• The Journal of Korean Academy of Prosthodontics
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• v.49 no.4
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• pp.346-353
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• 2011

Purpose: The peri-implant soft tissue is remodeled by the initial marginal bone resorption affecting the prognosis and esthetic result of treatment. Thus various designs on implant neck design are studied to preserve peri-implant bone. The purpose of this study is to review on the causes of initial marginal bone resorption, the configuration of peri-implant soft tissue, and the implant crestal module favorable in preserving peri-implant tissue. Materials and methods: The studies on the causes of initial marginal bone resorption and the implant crestal modules are researched and reviewed using Pubmed database. The implant crestal modules including one piece and two-piece implant, internal and external hex abutment, taper and butt joint connection, scalloped design abutment, and platform switching concept are reviewed. Results: A number of clinical and experimental studies preferred one piece implant to two-piece in preserving initial peri-implant tissue. For two piece implants, internal hex abutment and taper joint connection appear more favorable than external hex abutment and butt joint connection relatively. Controversial issues still exist on scalloped design requiring more studies on it. Although the rationale is not certain, the concept of platform switching seems favorable in preserving initial peri-implant tissue based on clinical and experimental studies. Conclusion: Each implant crestal module contains its own advantages and disadvantages with various controversial issues. In the aspect of preservation of initial peri-implant tissue, however, one-piece implant seems beneficial. In cases when two-piece implant is more appropriate due to prosthodontic concerns or any other problems, the application of platform switching concept, internal connection abutment, and taper joint connection may be favorable for the preservation of peri-implant tissues.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.11
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• pp.511-514
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• 1997

The objective of this study is to propose a finite element based design of the dental implant replacing unction and shape of natural teeth. For this, geometric actors were varied to investigate stress distribution of the alveolar bone around dental implant. In this study, the results were obtained based on the theory of linear elastic, with geometrically axisymmetric assumption. Geometric actors determining implant shape are ranged as 0.2mm-0.6mm, 0.04mm-0.1mm, 0.46mm-0.84mm or height of thread, radius of curvature of thread, and pitch, respectively. The stresses in the alveolar bone caused by biting force playa major role in determining implant stability. Especially, the stress concentration in the cortical bone causes bone resorption and finally makes the implant unstable. Therefore, the stress distributions were investigated on the side of the alveolar bone focusing on the area of cortical bone. The maximum von Mises stress was found to increase up to 6% as the height of thread increases, while its value was to decrease to 19% when the radius of curvature increase within the assigned ranges. For the variation of pitch, the larger size of pitch results in greater maximum von Mises stress when the length of the implant under consideration is fixed. The existence of the neck below the shoulder did not affect the stress distribution in the region of alveolar bone. However, the stresses on the side of the implant near the neck were found to be different by 20% approximately. Therefore, the neck can provide the stability of the implant against continuing biting movement. As a conclusion, the finite element based study shows a potential in designing the dental implant systematically.

• The Journal of Advanced Prosthodontics
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• v.7 no.6
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• pp.423-430
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• 2015

PURPOSE. To evaluate the cumulative survival rate (CSR) and mechanical complications of single-tooth $Ankylos^{(R)}$ implants. MATERIALS AND METHODS. This was a retrospective clinical study that analyzed 450 single $Ankylos^{(R)}$ implants installed in 275 patients between December 2005 and December 2012. The main outcomes were survival results CSR and implant failure) and mechanical complications (screw loosening, fracture, and cumulative fracture rate [CFR]). The main outcomes were analyzed according to age, sex, implant length or diameter, bone graft, arch, and position. RESULTS. The 8-year CSR was 96.9%. Thirteen (2.9%) implants failed because of early osseointegration failure in 3, marginal bone loss in 6, and abutment fracture in 4. Screw loosening occurred in 10 implants (2.2%), and 10 abutment fractures occurred. All abutment fractures were located in the neck, and concurrent screw fractures were observed. The CSR and rate of screw loosening did not differ significantly according to factors. The CFR was higher in middle-aged patients (5.3% vs 0.0% in younger and older patients); for teeth in a molar position (5.8% vs 0.0% for premolar or 1.1% for anterior position); and for larger-diameter implants (4.5% for 4.5 mm and 6.7% for 5.5 mm diameter vs 0.5% for 3.5 mm diameter) (all P<.05). CONCLUSION. The $Ankylos^{(R)}$ implant is suitable for single-tooth restoration in Koreans. However, relatively frequent abutment fractures (2.2%) were observed and some fractures resulted in implant failures. Middle-aged patients, the molar position, and a large implant diameter were associated with a high incidence of abutment fracture.

