• The Journal of Korean Academy of Prosthodontics
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• v.31 no.1
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• pp.129-150
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• 1993

Since the restoration or masticatory function is the most important aim of implants, it should be substituted for the role of natural teeth and deliver the stress to the bone under the continous load during function. In natural teeth, stress distribution can be obtained through enamel, dentin and cementum and the elasticity of the periodontal ligament play a role of buffering action. In contrast, implant prosthesis has a very unique characteristics that it delvers the load directly to bone through the implant and superstructure. This fact arise the needs to evaluate the stress distribution of the implant in the mechnical aspects, which has a similar role of natural teeth but different pathway of stress. With 3 kinds of implant in prevalent use, 2 types of experimental PEA implant models were made, axisymmetric and 2-dimensional type. In axisymmetric model, the stiffness of the part including the prosthesis and implant which extrude out of bony surface could be calculated with displacement of the superstructure un er 100N vertical load and then damping effects could be determined through this stiffness. In axisymmetric FEA model, load to the bone could be deduced by evaluation the stress distribution of the designed surface under the 100N vertical force and in 2-dimensional model, 100N eccentric vertical load and 20N horizontal loda. The result are as follows. 1. In every implant, stress to the bone tends to be concenturated on the cortical bone. 2. Though the stress of the cancellous bone is larger at the apex of implants, it is less compared with cortical bone. 3. Under 20N horizontal load, stress of the left and right sides of implant shows a symmetrical pattern. But under 100N eccentric vertical load, loaded side shows much larger stress value. 4. In the 1mm interface, stress distribution among implants tend to have a similar pattern. But under 20N horizontal load apposite side of being loaded shows less stress in IMZ. 5. In the case of screw type implant, stress tends to vary along with screw shape. 6. According to the result determined with microstrain, cancellous bone id generally under the condition of overload, while cortical bone is usually within the limitation of physiologic load. 7. In the Branemark implant, maximum stress to the cortical bone is larger than any other implant except for the condition of 20N horizontal force and 0.05mm interface. 8. Damping effects of implants is maximum in IMZ.

• The Journal of Advanced Prosthodontics
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• v.8 no.2
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• pp.131-136
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• 2016

PURPOSE. The aim of this study was to observe stress concentration in the implant, the surrounding bone, and other components under the pull-out force during the crown removal. MATERIALS AND METHODS. Two 3-dimensional models of implant-supported conventional metal ceramic crowns were digitally constructed. One model was designed as a vertically placed implant ($3.7mm{\times}10mm$) with a straight abutment, and the other model was designed as a 30-degree inclined implant ($3.7mm{\times}10mm$) with an angled abutment. A pull-out force of 40 N was applied to the crown. The stress values were calculated within the dental implant, the abutment, the abutment screw, and the surrounding bone. RESULTS. The highest stress concentration was observed at the coronal portion of the straight implant (9.29 MPa). The stress concentrations at the cortical bone were lower than at the implants, and maximum stress concentration in bone structure was 1.73 MPa. At the abutment screws, the stress concentration levels were similiar (3.09 MPa and 3.44 MPa), but the localizations were different. The stress at the angled abutment was higher than the stress at the straight abutment. CONCLUSION. The pull-out force, applied during a crown removal, did not show an evident effect in bone structure. The higher stress concentrations were mostly observed at the implant and the abutment collar. In addition, the abutment screw, which is the weakest part of an implant system, also showed stress concentrations. Implant angulation affected the stress concentration levels and localizations. CLINICAL IMPLICATIONS. These results will help clinicians understand the mechanical behavior of cement-retained implant-supported crowns during crown retrieval.

