• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.5
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• pp.417-422
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• 2010

Introduction: Bone density is one of the important factors for the long term success of endosseous implants. The bone density varies from site to site and from patient to patient. A preoperative evaluation of the bone density is quite useful to oral surgeons for planning dental implantation. More accurate information on the bone density will help surgeons identify suitable implant sites, thereby increase the success rate of dental implantation. This study examined the correlation between the bone density measured preoperatively by computed tomography (CT) and the implant primary stability measured by resonance frequency analysis. Furthermore, the effects of the implant sites, gender, age and generalized systemic disorder patients on the bone density and primary implant stability were examined. Materials and Methods: One hundred and fourteen patients were selected. None of the patients had undergone a tooth extraction or bone graft history in the previous year. Preoperatively, the patients underwent CT scanning to evaluate the Hounsfield unit (HU), and resonance frequency analysis (RFA) was used to evaluate the implant primary stability at the time of implant installation. All implants were 4.0 mm diameter and 11.5 mm length US II. All patients were recorded and the HU and implant stability quotient (ISQ) value were evaluated according to the sites, gender and age. Results: The highest HU values were found in the mandibular anterior site ($827.6{\pm}151.4$), followed by the mandibular molar site ($797{\pm}135.1$), mandibular premolar site ($753.8{\pm}171.2$), maxillary anterior site ($726.3{\pm}154.4$), maxillary premolar site ($656.7{\pm}173.8$) and maxillary molar site ($621.5{\pm}164.9$). The ISQ value was the highest in the mandibular premolar site ($81.5{\pm}2.4$) followed by the mandibular molar site ($80.0{\pm}5.7$), maxillary anterior site ($77.4{\pm}4.1$), mandibular anterior site ($76.4{\pm}11.9$), maxillary premolar site ($74.2{\pm}14.3$) and maxillary molar site ($73.7{\pm}7.4$). The mean HU and ISQ value were similar in females and males. (HU: P=0.331, ISQ: P=0.595) No significant difference was also found in the age group respectively. However, the correlation coefficients between the variables showed a closed correlation between the HU and ISQ value. Conclusion: These results showed close correlation between the bone density (HU) and primary stability value (ISQ) at the time of implant installation (Correlation coefficients=0.497, P<0.01). These results strengthen the hypothesis that it might be possible to predict and quantify the initial implant stability and bone density from a presurgical CT diagnosis.

• The Journal of Korean Academy of Prosthodontics
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• v.39 no.2
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• pp.125-145
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• 2001

To compare the stress distribution patterns between cement-retained and screw-retained implant supported fixed prostheses according to four different abutment types, a three dimensional finite element analysis was performed. The hypothetical three unit fixed partial denture case was modelled on the three implants(10mm length and 3.75 diameter) in mandibular bone. Four angles of implantation(vertical, 10, 15 and 20 degree inclined mesially) were created and three different directions of force (vertical, oblique, horizontal) were applied at the center of the second premolar and distal end of the first molar for each cases. Within the limits of this study, the results were as follows, 1. In vertically installed cases, the more stress was concentrated at upper components, but mesially inclined cases, the more stress was concentrated at cortical bone. 2, The more inclined mesially the more stress was observed, especially at cortical bone. 3. The cement-retained models showed lower principal stress and more even stress distribution than the screw-retained models. 4. The similar stress distribution pattern was showed in model 1 and model 2, model 3 and model 4. 5. The more stress was observed when the loads were applied at the distal end of 1st molar than the center of 2nd premolar. 6 The fixture and the model as a whole, lesser stress values were observed when vertical loads were applied as compared to horizontal and oblique loads.

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.461-471
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• 2006

