• The Journal of Korean Academy of Prosthodontics
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• v.56 no.1
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• pp.40-49
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• 2018

It is reported that the causes of unaesthetic proportion of anterior teeth vary widely. Especially, when the unaesthetic tooth proportion of the mandibular incisors arises due to the wear of the anterior teeth accompanied by the compensation of the alveolar bone, it may cause serious functional and aesthetic problems. In such case, it should be considered that the evaluation of vertical dimension and tooth proportion as well as smile line, soft tissue and hard tissue morphology. And, increase of vertical dimension or clinical crown lengthening followed by prosthodontic restorations is needed to improve the interdental mesial/distal, width/length ratio considering the anterior guidance. This case report demonstrates functional and aesthetic improvements through systematic diagnosis and treatment procedures in a 48-year-old male patient with unaesthetic anterior teeth proportion because of tooth wear accompanied by the compensation of alveolar bone and defect of several central incisors due to chronic periodontitis.

• The Journal of Korean Academy of Prosthodontics
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• v.49 no.1
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• pp.80-86
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• 2011

When a tooth adjacent to implant has coronal damages caused by severe dental caries or fracture, the clinical crown lengthening by forced eruption makes it possible to get esthetic restoration due to the prevention of alveolar crestal bone resorption and loss of interdental papilla. A 54-years-old male patient wanted prosthetic treatment because his anterior 3 unit bridges had fallen out. A right maxillary central incisor showed mild dental caries but a right maxillary canine lost most clinical crowns. Forced eruption combined with a gingival fiberotomy of a right maxillary canine was performed for 1 month after the dental implant had been simultaneously placed with bone grafts on a right maxillary lateral incisor. About 5 months after implant placement, 2nd surgical operation was performed. The provisional restorations were adjusted to make esthetic gingival contour for 8 weeks. The porcelain fused gold restorations were fabricated and set. The patient was satisfied with the final restorations in esthetic and functional aspect.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.32 no.1
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• pp.16-22
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• 2023

Esthetic factors are very important in the success of maxillary anterior implant restoration. However, achieving esthetic results is difficult, especially in cases where periodontitis has resulted in severe alveolar bone loss. In the case of maxillary anterior teeth, the alveolar ridge resorption that begins immediately after tooth extraction interferes with the esthetic implant restoration. Therefore immediate implant placement can be performed to minimize the alveolar ridge resorption. However, in severe bone loss cases, immediate implant placement could result in esthetic failure, and this result might cause irreparable problems. We can also perform alveolar ridge preservation and then place implants later. On JCP published in 2019, there is the consensus of European academy of periodontology on the extraction socket management and the timing of implant placement. This consensus states that alveolar ridge preservation should be considered when there is severe labial bone loss in an esthetically important area such as maxillary anterior region. On performing the alveolar ridge preservation, we cannot obtain the primary wound closure, so secondary wound healing is induced with open membrane technique or soft tissue grafting should be performed for primary wound closure. However, the secondary wound healing can have a negative impact on bone regeneration, and soft tissue grafting such as FGG or CT graft can be burdensome for both patients and dentists. On the other hand, by using the granulation tissue in the extraction socket, primary closure can be achieved without soft tissue grafting. Also some studies have shown that granulation tissue in periodontal defects contains stem cells that may help in tissue regeneration. Based on this, implant restorations were performed on maxillary anterior teeth with severe alveolar bone loss by alveolar ridge preservation using granulation tissue. In spite of the severe bone defect of the extraction socket, relatively esthetic results could be obtained in implant restorations.

• Journal of the korean academy of Pediatric Dentistry
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• v.46 no.2
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• pp.209-218
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• 2019

This study was aimed to evaluate orofacial morphologies on the cases of developmental disorders of maxillary first molars. Panoramic radiographs, lateral cephalographs, and clinical photos of 2983 children who attended the Pediatric Dental Clinic of Pusan National University Dental Hospital from 2006 to August 2017 were assessed retrospectively. 34 patients were selected whose maxillary first molars were missed or developmentally delayed unilaterally or bilaterally. Demirjian's method was used for estimating dental age, then which was compared to chronologic age of children. Parameters expressing skeletal and dentoalveolar disharmony were checked and compared with control. Additionally, occlusion relationship was evaluated. Maxillary dental age was significantly delayed compared to chronologic age. Several parameters which show skeletal open-bite tendency and skeletal class III malocclusion with maxillary retrusion were statistically significant. Anterior crossbite and edge-bite were expected in most of these cases, but compensation by occlusion and soft tissue was also verified which might mask skeletal class III tendency. Congenital missed or developmentally delayed maxillary first molars might be related with declined growth of maxilla. If developmental disorders of maxillary first molars were verified during clinical examination, careful monitoring of orofacial growth was necessary during puberty and timed orthopedic and orthodontic intervention were considered.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.2
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• pp.181-191
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• 2006