• The Journal of Korean Academy of Prosthodontics
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• v.44 no.1
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• pp.40-50
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• 2006

Statement of problem: $Periotest^(R)\;and\;Osstell^{TM}$ were known as the most objective and quantitative mobility tests available for evaluating stability of implant in vivo. Although a correlation between PTV widely used and ISQ recently introduced exist, a PTV was corresponded to various ISQ. A correct evaluation of implant stability could be obtained only after one has a thorough understanding of the limitations of devices and factors that affect measurements. Purpose: The purpose of this study was to investigate the causes of variables in the values obtained with these two tests. Material and method: A total of 333 implants 134 $Br{\aa}nemark$, 5 Silhouette and 194 ITI implants were investigated. Result: 1. There was a correlation between PTV and ISQ (Spearman correlation =0.39, p<0.0001) 2. The factors that affected ISQ were diameter of implant future, location of implant and implant system (submerged type vs non-submerged type). 3. The factors that affected W were dimeter of implant future, location of implant, and elapsed time after implant placement. 4. There was no significant difference between different surface treatments of RBM, smooth surface and ti-unite on PTY and ISQ. 5. In radiographic finding, no saucerization or bone resorption has been detected in implants with ISQ values that were above the average level of each PTV. These higher values had higher bone densities around the implant fixture. Saucerization was observed in the most impants with ISQ values that were below the average level of each PTV. Conclusion: There was a correlation between ISQ and PTV. However, each measuring methods had factors influencing the measured values. PTV were less sensitive to marginal bone resorption and influenced with the striking point on an implant to the level of bone. With ISQ, the height of implant from bone level to transducer should be considered.

• Imaging Science in Dentistry
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• v.44 no.3
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• pp.213-220
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• 2014

Purpose: This study was performed to determine the efficacy of observers' prediction for the need of bone grafting and presence of perioperative complications on the basis of cone-beam computed tomography (CBCT) and panoramic radiographic (PAN) planning as compared to the surgical outcome. Materials and Methods: One hundred and eight partially edentulous patients with a need for implant rehabilitation were referred for preoperative imaging. Imaging consisted of PAN and CBCT images. Four observers carried out implant planning using PAN image datasets, and at least one month later, using CBCT image datasets. Based on their own planning, the observers assessed the need for bone graft augmentation as well as complication prediction. The implant length and diameter, the need for bone graft augmentation, and the occurrence of anatomical complications during planning and implant placement were statistically compared. Results: In the 108 patients, 365 implants were installed. Receiver operating characteristic analyses of both PAN and CBCT preoperative planning showed that CBCT performed better than PAN-based planning with respect to the need for bone graft augmentation and perioperative complications. The sensitivity and the specificity of CBCT for implant complications were 96.5% and 90.5%, respectively, and for bone graft augmentation, they were 95.2% and 96.3%, respectively. Significant differences were found between PAN-based planning and the surgery of posterior implant lengths. Conclusion: Our findings indicated that CBCT-based preoperative implant planning enabled treatment planning with a higher degree of prediction and agreement as compared to the surgical standard. In PAN-based surgery, the prediction of implant length was poor.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.2
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• pp.123-130
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• 2005

Many of the molecular and genotypic events taking place at the osteoblast cell level during bone-implant integration are still largely unknown. The objective of this study was to examine expression patterns of TGF-$\beta$ and IGF-I related genes during bone-implant integration. Titanium implants with machined surface were placed into 8 rabbit tibias. At 3rd, 7th, 14th, 28th day after implantation, the expression pattern of TGF-$\beta$ and IGF-I genes in bone with or without implant was examined using reverse transcriptase-polymerase chain reaction (RT-PCR). At the same time, histomorphometric analysis was evaluated, respectively. The bone-to-implant contacts (BIC) of experimental groups were 5.2%, 6.2%, 6.6%, 24.6% at 3rd, 7th, 14th, 28th day. This indicated that newly formed bone increased at the implant surface in bone marrow space after implantation. The expressions of TGF-$\beta$ and IGF-I were higher in implantation groups than untreated control groups during all experimental days. The increased expression of TGF-$\beta$ and IGF-I genes may be associated with the increased bone-to-implant contact. This result provided the evidence for existing biologic differences in tissue response after implantation and helped us to understand molecular biologic processes in tissue-implant integration.