In order to achieve a satisfactory esthetic result of periodontal surgery or implant in maxillary anterior area, periodontists must be aware of normal alveolar bone anatomy. The purpose of this study was to evaluate the relationship of alveolar bone morphology to tooth shape and form. 78(mean age : 25 yrs) periodontally healthy volunteers participated in this study. Two maxillary central incisor and one lateral incisor were selected to study. With minimal local anesthesia, gutta-percha cone inserted to labial gingival sulcus of selected teeth just after bone sounding with periodontal probe. Metal ball (4mm diameter) attached to palatal fossa of central incisor. Then, periapical radiograph was taken according to long cone paralleling technique. After film scan, labial alveolar bone profile reproduced along interproximal bone and apical ends of gutta-percha cones on computer screen. By utilizing computer program, the distance from height of interproximal bone to the labial bone crest in central incisor-central incisor and central incisor-lateral incisor area was measured and converted to real distance by using vertical length of metal ball on film. After measuring crown length & width of central incisor, the 10 individuals ranked lowest GW/L ratio (crown width/length ratio) and the 10 ranked highest were selected as having a long-narrow(group N), or a short-wide(group W) form of the central incisors. Means of the distance from height of interproximal bone to the labial bone crest of group N, W were calculated and compared by means of independent t-test. The results were as follows: 1. Mean distance from the height of the interproximal bone to the labial bone crest was $3.5{\pm}0.7mm$ between two central incisor, and $2.8{\pm}0.6mm$ between central and lateral incisor. 2. Mean GW/L ratio of group N was 0.57, and group W was 0.8. Mean distance from the height of the interproximal bone to the labial bone crest of group N was higher than group W in both measured area(measurements of group N, W were $3.9{\pm0.2mm$ and $3.5{\pm}0.2mm$ between two central incisor, $3.0{\pm}0.2mm$ and $2.8{\pm}0.2mm$ between central and lateral incisor), but there were no statistically significant differences when the groups were compared. Within the limits of the present study, there was a tendency that subjects with long-narrow teeth have more scalloped alveolar bone profile than subjects with short-wide teeth in upper anterior area, but no statistically significant differences were found.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.2
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• pp.131-138
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• 2007

The purpose of this study was to observe the effect of calcium and vitamin D to the titanium implant osseointegration in animal model. 32 rats, 10 weeks of age, were divided into two group: additional calcium and vitamin D supplementation group and a control group. Titanium screw implant(diameter, 2.0mm; length, 3.5mm; pitch-height 0.4mm) were placed into tibia of 32 rats, 16 in the control group and 16 in the experimental group. The rats were sacrificed at different time interval(1, 2, 4, and 8 weeks after implantation) for histopathologic observation, histomorphometric analysis and immunohistochemistry with osteocalcin and osteopontin antibody. Histopathologically findings, newly formed bone was seen at 1 weeks and became lamellar bone at 2 weeks, and mature trabecullar bone was seen at 4 weeks experimental group. In control group, thickness of regenerated bone increased till 4 weeks gradually and trabecullar bone was seen at 8 weeks. By histomorphometric analysis, bone marrow density was increased significantly at 1 and 2 weeks in experimental group compared to control group. Osteocalcin immunoreactivity was strong at 1 week experimental group and reduced after 4 weeks gradually. But it was continuously weakly from 1 to 4 weeks in control group. Osteopontin immunoreactivity was very strong in newly formed bone from 2 to 8 weeks experimental group. And the amount of osteopontin expression was more abundant in experimental group. The results of this study suggest that calcium and vitamin D supplementation promotes bone healing around dental implants

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.3
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• pp.276-284
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• 2008

Purpose: The purpose of this study was to observe the effect of calcium and vitamin D to the titanium implant osseointegration in the osteoporosisinduced animal model. Material and method: Thirty-two rats, 10 weeks of age, were divided into two groups: experimental group was ingested additional calcium and vitamin D, and a control group was not. Titanium screw implant(diameter, 2.0 mm; length, 3.5 mm; pitch-height 0.4 mm) were placed into tibia of 32 rats, 16 in the control group and 16 in the experimental group. The rats were sacrificed at 1, 2, 4 and 8 weeks after implantation for histopathologic examination, histomorphometric analysis and immunohistochemistry with fibronectin and collagen type I antibody. Result: In histopathological findings, newly formed bone was seen at 2 weeks and became lamellar bone at 4 weeks, and mature trabecullar bone was seen at 8 weeks in experimental group. In control group, thickness of regenerated bone increased till 4 weeks gradually and trabecullar bone was seen at 8 weeks. In histomorphometric analysis, marrow bone density increased significantly in experimental group compared to control group. Fibronectin immunoreactivity was strong at 2 weeks in experimental group and reduced after 4 weeks gradually. But it was maintained continuously from 2 to 8 weeks in control group. Collagen type I immunoreactivity was very strong from 2 to 4 week in experimental group. And the amount of Collagen type I expression was more abundant in experimental group. Conclusion: The results of this study suggest that calcium and vitamin D supplementation promote bone healing around titanium implants in osteoporosis induced animals.

