• Title/Summary/Keyword: 보철물 유지력

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A finite element analysis of implant-supported overdenture on the effect of anterior cantilever (임플랜트 bar overdenture에서 bar의 cantilever양이 임플랜트에 미치는 영향에 관한 삼차원 유한요소분석적 연구)

  • Jung, Tae-Wook;Kim, Young-Soo;Kim, Chang-Whe;Ling, Booi-Cie
    • The Journal of Korean Academy of Prosthodontics
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    • v.36 no.1
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    • pp.1-17
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    • 1998
  • 두개의 임플랜트로 지지되는 overdenture를 이용한 하악무치악환자의 치료법은 경제적이면서, 실용적인 치료로 인정을 받고 있다. 하지만 해부학적인 조건으로 임플랜트를 설측 혹은 후방에 식립해야 되는 경우에는 일반적인 bar설계는 bar가 구강저 상방을 지나게 되어 혀운동, 발음, 위생관리 등에 많은 문제점을 부여한다. 이에 대한 해결방법으로 전방부 치조제 상에 보철물의 회전을 허용하는 angular bar를 설계할 수 있다. 하지만 이 설계는 임플랜트에 불리한 moment를 유발한다. 그럼에도 불구하고 뛰어난 유지력과 지지능력, 경제적인 면 때문에 angular bar는 임상에서 많이 사용되고 있다. 이에 본 연구는 angular bar의 전방 cantilever양을 달리하여 임플랜트 및 주변조직에 미치는 영향을 삼차원 유한요소분석법을 통해서 알아보고자 하였다. 이공사이의 하악골을 단순화시킨 준하악골모형에 직경 3.75mm인 브로네마르크 임플랜트 2개를 길이가 13,15mm인 경우로 설정하여 제 1소구치 부위에 식립하였다. 두 임플랜트를 연결하는 bar는 전방부 cantilever양을 0-5mm, 1mm씩 하여 6가지 경우를 가정하고 제작하였다. 각각 bar 중앙부에 수직압 (90도) 35N, 경사압(120도) 70N, 수평압(0도) 10N을 가하였으며 이때 나타나는 응력 분산형태와 임플랜트의 골유착에 불리하게 작용하는 최대주응력(인장력)과 변위량을 살펴보았다. 연구결과 다음과 같은 결론을 얻었다. 1. Cantilever양이 증가할수록 주변피질골과 임플랜트로 응력이 집중되었으며 상부 보철물의 변위량도 커졌다. 2. Cantilever양에 대한 수평압의 영향은 크지 않았으며 임플랜트 길이가 긴 것이 변위량과 응력이 작았다. 3. 경사압에 대한 응력의 변화는 cantilever양의 증가에 따라 급격히 증가하는 양상을 띠었으며 임플랜트길이가 응력 및 변위의 양에 미치는 영향은 없었다. 4. 수직압에 대한 응력의 변화는 초기에는 완만한 증가를 보이다가 일정 시점 지난 후에는 증가율이 커지는 경향을 띠었다. 증가현상이 두드러지기 전에는 길이의 증가가 응력의 분산효과는 가져왔으나 이후에는 길이의 응력분산 효과는 없었다. 5. 응력분포양상은 cantilever양이 증가할수록 골조직을 통한 분산정도는 작아지고 특정부위의 피질골과 임플랜트, 상부보철물에 집중되는 경향을 보였다. 6. 임플랜트와 주변 골조직으로의 응력분산능력이 예후를 좌우한다는 점에서 angular bar는 적합치 못하며 부득이한 경우는 임플랜트 길이를 길게 하고 최대한 3mm이내로 cantilever양을 제한하는 것이 추천된다.

