• 대한심미치과학회지
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• 제30권2호
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• pp.71-90
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• 2021

가상 환자 데이터 세트는 단일 환자로부터 획득한 구강스캔 안면스캔 전신스캔 하악운동경로데이터 등 다양한 소스의 진단 데이터를 하나의 3차원 좌표계로 정렬한 데이터의 집합이다. 치과의사는 가상 환자 데이터 세트를 사용하여 효과적으로 치료 계획을 수립하고 다양한 치료 계획을 가상공간상에서 시뮬레이션 할 수 있으며, 가상 환자 데이터 세트에서 환자의 미소를 디자인 후 그 결과를 시뮬레이션하고 최적의 치료결과를 선택할 수 있다. 가상공간에서 선택된 치료 계획은 3D 프린팅, 밀링, 사출 성형과 같은 제조 기술을 사용하여 환자에게 동일하게 전달될 수 있다. 이러 치료 계획의 전달은 임시 수복물 제작 및 환자의 구강 내에서 목업 확인을 통해 최종 보철물 제작으로 연결할 수 있다. 이와 같이 진단 데이터, 중첩 및 가공의 정확도가 보장된다면 3차원 가상공간 상에서 시뮬레이션된 3D 디지털 스마일 디자인을 실제 환자에게 정확하게 전달할 수 있다. 가상환자데이터세트의 임상적용방법으로 동기능적교합측정 검사를 통해 교합조정치료를 치료계획에서 배제할수 있는 의사결정방법과, 턱관절질환을 가지고 있는 청소년기 특발성 척추측만증 환자의 턱관절 치료전후 전신스캔 비교분석방법, 그리고 전악수복증례인 상하악 총의치환자 진료시 가상환자데이터세트에 기반한 교합평면분석 및 디지털심미분석방법을 제시하였다.

• The Journal of Advanced Prosthodontics
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• 제14권1호
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• pp.1-11
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• 2022

PURPOSE. The maximum width between the mesial and distal labial transitional line angles, described as "esthetic width" herein, could significantly influence the visual perception of the teeth and smile. This study aimed to conduct biometric research on esthetic width and to explore whether regular distribution exists in the esthetic width of human teeth. MATERIALS AND METHODS. A total of 4,264 maxillary and mandibular anterior teeth were measured using the Geomagic studio software program. The proportions of maxillary to mandibular homonymous teeth and proportions between the adjacent teeth were calculated. Bilateral symmetry and the correlation between the esthetic and mesiodistal widths were both accounted for during the measurement procedures. RESULTS. The mean esthetic widths were 6.773 ± 0.518 mm and 4.329 ± 0.331 mm for maxillary and mandibular central incisors, respectively, 5.451 ± 0.487 mm and 5.008 ± 0.351 mm for maxillary and mandibular lateral incisors, respectively, and 3.340 ± 0.353 mm and 5.958 ± 0.415 mm for maxillary and mandibular canines, respectively. Except for the mandibular canines, no significant difference in esthetic width was found among homonymous teeth from the same jaw. A high linear correlation was found between the esthetic and mesiodistal widths of the same tooth, except for the maxillary canines. Esthetic width proportions among different tooth categories showed some regular patterns, which were similar to those of the mesiodistal width. CONCLUSION. Esthetic width is regularly distributed among the teeth in the Chinese population. This could provide an important reference for anterior dental restorations and dimension recovery in esthetic reconstruction of anterior teeth.

• The Journal of Advanced Prosthodontics
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• 제14권4호
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• pp.203-211
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• 2022

PURPOSE. The aim of this study was to introduce rating criteria to evaluate student performance in a newly developed, digital wax-up preclinical program for computer-aided design (CAD) of full-coverage crowns and preliminarily investigate the reliability and internal consistency of the rating system. MATERIALS AND METHODS. This study, conducted in 2017, enrolled 47 fifth-year dental students of Okayama University Dental School. Digital wax-up training included a fundamental practice using computer graphics (CG), multipurpose CAD software programs, and an advanced practice to execute a digital wax-up of the right mandibular second molar (#47). Each student's digital wax-up work (stereolithography data) was evaluated by two instructors using seven qualitative criteria. The total qualitative score (0-90) of the criteria was calculated. The total volumetric discrepancy between each student's digital wax-up work and a reference prepared by an instructor was automatically measured by the CAD software. The inter-rater reliability of each criterion was analyzed using a weighted kappa index. The relationship between the total volume discrepancy and the total qualitative score was analyzed using Spearman's correlation. RESULTS. The weighted kappa values for the seven qualitative criteria ranged from 0.62 - 0.93. The total qualitative score and the total volumetric discrepancy were negatively correlated (ρ = -0.27, P = .09, respectively); however, this was not statistically significant. CONCLUSION. The established qualitative criteria to evaluate students' work showed sufficiently high inter-rater reliability; however, the digitally measured volumetric discrepancy could not sufficiently predict the total qualitative score.

