Purpose: The purpose of this study was to investigate the influence of mobilization on bone-implant interface prior to osseointegration of fixtures. Materials and methods: The experimental implants (3.75 mm in diameter, 4.0 mm in length) were made of commercially pure (Grade IV) titanium, and were treated with RBM ($MegaGen^{(R)}$: Ca-P). The 80 implants (two in each tibia) were inserted into the monocortical tibias of 20 rabbits which each weighed more than 3.5 kg (Female, New Zealand White). According to the removal torque interval, the groups were divided into 10 groups, Group I (6 wks), Group II (4 days+6 wks), Group III (4 days+1 wk+6 wks), Group IV (1 wk+6 wks), Group V (1 wk+1 wk+6 wks), Group VI (2 wks+6 wks), Group VII (2 wks+ 1 wk+6 wk), Group VIII (3 wks+6 wks), Group IX (3 wks+1 wk+6 wks) and Group X (10 wks). The control groups were Group I and X, the removal torque was measured at 6 wks and 10 wks with a digital torque gauge (Mark-10, USA). In the experimental groups, the removal torque was given once or twice before the final removal torque and the value was measured each time. After which, the implants were put back where they had been except the control groups. All the experimental groups were given a final healing time (6 wks) before the final removal torque test, in which values were compared with the control groups and the 1st and/or 2nd removal torque values in each experimental group. Results: In the final removal torque tests, the removal torque value of Group X (10 wks) was higher than that of Group I (6 wks) in the control groups but not statistically different. There were no significant differences between the experimental groups and control groups (P>.05). In the first removal torque comparison, the experimental groups (4 days or 1 wk) values were significantly lower than the other experimental groups (2 wks or 3 wks). In the comparison of each experimental group according to healing time, the final removal torque value was significantly higher than the 1st torque test value. Conclusion: Once or twice mobilization of fixture prior to osseointegration did not deter the final bone to implant osseointegration, if sufficient healing time was given.
Implant-supported fixed and removable prostheses provide a proper treatment modality with reliable success. The SS $II^{(R)}$ Implants is a one-stage nonsubmerged threaded titanium implants with Resorbable Blasting Media (RBM) surface developed by Osstem company (Busan, Korea) in October of 2002. This study is to evaluate the survival rate of the SS $II^{(R)}$ Implants for 4 years using radiographic parameters and to review the retrieved implants by the cytotoxicity tests. Since September 2003, 439 SS $II^{(R)}$ implants had been used for 173 patients at Ewha Womans University Medical Center in Korea. Patients consisted of 91 females (52.6 %) and 82 males (47.4 %). The patients' mean age was $42\;{\pm}16$ years, ranging from 21 to 83 years. The follow-up period ranged from 9 to 46 months (mean F/U $24.2\;{\pm}\;10.2$ months). The results are as follows; 1. Of 439 implants, 17 implants were removed and 4-year cumulative survival rate was 96.1%. 2. 82.3% of 17 failed implants were founded during healing phase, and 94.1% of failed fixtures were removed within 5 months after implantation. 3. Crestal bone around the implants was resorbed to 1 mm in 89.0%, to 1 - 2 mm loss of the marginal bone in 8.3%, and the bone loss over 2 mm was occurred in 2.7%. 4. Microscopic examination of the retrieved implants disclosed Grade 0 cytotoxicity in 4 and Grade 1 cytotoxicity in 2 of 6 groups divided according to LOT numbers. Inhibition rate with optical density was acceptable as low as ISO standard.
Purpose - Foodservices have grown to over 60% of the franchise industry. However, despite reaching this high level, the foodservice franchise industry is experiencing severe ups and downs. While factors such as expansion by franchises and the entry of large multinational firms are causing this imbalance, the more serious problem faced by franchisees is the lack of know-how and correct operating procedures. Franchise headquarters should advise franchisees on important matters such as food ingredients, interior design, tableware, and fixtures. However, even though franchise headquarters have the ability to impart such management know-how, this is often a neglected area. Research design, data and methodology - This study was conducted in an industrial environment to present suitable competitive alternatives for foodservice franchises. Empirical analysis was conducted using a sample of 232 people with experience in targeting customers. The main purpose of this study is not to identify and analyze the factors affecting customer satisfaction. Customers of the Food Service Industry to invite contacts until departure for the service flow by identifying the expectations and allow this area by analyzing the resulting measures to enhance the competitiveness has presented. Results - Actual results contact factors affecting the quality of service on customer satisfaction was a significant influence. However, the end of this analysis, the actual customer satisfaction directly affects the quality of service that is only important factor can commit mistakes. Relatively large impact on customer satisfaction, which is relatively independent of the quality factor should be a review of zone of tolerance. In this study, eating phase relative to contact the service customer satisfaction was the most influential. The results, however, zone of tolerance for an area in the waiting and ordering dissatisfaction factors are appearing. And in the course of these services outside the zone of tolerance area is unsatisfactory evaluation is being done. Conclusions - After all, Foodservice, the contact service management for zone of tolerance the top priority should be can be seen. Foodservice contact first in the case of service quality factors caused by the continuous flow of services, so this step-by-step identification needs to be clearer. This, of course, to distinguish between the actual per unit of activity appears to be more difficult to follow, for it seems to need a lot of future complementary. Next is the assessment of customer service quality. Customers remember the experience for the services of a real contact through the assessment and service evaluation clearly emerge as the expected level can be difficult. However, this situation is controlled by the test method cannot be avoided unless there is no limit to the number of leave. Despite these limitations, the next step to contact a service evaluation and analysis have to continue to refine and thereby franchisees for the operation of the store in terms of practical know-how required to provide to the office believe.