• The Journal of Korean Academy of Prosthodontics
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• v.41 no.4
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• pp.503-518
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• 2003

Statement of problem : There have been previous studies about considerable variations in machining accuracy and consistency in the implant-abutment-screw interfaces. Purpose : The purpose of this study was to evaluate the machining accuracy and consistency of implant/abutment/screw combinations on two randomly selected implants from each of four manufactures. Material and methods : In this study, screws were respectively used to secure a cemented abutment, to a hexlock implant fixture ; teflon coated titanium alloy screw(Torq-Tite) and titanium alloy screw in Steri--Oss system, gold-plated gold-palladium alloy screw(Gold-Tite) and titanium alloy screw in 3i system gild screw ana titanium screw in AVANA Dental Implant system, and titanium screws in Paragon System. The implants were perpendicularly mounted in polymethyl methacrylate autopolymerizing acrylic resin block(Orthodontic resin, Densply International Inc. USA) by use of dental surveyer. Each abutment screw was secured to the implant with recommended torque value using a digital torque controller. Each screw was again tightened after 10 minutes. All samples were cross sectioned with grinder-polisher unit(Omnilap 2000 SBT Inc) after embeded in liquid unsaturated polyester (Epovia, Cray Valley Inc) Results : There were the largest gaps in the neck areas of screws in hexagonal extension implants which were examined in this study. The leading edge of the abutment screw thread (superior surface) was in contact with the implant body thread, and the majority of the contacting surfaces were localized to the middle portion of the mating threads. Considerable variation in the contacting surfaces was noted in the samples evaluated. Amounts of contact in the abutment screw thread were larger for assemblies with Gold-Tite screw, gold alloy screw. Torq-Tite screw than those with titanium screws. The findings of intimate contact between the screw and screw seat were seen in all samples, regardless of manufacturers. However, microgap between the head and lateral neck surface of the screw and the abutment could be dectected in all samples. The findings of intimate contact between the platform of the implant and the bottom of the abutment were consistent in all samples, regardless of manufacturers. However, microgaps between the lateral surface of external hex of the fixture and the abutment could be dectected in all samples. Conclusion : Considerable variations in machining accuracy and consistency were noted in the samples and the implant-abutment-screw interfaces were incomplete. From the results of this study, further development of the system will be required, including improvements in pattern design.

• Journal of Periodontal and Implant Science
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• v.39 no.1
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• pp.27-36
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• 2009

Purpose: The stability of periodontal condition and marginal bone level were important to achieve long-term success of dental implant treatment. The aim of this study was to evaluate periodontal conditions and marginal bone loss around 67 GSII(OSSTEM, Seoul, Korea) dental implants with dual-microthread at the neck portion, 1 year after prosthetic loading. Materials and methods: Sixty-seven GS II dental implants in 27 patients(mean age; $47.4{\pm}14.0$ years) who received implant treatments at Pusan National University Hospital, were included in this study. Thirteen US II(OSSTEM, Seoul, Korea) implants with smooth neck design were selected for the control group. Periodontal and radiographic evaluations were carried out at baseline, 6 months and 12 months after prosthetic loading. Results: In the GS II group, plaque index(PI), gingival index(GI) and probing depth(PD) increased as time passed. In the US II group, GI and PD increased. Although marginal bone level was lower in the US II group in all evaluation periods, the changes between the periods were not statistically significant(p>0.05). In each period, periodontal parameters were not statistically significant between groups. Conclusion: One year after prosthetic loading, GS II and US II dental implants showed similar periodontal conditions and marginal bone response, and were within the criteria of success.

• Journal of Dental Rehabilitation and Applied Science
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• v.20 no.2
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• pp.83-94
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• 2004

The purpose of this study was to compare the distributing pattern of stress according to the types of occlusal load on the finite element models of the splinted implant prostheses. The finite element model was designed with the parallel placement of two fixtures ($4.0mm{\times}11.5mm$) on mandibular first and second molars. The cemented crowns for mandibular first and second molars were made. Three-dimensional finite element model was created with the components of the implant, surrounding bone and cemented crowns. Two types of occlusal load, the point load and the surface load within 0.5 mm radius circle, were applied to the finite element models with 200N magnitude in axial(along the long axis of the implant and oblique(angulation of $30^{\circ}$ to the long axis) directions perpendicular to cuspal incline. Loads were positioned from the center of central fossa and to distance of 2 mm and 4 mm apart from the center of central fossa. Von-Mises stresses were recorded and compared in the fixtures and sections. The results were as following : 1. Under axial loading at the central fossa, the stress was distributed along the fixture except for the apical portion, not relative to both point & surface contacts. 2. With offset distance increasing, the highest stresses were concentrated in the neck portion of the fixture. 3. The maximum von Mises stress under the oblique load was greater than that under the axial load. 4. Under the oblique load, the highest stress were concentrated in the buccal side and lingual neck portion of the fixture with offset distance increasing. The results had a tendency to increase the stress on the neck portion of fixture with the offset and oblique loads increasing. The design of occlusal scheme should be allowed to distribute stress axially in maximum intercuspation and to decrease the angulation of cuspal incline.