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Full mouth rehabilitation with reorientation of occlusal plane using facial scan: a case report (교모 환자에서 안면 스캔을 활용하여 교합 평면을 재설정한 전악 보철 수복 증례)

  • Eun-Gyeong Kim;Sae-Eun Oh;Jee-Hwan Kim
    • The Journal of Korean Academy of Prosthodontics
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    • v.62 no.1
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    • pp.64-71
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    • 2024
  • The most critical aspect of full-arch prosthodontic treatment is evaluating whether the patient's vertical occlusal dimension is appropriate, and if necessary, restoring it through increasing vertical dimension. If the vertical occlusal dimension is too low, it can lead to reduced chewing efficiency, as well as not only aesthetic concerns but also potential issues like hyperactivity of muscles and posterior displacement of the mandible. This report is about the patient dissatisfied with pronunciation and aesthetics due to an inappropriate vertical occlusal dimension resulting from prior prosthetic interventions, underwent full-arch prosthodontic restoration treatment. Through the utilization of digital diagnostic apparatus, a comprehensive evaluation was undertaken for patient's vertical occlusal dimension, occlusal plane orientation, and the condition of prosthetic restorations. Through 3D facial scanning, the facial landmarks were discerned, and subsequently, the new occlusal plane was established. This provided the foundation for a digitally guided diagnostic wax-up. An elevation of 5 mm from the incisor was determined. Comprehensive dental rehabilitation was then executed for all remaining teeth, excluding the maxillary four incisors. The treatment protocol followed a systematic approach by initially creating implant-supported restorations on both sides of the dental arch to establish a stable occlusal contact. Subsequently, prosthetic restorations for the natural dentition were generated. Diagnostic and treatment planning were established through the utilization of facial scanning. This subsequently led to a reduction in treatment complexity and an expedited treatment timeline.

Implant assisted removable partial denture with implant surveyed crown: A 20-month follow-up case report (단일 임플란트 서베이드 크라운을 이용한 하악 임플란트 융합 국소의치: 20 개월 경과 관찰 증례 보고)

  • Roh, Kyoung-Woo;Jeon, Young-Chan;Jeong, Chang-Mo;Yoon, Mi-Jung;Lee, So-Hyoun;Huh, Jung-Bo
    • The Journal of Korean Academy of Prosthodontics
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    • v.56 no.4
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    • pp.323-329
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    • 2018
  • Traditional options for posterior edentulous treatment include removable partial dentures and implant fixed prostheses. Recently, the concept of implant assisted removable partial denture, in which two treatments are fused, has been introduced in consideration of systemic health and patient's needs, costs, residual alveolar bone status and so on. Implant assisted removable partial denture has the advantage of increasing the retention and stability of the denture and improving its esthetics in cases of large bone defects or biomechanical disadvantages. In addition, it is possible to strategically place the implants in a site where the alveolar bone is relatively sufficient, thereby overcome the limit of the conventional removable partial denture design as well as reducing the burden on a wide range of implant surgery. Cost reduction is also expected. In this case, the patient was treated by placing the implant in both premolar sites of the mandible and fabricating the distal extension removable partial denture with the implant fixed prosthesis as an abutment. After delivering the definitive prosthesis, the patient showed satisfaction with the masticatory function and esthetics. and has been regularly followed-up for more than one year. The following 20-months follow-up case report describes the design of an implant-assisted-removable partial denture (IARPD) in which two cementretained implant crowns used to provide support and stability.

Case Reports of Elderly Patients in Aging Society (성이 교정환장의 치험 예)

  • Park, Yang-Ho;Cheon, Se-Hwan;Lee, Kyu-Hong;Hwang, Yong-In;Kim, Yoon-Ji;Kim, Seon-Ah
    • The Journal of the Korean dental association
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    • v.45 no.12 s.463
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    • pp.753-760
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    • 2007
  • Recently orthodontics in elderly people is continually increasing due to aging of the society arising from decrease of birth rate as well as death rate. As the elderly population grows, needs for oral health care increases, and elderly patients with poor teeth alignment need more attention with orthodontic treatment. Our study analyzes various treatment protocols for different cases of aged orthodontic patients, and following are considerations in orthodontic treatment of elderly patients. 1. Periodontal treatment should be preceded before orthodontic treatment. 2. Periodontal condition should be considered when selecting teeth for extraction 3. In dealing with the residual prosthesis, condition of prosthesis, anchorage availability, and need for size reduction, patient seconomic status should be taken into consideration. 4. Fixed retainers are recommended for retention.

