• 대한심미치과학회지
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• 제28권1호
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• pp.27-41
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• 2019

예지성 있는 대구치부 임플란트을 위해서는 Crestal bone Stabliity를 위해 임플란트 주위에 biologic width라 할 수 있는 적절한 두께의 연조직이 필요하다. 그러기 위해선 기존에 우리가 적절하다고 혹은 어쩔 수 없는 한계라고 생각했던 깊이보다 좀 더 치조골 하방으로 깊이 심어야 하는 경우가 많은 것 같다. 이번 투고에서는 case report와 함께 관련된 surgical technique에 대해서 소개하면서 구치부 임플란트의 수직적 위치에 대해서 생각보고자 한다.

• 구강회복응용과학지
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• 제21권1호
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• pp.1-14
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• 2005

The purpose of this study was to assess the loading distributing characteristics of implant prosthesis of internal connection system(ITI system) according to position and direction of load, under vertical and inclined loading using finite element analysis (FEA). The finite element model of a synOcta implant and a solid abutment with $8^{\circ}$ internal conical joint used by the ITI implant was constructed. The gold crown for mandibular first molar was made on solid abutment. Each three-dimensional finite element model was created with the physical properties of the implant and surrounding bone. This study simulated loads of 200N at the central fossa in a vertical direction (loading condition A), 200N at the outside point of the central fossa with resin filling into screw hole in a vertical direction (loading condition B), 200N at the centric cusp in a $15^{\circ}$ inward oblique direction (loading condition C), 200N at the in a $30^{\circ}$ inward oblique direction (loading condition D) or 200N at the centric cusp in a $30^{\circ}$ outward oblique direction (loading condition E) individually. Von Mises stresses were recorded and compared in the supporting bone, fixture, and abutment. The following results have been made based on this study: 1. Stresses were concentrated mainly at the ridge crest around implant under both vertical and oblique loading but stresses in the cancellous bone were low under both vertical and oblique loading. 2. Bending moments resulting from non-axial loading of dental implants caused stress concentrations on cortical bone. The magnitude of the stress was greater with the oblique loading than with the vertical loading. 3. An offset of the vertical occlusal force in the buccolingual direction relative to the implant axis gave rise to increased bending of the implant. So, the relative positions of the resultant line of force from occlusal contact and the center of rotation seems to be more important. 4. In this internal conical joint, vertical and oblique loads were resisted mainly by the implant-abutment joint at the screw level and by the implant collar. Conclusively, It seems to be more important that how long the distance is from center of rotation of the implant itself to the resultant line of force from occlusal contact (leverage). In a morse taper implant, vertical and oblique loads are resisted mainly by the implant-abutment joint at the screw level and by the implant collar. This type of implant-abutment connection can also distribute forces deeper within the implant and shield the retention screw from excessive loading. Lateral forces are transmitted directly to the walls of the implant and the implant abutment mating bevels, providing greater resistance to interface opening.

• Journal of Periodontal and Implant Science
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• 제47권4호
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• pp.231-239
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• 2017

Purpose: To retrospectively evaluate the relationship between the vertical position of the implant-abutment interface and marginal bone loss over 3 years using radiological analysis. Methods: In total, 286 implant surfaces of 143 implants from 61 patients were analyzed. Panoramic radiographic images were taken immediately after implant installation and at 6, 12, and 36 months after loading. The implants were classified into 3 groups based on the vertical position of the implant-abutment interface: group A (above bone level), group B (at bone level), and group C (below bone level). The radiographs were analyzed by a single examiner. Results: Changes in marginal bone levels of $0.99{\pm}1.45$, $1.13{\pm}0.91$, and $1.76{\pm}0.78mm$ were observed at 36 months after loading in groups A, B, and C, respectively, and bone loss was significantly greater in group C than in groups A and B. Conclusions: The vertical position of the implant-abutment interface may affect marginal bone level change. Marginal bone loss was significantly greater in cases where the implantabutment interface was positioned below the marginal bone. Further long-term study is required to validate our results.

• 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.

