• Journal of Periodontal and Implant Science
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• v.38 no.4
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• pp.723-728
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• 2008

Purpose: During guided bone regeneration procedures for the augmentation of deficient alveolar ridge, primary closure of flap is necessary. For primary flap closure, flap is repositioned coronally and the zone of attached keratinized mucosa may decreased. The need for attached keratinized mucosa around dental implants is still controversial, but sufficient peri-implant attached keratinized mucosa would be beneficial for functional and esthetic aspects. This case report presents three cases that demonstrated free gingival graft for increasing the zone of peri-implant attached keratinized mucosa which was decreased after guided bone regeneration. Materials and Methods: In first case, maxillary incisors were extracted and guided bone regeneration was performed simultaneously. Because the membrane was exposed at 3 weeks after operation, the membrane was removed and free gingival graft was performed for primary flap closure. Free gingival graft was performed again at implant placement for the increase of attached keratinized mucosa. In second case, guided bone regeneration was performed on lower right first molar area, and implant was placed with free gingival graft. In third case, lower right molar area showed insufficient attached keratinized mucosa after implant placement with guided bone regeneration. When abutments were connected, free gingival graft with apically positioned flap was performed. Result: In these three cases, the zone of attached keratinized mucosa around dental implants was decreased after guided bone regeneration. And the increase of peri-implant attached keratinized mucosa could be obtained effectively by free gingival graft. Conclusion: Free gingival graft could be a effective treatment method increasing the zone of attached keratinized mucosa which was decreased after guided bone regeneration procedures.

• The Journal of Korean Academy of Prosthodontics
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• v.36 no.1
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• pp.183-198
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• 1998

This study was designed to investigate the peri-implant tissue reaction in ovariectomized osteoporotic female rats, and to evaluate effects of estrogen, calcitonin, parathyroid hormone on the bone - implant interface in osteoporotic rats. 120 Sprague - Dawley rats were used in this experiments. Osteoporosis was induced by bilateral ovariectomy. They were divided 5 groups : sham-operated control group(Sham), ovariectomized group (OVX), OVX and estrogen treated group (OVX+E), OVX and PTH treated group (OVX+PTH), and OVX and calcitonin treated group (OVX+CT). Eight weeks after ovariectomy, two titanium screw implants were inserted into the left tibia of each rat. Eight weeks after the insertion of the implants, the periotest values (PTV) of implant were examined, and the rats were sacrificed, and examined the reaction of bone tissue surrounding the implant both histologically and histomorphometrically. The bone density and ash weight of opposite right tibia were examined. Over 40 rats were fractured on left tibia that was implant inserted. On histologically finding, all groups were osseointegrated well, especially in OVX+PTH group. In OVX group, tibial cortical bone showed many large harversian canal and microfracture lines. The OVX+PTH group showed the lowest mean PTV (-2.33) (p<0.05), and the hightest mean bone - implant contact percentage (89%) (p>0.05). But the OVX+CT group showed the highest mean bone density ($5.45mg/cm^3$) and ash weight (56.12%) (p<0.05). The results indicate that PTH treatment enhances osseointegration of implant in OVX rats, and CT treatment depresses bone turnover and prevent the development of osteopenia in OVX rats.

• Journal of Periodontal and Implant Science
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• v.35 no.1
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• pp.53-63
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• 2005

Number of fixtures supporting prosthesis for rehabilitation of partial edentulism in distal area is an important factor in distal area to the bone tissue response around dental implant. Optimal number and optimal positioning of dental implant has leaded to the stable condition of bone tissue and successful long-term treatment outcome. This clinical and radiographic study was performed to document and evaluate the short-term result of occlusal rehabilitation by means of implant-supported fixed prostheses (ISPs) especially for partial edentulism in distal area in patients treated for advanced periodontal disease and to verify the number of fixture affecting the bone tissue response. A total of 30 consecutive patients referred because of advanced periodontal disease were included. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6-month period. An individual maintenance care program was designed for each patient. All 75 implants were placed using a 2-stage surgical approach. The patients were divided into 2 groups, in one of which two fixtures were placed and in the other of which three fixtures were placed with tripodal geometry. Following installation of the ISPs, all patients underwent a baseline examination including evaluation of i) oral hygiene, and ii) periodontal/ peri-implant conditions, and iii) radiographs. These examinations were repeated annually during the 1 or 2-year observation period. The results were as follows: 1.No single implant was lost during the observation follow-up period. 1.The percentage of plaque harboring surfaces and bleeding units upon probing were found to be low (<10%), and no soft tissue complications were recorded. 1.Two-fixture group showed bone destruction ranged from 0.0mm to 1.5mm and the mean was 0.31mm. Three-fixture group showed more bone destruction of 0.51mm. There was no statistically difference between two groups. These results suggested that the factor for success is not the number of fixture but the strict maintenance of peri-implant tissue health and initial stability of fixture.