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An experimental study of repair of porcelain-fused to metal restorations (치과용 도재용착주조관(陶材溶着鑄造冠)의 수리에 대한 실험적 고찰)

  • Kim, Jin-Wan
    • Journal of Technologic Dentistry
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    • v.2 no.1
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    • pp.55-59
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    • 1980
  • 이와 같은 세 기술은 많은 도재용착주조관의 수리에 이용된다고 할 수 있고 이런 기술은 완전한 보철물을 다시 만들지 않고 연장된 도재용착주조관의 수리에 적용할 수 있는 것이다. 금속덮개(over casting)와 핀에서 유지를 얻는 금속 전장판에 의한 수리의 성공은 다시 제작한 도재용착주조관의 그것과 비교할 만하다. 그러나 도재에 합성수지(composite resin)를 결합시켜 수리하는 방법은 합성수지(composite resin)가 도재보다 잘 닳을 뿐만 아니라 색깔의 안정성도 좋지 않으며 도재가 금속판에 용착될 때 창조되는 결합력보다 silance bonding agent를 사용하여 창조되는 결합력 즉 화학적 결합(chemical bond)이 약하기 때문에 좋다고 할 수는 없다. 그러므로 silance bond repair에 관한 연구는 앞으로도 여러분들과 함께 더욱 더 연구할 과제가 아닌가 생각되는 바입니다.

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An Esthetic Restoration of the Missing Maxillary Anterior Teeth with the Rotational Path RPD: A Case Report (회전삽입로 국소의치를 이용한 심미적 상악 전치부 수복 증례)

  • Lee, Ji-Hye;Lim, So-Min;Jung, Hye-Eun;Park, Chan-Jin;Cho, Lee-Ra;Kim, Dae-Gon
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.2
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    • pp.209-222
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    • 2011
  • Missing anterior teeth can be replaced using any of a number of methods. Patients may choose to replace missing teeth with a prosthesis that is either removable, fixed, or retained with implants. For patients faced with financial, anatomical, and/or esthetic limitations, the edentulous region can be restored successfully and esthetically with a properly designed and fabricated rotational path RPD. The rotational path RPD is a partial removable dental prosthesis that incorporates a curved, arcuate, or variable path of placement allowing one or more of the rigid components of the framework to gain access to and engage an undercut area. The rigid retainer must gain access to the infrabulge portion of the tooth by rotating into place. Either a minor connector or proximal plate provides retention through its intimate contact with a proximal tooth surface. A specially designed dovetails or asymmetric rest seats provides support and embracing effects. Correctly designed and fabricated rotational path RPD can provide improved esthetics, cleanliness, and retention. But rotational path RPDs are technique sensitive since the rotational path RPD has little margin of laboratory error that rigid retainers cannot be adjusted like conventional clasps can, RPD framework must be remade once the retention is lost. The sufficient understanding of the concept for the rotational path RPD is required for clinically successful treatment. This clinical report describes in detail the theoretical, laboratory considerations and the treatment of a patient with an anterior maxillary edentulous area treated by an AP path rotational RPD that had a difficulty in long term maintenance and describes another clinical case in which more reasonable treatment procedures were approached after analyzing the former case.

Implant overdenture using milled bar and attachment in partially edentulous mandible: a case report (하악 부분 무치악 환자에서 Milled Bar와 부착장치를 이용한 임플란트 피개의치 수복 증례)

  • Kim, Min-Jung;Huh, Jung-Bo;Jeong, Chang-Mo;Yun, Mi-Jung;Lee, So-Hyoun;Jo, Yong-Bum
    • The Journal of Korean Academy of Prosthodontics
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    • v.60 no.1
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    • pp.71-79
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    • 2022
  • Excessive crown height space increases can cause crestal bone loss and screw loosening after prosthesis is placed. Milled bar and implant overdenture can be used as a treatment method for partially edentulous patients who have severe alveolar bone loss and excessive crown height space. Milled bar can provide primary splinting effect and stability between implants. Also, milled bar with additional retention device such as Advanced Dental Device-Treatment Of Choice (ADD-TOC) and magnet can provide additional retention force for implant overdenture. In this case, the patient has a partially edentulous mandible that has severe alveolar bone loss and multiple number of teeth loss after excision due to leiomyosarcoma. Because of the long-term loss of mandibular molars, the opposing teeth were extruded. Maxillary left molars were corrected to the occlusal plane through molar intrusion, and mandibular left molar region were treated with implant overdenture, using milled bar with ADD-TOC and magnet after implant placement. The clinical result was satisfactory on the aspect of esthetic and masticatory function.