• The Journal of Advanced Prosthodontics
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• 제15권4호
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• pp.202-213
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• 2023

PURPOSE. This prospective clinical study was conducted to evaluate the clinical usefulness of the freely detachable zirconia ball- and spring-retained implant prosthesis (BSRP) through a comparative analysis of screw- and cement-retained implant prosthesis (SCRP). MATERIALS AND METHODS. A multi-center, randomized, prospective clinical study evaluating the clinical usefulness of the detachable zirconia ball- and spring-retained implant prostheses was conducted. Sixty-four implant prostheses in 64 patients were examined. Periodic observational studies were conducted at 0, 3, 6, and 12 months after delivery of the implant prosthesis. Factors such as implant success rate, marginal bone resorption, periodontal pocket depth, plaque and bleeding index, and prosthetic complications were evaluated, respectively. RESULTS. During the 1-year observation period, all implants survived without functional problems and clinical mobility, showing a 100% implant success rate. Marginal bone resorption was significantly higher in the SCRP group than in the BSRP group only at the time of implant prosthesis delivery (P = .043). In all observation periods, periodontal pocket depth was slightly higher in the BSRP group than in the SCRP group, but there was no significant difference (P > .05). The modified plaque index (mPI) scores of both groups were moderate. Higher ratio of a score 2 in modified sulcus bleeding index (mBI) was observed in the BSRP group in the 6- and 12-months observation. CONCLUSION. Within the limitations of this study, the newly developed zirconia ball- and spring-retained implant prosthesis could be considered as an applicable and predictable treatment method along with the existing screw- and cement-retained prosthesis.

• 구강회복응용과학지
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• 제38권4호
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• pp.196-203
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• 2022

목적: 본 연구는 79종의 치과 임플란트에 대해 딥러닝을 이용한 식별 모델의 정확도와 임상적 유용성을 평가하는 것을 목적으로 하였다. 연구 재료 및 방법: 2001년부터 2020년까지 30개 치과에서 임플란트 치료를 받은 환자들의 파노라마 방사선 사진에서 총 45396개의 임플란트 고정체 이미지를 수집했다. 수집된 임플란트 이미지는 18개 제조사의 79개 유형이었다. 모델 학습을 위해 EfficientNet 및 Meta Pseudo Labels 알고리즘이 사용되었다. EfficientNet은 EfficientNet-B0 및 EfficientNet-B4가 하위 모델로 사용되었으며, Meta Pseudo Labels는 확장 계수에 따라 두 가지 모델을 적용했다. EfficientNet에 대해 Top 1 정확도를 측정하고 Meta Pseudo Labels에 대해 Top 1 및 Top 5 정확도를 측정하였다. 결과: EfficientNet-B0 및 EfficientNet-B4는 89.4의 Top 1 정확도를 보였다. Meta Pseudo Labels 1은 87.96의 Top 1 정확도를 보였고, 확장 계수가 증가한 Meta Pseudo Labels 2는 88.35를 나타냈다. Top 5 정확도에서 Meta Pseudo Labels 1의 점수는 97.90으로 Meta Pseudo Labels 2의 97.79보다 0.11% 높았다. 결론: 본 연구에서 임플란트 식별에 사용된 4가지 딥러닝 알고리즘은 모두 90%에 가까운 정확도를 보였다. 임플란트 식별을 위한 딥러닝의 임상적 적용 가능성을 높이려면 더 많은 데이터를 수집하고 임플란트에 적합한 미세 조정 알고리즘의 개발이 필요하다.