• Journal of Periodontal and Implant Science
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• v.34 no.1
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• pp.177-193
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• 2004

Several experimental studies showed that the application of small amounts of electric current to bone stimulated osteogenesis at the site of the cathode and suggested that electrical currents promote osseointegration around dental implants. The purpose of this study was to determine the effect of direct microcurrent to endosseous titanium implants placed in bone defects. The right and left 2nd, 3rd and 4th mandibular premolars in ten mongrel dogs (15Kg of weight) were extracted. One monthe later, Ti-machined screw type implants(3.8 mm diameter x 8.5 mm length, $AVANA^{(R)}$, Ostem) were placed in surgically created circumferential defect area(width 5mm, depth 4mm). The implants were divided into three groups according to the treatment modalities: Control group- implants without electrical stimulation; Experimental group I- implants with allogenic demineralized freeze dried bone grafting; and Experimental group II-implants allogenic demineralized freeze dried bone grafting and electric stimulation. The animals were sacrificed in the 4th and 8th week after implant placement and un-decalcified specimens were prepared for histological and histometrical evaluation of bone-implant contact ratio (BIC) and bone formation area ratio (BFA) in defect area. Some specimens at 8 weeks after implantation were used for removal torque testing. Histologically, there was connective tissue infiltration in the coronal part of defect area in control and the experimental group I, whereas direct bone contact was found in the experimental group II without connective tissue invasion. Average BIC ratios at 4 weeks of healing were 60.1% in the experimental group II, 47.4% in the experimental group I and 42.7% in the control. Average BIC ratios at 8 weeks after implantation were 67.6% in the experimental group II, 55.9% in the experimental group I and 54.6% in the control. The average BFA ratio was 84.0% in the experimental group II, 71.8% in the experimental group I and 58.8% in the control at 4 weeks, and the BFA ratios were 89.6% in the experimental group II, 81.4% in the experimental group I and 70.5% in the control at 8 weeks after implantation. The experimental group II showed also significantly greater BIC and BFA ratios compared to the control and the experimental group I (p<0.05). The removal torque values at 8 weeks after implantation were 56 Ncm in the experimental group II, 49 Ncm in the experimental group I and 43 Ncm in the control. There was a statistically significant difference among 3 groups (p<0.05). These results suggest that electrical stimulation improve and accelerate bone healing around endosseous titanium implants in bone defect.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.6
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• pp.397-406
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• 2003

The purpose of this study was to observe the titanium implant osseointegration in the osteoporosis-induced animal model. Seventy rats, 11 weeks of age, were divided into two groups : an ovariectomized group and a control group. Titanium screw implants(diameter, 2.0mm; length, 3.5mm) were placed into left tibias of 70 rats, 35 in the control group and 35 in the experimental group. The rats were sacrificed at different time interval (1, 2, 3, 4, 6, 8, and 12 weeks after implantation) for histopathologic observation, histomorphometric analysis and immunohistochemistry with fibronectin and CD34 antibody. The results obtained from this study were as follows: 1. Histopathologically findings, newly formed bone was seen at 3 weeks and became lamellar bone at 8 weeks, and mature trabecullar bone was seen at 12 weeks control group. In experimental group, thickness of regenerated bone increased till 8 weeks gradually and mature trabecullar bone was seen at 12 weeks. 2. By histomorphometric analysis, marrow bone density and contact ratio of marrow bone to implant decreased significantly from 8 to 12 weeks in experimental group compared to control group and also total bone to implant contact ratio decreased significantly from 8 to 12 weeks in experimental group. 3. Fibronectin immunoreactivity was strong at 3 weeks control group and reduced after 8weeks gradually. But it was continuously strong from 3 to 8 weeks in experimental group. 4. CD34 immunoreactivity was very strong in the newly formed osteoblasts from 3 to 8 weeks control group. But it reacted minimally later. While in experimental group, it reacted continuously strong from 3 to 12 weeks. The results of this study suggest that osteoporosis is not an absolute contraindication to dental implantation if sufficient period suggested after fixture installation till second stage surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.199-209
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• 2011

