• The Journal of the Korean dental association
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• v.54 no.4
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• pp.296-305
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• 2016

Narrow zone of attached gingiva and shallow vestibule around the implants might contribute to difficulty of cleasing, periimplant mucositis caused by incomplete cleansing and further peri-implantitis. The aim of this case report is to present modification of soft tissue biotype around the implants by free gingival grafts according to timing of surgical intervention and shape of free gingiva. A 44 year-old male patient had a missing area on lower right second molar area with 1 to 2 mm of narrow attached gingiva zone and wanted to be treated by implant placement. In radiographic analysis, there was enough alveolar bone to install an implant, free gingiva from hard palate was grafted following implant placement using double layer flap. The width of attached gingival was increased to 4 to 5mm and well maintained during 5 months of follow up. A 69 year-old female patient also had a missing area on lower right first and second molar area with 1 to 2 mm narrow attached gingiva. Since she had systematically angina pectoris and dental phobia, minimal invasive free gingival graft after implants placement was planned. After 2 months of implant surgery, free gingival graft surgery was performed with healing abutments connection. The grafted gingiva was composed of two strip shaped free gingiva, and they were immobilized by periodontal pack. The width of attached gingival was increased to 4 to 5mm and well maintained during 10 months of follow up. With prosthesis delivery, the patients recovered ideal periodontal environment around implants and masticatory function. In conclusion, periodontal health and masticatory function could be achieved through implant placement and free gingival graft.

• The Journal of Korean Academy of Prosthodontics
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• v.51 no.1
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• pp.47-51
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• 2013

With the introduction of dental implants, restoration of missing teeth with conventional fixed or removable partial dentures is being replaced with implants. Especially, with young patients, not only longevity but also esthetic factors need to be considered. Implant restorations provide long-term success functionally but, esthetic complications such as, marginal exposure due to gingival recession, loss of the papilla and dark color of metal abutments may occur. Recently, zirconia restorations with CAD/CAM technology provide functional, biocompatible and esthetic restorations possible. All-ceramic restorations using the pressed ceramic technique show better fracture toughness values than those of the conventional porcelain veneering technique. Pressed ceramic technique creates the veneer design in wax and the lost wax technique is used to create the restoration. The final contour of the restoration may be controlled during wax-up. A 22-year old female patient was restored with dental implants and zirconia restorations using the pressed ceramic technique presenting short-term but optimistic prognosis.

• The Journal of Advanced Prosthodontics
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• v.9 no.4
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• pp.244-251
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• 2017

PURPOSE. The purpose of this study was to determine fracture resistance and failure modes of three-unit fixed dental prostheses (FDPs) made of lithium disilicate pressed on zirconia (LZ), monolithic lithium disilicate (ML), and monolithic zirconia (MZ). MATERIALS AND METHODS. Co-Cr alloy three-unit metal FDPs model with maxillary first premolar and first molar abutments was fabricated. Three different FDPs groups, LZ, ML, and MZ, were prepared (n = 5 per group). The three-unit FDPs designs were identical for all specimens and cemented with resin cement on the prepared metal model. The region of pontic in FDPs was given 50,000 times of cyclic preloading at 2 Hz via dental chewing simulator and received a static load until fracture with universal testing machine fixed at $10^{\circ}$. The fracture resistance and mode of failure were recorded. Statistical analyses were performed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni's correction (${\alpha}=0.05/3=0.017$). RESULTS. A significant difference in fracture resistance was found between LZ ($4943.87{\pm}1243.70N$) and ML ($2872.61{\pm}658.78N$) groups, as well as between ML and MZ ($4948.02{\pm}974.51N$) groups (P<.05), but no significant difference was found between LZ and MZ groups (P>.05). With regard to fracture pattern, there were three cases of veneer chipping and two interfacial fractures in LZ group, and complete fracture was observed in all the specimens of ML and MZ groups. CONCLUSION. Compared to monolithic lithium disilicate FDPs, monolithic zirconia FDPs and lithium disilicate glass ceramics pressed on zirconia-based FDPs showed superior fracture resistance while they manifested comparable fracture resistances.

