• Archives of Plastic Surgery
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• v.49 no.5
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• pp.642-647
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• 2022

Hemifacial microsomia (HFM) is a complex congenital condition with heterogeneous malformations of the facial skeleton that almost always involves mandibular hypoplasia. Here we introduce a unique case in which a patient with HFM had initially successful optimization of facial symmetry using a polyetheretherketone implant for mandibular augmentation. However, multiple factors associated with the intraoperative and postoperative course, including hardware failure and infection, led to diminished mechanical strength of the mandible, ultimately resulting in a mandibular fracture. In this unique case presentation of HFM, we discuss the various factors that contributed to mandibular weakness and increased susceptibility to fracture.

• Journal of Technologic Dentistry
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• v.44 no.3
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• pp.67-75
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• 2022

Purpose: This study aimed to comparatively evaluate the stress distribution of bones surrounding the implant system to which both titanium and polyetheretherketone (PEEK) abutments are applied using a three-dimensional finite element analysis. Methods: The three-dimensional implant system was designed by the computer-aided design program (CATIA; Dassault Systemes). The discretization process for setting nodes and elements was conducted using the HyperMesh program (Altair), after finishing the design of each structure for the customized abutment implant system. The results of the stress analysis were drawn from the Abaqus program (Dassault Systèmes). This study applied 200 N of vertical load and 100 N of oblique load to the occlusal surface of a mandibular first molar. Results: Under external load application, the PEEK-modeled dental implant showed the highest von Mises stress (VMS). The lowest VMS was observed in the Ti-modeled abutment screws. In all groups, the VMS was observed in the crestal regions or necks of implants. Conclusion: The bones surrounding the implant system to which the PEEK abutment was applied, such as the cortical and trabecular bones, showed stress distribution similar to that of the titanium implant system. This finding suggests that the difference in the abutment materials had no effect on the stress distribution of the bones surrounding implants. However, the PEEK abutments require mechanical and physical properties improved for clinical application, and the clinical application is thought to be limited.

• Archives of Craniofacial Surgery
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• v.21 no.5
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• pp.309-314
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• 2020

Reconstructions of extensive composite scalp and cranial defects are challenging due to high incidence of postoperative infection and reconstruction failure. In such cases, cranial reconstruction and vascularized soft tissue coverage are required. However, optimal reconstruction timing and material for cranioplasty are not yet determined. Herein, we present a large skull defect with a chronically infected wound that was not improved by repeated debridement and antibiotic treatment for 3 months. It was successfully treated with anterolateral thigh (ALT) free flap transfer for wound salvage and delayed cranioplasty with a patient-specific polyetheretherketone implant. To reduce infection risk, we performed the cranioplasty 1 year after the infection had resolved. In the meantime, depression of ALT flap at the skull defect site was observed, and the midline shift to the contralateral side was reported in a brain computed tomography (CT) scan, but no evidence of neurologic deterioration was found. After the surgery, sufficient cerebral expansion without noticeable dead-space was confirmed in a follow-up CT scan, and there was no complication over the 1-year follow-up period.

• The Journal of Advanced Prosthodontics
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• v.14 no.6
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• pp.346-359
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• 2022

PURPOSE. Four and six implant-supported fixed full-arch prostheses with various framework materials were assessed under different loading conditions. MATERIALS AND METHODS. In the edentulous maxilla, the implants were positioned in a configuration of four to six implant modalities. CoCr, Ti, ZrO₂, and PEEK materials were used to produce the prosthetic structure. Using finite element stress analysis, the first molar was subjected to a 200 N axial and 45° oblique force. Stresses were measured on the bone, implants, abutment screw, abutment, and prosthetic screw. The Von Mises, maximum, and minimum principal stress values were calculated and compared. RESULTS. The maximum and minimum principal stresses in bone were determined as CoCr < ZrO₂ < Ti < PEEK. The Von Mises stresses on the implant, implant screw, abutment, and prosthetic screws were determined as CoCr < ZrO₂ < Ti < PEEK. The highest Von Mises stress was 9584.4 Mpa in PEEK material on the prosthetic screw under 4 implant-oblique loading. The highest maximum principal stress value in bone was found to be 120.89 Mpa, for PEEK in 4 implant-oblique loading. CONCLUSION. For four and six implant-supported structures, and depending on the loading condition, the system accumulated different stresses. The distribution of stress was reduced in materials with a high elastic modulus. When choosing materials for implant-supported fixed prostheses, it is essential to consider both the number of implants and the mechanical and physical attributes of the framework material.

• Archives of Plastic Surgery
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• v.46 no.4
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• pp.365-370
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• 2019

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed-correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.2.1-2.7
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• 2018

With the development of computer-aided design/computer-aided manufacturing (CAD/CAM) technology, it has been possible to reconstruct the cranio-maxillofacial defect with more accurate preoperative planning, precise patient-specific implants (PSIs), and shorter operation times. The manufacturing processes include subtractive manufacturing and additive manufacturing and should be selected in consideration of the material type, available technology, post-processing, accuracy, lead time, properties, and surface quality. Materials such as titanium, polyethylene, polyetheretherketone (PEEK), hydroxyapatite (HA), poly-DL-lactic acid (PDLLA), polylactide-co-glycolide acid (PLGA), and calcium phosphate are used. Design methods for the reconstruction of cranio-maxillofacial defects include the use of a pre-operative model printed with pre-operative data, printing a cutting guide or template after virtual surgery, a model after virtual surgery printed with reconstructed data using a mirror image, and manufacturing PSIs by directly obtaining PSI data after reconstruction using a mirror image. By selecting the appropriate design method, manufacturing process, and implant material according to the case, it is possible to obtain a more accurate surgical procedure, reduced operation time, the prevention of various complications that can occur using the traditional method, and predictive results compared to the traditional method.

