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Effect of femoral mechanical properties on primary stability of cementless total hip arthroplasty: a finite element analysis

  • Reimeringer, Michael;Nuno, Natalia
    • Advances in biomechanics and applications
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    • v.1 no.3
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    • pp.187-210
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    • 2014
  • With the goal of increasing the survivorship of the prosthesis and anticipating primary stability problems of new prosthetic implants, finite element evaluation of the micromotion, at an early stage of the development, is mandatory. This allows assessing and optimizing different designs without manufacturing prostheses. This study aimed at investigating, using finite element analysis (FEA), the difference in the prediction of the primary stability of cementless hip prostheses implanted into a $Sawbones^{(R)}$ 4th generation, using the manufacturer's mechanical properties and using mechanical properties close to that of human bone provided by the literature (39 papers). FEA was carried out on the composite $Sawbones^{(R)}$ implanted with a straight taper femoral stem subjected to a loading condition simulating normal walking. Our results show that micromotion increases with a reduction of the bone material properties and decreases with the augmentation of the bone material properties at the stem-bone interface. Indeed, a decrease of the cancellous Young modulus from 155MPa to 50MPa increased the average micromotion from $29{\mu}m$ up to $41{\mu}m$ (+42%), whereas an increase of the cancellous Young modulus from 155MPa to 1000MPa decreased the average micromotion from $29{\mu}m$ to $5{\mu}m$ (-83%). A decrease of cortical Young modulus from 16.7GPa to 9GPa increase the average global micromotion from $29{\mu}m$ to $35{\mu}m$ (+33%), whereas an increase of the cortical Young modulus from 16.7GPa to 21GPa decreased the average global micromotion from $29{\mu}m$ to $27{\mu}m$ (-7%). It can also be seen that the material properties of the cancellous structure had a greater influence on the micromotion than the material properties of the cortical structure. The present study shows that micromotion predicted at the stem-bone interface with material properties of the $Sawbones^{(R)}$ 4th generation is close to that predicted with mechanical properties of human femur.

Analysis of the Dental Implants MRI Artifacts by Using the ACR Phantom (ACR 팬텀을 이용한 치아 임플란트 자기공명영상 인공물 분석)

  • Shin, Woon-Jae
    • Journal of the Korean Society of Radiology
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    • v.10 no.8
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    • pp.629-635
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    • 2016
  • ACR phantom for quality control of magnetic resonance imaging equipment can evaluate magnetic resonance imaging picture quality through various structures within the phantom. In this study, percent Signal Ghosting and Slice position accuracy of imaging could be analyzed by attaching implant and the wire for correction of tooth using ACR phantom in Head coil of 3.0T equipment. In the T1 weighted imaging of the first slice and the eleventh slice of implant, the slice position accuracy appeared to be good in ingress bandwidth 300, and it was good in ingress bandwidth 130 when wire for correction was attached. Percent Signal Ghosting in the seventh slice of SE T1 weighted imaging, implant and wire for correction added all appeared to be good when ingress bandwidth was 230. It is thought that in case of implant dental prosthesis patients in brain exam using magnetic resonance imaging, optimum image can be obtained by changing ingress bandwidth.

The Effective Utilization of GBR and VIP-CT(Vascularized Interpositional Periosteal Connective Tissue) graft in the Anterior Maxillary Immediate Implantation : A Clinical Case Report (상악 전치부 발치 즉시 식립시 골유도재생술과 혈관개재 골막-결합조직 판막술(VIP-CT graft)의 활용)

  • Lim, Pil
    • Journal of the Korean Academy of Esthetic Dentistry
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    • v.28 no.2
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    • pp.74-85
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    • 2019
  • The aesthetic restoration of dental implants in the anterior maxilla is a challenge for clinicians because it requires proper harmony in three following conditions; reconstruction of hard tissue, soft tissue, and aesthetic prosthesis. A newer technique, VIP-CT (Vacularized Interpositional Periosteal Connective Tissue) graft has been introduced as an alternative to these technique which allows the clinicians perform large volume soft tissue augmentation in esthetic sites with a single procedure. The advantages of the VIP-CT graft technique are that it allows the reconstruction of large soft tissue deficiency, with little constriction postoperatively. Furthermore, it facilitates improved hard tissue augmentation due to the additional blood supply and improved bone healing by mesenchymal cells. Moreover, this technique reduces patient discomfort and treatment time. This clinical report describes the procedure of bone augmentation during immediate implantation in facial dehiscence defect, especially Vascularized Interpositional Periosteal Connective Tissue(VIP-CT) graft for aesthetic anterior soft tissue.