• Journal of Biomedical Engineering Research
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• v.26 no.2
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• pp.123-127
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• 2005

Compression Hip Screw (CHS) is one of the most widely-used prostheses for the treatment of intertrochanteric fractures because of its strong fixation capability. Fractures at the neck and screw holes are frequently noted as some of its clinical drawbacks, which warrant more in-depth biomechanical analysis on its design variables. The purpose of this study was to evaluate changes in the strength with respect to the changes in design such as the plate thickness and the number of screw holes. Both mechanical test and FEM analysis were used to systematically investigate the sensitivities of the above-mentioned design variables. For the first part of the mechanical test, CHS (n=20) were tested until failure. The CHS specimens were classified into four groups: Group Ⅰ was the control group with the neck thickness of 6-㎜ and 5 screw holes on the side plate, Group Ⅱ 6-㎜ thick and 8 holes, Group Ⅲ 7.5-㎜ thick and 5 holes, and Group Ⅳ 7.5-㎜ thick and 8 holes. Then, the fatigue test was done for each group by imparting 50% and 75% of the failure loads for one million cycles. For the FEM analysis, FE models were made for each group. Appropriate loading and boundary conditions were applied based on the failure test results. Stresses were assessed. Mechanical test results indicated that the failure strength increased dramatically by 80% with thicker plate. However, the strength remained unchanged or decreased slightly despite the increase in number of holes. These results indicated the higher sensitivity of plate thickness to the implant strength. No fatigue failures were observed which suggested the implant could withstand at least one million cycles of fatigue load regardless of the design changes. Our FEM results also supported the above results by showing a similar trend in stress as those of mechanical test. In summary, our biomechanical results were able to show that plate thickness could be a more important variable in design for reinforcing the strength of CHS than the number of screw holes.

• Journal of Periodontal and Implant Science
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• v.50 no.6
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• pp.392-405
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• 2020

Purpose: Titanium implants are widely used in the treatment of dentition defects; however, due to problems such as osseointegration failure, peri-implant bone resorption, and periimplant inflammation, their application is subject to certain restrictions. The surface modification of titanium implants can improve the implant success rate and meet the needs of clinical applications. The goal of this study was to evaluate the effect of the use of porous titanium with a chitosan/hydroxyapatite coating on osseointegration. Methods: Titanium implants with a dense core and a porous outer structure were prepared using a computer-aided design model and selective laser sintering technology, with a fabricated chitosan/hydroxyapatite composite coating on their surfaces. In vivo and in vitro experiments were used to assess osteogenesis. Results: The quasi-elastic gradient and compressive strength of porous titanium implants were observed to decrease as the porosity increased. The in vitro experiments demonstrated that, the porous titanium implants had no biological toxicity; additionally, the porous structure was shown to be superior to dense titanium with regard to facilitating the adhesion and proliferation of osteoblast-like MC3T3-E1 cells. The in vivo experimental results also showed that the porous structure was beneficial, as bone tissue could grow into the pores, thereby exhibiting good osseointegration. Conclusions: Porous titanium with a chitosan/hydroxyapatite coating promoted MC3T3-E1 cell proliferation and differentiation, and also improved osseointegration in vitro. This study has meaningful implications for research into ways of improving the surface structures of implants and promoting implant osseointegration.

• Clinics in Shoulder and Elbow
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• v.18 no.4
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• pp.248-253
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• 2015

Background: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. Methods: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. Results: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. Conclusions: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck.

• The Journal of Advanced Prosthodontics
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• v.6 no.2
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• pp.126-132
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• 2014

PURPOSE. This study was conducted to evaluate the influence of the implant-abutment connection design and diameter on the screw joint stability. MATERIALS AND METHODS. Regular and wide-diameter implant systems with three different joint connection designs: an external butt joint, a one-stage internal cone, and a two-stage internal cone were divided into seven groups (n=5, in each group). The initial removal torque values of the abutment screw were measured with a digital torque gauge. The postload removal torque values were measured after 100,000 cycles of a 150 N and a 10 Hz cyclic load had been applied. Subsequently, the rates of the initial and postload removal torque losses were calculated to evaluate the effect of the joint connection design and diameter on the screw joint stability. Each group was compared using Kruskal-Wallis test and Mann-Whitney U test as post-hoc test (${\alpha}$=0.05). RESULTS. The postload removal torque value was high in the following order with regard to magnitude: two-stage internal cone, one-stage internal cone, and external butt joint systems. In the regular-diameter group, the external butt joint and one-stage internal cone systems showed lower postload removal torque loss rates than the two-stage internal cone system. In the wide-diameter group, the external butt joint system showed a lower loss rate than the one-stage internal cone and two-stage internal cone systems. In the two-stage internal cone system, the wide-diameter group showed a significantly lower loss rate than the regular-diameter group (P<.05). CONCLUSION. The results of this study showed that the external butt joint was more advantageous than the internal cone in terms of the postload removal torque loss. For the difference in the implant diameter, a wide diameter was more advantageous in terms of the torque loss rate.