• Journal of Periodontal and Implant Science
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• 제52권6호
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• pp.496-508
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• 2022

Purpose: This study aimed to compare the long-term survival rate and peri-implant marginal bone loss between different types of dental implant-abutment connections. Methods: Implants with external or internal abutment connections, which were fitted at Gangneung-Wonju National University Dental Hospital from November 2011 to December 2015 and followed up for >5 years, were retrospectively investigated. Cumulative survival rates were evaluated for >5 years, and peri-implant marginal bone loss was evaluated at 1- and 5-year follow-up examinations after functional loading. Results: The 8-year cumulative survival rates were 93.3% and 90.7% in the external and internal connection types, respectively (P=0.353). The mean values of marginal bone loss were 1.23 mm (external) and 0.72 mm (internal) (P<0.001) after 1 year of loading, and 1.20 mm and 1.00 mm for external and internal abutment connections, respectively (P=0.137) after 5 years. Implant length (longer, P=0.018), smoking status (heavy, P=0.001), and prosthetic type (bridge, P=0.004) were associated with significantly greater marginal bone loss, and the use of screw-cement-retained prosthesis was significantly associated (P=0.027) with less marginal bone loss. Conclusions: There was no significant difference in the cumulative survival rate between implants with external and internal abutment connections. After 1 year of loading, marginal bone loss was greater around the implants with an external abutment connection. However, no significant difference between the external and internal connection groups was found after 5 years. Both types of abutment connections are viable treatment options for the reconstruction of partially edentulous ridges.

• 대한치과보철학회지
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• 제55권1호
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• pp.9-17
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• 2017

목적: 내부 연결형과 외부 연결형의 임플란트에서 직선형과 경사형 지르코니아 지대주의 파절강도를 비교하였다. 재료 및 방법: 내부육각 연결형 임플란트 20개와 외부육각 연결형 임플란트 20개에, 기성 직선형 지르코니아 지대주와, $17^{\circ}$ 경사형 지르코니아 지대주를 10개씩 체결하였다. 시편은 연결 방식과 지대주 각도에 따라 4개의 군으로 나누었다: 내부 연결형/ 직선형 지대주, INS군; 내부 연결형/ 경사형 지대주, INA 군; 외부 연결형/ 직선형 지대주, EXS 군; 외부 연결형/ 경사형 지대주, EXA 군. 모든 시편은 만능시험기에서 1 mm/min의 crosshead speed로 $30^{\circ}$ 하중을 가했다. 지대주의 파절강도를 측정하고, 2-way ANOVA와 independent t-test로 통계처리 하였다(${\alpha}=.05$). 결과: 각 군의 평균파절강도는 다음과 같다: INS군, 955.91 N; INA군, 933.65 N; EXS군, 1267.20 N; EXA군, 1405.93 N. 외부 연결형이 내부 연결형에 비해 파절강도가 높았다(P < .001). 내부연결형(P = .747)과 외부 연결형(P = .222)에서 지대주 각도에 따른 파절강도는 차이가 없었다. 또한 내부 연결형 지대주는 육각 부위에서 수평 파절이 일어난 반면, 외부 연결형 지대주는 설측 치경부에서 파절되었다. 결론: 외부 연결형 지르코니아 지대주가 내부 연결형 지대주에 비해 파절 강도가 높았고, 직선형과 경사형 지르코니아 지대주의 파절강도는 차이가 없었다.

• 대한치과의사협회지
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• 제54권3호
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• pp.184-190
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• 2016

The osseointegration of titanium implants has been examined over the past 50 years. Many implant systems have been introduced and have become popular to the implant dentistry. The designs of the connection between implant fixture and abutment are divided into external vs internal connection. From beginning, the $Br{\aa}nemark$ system was characterized by an external hexagon. Internal connection has been developed to reduce stress transferred to the bone. These differences may have impact on the clinical procedures and protocols, laboratory and components costs, and incidence of complications. Therefore, the clinician has to know the different biomechanical features and understand their implications to produce successful implant-supported prosthesis with an external or an internal connection system.