Implant-supported milled bar overdenture with two implant surgical guides (두 개의 수술용 가이드와 Milled-bar를 이용한 임플란트 피개 의치 수복 증례)

  • Pill-Sang Yun;Sunjai Kim;Se-Wook Pyo;Jae-Seung Chang
    • The Journal of Korean Academy of Prosthodontics
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    • v.61 no.1
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    • pp.55-62
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    • 2023
  • For fully edentulous patients, implant-supported overdenture can be considered to enhance chewing efficiency and denture stability. Implant planning software can be used to fabricate a surgical guide for a more precise consideration of anatomic factors and prediction of the shape of definitive prosthesis. Though there are many possible attachments for implant overdenture, milled bar can be useful due to its splinting effect of implants and rigid support of overdenture. This report presents a case of implant-supported milled bar overdenture after guided implant surgery performed with two surgical guide that was fabricated before and after bone reduction.

Biological stability of Zirconia/Alumina composite ceramic Implant abutment (지르코니아/알루미나 복합 지대주의 생물학적 안정성에 관한 연구)

  • Bae, Kyu-Hyun;Han, Jung-Suk.;Kim, Tae-Il;Seol, Yang-Jo;Lee, Yong-Moo;Ku, Young;Cho, Ki-Young;Chung, Chong-Pyoung;Han, Soo-Boo;Rhyu, In-Chul
    • Journal of Periodontal and Implant Science
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    • v.36 no.2
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    • pp.555-565
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    • 2006
  • The purpose of the present study is to evaluate the biological stability of the zirconia/alumina composite abutment by histologic and radiographic examination in clinical cases. 17 partially edentulous patients (5 men and 12 women, mean age 47) were treated with 37 implants. The implants were placed following the standard two-stage protocol. After a healing period of 3 to 6 months, zirconia/alumina composite abutments were connected. All radiographs were taken using paralleling technique with individually fabricated impression bite block, following insertion of the prosthesis and at the 3-, 6-, 12 month re-examinations. After processing the obtained images, the osseous level was calculated using the digital image in the mesial and distal aspect in each implant. An ANOVA and t-test were used to test for difference between the baseline and 3-, 6-, 12 months re-examinations, and for difference between maxilla and mandible. Differences at P <0.05 were considered statistically significant. For histologic examination, sample was obtained from the palatal gingiva which implant functioned for 12 months. Sections were examined under a light microscope under various magnifications. Clinically, no abutment fracture or crack as well as periimplantitis was observed during the period of study. The mean bone level reduction(${\pm}standard$ deviation) was 0.34 rom(${\pm}\;0.26$) at 3-months, 0.4 2mm(${\pm}\;0.30$) at 6-months, 0.62 mm(${\pm}\;0.28$) at 12-months respectively. No statistically significant difference was found between baseline and 3-, 6-, 12-months re-examinations (p > 0.05). The mean bone level reduction in maxilla was 0.33(${\pm}0.25$) at 3-months, 0.36(${\pm}0.33$) at 6-months, 0.56(${\pm}0.26$) at 12-months. And the mean bone level reduction in mandible was 0.35(${\pm}0.27$) at 3-months, 0,49(${\pm}0.27$) at 6-months, 0.68(${\pm}0.30$) at 12-months. No statistical difference in bone level reduction between implants placed in the maxilla and mandible. Histologically, the height of the junctional epithelium was about 2.09 mm. And the width was about 0.51 mm. Scattered fibroblasts and inflammatory cells, and dense collagen network with few vascular structures characterized the portion of connective tissue. The inflammatory cell infiltration was observed just beneath the apical end of junctional epithelium and the area of direct in contact with zirconia/alumina abutment. These results suggest the zirconia/alumina composite abutment can be used in variable intraoral condition, in posterior segment as well as anterior segment without adverse effects.

