattern. Regardless of loading conditions and type of abutment system, the stress of bone was concentrated on the cortical bone. The von-Mises stress on abutment, abutment screw, and prosthetic screw showed the lower values for the screw-retained type abutment than for the cement-retained type abutment regardless of the model type. There was little reciprocal effect of the abutment system between the molar and the premolar position. For all models, buccal cusp oblique loading caused the largest stress, followed by buccal cusp vertical loading and center vertical loading. Conclusion: Within the limitation of the FEA study, the combined type implant prosthesis did not demonstrate more stress around implant components than the cement type implant prosthesis. Under the assumption of ideal passive fit, the screw-type implant prosthesis showed the east stress around implant components.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.2
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• pp.125-136
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• 2008

Statement of problem: Since the concept of osseointegration in dental implants was introduced by $Br{{\aa}}nemark$ et al, high long-term success rates have been achieved. Though the use of dental implants have increased dramatically, there are few studies on domestic implants with clinical and objective long-term data. Purpose: The aim of this retrospective study was to provide long-term data on the $Neoplan^{(R)}$ implant, which features a sandblasted and acid-etched surface and external connection. Material and methods: 96 $Neoplan^{(R)}$ implants placed in 25 patients in Yonsei University Hospital were examined to determine the effect of the factors on marginal bone loss, through clinical and radiographic results during 18 to 57 month period. Results: 1. Out of a total of 96 implants placed in 25 patients, two fixtures were lost, resulting in 97.9% of cumulative survival rate. 2. Throughout the study period, the survival rates were 96.8% in the maxilla and 98.5% in the mandible. The survival rates were 97.6% in the posterior regions and 100% in the anterior regions. 3. The mean bone loss for the first year after prosthesis placement and the mean annual bone loss after the first year for men were significantly higher than that of women (P<0.05). 4. The group of partial edentulism with no posterior teeth distal to the implant prosthesis showed significantly more bone loss compared to the group of partial edentulism with presence of posterior teeth distal to the implant prosthesis in terms of mean bone loss for the first year and after the first year (P<0.05). 5. The mean annual bone loss after the first year was more pronounced in posterior regions compared to anterior regions (P<0.05). 6. No significant difference in marginal bone loss was found in the following factors: jaws, type of prostheses, type of opposing dentition, and submerged /non-submerged implants (P<0.05). Conclusion: On the basis of these results, the factors influencing marginal bone loss were gender, type of edentulism, and location in the arch, while the factors such as arch, type of prostheses, type of opposing dentition, submerged / non- submerged implants had no significant effect on bone loss. In the present study, the cumulative survival rate of the $Neoplan^{(R)}$ implant with a sandblasted and acid-etched surface was 97.9% up to a maximum 57-month period. Further long-term investigations for this type of implant system and evaluation of other various domestic implant systems are needed in future studies.

• Journal of the korean academy of Pediatric Dentistry
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• v.26 no.2
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• pp.339-349
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• 1999

The dental structure substituted by restorative materials may produce discomfort resulting from hot or cold stimuli. To investigate the effects of this stimuli on the human teeth, thermal analysis was carried out by calculation of general heat conduction equation in a modeled tooth using numerical method. The method has been applied to axisymmetric and two-dimensional model, analyzing the effects of constant temperature $4^{\circ}C\;and\;60^{\circ}C$. That thermal shock was provided for 2 seconds and 4 seconds, respectively and recovered to normal condition of $20^{\circ}C$ until 10 seconds. The thermal behavior of tooth covered with a crown of gold or stainless steel was compared with that of tooth without crown. At the same time, the effects of restorative materials(amalgam, gold and zinc oxide-eugenol(ZOE)) on the temperature of PDJ(pulpo-dentinal junction) has been studied. The geometry used for thermal analysis so far has been limited to two-dimensional as well as axisymmetric tooth models. But the general restorative tooth forms a cross shaped cavity which is no longer two-dimensional and axisymmetric. Therefore, in this study, the three-dimensional model was developed to investigate the effect of shape and size of cavity. This three-dimensional model might be used for further research to investigate the effects of restorative materials and cavity design on the thermal behavior of the real shaped tooth. The results were as follows; 1. When cold temperature of $4^{\circ}C$ was applied to the surface of the restored teeth with amalgam for 2 seconds and recovered to ambient temperature of $20^{\circ}C$, the PDJ temperature decreased rapidly to $29^{\circ}C$ until 3 seconds and reached to $25^{\circ}C$ after 9 seconds. This temperature decreased rather slowly with stainless steel crown, but kept similar temperature within $1^{\circ}C$ differences. Using the gold as a restorative material, the PDJ temperature decreased very fast due to the high thermal conductivity and reached near to $25^{\circ}C$ but the temperature after 9 seconds was similar to that in the teeth without crown. The effects of coldness could be attenuated with the ZOE situated under the cavity. The low thermal conductivity caused a delay in temperature decrease and keeps $4^{\circ}C$ higher than the temperature of other conditions after 9 seconds. 2. The elapse time of cold stimuli was increased also until 4 seconds and recovered to $20^{\circ}C$ after 4 seconds to 9 seconds. The temperature after 9 seconds was about $2-3^{\circ}C$ lower than the temperature of 2 seconds stimuli, but in case of gold restoration, the high thermal conductivity of gold caused the minimum temperature of $21^{\circ}C$ after 5 seconds and got warm to $23^{\circ}C$ after 9 seconds. 3. The effects of hot stimuli was also investigated with the temperature of $60^{\circ}C$. For 2 seconds stimuli, the temperature increased to $40^{\circ}C$ from the initial temperature of $35^{\circ}C$ after 3 seconds of stimuli and decreased to $30^{\circ}C$ after 9 seconds in the teeth without crown. This temperature was sensitive to surface temperature in the teeth with gold restoration. It increased rapidly to $41^{\circ}C$ from the initial temperature of $35^{\circ}C$ after 2 seconds and decreased to $28^{\circ}C$ after 9 seconds, which showed $13^{\circ}C$ temperature variations for 9 seconds upon the surface temperature. This temperature variations were only in the range of $5^{\circ}C$ by using ZOE in the bottom of cavity and showed maximum temperature of $37^{\circ}C$ after 3 seconds of stimuli.