Alveolar bone loss and deformation can be a risk factor in removable prosthetic restoration treatment for partially or fully edentulous patients. The use of implants to solve this problem could improve the support, retention and stability of removable restoration. Attachments used in implant overdenture are versatile. The attachment should be selected according to the patients' conditions. Milled bar has been chosen when readymade bar could not be used because of the narrow distance between implants or firm stability and support of supra-structure were needed. Milled bar design is able to provide cross arch stabilization and comfortability to patients. However, it needs skilled laboratory procedures. Recently, the fabrication of milled bar has become simple and its suitability has been improved through the development of CAD/CAM system. In a 67-year-old female Alzheimer's disease patient with 8 implant fixtures on the fully edentulous site of mandible, implant overdenture with using milled bar and magnet attachment was planned. As rapid treatment was required, CAD/CAM system was used to make a simple laboratory procedure instead of a traditional fabrication process. With this system, implant overdenture with milled bar can be fabricated esthetically and functionally.
The success of dental implant therapy relies mainly upon the presence and maintenance of bone adjacent to implant. An 1-year prospective study was performed, upon the patients who were diagnosed as having chronic adult periodontitis, and had been treated with dental implant. The purpose of this study was to measure the radiographic bone level changes proximal to Astra Tech Single Tooth Implants (ATST, Astra Tech AB, $M{\"{o}}lndal$, Sweden) with microthread and Astra Tech TiOblast Implant (ATTB) without microthread supporting fixed partial prosthesis. Measurements were used to determine mean marginal bone loss during the first year of loading, 17 subjects with its partial prosthesis supported by 37 implants were followed up for an 1-year period. The marginal bone loss of implants was positively correlated with the retention factor, microthread($Microthread^{TM}$) in crestal area of ATST. The results were as follows. 1. The mean marginal bone loss of ATST was 0.226${\pm}$0.395mm, while ATTB was 0.440${\pm}$0.360mm. There was a statistically significant difference between ATST and ATTB (p<0.05). 2. The mean bone loss of the upper jaw fixtures was 0.269${\pm}$0.265mm for ATST and 0.529${\pm}$0.417mm for ATTB . There was a statistically significant difference between ATST and ATTB (p<0.05). In the lower jaw the corresponding figures were 0.167${\pm}$0.231mm and 0.313${\pm}$0.214mm, respectively. There was no significant difference between ATST and ATTB (p>0.05). 3. The mean bone loss of ATST was lower than that of ATTB at all sites according to bone quality. There was a statistically significant difference between ATST and ATTB at bone quality type III(p <0.05). In conclusion, the mean bone loss of ATST was smaller than that of ATTB . Therefore, the retention factor of crestal area, microthread ($Microthread^{TM}$) was effective to maintenance of marginal bone level around fixture.