• The Journal of Advanced Prosthodontics
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• v.10 no.5
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• pp.374-380
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• 2018

PURPOSE. The effect of silica-based glass-ceramic liners on the tensile bond strength between zirconia and resin-based luting agent was evaluated and compared with the effect of 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing primers. MATERIALS AND METHODS. Titanium abutments and zirconia crowns (n = 60) were fabricated, and the adhesive surfaces of the specimens were treated by airborne-particle abrasion. The specimens were divided into 5 groups based on surface treatment: a control group, 2 primer groups (MP: Monobond Plus; ZP: Z Prime Plus), and 2 liner groups (PL: P-containing Liner; PFL: P-free Liner). All specimens were cemented with self-adhesive resin-based luting agent. After 24-hour water storage and thermocycling (5,000 cycles, $5^{\circ}C/55^{\circ}C$), the tensile bond strength was measured using a universal testing machine. Failure mode analysis and elemental analysis on the bonding interface were performed. The data were analyzed using Kruskal-Wallis test, Dunn's post hoc test, and Fisher's exact test. RESULTS. The liner groups and primer groups showed significantly higher tensile bond strengths than that of the control group (P<.05). PFL showed a significantly higher tensile bond strength than the primer groups (P<.05). The percentage of mixed failure was higher in the primer groups than in the control group (P<.001), and all the specimens showed mixed failure in the liner groups (P<.001). A chemical reaction area was observed at the bonding interface between zirconia and liner. CONCLUSION. The application of liner significantly increased the tensile bond strength between zirconia and resin-based luting agent. PFL was more effective than MDP-containing primers in improving the tensile bond strength with the resin-based luting agent.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.11
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• pp.5939-5946
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• 2013

The bridge approach slabs (BAS) to provide a transitional roadway between a roadway pavement and a bridge structure have not performed adequately due to various factors. The current Korean Roadway Design Guidelines treat the BAS as a simply supported beam with 70% of the span length and do not consider settlement and void development underneath the slab. To investigate the effect of soil settlements on the bending moment of BAS, a beam on elastic support (BAS-ES) was used in the present study. The parameters used in this study were span length, washout length, washout location, and soil modulus. It was shown from the parametric study that washout regions closer to the midspan exhibit maximum moment in the slab. Since voids under the BAS have typically been observed to be closer to bridge abutments, the springs from the abutment were removed to simulate settlement and void development in the model. The design moments based on AASHTO LRFD Bridge Design Specifications were compared to those of Korean Standard Specifications for Highway Bridge and Design Trucks for Highway Bridges. Even if the design moment from BAS-ES was used to incorporate the effect of the potential washout, significant savings could still be achieved compared to the current BAS design.

• Journal of Periodontal and Implant Science
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• v.32 no.3
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• pp.615-630
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• 2002

Various long-term studies have shown that titanium implants as abutments for different types of prostheses have become a predictable adjunct in the treatment of partially or fully edentulous patients. The continuous exposure of dental implants to the oral cavity with all its possible contaminants creates a problem. A lack of attachment, together with or caused by bacterial insult, may lead to peri-implantitis and eventual implant failure. Removal of plaque and calculus deposits from dental titanium implants with procedures and instruments originally made for cleaning natural teeth or roots may cause major alterations of the delicate titanium oxide layer. Therefore, the ultimate goal of a cleaning procedure should be to remove the contaminants and restore the elemental composition of the surface oxide without changing the surface topography and harming the surrounding tissues. Among many chemical and mechanical procedure, air-powder abrasive have been known to be most effective for cleaning and detoxification of implant surface. Most of published studies show that the dental laser may be useful in the treatment of pen-implantitis. $CO_2$ laser and Soft Diode laser were reported to kill bacteria of implant surface. The purpose of this study was to obtain clinical guide by application these laser to implant surface by means of Non-contact Surface profilometer and X-ray photoelectron spectroscopy(XPS) with respect to surface roughness and atomic composition. Experimental rough pure titanium cylinder models were fabricated. All of them was air-powder abraded for 1 minute and they were named control group. And then, the $CO_2$ laser treatment under dry, hydrogen peroxide and wet condition or the Soft Diode laser treatment under Toluidine blue O solution condition was performed on the each of the control models. The results were as follows: 1. Mean Surface roughness(Ra) of all experimental group was decreased than that of control group. But it wasn't statistically significant. 2. XPS analysis showed that in the all experimental group, titanium level were decreased, when compared with control group. 3. XPS analysis showed that the level of oxygen in the experimental group 1, 3($CO_2$ laser treatment under dry and wet condition) and 4(Soft Diode laser was used under toluidine blue O solution) were decreased, when compared with control group. 4. XPS analysis showed that the atomic composition of experimental group 2($CO_2$ laser treatment under hydrogen peroxide) was to be closest to that of control group than the other experimental group. From the result of this study, this may be concluded. Following air-powder abrasive treatment, the $CO_2$ laser in safe d-pulse mode and the Soft Diode laser used with photosensitizer would not change rough titanium surface roughness. Especially, $CO_2$ laser treatment under hydrogen peroxide gave the best results from elemental points of view, and can be used safely to treat peri-implantitis.