• Journal of Periodontal and Implant Science
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• v.29 no.1
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• pp.233-249
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• 1999

Primary fixation is one of the most important factor in establishing adequate osseointegration between implant and bone. To evaluate the initial healing response of bone around implants without primary bone contact, this study was designed to create considerable space between implant and bone in 5 mongrel dogs, about 1-year old. After 3 holes of 6.0mm in diameter were prepared at the femur neck of the dogs, commercially pure titanium thread type implants(STERI-$OSS^{(R)}$), 8mm in length and 3.8mm, 5.0mm and 6.0mm in diameter, were inserted. Implants were supported by only nonresorbable membrane($Teflon^{(R)}$), and the penetration of upper soft tissue into the gap was inhibited by it. The each implant was positioned in the center of the drilled hole. 9 implants with different diameters were inserted in 3 dogs for histologic observation, and 12 were inserted in 2 dogs for mobility test and removal torque test.Fluorescent dyes were injected in order of Doxycycline, Alizarin Red S, and Calcein at intervals of 2 weeks. At 4-, 8-, and 12-week after placement, 3 dogs were sacrificed for histologic observation, and at 8- and 12-week after placement, 2 dogs were sacrificed for mobility test using $Periotest^{(R)}$ (Simens AG, Bensheim, Germany) and torque test using Autograph AGS-1000D $series^{(R)}$(Japan). The result were as follows: 1. The wider the gap between bone and implant was, the less bone maturity was, and the later osseointegration was occurred. Trabecular direction of new bone around implant was changed from parallel to perpendicular to the implant, and the gap was filled with new bone, over time. 2. There was a decreasing tendency over time in the mobility of all implants, but the wider gap between bone and implant was, the smaller decrease of the mobility was. 3. There was a increasing tendency over time in the removal torque gauge of all implants, and the wider gap was, the smaller increase of the removal torque gauge was. The results suggest that osseointegration in case of implant without primary bone contact may be obtained by guided bone regeneration technique with prolonged healing period, but the time of second surgery should be considered carefully.

• Journal of Periodontal and Implant Science
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• v.48 no.6
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• pp.360-372
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• 2018

Purpose: It has been suggested that resonance frequency analysis (RFA) can measure changes in the stability of dental implants during osseointegration. This retrospective study aimed to evaluate dental implant stability at the time of surgery (primary stability; PS) and secondary stability (SS) after ossseointegration using RFA, and to investigate the relationship between implant stability and cortical bone thickness. Methods: In total, 113 patients who attended the Tohoku University Hospital Dental Implant Center were included in this study. A total of 229 implants were placed in either the mandibular region (n=118) or the maxilla region (n=111), with bone augmentation procedures used in some cases. RFA was performed in 3 directions, and the lowest value was recorded. The preoperative thickness of cortical bone at the site of implant insertion was measured digitally using computed tomography, excluding cases of bone grafts and immediate implant placements. Results: The mean implant stability quotient (ISQ) was $69.34{\pm}9.43$ for PS and $75.99{\pm}6.23$ for SS. The mandibular group had significantly higher mean ISQ values than the maxillary group for both PS and SS (P<0.01). A significant difference was found in the mean ISQ values for PS between 1-stage and 2-stage surgery (P<0.5). The mean ISQ values in the non-augmentation group were higher than in the augmentation group for both PS and SS (P<0.01). A weak positive correlation was observed between cortical bone thickness and implant stability for both PS and SS in all cases (P<0.01). Conclusions: Based on the present study, the ISQ may be affected by implant position site, the use of a bone graft, and cortical bone thickness before implant therapy.

• The Journal of Korean Academy of Prosthodontics
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• v.33 no.2
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• pp.317-334
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• 1995