• Journal of Technologic Dentistry
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• v.42 no.4
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• pp.348-354
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• 2020

Purpose: Zirconia is differentiated from other ceramics because of its high resistance to corrosion and wear, excellent flexural strength (900~1400 MPa), and high hardness. Dental zirconia with proven mechanical/biological stability is suitable for the manufacture of implants. However, there are limited in vivo studies evaluating stress distribution in zirconia compared with that in titanium implants and studies analyzing finite elements. This study was conducted to evaluate the stress distribution of the supporting bone surrounding zirconia and titanium implants using the finite element analysis method. Methods: For finite element analysis, a single implant-supported restoration was designed. Using a universal analysis program, eight occlusal points were set in the direction of the occlusal long axis. The occlusal load was simulated at 700 N. Results: The zirconia implant (47.7 MPa) von Mises stress decreased by 5.3% in the upper cortical bone compared with the titanium implant (50.2 MPa) von Mises stress. Similarly, the zirconia implant (20.8 MPa) von Mises stress decreased by almost 4% in the cancellous bone compared with the titanium implant (21.7 MPa) von Mises stress. The principal stress in the cortical and cancellous bone exhibited a similar propensity to von Mises stress. Conclusion: In the supporting bone, the zirconia implant is able to reduce bone resorption caused by mechanically transferred stress. It is believed that the zirconia implant can be a potential substitute for the titanium implant by reinforcing aesthetic characteristics and improving stress distribution.

• The Journal of Korean Academy of Prosthodontics
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• v.43 no.2
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• pp.248-257
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• 2005

Statement of problem. Cortical bone plays an important role in the primary implant stability, which is essential to immediate/early loading. However, immediate load-bearing capacity and primary implant stability according to the change of the cortical bone thickness have not been reported. Purpose. The objectives of this study were (1) to measure the immediate load-bearing capacity of implant and primary implant stability according to the change of cortical bone thickness, and (2) to evaluate the correlation between them. Material and methods.48, screw-shaped implants (3.75 mm$\times$7 mm) were placed into bovine rib bone blocks with different upper cortical bone thickness (0-2.5 mm) and resonance frequency (RF) values were measured subsequently. After fastening of healing abutment. implants were subjected to a compressive load until tolerated micromotion threshold known for the osseointegration and load values at threshold were recorded. Thereafter, RF measurement after loading, CT taking and image analysis were performed serially to evaluate the cortical bone quality and quantity. Immediate load-bearing capacity and RF values were analyzed statistically with ANOVA and post-hoc method at 95% confidence level (P<0.05). Regression analysis and correlation test were also performed. Results. Existence and increase of cortical bone thickness increased the immediate load-bearing capacity and RF value (P<0.05) With the result of regression analysis, all parameter's of cortical bone thickness to immediate load-bearing capacity and resonance frequency showed significant positive values (P<0.0001). A significant high correlation was observed between the cortical bone thickness and immediate load-beating capacity (r=0.706, P<0.0001), between the cortical bone thickness and resonance frequency (r=0.753, P<0.0001) and between the immediate load-bearing capacity and resonance frequency (r=0.755, P<0.0001). Conclusion. In summary, cortical bone thickness change affected the immediate load-baring capacity and the RF value. Although RF analysis (RFA) is based on the measurement of implant/bone interfacial stiffness, when the implant is inserted stably, RFA is also considered to reflect implant/bone interfacial strength of immediately after placement from high correlation with the immediate load-baring capacity. RFA and measuring the cortical bone thickness with X-ray before and during surgery could be an effective diagnosis tool for the success of immediate loading of implant.

• Journal of Periodontal and Implant Science
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• v.29 no.4
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• pp.929-942
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• 1999

Three beagle dogs aged over one and half years were used in this study. All mandibular premolars were carefully extracted. Two AVANA implants(Sumin, Korea) and two 3i implants(Implant Innovation, USA) were installed at each right and left side respectively. Each dog was sacrificed at 4, 8. 12 weeks. Non-decalcified specimens were made and stained for a light microscopic study. The results were as follows ; 1. Inflammation was not observed in the area of bone tissue adjacent to the implant body. 2. With time, quantity of osseointe-gration increased in each type of den-dental implant. There was no difference between AVANA implant and 3i implant. 3. Maturation of the bone around each type of the dental implant increased with time. 12 weeks after implant installation, the bone around dental implant represented compact bone-like appreance. 4. In case implants were located adjacent to a root, newly-formed periodontal ligament tissue was observed around the implant. And the direction of the periodontal ligament fiber was parallel to the surface of the implant . Within the results of this study, AVANA implants represented similar osseointegra-tion in comparision with 3i implants.