• The Journal of Korean Academy of Prosthodontics
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• v.42 no.6
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• pp.628-640
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• 2004

Statement of problem. Wear as a result of repeated closing/opening cycles may decrease the friction coefficient of screw head, threads, and other mating components and, consequently, resistance to opening gradually decreases. It may cause screw loosening, which is one of the most common failures in implant prosthesis. Purpose. The purpose of this study is to evaluate the changes on the head and thread surface of the abutment screws after repeated closing and opening through the examination of tested screws in SEM(scanning electron microscope). Materials and methods. Five species of abutments were selected (3i-three, Avana-two) respectively by two pieces. The implant fixtures were perpendicularly mounted in liquid unsaturated polyesther(Epovia, Cray Valley Inc.) with dental surveyor. Each abutment was secured to the implant fixture by each abutment screw with recommended torque value using a digital torque controller. The abutment screws were repeatedly tightened and removed 20 times with a digital controller. FESEM (field emission scanning electron microscope, Netherland, Phillips co., model:XL 30 SFEG) was used to observe changes of each part caused by repeatedly closing/opening expeiment. First, the Photomicrographs of pre-test screws provided by each manufacturer were taken. The changes of each screw were investigated after every fifth closing and opening experiment with FESEM. Scaning electron microscope photomicrographs of each screw were taken four times. Results. As the number of closing and opening was increased, the wear or distortion of hexed or squared slot that contacted with the driver tip was more severely progressed. Wear or distortion of hexed slot was more severe than that of squared slot and it was more remarkable in the titanium screw than in the gold screw. All the tested screws showed that the width in the crest of their screw thread decreased gradually as the test was proceeded. Conclusions. Conclusively, we recommend the clinical use of gold screw, a periodic exchanges of abutment screws and avoiding repeated closing/opening unnecessarily. We also suggest a more careful manipulation of the abutment screw and screw-driver and using of abutment screw with an acute-angled slot design rather than an obtuse-angled one. Finally, it is suggested that the new slot design and the surface treatment for enduring wear or distortion should be devised.

• The Journal of Korean Academy of Prosthodontics
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• v.44 no.4
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• pp.432-442
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• 2006

Statement of problem: One of common problems associated with dental implant is the loosening of abutment screws that retain the implants. Purpose : This study was performed to investigate the influence of abutment screw length and repeated tightening on screw loosening in dental implant. Material and method: Forty nine Hexplants (13mm length, 4.3mm diameter, Ti grade IV, Warantec. Co. Ltd. Seongnam, Korea) and cementation type abutments(straight abutment) and abutment screws (0.4mm/pitch) were divided into 7 groups, depending on abutment screw length. Each implant and abutment was tightened to 30Ncm by torque controller(MGT50, MARK-10 Inc., USA) and the removal torque values were measured during 10 consecutive closure/opening trials. Results and Conclusion: The results of comparing the removal torque value are as follows : 1. There is no significant difference in the removal torque value between groups in 10 consecutive closure/opening trials (p = 0.97). 2. If the fractured abutment screw is engaged in longer than 2.425 thread length, there is no significant difference in the preload between the fractured abutment screw and the new abutment screw when both are equally tightened to 30 Ncm. 3. The removal torque value in the 1st trial(24.510 Ncm) was lower than that in the 2nd, 3rd, 4th, 5th, 6th, 7th trials and the removal torque value in the 2nd trials(25.551 Ncm) was maximum and was decreased in 1311owing trials. The removal torque value in the 1st trial was significantly lower than that in the 2nd, 3rd, 4th trials and was significantly higher than that in the 8th, 9th, l0th trials(p<0.05). 4. In the 2nd, 3rd, 4th, 5th, 6th, 7th trials, the abutment screw was mainly influenced by settling effect and the higher preload was obtained In the 8th, 9th, l0th trials, the abutment screw was mainly influenced by adhesive wear and the progressively lower preload was obtained.