Purpose: Osteoporosis, is a major health problem for the elderly and post-menopausal women and shown to alter the properties of bone as well as impair bone healing around titanium implants in both human and animals. The objective of this study was to examine the effect of LIPUS with adipose-derived stem cells on the healing process around a titanium implant in rats with osteoporosis. Methods: Sixteen osteoporosis-induced rats were divided into two groups: an adipose-derived stem cell injected with Low Intensity Pulsed Ultrasound (LIPUS) application group and a control group. Titanium screw implants (diameter, 2.0 mm: length, 3.5 mm, Cowell Medi, Korea) were placed into both tibia of 16 rats, on 8 rats as the control group and the other 8 rats as the experimental group. Rats were sacrificed at different intervals from 1, 2, 4 and 8 weeks after implantation for histopathologic and immunohistochemical analyses. Results: Histopathological analysis revealed newly formed bone in experimental group earlier than that in control group. Especially at 1 week after implantation, more amounts of new bone matrix and collagen around the implant in the experimental group were seen compared with the control group. Immunohistochemical analysis showed that the levels of osteoprotegerin (OPG) expression in the experimental group were increased at early stages compared with that of control group until 2 weeks after implantation. But after 2 weeks, the expression level of OPG similar in both groups. The expression levels of receptor activator of nuclear factor kB ligand (RANKL) were stronger in the experimental group than the control group until 2 weeks after implantation. After 4 weeks, expression of RANKL in experimental group was similar to the control group. Conclusion: The results of this study suggest that LIPUS with Adipose-Derived Stem Cells in implantation could promote bone healing around titanium implants in rats with osteoporosis.

• Journal of Dental Rehabilitation and Applied Science
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• v.23 no.4
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• pp.327-336
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• 2007

Purpose This study was planned to compare and evaluate the stability of implant using $Osstell^{TM}$ and Osstell $Mentor^{TM}$. Material and methods Artificial bone and RBM(resorbable blasting media) surface blasted implants(Osstem US II, SS II implants - diameter: 4mm, length: 13mm) were used. To measure the stability of installed implants, $Osstell^{TM}$ and Osstell $Mentor^{TM}$ were used. In the first experiment, five implants were installed in D1(external type implants) and D3(internal type implants). In the second experiment, 4 internal type implants were divided in two groups and installed in D1 artificial bone with different depth. In the third experiment, two external implants were installed in D1 and D3 artificial bone each and two internal implants were installed in D1 and D3 artificial bone. In all groups, their stability were measured by $Osstell^{TM}$ and Osstell $Mentor^{TM}$. Results In all groups, $Osstell^{TM}$ and Osstell $Mentor^{TM}$ both showed reliable measurement values. The value difference between $Osstell^{TM}$ and Osstell $Mentor^{TM}$ was observed but the difference was small and clinically acceptable. Conclusion These results suggest that the use of Osstell $Mentor^{TM}$ has clinical relevance in the assessment of implant stability.

• The korean journal of orthodontics
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• v.36 no.5
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• pp.324-330
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• 2006

Objective: The purposes of this study were to evaluate the differences between sand blasted, large grit and acid-etched (SLA) treated mini-implants and smooth surface orthodontic mini-implants in relation to the removal torque as well as the histologic analysis. Methods: Custom-made, screw-shaped, titanium implants with a length of 9.5 mm and an outer diameter of 1.8 mm were divided into 2 groups; the SLA group (20 SLA treated orthodontic mini-implants) and the smooth surface group (20 smooth surface mini-implants), and placed In the tibia metaphysis of 10 rabbits. Each rabbit had 4 mini-implants placed, 2 in each tibia. The right tibia were implanted with the SLA group mini-implants and the left tibia had the smooth group mini-implants placed. Each mini-implant group were immediately applied with a continuous traction force of 150 g using a Ni-Ti coil spring. The rabbits were sacrificed 6 weeks post-surgically. Subsequently, the legs were stabilized, the Ni-Ti coil springs were removed and the mini-implants were removed under reverse torque rotation with a digital torque gauge. Results: 6 weeks after placement, the SIA group presented a higher mean removal torque value (8.29 Ncm) than the smooth group (3.34 Ncm) and histologic analysis revealed a higher new bone formation aspect along the screw in the SLA group. Conclusion: Results of this study indicates that SLA treated mini-implants may endure higher orthodontic forces without loosening.