Purpose: Four finite element models were constructed in the mandible having a single implant fixture connected to the first premolar-shaped superstructure, in order to evaluate how the shape of the fixture and the implant-abutment connection would influence the stress level of the supporting tissues fixtures, and prosthethic components. Material and methods : The superstructures were constructed using UCLA type abutment, ADA type III gold alloy was used to fabricate a crown and then connected to the fixture with an abutment screw. The models BRA, END , FRI, ITI were constructed from the mandible implanted with Branemark, Endopore, Frialit-2, I.T.I. systems respectively. In each model, 150 N of vertical load was placed on the central pit of an occlusal plane and 150 N of $40^{\circ}$ oblique load was placed on the buccal cusp. The displacement and stress distribution in the supporting tissues and the other components were analysed using a 2-dimensional finite element analysis . The maximum stress in each reference area was compared. Results : 1. Under $40^{\circ}$ oblique loading, the maximum stress was larger in the implant, superstructure and supporting tissue, compared to the stress pattern under vertical loading. 2. In the implant, prosthesis and supporting tissue, the maximum stress was smaller with the internal connection type (FRI) and the morse taper type (ITI) when compared to that of the external connection type (BRA & END). 3. In the superstructure and implant/abutment interface, the maximum stress was smaller with the internal connection type (FRI) and the morse taper type (ITI) when compared to that of the external connection type (BRA & END). 4. In the implant fixture, the maximum stress was smaller with the internal connection type (FRI) and the morse taper type (ITI) when compared to that of the external connection type (BRA & END). 5 The stress was more evenly distributed in the bone/implant interface through the FRI of trapezoidal step design. Especially Under $40^{\circ}$ oblique loading, The maximum stress was smallest in the bone/implant interface. 6. In the implant and superstructure and supporting tissue, the maximum stress occured at the crown loading point through the ITI. Conclusion: The stress distribution of the supporting tissue was affected by shape of a fixture and implant-abutment connection. The magnitude of maximum stress was reduced with the internal connection type (FRI) and the morse taper type (ITI) in the implant, prosthesis and supporting tissue. Trapezoidal step design of FRI showed evenly distributed the stress at the bone/implant interface.
Purpose : The purpose of this study was to evaluate the machining accuracy and consistency of implant/abutment/screw combination or internal connection type. Material and methods: In this study, each two randomly selected internal implant fixtures from ITI, 3i, Avana, Bicon, Friadent, Astra, and Paragon system were used. Each abutment was connected to the implant with 32Ncm torque value using a digital torque controller or tapping. All samples were cross-sectioned with grinder-polisher unit (Omnilap 2000 SBT Inc) after embeded in liquid unsaturated polyester (Epovia, Cray Valley Inc). Then optical microscopic and scanning electron microscopic(SEM) evaluations of the implant-abutment interfaces were conducted to assess quality of fit between the mating components. Results : 1) Generally, the geometry of the internal connection system provided for a precision fit of the implant/abutment into interface. 2) The most precision fit of the implant/abutment interface was provided in the case of Bicon System which has not screw. 3) The fit of the implant/abutment interface was usually good in the case of ITI, 3I and Avana system and the amount of fit of the implant/abutment interface was similar to each other. 4) The fit of the implant/abutment interface was usually good in the case of Friadent, Astra and Paragon system. The case of Astra system with the inclined contacting surface had the most Intimate contact among them. 5) Amount of intimate contact in the abutment screw thread to the mating fixture was larger in assembly with two-piece type which is separated screw from abutment such as Friadent, Astra and Paragon system than in that with one-piece type which is not seperated screw from abutment such as ITI, 3I and Avana system. 6) Amount of contact in the screw and the screw seat of abutment was larger in assembly of Friadent system than in asembly of Astra system of Paragon system. Conclusion: Although a little variation in machining accuracy and consistency was noted in the samples, important features of all internal connection systems were the deep, internal implant-abutment connections which provides intimate contact with the implant walls to resist micro-movement, resulting in a strong stable interface. From the results of this study, further research of the stress distribution according to the design of internal connection system will be required.
In this study, we designed the finite element models of mandible with varying their connecting types between the prosthesis on implant fixture and 2nd premolar, which were free-standing case(Mf), precision attachment case(Mp), semiprecision attachment case(Ms) and telescopic case(Mt). The basic model of the designed finite element models, which contained a canine and the 1st & 2nd premolar, was implanted in the edentulous site of the 1st & 2nd molar by two implant fixtures. We applied the load in all models by two ways. A vertical load of 200N was applied at each central fossa of 2nd premolar and 1st implant. A tilting load of 20N with inclination of $45^{\circ}$ to lingual side was applied to buccal cusp tips of each 2nd premolar and 1st implant. And then we analyzed three-dimensional finite element models, making a comparative study of principal stress and displacement in four cases respectively. Three-dimensional finite element analysis was performed for the stress distribution and the displacement using commercial software(IDEAS program) for SUN-SPARC workstation. The results were as follows : 1 Under vertical load or tilting load, maximum displacement appeared at the 2nd premolar. Semiprecision case showed the largest maximum displacement, and maximum displacement reduced in the order of precision attachment, free-standing and telescopic case. 2. Under vertical load. the pattern of displacement of the 1st implant appeared mesio-inclined because of the 2nd implant splinted together. But displacement pattern of the 2nd premolar varied according to their connection type with prosthesis. The 2nd premolar showed a little mesio-inclined vertical displacement in case of free-standing and disto-inclined vertical displacement due to attachment in case of precision and semiprecision attachment. In telescopic case, the largest mesio-inclined vertical displacement has been shown, so, the 1st premolar leaned mesial side. 3. Under tilting load, The pattern of displacement was similar in all four cases which appeared displaced to lingual side. But, the maximum displacement of 2nd premolar appeared larger than that of the first implant. Therefore, there was large discrepancy in displacement between natural tooth and implant during tilting load. 4. Under vertical load, the maximum compressive stress appeared at the 1st implant's neck. Semiprecision attachment case showed the largest maximum compressive stress, and the maximum compressive stress reduced in the order of precision attachment, telescopic and free-standing case. 5 Under vertical load, the maximum tensile stress appeared at the 2nd implant's distal neck. Semiprecision attachment case showed the largest maximum tensile stress, and the maximum tensile stress reduced in the order of precision attachment, telescopic and free-standing case. 6. Under vertical load or tilting load, principal stress appeared little between natural tooth & implant in free-standing case, but large principal stress was distributed at upper crown and distal contact site of the 2nd premolar in telescopic case. Principal stress appeared large at keyway & around keyway of distal contact site of the 2nd premolar in precision and semiprecision attachment case, appearing more broad and homogeneous in precision attachment case than in semiprecision attachment case.