• Journal of Technologic Dentistry
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• v.45 no.3
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• pp.61-66
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• 2023

Purpose: The current study examined the retention and wear resistance of stud-type attachments made of high-performance polyetheretherketone (PEEK) or polyetherketoneketone (PEKK) from the polyaryletherketones (PAEKs) family. Methods: The study sample included 10 PEEK or PEKK attachments that were mounted onto their male parts, designed on the upper aspect of the attachment, with a load of 30 N. Tensile stress was applied using an Instron machine to separate the male and female parts, and the maximum tensile stress to be applied was determined based on the retention force observed. The wear resistances of PEEK and PEKK were evaluated by measuring the inner diameter of the inserted female part 10 times. Results: The maximum tensile stresses of PEEK and PEKK were 56.26±0.58 and 69.12±0.92 N, respectively, with the maximum stress required to remove the PEKK specimens from the abutment being 12.86 N higher than that required to remove the PEEK specimens. Furthermore, PEKK exhibited higher wear resistance than PEEK. Conclusion: This study evaluated custom-made removable implant-retained attachment components for overdentures, wherein the female parts were made of PEEK or PEKK. The retention stress and wear resistance were evaluated based on the type of attachment material, and the results showed that both types of attachment inserts demonstrated clinically acceptable results in terms of retention.

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.2
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• pp.189-194
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• 2019

It is necessary to set the correct occlusal plane and to distribute the occlusal force uniformly considering the state of the opposing dentition during the prosthetic of the single edentulous patient with severe alveolar bone resorption. Implant supported overdenture is superior to complete denture in terms of maintenance and stability, and limited implants are used in fully edentulous patients with high alveolar bone resorption. Telescopic attachments using a newly introduced material based on poly-aryl-ether-ketone (PAEK) have the advantages of typical telescopic copping, excellent abrasion resistance, and are lighter and more economical than conventional implant overdentures. In this case, we restored maxillary arch with a implant retained overdenture using the telescopic attachment made of Pekktonand the mandible was restored with fixed implant prosthesis. Through these procedures esthetic aspects and functional outcomes were satisfactorily achieved.

• Journal of Technologic Dentistry
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• v.38 no.1
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• pp.1-6
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• 2016

Purpose: The present study was to determine the stress distribution of an abutment screw according to implant abutment material. Methods: This study was a tightening torque 10 Ncm, 20 Ncm, set to 30 Ncm, and a titanium alloy (Ti-6Al-4V), PEEK (polyetheretherketone), Endoligns (60% Carbon Fiber Reinforced PEEK) material of the custom abutment titanium alloy (Ti-6Al-4V) the stress distribution in the material of the abutment screw will be evaluated by the finite element analysis. Results: Abutment screw most stress has been concentrated on the interface between the fixture and the abutment was also part of the interface that the threads are started. Depending on the abutment of the abutment screw Material von Mises stress values are shown differently. 10Ncm T10 under the tightening torque of 294.2 MPa, P10 is 562.8 MPa, appeared to E10 is 295.8 MPa, 20Ncm tightening torque under T20 is 581.1 MPa, P20 is 1125 MPa, E20 was shown to 585.1 MPa, 30Ncm tightening torque under T30 is 918.2 MPa, P30 is 1795 MPa, E30 has appeared 925.1 MPa. Conclusion: If the abutment is used as Endoligns, it was confirmed that the abutment screw exhibits of von Mises stress value is similar to the titanium alloy abutment.

• The Journal of Advanced Prosthodontics
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• v.15 no.1
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• pp.33-43
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• 2023

PURPOSE. This study investigated the physical and mechanical changes in the titanium base of three different hybrid abutment materials after cyclic loading by estimating the post-load reverse torque value (RTV), compressive side fulcrum wear pattern of titanium base, and surface roughness. MATERIALS AND METHODS. A total of 24 dental implants were divided into three groups (n = 8 each): Group Z, LD, and P used zirconia, lithium disilicate, and polyetheretherketone, respectively, for hybrid abutment fabrication. RTV was evaluated after cyclic loading with 50 N for 1.2 × 10⁶ chewing cycles. The compressive sides of the titanium bases were analyzed using a scanning electron microscope, and the roughness of the affected areas was measured using an optical profilometer after loading. Datasets were analyzed using Kruskal-Wallis test followed by Mann-Whitney tests with the Bonferroni correction (α = .05). RESULTS. Twenty-three samples passed the test; one LD sample fractured after 770,474 cycles. Post-load RTV varied significantly depending on the hybridabutment material (P = .020). Group P had a significantly higher median of post-load RTVs than group Z (16.5 and 14.3 Ncm, respectively). Groups LD and P showed minor signs of wear, and group Z showed a more pronounced wear pattern. While evaluating compressive side affected area roughness of titanium bases, lower medians were shown in group LD (Ra 0.16 and Rq 0.22 ㎛) and group P (Ra 0.16 and Rq 0.23 ㎛) than in group Z (Ra 0.26 and Rq 0.34 ㎛); significant differences were found only among the unaffected surface and group Z. CONCLUSION. The hybrid abutment material influences the post-load RTV. Group Z had a more pronounced wear pattern on the compressive side of titanium base; however, the surface roughness was not statistically different among the hybridabutment groups.