• The Journal of Advanced Prosthodontics
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• 제4권2호
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• pp.61-71
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• 2012

PURPOSE. To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture. MATERIALS AND METHODS. Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables. RESULTS. Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance. CONCLUSION. Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.

• 구강회복응용과학지
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• 제23권1호
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• pp.55-68
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• 2007

The purpose of this study was to analyze the distribution of stress in the surrounding bone around implant placed in the first and second molar region. Two different three-dimensional finite element model were designed according to vertical bone level around fixture ($4.0mm{\times}11.5mm$) on the second molar region. A mandibular segment containing two implant-abutments and a two-unit bridge system was molded as a cancellous core surrounded by a 2mm cortical layer. The mesial and distal section planes of the model were not covered by cortical bone and were constrained in all directions at the nodes. Two vertical loads and oblique loads of 200 N were applied at the center of occlusal surface (load A) or at a position of 2mm apart buccally from the center (load B). Von-Mises stresses were analyzed in the supporting bone. The results were as follows; 1. With the vertical load at the center of occlusal surface, the stress pattern on the cortical and cancellous bones around the implant on model 1 and 2 was changed, while the stress pattern on the cancellous bone with oblique load was not. 2. With the vertical load at the center of occlusal surface, the maximum von-Mises stress appeared in the outer distal side of the cortical bone on Model 1 and 2, while the maximum von-Mises stress appeared in the distal and lingual distal side of the cortical bone with oblique load. 3. With the vertical load at a position of 2 mm apart buccally from the center, there was the distribution of stress on the upper portion of the implant-bone interface and the cortical bone except for the cancellous bone, while there was a distribution of stress on the cancellous bones at the apical and lingual sides around the fixture and on the cortical bone with oblique load. 4. With the changes of the supporting bone on the second molar area, the stress pattern on the upper part of the cortical bone between two implants was changed, while the stress pattern on the cancellous bone was not. The results of this study suggest that establishing the optimum occlusal contact considering the direction and position of the load from the standpoint of stress distribution of surrounding bone will be clinically useful.

• 대한치과기공학회지
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• 제27권1호
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• pp.105-113
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• 2005

The purpose of this study is to evaluate the effect of loading at three different occlusal surface position of the gold alloy crown on the stress distributions in surrounding bone, utilizing 3-dimensional finite element method. A three dimensional finite element model of an implant with simplified gold alloy crown and supporting bone was developed for this study. A oblique or vertical load of 100 N was applied at the following position at each FE model : 1) center of occlusal surface, 2) a point on the buccal side away from center of occlusal surface (COS) by 2.8mm, 3) a point on the lingual side away from COS by 2.8mm. In the results, Minimum von Mises stresses under vertical load or oblique load of 100N were about 6MPa at the center of occlusal surface and about 40MPa at the point on the buccal side, respectively. From the results we could come to the conclusion that occlusive loading position could be an important factor for establishment of structural safety of supporting bone.

• 구강회복응용과학지
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• 제19권4호
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• pp.257-268
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• 2003

The purpose of this study was to assess the loading distributing characteristics of implant prosthesis according to position and direction of load, under vertical and inclined loading using FEA analysis. The finite element model was designed according to standard fixture (4.1mm restorative component x 11.5mm length). The crown for mandibular first molar was made using UCLA abutment. Each three-dimensional finite element model was created with the physical properties of the implant and surrounding bone. This study simulated loads of 200N at the central fossa in a vertical direction (loading condition A), 200N at the outside point of the central fossa with resin filling into screw hole in a vertical direction (loading condition B), 200N at the centric usp in a $15^{\circ}$ inward oblique direction (loading condition C), 200N at the in a $30^{\circ}$ inward oblique direction (loading condition D) or 200N at the centric cusp in a $30^{\circ}$ outward oblique direction (loading condition E) individually. Von Mises stresses were recorded and compared in the supporting bone, fixture, and abutment screw. The following results have been made based on this study: 1. Stresses were concentrated mainly at the ridge crest around implant in both vertical and oblique loading but stresses in the cancellous bone were low in both vertical and oblique loading. 2. Bending moments resulting from non-axial loading of dental implants caused stress concentrations on cortical bone. The magnitude of the stress was greater with the oblique loading than with the vertical loading. 3. An offset of the vertical occlusal force in the buccolingual direction relative to the implant axis gave rise to increased bending of the implant. 4. The relative positions of the resultant line of force from occlusal contact and the center of rotation seems to be more important. 5. The magnitude of the stress in the supporting bone, fixture and abutment screw was greater with the outward oblique loading than with the inward oblique loading and was the greatest under loading at the centric cusp in a $30^{\circ}$ outward oblique direction. Conclusively, this study provides evidence that bending moments resulting from non-axial loading of dental implants caused stress concentrations on cortical bone. But it seems to be more important that how long is the distance from center of rotation of the implant itself to the resultant line of force from occlusal contact(leverage). The goal of improving implants should be to avoid bending of the implant.