The purpose of this study was to the determine the optimal torques values to tighten the retaining screw. 3-different implant system tested were as follows : Branemark implant system$(3.75mmD{\times}100mm)$, Steri-Oss implant system$(3.8mmD{\times}10mm)$. One fixtures of each implant system was mounted into the epoxy resin block and abutment/superstructure complex was constructed. Eighty dental college students(male : 40, female : 40) of Chosun University were selected and were asked to tighten the retaining screws. Abutment/superstructure complex of each implant system was tightened to the maximum torque by use of hand-held screw driver, and then torque value was measured with torque value was measured with torque driver(Tohnichi torque driver, model 20 FTD, Tohnichi MFG, Co., LTD., Tokyo, Japan). Abutment/superstructure complex of each implant system was titghtened to each torque of 10 N-cm, 20 N-cm and 30 N-cm, and then the dynamic load(vertical & diagonal load) was applied to the abutment / superstructure complex. The gap between abutment/superstrure in each implant system was measured with 3-dimensional measuring microscope(model No. 850, Germany). The results were as follow : 1. Torque values according to the individual subjects showed wide range. 2. Torque values according to sex showed statistical significant difference. Those are as follows : in case of male, $9.38{\pm}2.93$ N-cm ; incase of female, $7.80{\pm}2.25$ N-cm. 3. Torque values according t implant systems showed statistical significant difference. Those are as follows : in ase of Branemark implant system, $6.54{\pm}1.54$ N-cm : in ase of Steri-Oss implant system, $10.1{\pm}2.88$ N-cm ; in case of IMZ implant system, $9.18{\pm}2.17$ N-cm. 4. The more torque value of tightening screw was increased, the less the gap was after the vertical and diagonal loading. 5. The gap after the diagonal loading was greater than that after the vertical loading. 6. The magnitude of gap between abutment/superstructure in order of IMZ, Steri-Oss, Branemark implant system after the verical and diagonal loading. 7. The gap under the diagonal loading after applying 30 N-cm torque showed no statistical significant difference in cases of the Branemark system and the Steri-Oss implant system but it showed significant different in case of the IMZ implant system.
One of the biggest clinical problems of osseointegrated implant prosthesis is the excessive stress caused by bite forces which are transfered directly into the bone through the osseointegrated implant fixtures. So several biodynamic problems occur when there is an excessive fatigue stress. The factors of stress distribution are the number, kind, position, arrangement of the implants, and the distance between the implants, and the kind, quality of superstructure prosthesis and connection type between the rest implant and the superstructure. Recently, a distal short additional implant, socalled rest implant, is employed to reduced the stresses in conventional cantilevered prostheses. This study was undertaken to analyze the stresses transfered by osseointegrated implant cantilevered prostheses depending upon the number and the position of implants, the presence of rest implant, and the type of their connection. Three dimensional finite element analysis was attempted using ANSIS ver. 5.3 program under IBM INDIGO computer. The results were as follows : 1. The rest implant influenced on the pattern of stress distribution on the anterior area of the mandible and the superstructure. 2. In the group employing the rest implants, the fixed type of connection between the rest implant and the superstructure was more stable than the ball attachment type on the stress distribution. 3. In the group employing the ball attachment between the rest implant and the superstructure, the case with 4-implants(on canine, premolar) was little more stable than the case with 6-implants and the case with 4-implants(on incisor, premolar) on the stress distribution. 4. In the cantilevered group, the case with 4-implants(on incisor, premolar) and the case with 6-implants were more stable than the case with 4-implants(on canine, premolar) on the stress distribution. 5. In all of the group, the case with 6-implants and the fixed type of connection was the most stable and the case with 4-implants (on canine, premolar) was the most unstable on the stress distribution.
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