• 구강회복응용과학지
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• 제39권1호
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• pp.1-8
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• 2023

목적: 이 연구의 목적은 치주질환자를 대상으로 치주판막술 시행 5년 후 치아의 상실여부를 파악한 뒤 치아 상실과 관련된 예후 요인을 분석하는 것이다. 연구 재료 및 방법: 2017년 1월부터 12월까지 치주치료를 시행한 22명의 환자, 124개의 치아를 대상으로 하였다. 치아 관련요인은 치료 당시에 수술을 진행한 술자에 의해 임상적으로 기록된 요인으로 치주수술 당일 최대 치주낭 깊이, 치근의 수, 치근 이개부 이환, 근관치료 여부, 보철상태를 기록하였다. 내원 당시의 초진 기록을 기준으로 환자관련 요인은 성별, 나이, 흡연 여부, 첫 내원 당시 치주질환으로 상실된 치아 여부, 당뇨병 이환 여부, 5년간 유지관리 응답도가 있으며 각각 요인들을 기록하였다. 각각의 요인들의 치아 상실 여부와 관련한 영향력을 평가하였다. 결과: 치아 관련요인이 발치에 미치는 영향력을 살펴본 결과 최대 치주낭 깊이, 골 소실, 치근 이개부 이환 중 치주낭 깊이(P : 0.000), 골 소실(P : 0.021)이 발치에 유의미한 영향을 미치는 것으로 나타났다. 특히, 최대 치주낭 깊이의 영향력이 가장 높은 것으로 나타났다. 환자 관련 요인은 치아발치에 유의한 결과를 보이지 않았다. 결론: 치주판막술을 시행한 환자에서 골 소실, 최대 치주낭 깊이가 치아 상실과 관련하여 통계적으로 유의성 있는 예후 요인으로 작용하였다.

• 대한치과기공학회지
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• 제45권2호
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• pp.31-38
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• 2023

Purpose: This in vitro study aimed to compare the trueness of 3-unit fixed dental provisional prostheses (FDPs) fabricated by three different additive manufacturing and subtractive manufacturing procedures. Methods: A reference model with a maxillary left second premolar and the second molar prepped and the first molar missing was scanned for the fabrication of 3-unit FDPs. An anatomically shaped 3-unit FDP was designed on computer-aided design software. 10 FDPs were fabricated by subtractive (MI group) and additive manufacturing (stereolithography: SL group, digital light processing: DL group, liquid crystal displays: LC group) methods, respectively (N=40). All FDPs were scanned and exported to the standard triangulated language file. A three-dimensional analysis program measured the discrepancy of the internal, margin, and pontic base area. As for the comparison among manufacturing procedures, the Kruskal-Wallis test and the Mann-Whitney test with Bonferroni correction were evaluated statistically. Results: Regarding the internal area, the root mean square (RMS) value of the 3-unit FDPs was the lowest in the MI group (31.79±6.39 ㎛) and the highest in the SL group (69.34±29.88 ㎛; p=0.001). In the marginal area, those of the 3-unit FDPs were the lowest in the LC group (25.39±4.36 ㎛) and the highest in the SL group (48.94±18.98 ㎛; p=0.001). In the pontic base area, those of the 3-unit FDPs were the lowest in the LC group (8.72±2.74 ㎛) and the highest in the DL group (20.75±2.03 ㎛; p=0.001). Conclusion: A statistically significant difference was observed in the RMS mean values of all the groups. However, in comparison to the subtractive manufacturing method, all measurement areas of 3-unit FDPs fabricated by three different additive manufacturing methods are within a clinically acceptable range.

• The Journal of Advanced Prosthodontics
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• 제15권3호
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• pp.155-170
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• 2023

PURPOSE. This study aims to clinically compare the fitness and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems. MATERIALS AND METHODS. Total of 40 patients were enrolled in this study, and 9 different zirconia crowns were prepared per patient. Each crown was made through the cross-application of 3 different design software (EZIS VR, 3Shape Dental System, Exocad) with 3 different processing devices (Aegis HM, Trione Z, Motion 2). The marginal gap, absolute marginal discrepancy, internal gap(axial, line angle, occlusal) by a silicone replica technique were measured to compare the fit of the crown. The scanned inner and outer surfaces of the crowns were compared to CAD data using 3D metrology software to evaluate trueness. RESULTS. There were significant differences in the marginal gap, absolute marginal discrepancy, axial and line angle internal gap among the groups (P < .05) in the comparison of fit. There was no statistically significant difference among the groups in terms of occlusal internal gap. The trueness ranged from 36.19 to 43.78 ㎛ but there was no statistically significant difference within the groups (P > .05). CONCLUSION. All 9 groups showed clinically acceptable level of marginal gaps ranging from 74.26 to 112.20 ㎛ in terms of fit comparison. In the comparison of trueness, no significant difference within each group was spotted. Within the limitation of this study, open CAD-CAM systems used in this study can be assembled properly to fabricate zirconia crown.