The Comparison of the Retention of the Full Veneer Casted Gold Crowns with Different Implant Abutment Shapes and Types of Cements (임플란트 지대주 형태와 시멘트 종류에 따른 전부주조금관의 유지력 비교)

  • Jung, Jae-Wook;Kim, Jee-hwan;Kim, Sun-jai;Moon, Hong-suk;Shim, June-sung
    • Journal of Dental Rehabilitation and Applied Science
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    • v.25 no.4
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    • pp.403-415
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    • 2009
  • The purpose of the study is to establish the effect of different abutment shapes and types of cements on the retention of the full veneer casted gold crowns. Metal dies that has the similar shape with the implant abutment were manufactured using a short(5mm) and long(10mm) dies with different convergence angles. Metal dies and gold crowns, which were made from the metal dies, were cemented with Temp-bond, Temp-bond mixed with petroleum jelly, ZPC and Premier implant cement. After that, these were tested for tensile force at the point of separation. The effect of convergence angle changes of different cement types on the retention was studied as well as the effects of the cement type changes with different convergence angles on the retention. In addition, study about the marginal gap of Premier implant cement used for this experiment was conducted. The results are as followed under the in-vitro experimental limits; 1. The retention of the Temp-bond mixed with petroleum jelly decreased as the convergence angle increased, and the retention was weakest among the cements. 2. The retention of ZPC decreased as convergence angle increased. When convergence angle was 5 degrees, ZPC showed stronger retention than Premier implant cement. 3. Premier implant cement had the weakest retention when the convergence angle was 5 degrees but when the convergence angle was 10 degrees, it had the strongest retention. As the angle increased more than 10 degrees, the retention decreased. 4. Premier implant cement showed bigger marginal gap when the convergence angle was 5 degrees than 10 degrees under the experimental condition.

Prosthetic treatment for patient with upper lip cancer and severe periodontitis: Maxillary complete denture with denture adhesive and mandibular double crown-retained removable partial denture (구순암 환자에서의 의치접착제를 이용한 상악 총의치와 심한 치주 상태에서의 하악 이중관의치를 이용한 수복 증례)

  • Choi, Hyun-Suk;Lee, Cheong-Hee;Cho, Jin-Hyun
    • The Journal of Korean Academy of Prosthodontics
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    • v.53 no.1
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    • pp.74-80
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    • 2015
  • When oral cancer is occured, one may experience problems such as lip defect, necrosis of periodontal tissue and cervical caries caused by radiotherapy. According to ADI (Association of dental implantology), recent radiotherapy on jaw bone could be a relative contraindication of implant treatment. Due to this controversy, in most cases, treatment is done with removable dentures rather than implants. Especially, lip defect caused by an oral cancer operation have a serious repercussion on the retention of the denture. In this case report, patient with upper lip cancer had undergone resection primarily and secondary radiotherapy was done periodically. As a result, upper teeth of patient were extracted gradually and lower teeth showed very poor periodontal status. Therefore, Polident$^{(R)}$ denture adhesive cream (GlaxoSmithKline, London, England) was applied on maxillary complete denture to overcome reduced retention due to the lip defect and double crown RPD with friction pin was applied on the mandible successfully for two years.

Full mouth rehabilitation of a patient with worn dentition and loss of posterior support by vertical dimension reestablishment: a clinical report (구치부 상실과 과도한 교모가 있는 환자의 수직 고경 회복을 통한 전악 보철 수복)

  • Ryu, Jung-Hyun;Lee, Won-Sup;Lee, Cheol-Won;Lee, Su-Young
    • The Journal of Korean Academy of Prosthodontics
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    • v.56 no.3
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    • pp.227-234
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    • 2018
  • Excessive teeth wear may result in the complications such as esthetic problems, hypersensitivity, and loss of vertical dimension. This clinical report focuses on the causes of severely worn dentition and the full-mouth rehabilitation of a patient with rheumatoid arthritis for 20 years. An interview, clinical and radiological examinations were performed to analyze the causes and decide the treatment plan. After delivery of the final prostheses, a night guard was used to protect the restorations and temporomandibular joints. The patient was satisfied esthetically and functionally.