FINITE ELEMENT ANALYSIS OF STRESSES INDUCED BY OSSEOINTEGRATED PROSTHESES WITH OR WITHOUT CONNECT10N BETWEEN NATURAL TOOTH AND OSSEOINTEGRATED ABUTMENTS (골 유착성 임프란트 보철수복시 자연지대치와의 고정유무에 따른 유한요소법적 응력분석)

  • Ko, Heon-Ju;Chung, Chae-Heon
    • The Journal of Korean Academy of Prosthodontics
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    • v.29 no.2
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    • pp.147-160
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    • 1991
  • The purpose of this study was to examine, by the method of finite element analysis, how implant geometry with or without connection between natural tooth and osseointegrated abutments affected the stress distribution in surrounding bone and osseointegrated prosthesis. The mandibular first and second molars were removed and the two osseointegrated implants were placed in the first and second molar sites. Stress analysis induced by prostheses with connection(Model A)or without connection(Model B) between natural tooth(second bicuspid) and two osseointegrated abutments(first molar and second molar) was performed under vertical point load(Load P1) or distributed point load(Load P2). The results were as follows; 1. Under vertical point load, mesial tilting was shown in both Model A and Model B and inferior displacement of Model A was greater than that of Model B in the second bicuspid. 2. Under vortical point load, the first and second molars showed mesial tilting in both Model A and Model B, and inferior displacement of them was similar in Model A and Model B and was less than that of the second bicuspid. 3. Under distributed point load, mesial displacement was shown in Model A and Model B and inferior displacement of Model A was less than that of Model B in the second bicuspid. 4. Under distributed point load, mesial tilting was shown and inferior displacement of Model A was similar to that of Model B in the first and second molars. 5. In Model A under vertical point load, high stress was concentrated in the corneal portion of first molar and distributed throughout the second molar and the second bicuspid, and the stress distribution of the second molar was greater than that of the second bicuspid. 6. In Model B under vertical point load, high stress was concentrated in the coronal and mesio-cervical portion of the first molar. 7. In Model A under distributed point load, high stress was concentrated in the mesio-cervical portion of the first molar and evenly distributed throughout the second molar and the second bicuspid. 8. In Model B under distributed point load, high stress was concentrated in the disto-cervical portion of the second bicuspid and evenly distributed throughout the first and second molars.

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A Retrospective study of the type of patients, the distribution of implant and the survival rate of $Xive^{(R)}$ implant (($Xive^{(R)}$)임플란트 식립시 환자 유형 및 식립부 분포와 생존율에 대한 후향적 연구)