• The Journal of Korean Academy of Prosthodontics
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• v.44 no.4
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• pp.421-431
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• 2006

Statement of problem : Accurate impression is essential to success of implant prostheses. But there have been few studies about the accuracy of fixture-level impression technique in internal connection implant system. Purpose: This study evaluated the accuracy of splinted fixture-level impression technique using clinical methods and the effect of internal hex on fit of superstructure in internal connection implant system (Astra Tech). Material and method : Two metal master frameworks made from two abutments (Cast-to Abutment ST) each for parallel and divergent conditions and a corresponding. passively fitting, dental stone master cast with four future replicas (Fixture Replica ST) were fabricated. Ten dental stone casts were made with vinyl polysiloxane impressions from the master cast by acrylic resin splinted fixture-level impression technique. To evaluate the accuracy of impression technique, the fit of master frameworks for test models was evaluated using screw resistance test (SRT) and one-screw test. The results of SRT were recorded as SRT values from grade 1 to grade 5 by 1/4 turn. And to evaluate the effect of hex on fit of superstructure, the same tests were performed after removing hexes of master frameworks. Results: 1. There was only one case (2.5%) showing SRT value of test model below ade 2 in total before and after removing hexes of master frameworks. And, by removing hexes. SRT values decreased in only one test model (5%) and did not change in 17 test models (85%). 2. SRT values of the 1$^{st}$ screws were grade 2 in 80% of cases before, and grade 1 in 80% of cases after removing hexes. And, by removing hexes, SRT values decreased in 72.5% of cases. 3. SRT values of the 2$^{nd}$ screws were grade 3 in 85% of cases before, and grade 3 in 95% of cases after removing hexes. And, by removing hexes, SRT values did not change in 85% of cases. 4. There were only 2 cases regarded as acceptable fit by one-screw test, and SRT values of 2$^{nd}$ screws of both cases were grade 2. Conclusion. Within the limitations of this study, future-level impression of internal connection implant system is considered to obtain inaccurate working cast, even using acrylic resin splinted impression technique. And, it is considered to be unable improve the fit to remove the hexes of implant restoration.

• The Journal of Korean Academy of Prosthodontics
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• v.43 no.1
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• pp.61-77
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• 2005

Statement of problem. The implant prosthesis has been utilized in various clinical cases thanks to its increase in scientific effective application. The relevant implant therapy should have the high success rate in osseointegration, and the implant prosthesis should last for a long period of time without failure. Resorption of the peri-implant alveolar bone is the most frequent and serious problem in implant prosthesis. Excessive concentration of stress from the occlusal force and biopressure around the implant has been known to be the main cause of the bone destruction. Therefore, to decide the location and angulation of the implant is one of the major considering factors for the stress around the implant fixture to be dispersed in the limit of bio-capacity of load support for the successful and long-lasting clinical result. Yet, the detailed mechanism of this phenomenon is not well understood. To some extent, this is related to the paucity of basic science research. Purpose. The purpose of this study is to perform the stress analysis of the implant prosthesis in the partially edentulous mandible according to the different nature locations and angulations using three dimensional finite element method. Material and methods, Three 3.75mm standard implants were placed in the area of first and second bicuspids, and first molar in the mandible Thereafter, implant prostheses were fabricated using UCLA abutments. Five experimental groups were designed as follows : 1) straight placement of three implants, 2) 5$^{\circ}$ buccal and lingual angulation of straightly aligned three implants, 3) 10$^{\circ}$ buccal and lingual angulation of straightly aligned three implants. 4) lingual offset placement of three implants, and 5) buccal offset placement of three implants. Average occlusal force with a variation of perpendicular and 30$^{\circ}$ angulation was applied on the buccal cusp of each implant prosthesis, followed by the measurement of alteration and amount of stress on each configurational implant part and peri-implant bio-structures. The results of this study are extracted from the comparison between the distribution of Von mises stress and the maximum Von mises stress using three dimensional finite element stress analysis for each experimental group. Conclusion. The conclusions were as follows : 1. Providing angulations of the fixture did not help in stress dispersion in the restoration of partially edentulous mandible. 2. It is beneficial to place the fixture in a straight vertical direction, since bio-pressure in the peri-implant bone increases when the fixture is implanted in an angle. 3. It is important to select an appropriate prosthodontic material that prevents fractures, since the bio-pressure is concentrated on the prosthodontic structures when the fixture is implanted in an angle. 4. Offset placement of the fixtures is effective in stress dispersion in the restoration of partially edentulous mandible.