The purpose of this study was to compare the bone formation, maturation around HA-and titaniumcoated dental implants in dog. 5 hydroxyapatite coated IMZ implants and 5 titanium coated IMZ implants were placed into the previously extracted site in the mandible of 5 adults dogs. All dogs were injected intravenously Tetracycline, Alizalin red S, and Calcein for bone fluorescent labelling, After the experimental period of 16weeks, the dogs were sacrificed and tissue samples around the implants were obtained. Microscopic observations(ligth, polariged and fluorescence microscope), morphometric analysis, line profile with EPMA, and quantitative analysis for Ca,P, and Ti were performed. The results were as follows ; 1. Bone maturations around the implants were relatively lower than those of natural teeth. No significant differences in bone maturation and remodeling patterns were observed between the two implants groups. 2. Calcification of bone surrounding the implants was initiated in 8-11 weeks for HA-coated implants, while it took 11 weeks or more for Ti-coated implants. 3. Bone-to-implants contact ratio of 82.63% was recorded for HA-coated group and 72.25% for titanium coated group, with no significant difference between the two groups. 4. Bone around the implants exhibited reduced quantity of Ca and P in the $100{\mu}m$ region relative to natural teeth, while the rest of the regions showed no statistical differences. No significant differences were found between the two implant groups. 5. There was a separation of HA layer from the implant core and subsequent infiltration of inflammatory cells into the resulting space in the HA-coated implants, and evidences of phagocytosis of HA particles by macrophages. Bone calcification was more rapid around HA-coated implants compared to titanium-coated implants, but HA coated implants did not show any significant differences either in the degree of calcification or the bone-to-implant contact ratio over Ti coated implants. HA coated implants may have complications associated with HA absorption and separation of HA layer from the implant core.

• Journal of Periodontal and Implant Science
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• v.46 no.5
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• pp.291-302
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• 2016

Purpose: The aim of the present study was to evaluate the effectiveness of using a mineralized bone cortical allograft (MBCA), with or without a resorbable collagenous membrane derived from bovine pericardium, on alveolar bone remodeling after immediate implant placement in a dog model. Methods: Six mongrel dogs were included. The test and control sites were randomly selected. Four biradicular premolars were extracted from the mandible. In control sites, implants without an allograft or membrane were placed immediately in the fresh extraction sockets. In the test sites, an MBCA was placed to fill the gap between the bone socket wall and implant, with or without a resorbable collagenous membrane. Specimens were collected after 1 and 3 months. The amount of residual particles and new bone quality were evaluated by histomorphometry. Results: Few residual graft particles were observed to be closely embedded in the new bone without any contact with the implant surface. The allograft combined with a resorbable collagen membrane limited the resorption of the buccal wall in height and width. The histological quality of the new bone was equivalent to that of the original bone. The MBCA improved the quality of new bone formation, with few residual particles observed at 3 months. Conclusions: The preliminary results of this animal study indicate a real benefit in obtaining new bone as well as in enhancing osseointegration due to the high resorbability of cortical allograft particles, in comparison to the results of xenografts or other biomaterials (mineralized or demineralized cancellous allografts) that have been presented in the literature. Furthermore, the use of an MBCA combined with a collagen membrane in extraction and immediate implant placement limited the extent of post-extraction resorption.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.4
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• pp.240-247
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• 2009

Purpose: The purpose of this study was to evaluate marginal bone loss to the bone crest functionally loaded for up to eighteen months and also with regard to other variables of interest. Material and Methods: 135 endosseous implants(GS II, Osstem, South Korea) were placed in 35 patients. The design of GS II implant is straight with the microthread. Radiographic examinations were conducted at baseline (implant loading) and 3, 6, 9, 12 and 18 months after loading. Marginal bone level measurement was made from the reference point to the lowest observed point of contact of the marginal bone with the fixture. The reference point of the fixture was the border between the blasted surface and machined surface of the fixture. Results: Implants were on function for a mean 12.7 months(range, 3?18 months). For the 56 maxillary and 79 mandibular implants, mean marginal bone loss was 0.68 mm and 0.70 mm. Implants placed maxillary posterior area displayed more crestal bone loss than the other position. The difference between mesial and distal bone levels was statistically significant (p<0.05) with respective means of 0.51 mm and 0.62 mm. Also, The difference between bone graft group and no-bone graft group was statistically significant(p<0.05) with respective means of 0.38 mm and 0.66 mm. But no statistically significant influence of sex, type of surgery(one or two stage surgery), the implant length was observed(p>0.05). Conclusion: This study indicates the amount of marginal bone loss around implant has maintained a relative stable during follow-up periods.