  • Myung, Woo-Chun;Lee, Jung-Seok;Chae, Gyung-Joon;Jung, Ui-Won;Kim, Chang-Sung;Cho, Kyoo-Sung;Chai, Jung-Kiu;Kim, Chong-Kwan;Choi, Seong-Ho
    • Journal of Periodontal and Implant Science
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    • v.37 no.3
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    • pp.523-534
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    • 2007
  • This study is an analysis of types of patients and distribution of implant site and survival rate of $Xive^{(R)}$ implant. The following results on patient type, implant distribution and survival rate were compiled from 324 implant cases of 140 patients treated at the periodontal dept. of Yonsei University Hospital and G dental clinic between February 2003 and April 2006. 1. There are no dissimilarities between men and women, with patients in their 30, 40, 50s accounting for 80% of patients and accounted for 82% of implant treatments; the largest share of patients and implant treatments. 2. Mn, posterior area. accounted for 57% of implant treatments followed by Mx. posterior area(29%), Mx, anterior area(8%) and Mn, anterior area(6%). 3. Partial edentulous patients treated by single crown and bridge-type prosthesis accounted for 96% and fully edentulous patient accounted for the remaining 4%. 4. The major cause of tooth loss is periodontal disease, followed by dental canes, trauma and congenital missing. 5, The distribution of bone quality for maxillae was 54,2% for type III, followed by 30.8% for type II, 15% for type IV and 0% for type I. As for mandible, the distribution was 63% for type II, followed by 34% for type III, 2,5% for type I and 0,5% for type IV. 6. The distribution of bone quantity for maxillae was 55% for type C, followed by 35% for type B, 8% for type D and 2% for type A. As for mandible, the distribution was 60% for type B, followed by 32% for type C, 7% for type A and 0% for type D. 7. The majority of implants were those of 9.5-13 mm in length(95%) and regular diameter in width(82%). 8. The total survival rate was 98%. The survival rate was 97% in the maxillae region and 99% in the mandible region. 9. The survival rate in type I was 83%, in type II was 99%, in type III was 97% and in type IV was 100%. As for the bone quantity, the survival rate in type A and D(100%) was most, followed by type B(99%) and type C(96%). The results showed that $Xive^{(R)}$ implant could be used satisfactorily compare for the other implant system. But we most to approach carefully in certain extreme condition especially with poor bone quality and quantity.

A COMPARATIVE STUDY OF THE 1-PIECE AND 2-PIECE CONICAL ABUTMENT JOINT: THE STRENGTH AND THE FATIGUE RESISTANCE

  • Kwon, Taek-Ka;Yang, Jae-Ho;Kim, Sung-Hun;Han, Jung-Suk;Lee, Jai-Bong
    • The Journal of Korean Academy of Prosthodontics
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    • v.45 no.6
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    • pp.780-786
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    • 2007
  • Statement of problem. The performance and maintenance of implant-supported prostheses are primarily dependent upon load transmission both at the bone-to-implant interface and within the implant-abutment-prosthesis complex. The design of the interface between components has been shown to have a profound influence on the stability of screw joints. Purpose. The Purpose of this study was to compare the strength and the fatigue resistance of 1-piece and 2-piece abutment connected to oral implant, utilizing an internal conical interface. Material and methods. Twenty $Implatium^{(R)}$ tapered implants were embedded to the top of the fixture in acrylic resin blocks. Ten $Combi^{(R)}$(1-piece) and $Dual^{(R)}$(2-piece) abutments of the same dimension were assembled to the implant, respectively. The assembled units were mounted in a testing machine. A load was applied perpendicular to the long axis of the assemblies and the loading points was at the distance of 7mm from the block surface. Half of 1-piece and 2-piece abutment-implant units were tested for the evaluation of the bending strength, and the others were cyclically loaded for the evaluation of the fatigue resistance until plastic deformation occurred. Nonparametric statistical analysis was performed for the results. Results. Mean plastic and maximum bending moment were $1,900{\pm}18Nmm,\;3,609{\pm}106Nmm$ for the 1-piece abutment, and $1,250{\pm}31Nmm,\;2,688{\pm}166Nmm$ for the 2-piece abutment, respectively. Mean cycles and standard deviation when implant-abutment joint showed a first plastic deformation were $238,610{\pm}44,891$. cycles for the 1-piece abutment and $9,476{\pm}3,541$ cycles for the 2-piece abutment. A 1-piece abutment showed significantly higher value than a 2-piece abutment in the first plastic bending moment (p<.05), maximum bending moment (p<.05) and fatigue strength (p<.05). Conclusion. Both 1-piece and 2-piece conical abutment had high strength and fatigue resistance and this suggests long-term durability without mechanical complication. However, the 1-piece conical abutment was more stable than the 2-piece conical abutment in the strength and the fatigue resistance.