• 대한치과의사협회지
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• 제55권12호
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• pp.842-849
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• 2017

The term, 'crossed occlusion' implies clinical situation in which the residual teeth in one arch have no contact with those in the antagonistic arch, resulting in the collapse of occlusal vertical dimension. The treatment goal of this pathologic condition is restoration of the collapsed vertical dimension and stabilization of abnormal mandibular position. Previously, konus removable prostheses or tooth supported overdentures were suggested to solve crossed occlusion. Nowadays, dental implants have been used for definitive support to solve this problem. In this case report, a 65 years old female patient had a crossed occlusion, in which the maxillary posterior residual teeth and mandibular anterior residual teeth cross. Interim removable and fixed dental prostheses were used to confirm the proper vertical and horizontal jaw relation. After that, the mandibular posterior edentulous region was restored with implant-supported fixed dental prostheses. Computer tomography guided implant surgery was performed according to the concept of the restoration-driven implant placement. The maxillary anterior edentulous region was restored with Kennedy class IV removable prosthesis, considering the patient's economic status. The patient's jaw position and prostheses have been well maintained at the follow-up after 6 months of definitive restoration. The antero-posterior crossed occlusion problems appeared to be effectively solved with the combination of removable in one arch and implant-supported fixed prostheses in the other.

• 치과방사선
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• 제28권1호
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• pp.7-16
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• 1998

The Scanora/sup (R)/ X-ray unit uses the principles of narrow beam radiography and spiral tomography. Starting with a panoramic overview as a scout image. multiple tomographic projections could be selected. This study evaluated the accuracy of spiral tomography in comparison to routine panoramic radiography for dental implant treatment planning. An experimental study was performed on a cadaver mandible to assess the accuracy of panoramic radiography and spiral tomography film images for measurement of metallic spheres. After radiographic images of the metallic spheres on the surgical stent were measured and corrected for a fixed magnification of radiographic images. following results were obtained. 1. In the optimal position of the mandible. the minimal horizontal and vertical distortion was evident in the panoramic radiography images. The mean horizontal and vertical magnification error in anterior sites was 5.25％ and 0.75％. respectively. The mean horizontal and vertical magnification error in posterior sites was 0.50％ and 1.50％. respectively. 2. In the displaced forward or in an eccentric position of the mandible. the magnification error of the panoramic radiography images increased significantly over the optimal position. Overall, the mean horizontal magnification error of the anterior site in the different positions changed dramatically within a range of -17.25％ to 39.00％, compared to the posterior range of -5.25％ to 8.50％. However, the mean vertical magnification error stayed with the range of 0.5％ to 3.75％ for all the mandibular positions. 3. The magnification effects in the tomographic scans were nearly identical for the anterior and posterior with a range of 2.00％ to 5.75％ in the horizontal and 4.50％ to 5.50％ in the vertical dimension, respectively. 4. A statistically significant difference between the anterior and posterior measurements was found in the horizontal measurements of the panoramic radiography images of the displaced forward and backward position of the mandible(P<0.05). Also a significant difference between the optimal panoramic and tomographic projections was found only in the vertical measurement(P<0.05).