• 대한치과보철학회지
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• 제61권4호
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• pp.379-385
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• 2023

최근 디지털 치의학이 발달함에 따라 진료실 기반의 구내스캔과 computer-aided design/computer-aided manufacturing (CAD-CAM)을 이용한 완전 디지털 방식의 의치 제작이 증가하는 추세이다. 디지털 방식의 제작은 진료실과 기공실에서의 과정을 간소화하고 디지털 데이터를 보완할 수 있는 장점이 있다. 본 증례는 임플란트 식립이 불가하거나 지연되는 전치부 결손 환자에서 완전 디지털 제작 방식을 이용한 임시 가철성 의치의 수복 증례이다. 인공치와 의치상을 각각 디자인하고 프린팅하여 접착하는 방법과 인공치와 의치상을 일체형으로 디자인하고 프린팅하여 제작하는 두 가지 방법으로 임시 가철성 의치를 제작하고 구강 내 시적하였다. 발치 된 상태의 구내스캔, 임시 가철성 보철물을 구강 내에 장착 후의 구내 스캔과 보철물 자체의 스캔을 이용하는 삼중 스캔 기법으로 의치 적합도를 비교하였고, 두 가지 방법 모두에서 양호한 적합도를 보였다. 진료실 기반의 완전 디지털 방식을 이용하여 간소화된 과정으로 환자와 술자 모두 만족하는 결과를 얻었기에 본 증례를 보고하는 바이다.

• 구강회복응용과학지
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• 제27권4호
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• pp.437-447
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• 2011

오랜 기간 국소의치를 장착한 부분 무치악 환자에서, 치아가 결손된 부위는 점진적인 치조골의 흡수가 발생되는 반면, 잔존 지대치 부위는 치조골이 유지되어 있는 것을 볼 수 있다. 이는 차후 잔존 지대치를 상실한 후에도 치아 상실의 시점에 따라 수직적인 골 높이의 현저한 차이를 나타낸다. 이와 같이 전체 치아 발거 후 상하악 악간 거리가 좌우측 또는 전후방으로 다르게 나타나는 환자에서 임플란트를 이용한 고정성 보철물이나 임플란트 피개의치의 제작 시 여러 가지 보철적 문제가 야기될 수 있다. 본 논문은 구치부 결손으로 인해 오랫동안 국소의치를 사용했던 환자에서 치아 상실 후 잔존 치조골의 높이를 고려하여 임플란트 지지 국소의치를 제작한 증례로서 잔존 치조골 량이 많아 악간거리가 짧은 전치부는 임플란트를 식립하여 고정성 보철물로, 오랫동안 치조골의 흡수로 인해 악간거리가 긴 구치부는 국소의치로 수복하였다. 본 증례에서의 임플란트 지지 국소의치는 부가적인 수술이 없이 소수의 임플란트를 식립하고 환자에게 기존 보철물의 양식과 유사한 보철물을 제공함으로서 경제적이고 편안한 치료결과를 보여주었다.

• 대한치과보철학회지
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• 제19권1호
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• pp.39-45
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• 1981

Distal-extension removable partial dentures have long been implicated in the increase in mobility and the destruction of the supporting structures of the primary abutment teeth. Various clasping systems have traditionally been used to retain distal extension removable partial dentures, and other designs have been proposed to minimize torquing forces on the abutment teeth. Most recent studies investigating the effects of removable partial dentures on abutment teeth have been performed in it laboratory setting. Results obtained from in vitro research have given dentists insight into removable partial denture design, but laboratory test model cannot be constructed that simulates actual functional or parafunctiona1 movements and forces. The purpose of this study was to clinically evaluate the degree of tooth mobility produced by two clasping systems (suprabulge type and infrabulge type) used for distal extension removable partial dentures. Akers clasp and R.P.I. system were selected for the evaluation, and four patients required a distal extension removable partial denture on the mandibular arch were selected for participation in the study. Two partial dentures were constructed in the same condition expect the design of clasp. All abutments in the study were mandibular first or second premolars. Measurements of mobility were made with a research tool designed by $M\"{u}hlemann$. This instrument, periodontometer, measures tooth mobility in the mouth by means of a dial gauge accurated to 0.01mm when the tooth is stressed with a force meter. Lingual and buccal deflection of abutment tooth was measured using buccal and lingual pressure. The amount of force applied was 500gm. Tooth mobility tests were made at four key stages; 1. Before insertion of the first removable partial denture, baseline mobility was establsihed. 2. After wearing of the first prosthesis, measurement was made at weekly intervals for 4 weeks. 3. The removable partial denture was then taken from the patient, and tooth mobility was measured again at weekly intervals until the patient's established baseline mobility had returned. 4. The second prosthesis of different clasp design was worn for a month and evaluated in the same manner as the first. The sequence of placement of clasping system was alternated between patients. The following results were obtained from this study; 1. The mobility of abutment tooth increased during the initial stage of wear and returned to baseline mobility after removal of removable partial dentures. 2. The mobility of abutment tooth showed no difference between Akers clasp and I-bar clasp during the 4-week test period. 3. All teeth tested showed greater mobility toward the buccal than the lingual direction.