• 구강회복응용과학지
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• 제38권4호
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• pp.233-241
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• 2022

목적: 이 연구목적은 3차원 프린팅의치의 후경화후로 인한 의치의 체적변화를 평가하고자하였다. 연구 재료 및 방법: 상·하악 의치를 Exocad DentalCaD 프로그램을 이용하여 디자인하였으며, STL 파일로 추출하였다. DLP 방식의 치과용 3차원 플린터를 이용하여 상·하악 의치 STL파일을 상·하악 각기 10개씩 출력하였다. 출력된 상·하악 의치는 세척하였고, 후경화를 시행하기전과 후에 각 각 모형스캐너를 이용하여 스캔파일을 만들었다. 후경화 전후의 스캔된 의치파일을 중첩하여 변화를 평가하였으며, 의치상의 계측점사이의 거리를 측정하였다. 통계는 SPSS를 이용하였으며, 유의수준은 5%였다. 결과: 상악의치는 후경화 후에 전반적으로 수축하였으며, 후구개부위에서 가장 뚜렷한 변화를 보였다. 상악의치 전후방 (A-D, A-E, A-F)의 길이와 양측제1대구치사이(B-C)의 길이 감소가 통계학적으로 유의성을 보였다. 하악의치는 후경화 후에 전후방의 길이변화보다는 폭경의 변화가 비교적 뚜렷하였는데, 의치후방(A-M, A-D, A-E, A-L, A-H, A-I, H-I)과 설측(J-K, L-M)에서 통계학적으로 유의성있는 길이변화가 관찰되었다. 결론: 이 실험의 결과내에서, 3차원 프린터로 출력되는 상·하악 의치는 후경화 후에 길이와 폭이 모두 변화하였다. 결론적으로, 의치의 변형을 최소화할 수 있는 후경화 방법과 재료의 개발이 필요할 것으로 사료된다.

• The Journal of Advanced Prosthodontics
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• 제15권5호
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• pp.227-237
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• 2023

PURPOSE. This study aimed to assess and compare the color stability, flexural strength (FS), and surface roughness of occlusal splints fabricated from heat-cured acrylic resin, milled polymethyl methacrylate (PMMA)-based resin, and 3D-printed (PMMA) based-resin. MATERIALS AND METHODS. Samples of each type of resin were obtained, and baseline measurements of color and surface roughness were recorded. The specimens were divided into three groups (n = 10) and subjected to distinct aging protocols: thermomechanical cycling (TMC), simulated brushing (SB), and control (without aging). Final assessments of color and surface roughness and three-point bending test (ODM100; Odeme) were conducted, and data were statistically analyzed (2-way ANOVA, Tukey, P <.05). RESULTS. Across all resin types, the most significant increase in surface roughness (Ra) was observed after TMC (P < .05), with the 3D-printed resin exhibiting the lowest Ra (P < .05). After brushing, milled resin displayed the highest Ra (P < .05) and greater color alteration (∆E₀₀) compared to 3D-printed resin. The most substantial ∆E₀₀ was recorded after brushing for all resins, except for heat-cured resin subjected to TMC. Regardless of aging, milled resin exhibited the highest FS (P < .05), except when compared to 3D-printed resin subjected to TMC. Heat-cured resin exposed to TMC demonstrated the lowest FS, different (P < .05) from the control. Under control conditions, milled resin exhibited the highest FS, different (P < .05) from the brushed group. 3D-printed resin subjected to TMC displayed the highest FS (P < .05). CONCLUSION. Among the tested resins, 3D-printed resin demonstrated superior longevity, characterized by minimal surface roughness and color alterations. Aging had a negligible impact on its mechanical properties.