• The Journal of Korean Academy of Prosthodontics
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• v.42 no.3
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• pp.267-279
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• 2004

A modelling scheme for the stress analysis taking into account load transfer characteristics of the osseointegrated interfaces between dental implant and surrounding alveolar bone was investigated. Main aim was to develop a more realistic simulation methodology for the load transfer at the interfaces than the prefect bonding assumption at the interfaces which might end up the reduced level in the stress result. In the present study, characteristics of osseointegrated bone/implant interfaces was modelled with material nonlinearity assumption. Bones at the interface were given different stiffness properties as functions of stresses. Six different models, i.e. tens0, tens20, tens40, tens60, tens80, and tens100 of which the tensile moduli of the bones forming the bone/implant interfaces were specified from 0, 20, 40, 60, 80, and 100 percents, respectively, of the compressive modulus were analysed. Comparisons between each model were made to study the effect of the tensile load carrying abilities, i.e. the effectivity of load transfer, of interfacial bones on the stress distribution. Results of the present study showed significant differences in the bone stresses across the interfaces. The peak stresses, however, were virtually the same regardless of the difference in the effectivity of load transfer, indicating the conventional linear modelling scheme which assumes perfect bonding at the bone/implant interface can be used without causing significant errors in the stress levels.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.1
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• pp.17-20
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• 2014

Objectives: The aim of this study was to retrospectively evaluate the clinical survival rate of Astra Tech implants in the maxillary molar region performed with sinus lift and bone graft. Materials and Methods: Ninety-nine Astra Tech implants (Osseospeed) placed in the maxillary molar region using sinus lift from September 2009 to February 2012 were selected with a minimum follow-up period of 1 year. The height of alveolar bone, sinus approach technique, bone material and implant survival rate were evaluated. Results: Of the 99 implants, the survival rate was 90.9%; 8 implants failed within 1 year after implant placement, and 1 implant failed 1 year after implant loading. All failed implants were placed with sinus lift simultaneously. The average height of alveolar bone before implant placement was 6.9 mm, while the height of alveolar bone of failed implants was 2.1 mm, on average. Conclusion: Astra Tech implants placed in the maxillary molar region had generally good survival rates, but the relationship between reduced pre-implant alveolar bone height and implant failure requires further attention.

• The Journal of Advanced Prosthodontics
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• v.11 no.2
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• pp.112-119
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• 2019

PURPOSE. Zirconia materials have been used for implant-retained restorations, but the stress distribution of zirconia is not entirely clear. The aim of this study is to evaluate the stress distribution and risky areas caused by the different design of zirconia restorations on the atrophic bone of the posterior maxilla. MATERIALS AND METHODS. An edentulous D4-type bone model was prepared from radiography of an atrophic posterior maxilla. Monolithic zirconia and zirconia-fused porcelain implant-retained restorations were designed as splinted or non-splinted. 300-N occlusal forces were applied obliquely. Stress analyses were performed using a 3D FEA program. RESULTS. According to stress analysis, the bone between the 1) molar implant and the 2) premolar in the non-splinted monolithic zirconia restoration model was stated as the riskiest area. Similarly, the maximum von Mises stress value was detected on the bone of the non-splinted monolithic zirconia models. CONCLUSION. Splinting of implant-retained restorations can be more critical for monolithic zirconia than zirconia fused to porcelain for the longevity of the bone.

• The Journal of Korean Academy of Prosthodontics
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• v.39 no.4
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• pp.391-409
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• 2001

Since the early study about the osseointegration, lots of researches have been performed to increase the success rate and the stress around the implant in the jaw bone has been considered as one of the causes of failure. The purpose of this study was to examine the relationship between the implant failure and the stress by analysing the influence of different bone quality and bite force of some foods on the stress distribution around the implant, and to estimate the treatment result according to the bone quality and dietary pattern of patients. Bone quality was divided in 4 groups and models were drawn with the assumption that thread type implant(Nobel Biocare AB, Goteborg, Sweden) of 3.75mm diameter, 13mm length was installed to the bones. Various bite forces were applied to the occlusal surface of superstructure and the stress distributed around the implant were analysed with finite element analysis program. The results were as follows ; 1. The stress was changed proportionally to the bite forces of foods at all measuring points in all load cases. 2. The stress at the marginal bone was higher than that of the other measuring points in all load cases, and it was decreased at the first thread area. 3. The stress at the marginal bone was highest in type IV bone in all load cases. Especially it was twice those of other bone types at the bucco-lingual marginal bone and 50% higher at the mesio-distal marginal bone. 4. The stress at the bucco-lingual sides of the bone around the apical portions of implant showed little differences among the bone types, while type IV bone showed lower stress concentration than the other bone types in the mesio-distal sides. 5. Under the buccal oblique load ($15^{\circ}$ ), the stress at the lingual marginal bone was higher than that of buccal marginal bone, and the difference between the two points was almost same regardless of bone types.