Strategies for Managing Dementia Patients through Improving Oral Health and Occlusal Rehabilitation: A Review and Meta-analysis

  • Yeon-Hee Lee;Sung-Woo Lee;Hak Young Rhee;Min Kyu Sim;Su-Jin Jeong;Chang Won Won
    • Journal of Korean Dental Science
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    • v.16 no.2
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    • pp.128-148
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    • 2023
  • Dementia is an umbrella term that describes the loss of thinking, memory, attention, logical reasoning, and other mental abilities to the extent that it interferes with the activities of daily living. More than 50 million individuals worldwide live with dementia, which is expected to increase to 131 million by 2050. Recent research has shown that poor oral health increases the risk of dementia, while oral health declines with cognitive decline. In this narrative review, the literature was based on the "hypothesis" that dementia and oral health have a close relationship, and appropriate oral health and occlusal rehabilitation treatment can improve the quality of life of patients with dementia and prevent progression. We conducted a literature search in PubMed and Google Scholar databases, using the search terms "dementia," "major neurocognitive disorder," "dentition," "occlusion," "tooth loss," "dental prosthesis," "dental implant," and "occlusal rehabilitation" in the title field over the past 30 years. A total of 131 studies that scientifically addressed dementia, oral health, and/or oral rehabilitation were included. In a meta-analysis, the random effect model demonstrated significant tooth loss increasing the dementia risk 3.64-fold (pooled odds ratio=3.64, 95% confidence interval [2.50~5.32], P-value=0.0348). Tooth loss can be an important indicator of cognitive function decline. As the number of missing teeth increases, the risk of dementia increases. Loss of teeth can lead to a decrease in the ascending information to the brain and reduced masticatory ability, cerebral blood flow, and psychological atrophy. Oral microbiome dysbiosis and migration of key bacterial species to the brain can also cause dementia. Additionally, inflammation in the oral cavity affects the inflammatory response of the brain and the complete body. Conversely, proper oral hygiene management, the placement of dental implants or prostheses to replace lost teeth, and the restoration of masticatory function can inhibit symptom progression in patients with dementia. Therefore, improving oral health can prevent dementia progression and improve the quality of life of patients.

The Distribution of Implant Patients and the Type of Implant Site (임플란트 환자의 분포 및 식립부 유형)

  • Park, Ji-Eun;Yun, Jeong-Ho;Jung, Ui-Won;Kim, Chang-Seong;Cho, Kyoo-Sung;Chai, Jung-Kiu;Kim, Chong-Kwan;Choi, Seong-Ho
    • Journal of Periodontal and Implant Science
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    • v.34 no.4
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    • pp.819-836
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    • 2004
  • Nowdays, the awareness of implant treatment has grown rapidly among dentists and patients alike in Korea, as it becomes a widely accepted treatment. The reason is that unlike crown and bridge or denture treatment, implant treatment helps preserve existing bone and improve masticatory functions. So, It is needed understanding about the type, distribution of implant patient. The following results on patient type and implant distribution were compiled from 4433 implant cases of 1596 patients treated at the periodontal dept. of Y University Hospital during 1992 to 2004. 1. There are no dissimilarities between men and women, with patients in their 40, 50s accounting for 52.5% of patients and 57.5% of implant treatments; the largest share of patients and implant treatments. 2. Mn. posterior area accounted for 54.9% of implant treatments followed by Mx. posterior area(27.6%), Mx anterior area(11.9%) and Mn anterior area(5.6%). 3. Partial edentulous patients treated by single crown and bridge-type prosthesis accounted for 97.5% and fully edentulous patient accounted for the remaining 2.5%. 4. The major cause of tooth loss is periodontal disease, followed by dental caries, trauma and congenital missing. Also, older people are more likely to suffer from tooth loss due to periodontal disease rather than dental caries. 5. In the distribution of bone quality for maxillae, type III was most, followed by type II, r type IV and r type I. As for mandible, type II was most, followed by type III, type IV and for type I. 6. In the distribution of bone quantity for maxillae, type C was most, followed by type B, type D, type A, and for type E. As for mandible, type B was 52% most, followed by type C, type D, type A and type E. 7. The majority of implants were those of 1O-14mm in length (85.2%) and regular diameter in width (64%). The results provided us with basic data on patient type, implant distribution, bone condition, etc. We wish that our results coupled with other research data helps assist in the further study for better implant success/survival rates, etc.