• Journal of Korean Dental Science
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• 제14권1호
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• pp.32-39
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• 2021

'Crossed occlusion' is the condition in which occlusal intercuspation is lost when several teeth on upper and lower jaw remain. This report describes a clinical case in which a patient had two upper-left posterior teeth and two lower-right posterior teeth; typically known as left-right crossed occlusion. Considering the patient's general condition and financial situation, the treatment plan included placement of two implants on each jaw against the remaining teeth using surgical guide. To find out the ideal position of implants, digital diagnostic wax-up was preceded by superimposing the cast and cone beam computed tomography image, which was aided with radiographic stents. The consequent surveyed implant bridge provided stable vertical stop for fabrication of the implant assisted removable partial dentures. The patient was satisfied with the functionality and esthetics of definitive prosthesis.

• 대한구강악안면임플란트학회지
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• 제19권3호
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• pp.146-152
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• 2015

Mini-dental implants for overdenture applications are increasingly popular due to their ease in placement with simplified, less traumatic surgical protocols in limited-width alveolar ridges. However, the clinical decisions including implant number, position, and loading protocol must be based on a thorough evaluation and evidence-based diagnosis. Herein, we reported a case treated with the current method of mandibular mini-implant supported overdenture.

• 대한치과보철학회지
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• 제44권4호
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• pp.394-404
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• 2006

Statement of problem: A conventional 3-unit fixed partial denture design with a pontic between two retainers is the most commonly used. However in cases where the mental nerve is in close proximity to the second premolar, a cantilever design can be considered. As such, logical and scientific evidence is lacking for the number and position of implants to be placed for partially edentulous patients, and no clear-cut set of treatment principles currently exist. Purpose : The purpose of this study was to evaluate prognosis of implant-supported fixed partial dentures and to compare changes in bone level which may rise due to the different factors. Material and method : The present study examined radiographical marginal bone loss in patients treated with implant-supported fixed partial dentures (87 prostheses supported by 227 implants) and evaluated the influence of the span of the pontic, type of the opposing dentition. Clinical complications were studied using a retrospective method. Within the limitation of this study. the following result were drawn Result, 1. Seven of a total of 227 implants restored with fixed prostheses failed, resulting in a 96.9% success rate. 2. Complications encountered during recall appointments included dissolution of temporary luting agent (17 cases), porcelain fracture (8 cases), loosened screws (5 cases), gingival recession (4 cases), and gingival enlargement (1 case). 3. Marginal bone loss, 1 year after prosthesis placement, was significant(P<0.05) in the group that underwent bone grafting, however no difference in annual resorption rate was observed afterwards. 4. Marginal bono loss, 1 year post-placement, was greater in cantilever-type prostheses than in centric pontic protheses (P<0.05). 5. Marginal bone loss was more pronounced in posterior regions compared to anterior regions (P<0.05). 6. The degree of marginal bone loss was proportional to the length of the pontic (P<0.05). Conclusion: The success rate of implant-supported fixed partial dentures, including marginal bone loss, was satisfactory in the present study. Factors influencing marginal bone loss included whether bone graft was performed, location of the pontic (s), location of the surgical area in the arch pontic span. Long-term evaluation is necessary for implant-supported fixed partial dentures, as are further studies on the relationship between functional load and the number of implants to be placed.

• 대한치과보철학회지
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• 제43권1호
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• pp.120-131
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• 2005