NFI-C null mice demonstrated aberrant odontoblast differentiation and thus abnormal dentin formation while other tissues/organs in the body, including ameloblasts, appear to be unaffected and normal. However little is known about the mechanism of NFI-C function in odontoblast differentiation and dentin formation. Odontoblasts are tall, highly polarized cells that are responsible for formation and maintenance of the predentin and dentin. An indication of their polarity is the acquisition of specialized intercellular junctions. As preodontoblasts differentiate into odontoblasts, they are Joined and attached at the apical end by well developed terminal webs of cytoskeletal actins, and associated tight as well as adherent njunctions. In this study, in order to investigate if disruption of the NFI-C gene interferes with formation of a specific or other structural proteins of the intercellular junctions, we examined morphological characteristic of the aberrant odontoblast in NFI-C null mice using light and electron microscope. In addition, we determined the expression of major structural proteins of intercellular junctions, ZO-1 and occludin, during the differentiation of odontoblasts using immunohitochemistry. The results were as follows : 1. In light microscopy, abnormal odontoblasts of incisors of the NFI-C null mice were round in shape, lost their polarity, and trapped in osteodentin-like mineralized tissue. Mutant molars have relatively normal crowns, but short and abnormal differentiating adontoblasts in root formation area. 2. Electron microscopy of abnormal odontoblasts revealed the dissociation of the round osteoblast-like cells, the loss of their cellular polarity, and the absence of an intercellular junctional complex known as the tight junctions. 3. A mutant incisor showed labeling for ZO-1 at the proximal and distal ends of secreting ameloblasts, while staining for ZO-1 was not observed in the abnormal odontoblasts. 4. A normal incisor showed immunoreactivity for occludin in the differentiating odontoblasts. However, staining for occludin was not observed in the abnormal odontoblasts of mutant incisor. These results suggest that NFI-C gene causes dissociation of odontoblast and thus abberant odontoblast differentiation and abnormal dentin formation by interfering with the formation of intercellular junctions.

• The Journal of the Korean dental association
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• v.58 no.7
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• pp.435-442
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• 2020

Porcelain is the first ceramic material to be introduced into dentistry. Porcelain jacket crown was introduced by Dr. Charles H Land in 1886, which was an excellent aesthetic dental restoration but has not been widely used due to high firing shrinkage and low tensile strength. Then metal-ceramic system, which combines the esthetic properties of ceramics and the mechanical properties of metals, was introduced and nowadays it is still used in dental clinical field. However, the metal-ceramic system has shown some problems, such as increased lightness by reflection of light at opaque layer, shadow beneath the gingival line due to the block-out of light by metal coping, exposure of metal in margin part, bond failure between metal and porcelain, oxidation of metal coping during firing the porcelain, etc. Recently, along with the advance of fabrication methods of dental ceramics, the all-ceramic restorations with high esthetic and mechanical properties has increased and gradually replaced metal-ceramic restorations. Especially, CAD/CAM technology has opened a new era in fabricating the dental ceramic restorations. This overview will take a look at the past, present and future possibility of the dental ceramic materials.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.25 no.1
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• pp.35-49
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• 2016

With the increasing demand for aesthetic implant dentistry, the importance of implant restoration is emphasized not only in the functional aspect but also in the aesthetic aspect. 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. The soft tissue aesthetics are dependent upon the condition of the supporting hard tissue because the osseous structure provides a framework for the development of a healthy and aesthetic soft tissue interface. Therefore, the augmentation of hard tissue is a first step and especially, optimal 3-dimensional position of implant is the most important factor in aesthetic implant restoration. The management of soft tissue is a second step, and the final step is a restoration of harmonic prosthesis using provisional restoration with proper emergence profile. This clinical report describes the procedure of bone augmentation in labial dehiscence defect, Vascularized Interpositional Periosteal-Connective Tissue (VIP-CT) flap for aesthetic anterior soft tissue, and the importance of provisional restoration and impression taking stage with customized impression coping.

• Journal of Dental Rehabilitation and Applied Science
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• v.33 no.4
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• pp.291-298
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• 2017

It is challenging to produce esthetic implant restoration in the narrow anterior maxilla region where insufficient volume of alveolar bone could limit the angle and position of implant fixture, if preceding bone augmentation is not considered. Ideal angle and position of implant fixture placement should be established to reproduce harmonious emergence profile with marginal gingiva of implant prosthesis, bone augmentation considered to be preceded before implant placement occasionally. In this case, preceding bone augmentation has been operated before esthetic implant prosthesis in narrow anterior maxilla region. Preceded excessive bone augmentation in buccal area allowed proper angulation of implantation, which compensates unfavorable implant position. Provisional restorations were corrected during sufficient period to make harmonious level of marginal gingiva and interdental papilla. The definite restoration was fabricated using zirconia core based glass ceramic. Functionally and esthetically satisfactory results were obtained.

• The Journal of Korean Academy of Prosthodontics
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• v.60 no.2
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• pp.168-174
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• 2022

In case of gingival recession or bone defect in maxillary anterior implant treatment, it is not easy to obtain satisfactory clinical results. In this case, loss of the labial alveolar plate was diagnosed in the maxillary right central incisor, so after tooth extraction, soft tissue was secured and implant placement with bone graft was planned. In addition, digital guide surgery was performed for the ideal implant position, and GBR (Guided Bone Regeneration) was accompanied with the xenogeneic bone and the autologous bone collected from the mandibular ramus since alveolar bone defects were extensive. After a sufficient period of osseointegration of the implant, a temporary prosthesis was fabricated through secondary stage surgery and impression taking, and through periodic external adjustment, the shape of soft tissue was improved. In the final prosthesis fabrication, a color tone of natural teeth was induced by an gold anodized customized abutment, and an aesthetic and functional zirconia prosthesis with reproducing the shape of the temporary prosthesis through intraoral scan was delivered.

• The Journal of Korean Academy of Prosthodontics
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• v.60 no.4
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• pp.354-361
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• 2022

The development of digital technology is causing great changes in dentistry. This digital workflow combines various 3D data in the prosthetic treatment area for diagnosis and prosthetic manufacturing. The planned diagnosis and the fabrication of prosthesis in a virtual patient formed by synthesizing digital data can simulate the results of prosthetic treatment more intuitively than conventional methods, thereby increasing the predictability of aesthetic prosthetic treatment. In this case report, functionally and aesthetically satisfied clinical results were obtained by fabricating a fixed partial dentures through a digital workflow on congenital missing teeth in the maxillary anterior region.