Statement of problem. More than 70% of patients who need the implant supported restoration are parially edentulous. The principles of design for implant supported fixed partial denture in mandibular posterior region are many and varied. Jurisdiction for their use is usually based on clinical evaluation. There are several areas or interest regarding the design of implant supported fixed partial denture in mandibular posterior region. 1) Straight and tripod configuration in implant placement, 2) Two restoration types such as individualized and splinted restorations. Purpose. The purpose of this study was to compare the amount and distribution of stress around the implant fixtures placed in the mandibular posterior region with two different arrangements and to evaluate the effects of splinting using the photoelastic stress analysis. Material & methods. 1) Production of study model: Mandibular partially edentulous model was waxed-up and duplicated with silicone and two models were poured in stone. 2) Fixture installation and photoelastic model construction: Using surveyor(Ney, USh), 3 fixtures(two 4.0 $\times$13 mm, one 5.0$\times$10 mm, Lifecore, USA) were insta)led in straight & tripod configurations. Silicone molds were made and poured in photoelastic resin (PL-2. Measurements group, USA). 3) Prostheses construction: Four 3-unit bridges (Type III gold alloy, Dongmyung co., Korea) were produced with nonhexed and hexed UCLA abutments and fitted with conventional methods. The abutments were tightened with 30 Ncm torque and the static loads were applied at 12 points of the occlusal surface. 4) Photoelastic stress analysis : The polarizer analyzer system with digital camera(S-2 Pro, Fujifilm, Japan) was used to take the photoelastic fringes and analysed using computer analysis program. Results. Solitary hexed UCLA restoration developed different stress patterns between two implant arrangement configurations, but there were no stress transfer to adjacent implants from the loaded implant in both configurations. However splinted restorations showed lesser amount of stresses in the loaded implants and showed stress transfer to adjacent implants in both configurations. Solitary hexed UCLA restoration with tripod configuration developed higher stresses in anterior and middle implants under loading than implants with straight configurations. Splintied 3 unit fixed partial dentures with tripod configuration showed higher stress development in posterior implant under loading but there were no obvious differences between two configurations. Conclusions. The tripod configuration of implant arrangement didn't show any advantages over the straight configuration. Splinting of 3 unit bridges with nonhexed UCLA abutments showed less stress development around the fixtures. Solitary hexed UCLA restoration developed tilting of implant fixture under offset loads.

• 대한치과보철학회지
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• 제45권6호
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• pp.760-768
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• 2007

Statement of problem. Conventional denture treatment for totally edentulous patients is associated with a variety of functional and psychosocial problems. The placement of implants in the anterior region of the maxilla and mandible and the fabrication of an implant-retained overdenture might solve these problems. Purpose. This study compared the marginal bone loss around the implant and evaluated the implant survival rate and complications in patients treated with overdentures retained by implants for 2 years. Material and methods. Patients who had received implant-retained overdentures using a Dolder bar at Samsung Medical Center from January 1999 to June 2005 and had participated in the annual recall programs for two years were selected for this study. A total of 18 patients and 56 $Br{\aa}ne-mark\;system^{(R)}$ implants were used, and their data were reviewed. Evaluations of the survival rate, bone quality, marginal bone loss, and complications were performed. The data on the Dolder bar length and clip length were measured. The change in marginal bone loss and the correlation between the marginal bone loss and bar length, clip length, or bone quality were investigated. Results. Implants placed in this study showed a 100% survival rate. The average annual bone loss was 1.12mm in the first year and 0.27mm in the second year in the maxilla, and 0.58mm in the first year and 0.22mm in the second year in the mandible. The marginal bone loss in the maxilla showed no significant association with those in the mandible. (P>.05). There was no significant difference in marginal bone loss around implants between the first and second year. (P>.05) There was no statistically significant relationship (P>.05) between the marginal bone loss and bone quality, clip length, or Dolder bar length. The Dolder bar length showed a high correlation with the clip length. (P<.05) Various complications were noted. Conclusion. These results confirmed the favorable outcome for patients treated with implant-retained overdentures.

• 대한치과보철학회지
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• 제57권1호
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• pp.57-65
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• 2019

Computer guided implant surgery와 computer-aided design/computer-aided manufacturing, computer guided implant surgery (CAD/CAM) 기술의 발전은 수복 기반 임플란트 치료의 완성도를 한층 더 높였으며, 3D printing을 통한 국소의치의 제작도 빈도가 늘고 있다. 본 증례는 디지털 치의학의 작업 흐름을 따라서 콘빔컴퓨터단층촬영을 통한 치료 계획 수립 및 수술용 스텐트의 제작과 그를 바탕으로 한 임플란트 식립을 하였으며, 맞춤 지대주와 보철물을 제작하였다. 그 후 전자 서베잉과 3D printing을 통한 국소의치 금속 구조물 및 최종적으로 지르코니아 온레이의 제작을 통해 전악 수복을 완성하여 기능과 심미적으로 만족스러운 결과를 얻을 수 있었다.

• 대한치과보철학회지
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• 제56권2호
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• pp.126-133
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• 2018

Cone beam computerized tomography (CBCT)의 발전은 환자의 해부학적 구조를 3차원적으로 분석할 수 있게 하였다. Surgical guide는 CBCT와 CAD/CAM, 임플란트 진단 소프트웨어의 접목을 통해 미래의 보철물을 계획하고 적합한 위치에 임플란트를 식립할 수 있게 한다. Guided surgery를 통해 해부학적 구조물에 대한 침범을 최소한으로 줄일 수 있고 보다 재현성 있는 치료계획의 설정이 가능하다. 본 증례는 전악 무치악 환자에게 surgical guide를 이용하여 다수의 임플란트를 식립한 증례로 수술시간을 단축시킬 수 있었으며 임시 보철물을 미리 제작함으로써 보다 쉽게 immediate loading을 시행할 수 있었다. 환자는 개선된 안모와 저작기능에 만족하였다.