• 대한치과보철학회지
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• 제46권3호
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• pp.246-254
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• 2008

STATEMENT OF PROBLEM: The cast abutment has advantages of overcoming angulation problem and esthetic problem. However, when a gold-machined UCLA abutment undergoes casting, the abutment surfaces in contact with the implant may change. PURPOSE: The purpose of this study was to compare the detorque values of prefabricated machined abutments with gold-premachined cast-on UCLA abutments before and after casting in two types of internal implant-abutment connection systems: (1) internal hexagonal joint, (2) internal octagonal joint. Furthermore, the detorque values of two implant-abutment connection systems were compared. MATERIALS AND METHODS: Twenty internal hexagonal implants with an 11-degree taper and twenty internal octagonal implants with an 8-degree taper were acquired. Ten prefabricated titanium abutments and ten gold-premachined UCLA abutments were used for each systems. Each abutment was torqued to 30 N㎝ according to the manufacturer's instructions and detorque value was recorded. The detorque values were measured once more, after casting with gold alloy for UCLA abutment, and preparation for titanium abutments. Group means were calculated and compared using independent t-test and paired t-test (${\alpha}$=0.05). RESULTS: The results were as follows: 1. The detorque values between titanium abutments and UCLA-type abutments showed significant differences in internal octagonal implants (P<0.05), not in internal hexagonal implants (P>0.05). 2. In comparison of internal hexagonal and octagonal implants, the detorque values of titanium abutments had significant differences between two connection systems on the initial analysis (P<0.05), not on the second analysis (P>0.05) and the detorque values of UCLA-type abutments were not significantly different between two connection systems (P>0.05). 3. The detorque values of titanium abutments and UCLA-type abutments decreased significantly on the second analysis than the initial analysis in internal hexagonal implants (P<0.05), not in internal octagonal implants (P>0.05). CONCLUSION: Casting procedures of UCLA-type abutments had no significant effect on screw loosening in internal implant-abutment connection systems, and UCLA-type abutments showed higher detorque values than titanium abutments in internal octagonal implants.

• 대한치과보철학회지
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• 제31권4호
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• pp.611-624
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• 1993

The purpose of this study was to analyze the stress distribution of the natural teeth, the implant, the prosthesis and the supporting tissue according to the types of implant and connection modality in the five-unit fixed partial denture with a implant pier abutment. A Two dimensional stress analysis model was constructed to represent a mandible missing the first and second premolars and first molar. The model contained a canine and second molar as abutment teeth and implant pier abutments with and without stress-absorbing element. Finite element models were created and analyzed using software ANSYS 4.4A for IBM 32bit personal computer. The results obtained were as follows. 1. Implant group, compared to the natural teeth group, showed a maximum principal stress at the superior portion of implants and a stress concentration at :he neck and end portion. 2. Maximum principal stress and maximum Von Mises stress were always lower in the case of rigid connection than nonrigid connection. 3. A cylinder type implant with stress absorbing element and screw type implant were generally similar in the stress distribution pattern. 4. A screw type implant, compared to the cylinder type implant, showed a relatively higher stress concentration at both neck and end portion of it. 5. Load B cases showed higher stress concentration on the posterior abutments in the case of nonrigid connector than rigid connector. 6. A maximum displacement was always lower in the case of rigid connection than nonrigid connection. These results suggest that osseointegrated implant can be used as an intermediate abutment.

• 대한치과보철학회지
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• 제45권1호
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• pp.60-70
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• 2007

Statement of problem: The cement-type abutment would be needed for the reduction of its body in order to correct the axis and to assure occlusal clearance. In the case of intraoral preparation, there is a potential risk that generated heat could be transmitted into the bone-implant interface, where it can cause deterioration of tissues around the implant and failed osseointegration. Purpose: The purpose of this study was to assess the difference of the heat transmitting effect on external and internal connection implant types under various conditions. Material and method: For evaluating the effects of alternating temperature, the thermocoupling wires were attached on 3 areas of the implant fixture surface corresponding to the cervical, middle, and apex. The abutments were removed 1mm in depth horizontally with diamond burs and were polished for 30 seconds at low speed with silicone points using pressure as applied in routine clinical practice. Obtained data were analyzed using Mann-Whitney rank-sum test and Wilcoxon / Kruskal-Wallis Tests. Result: Increased temperature on bone-implant interface was evident without air-water spray coolant both at high speed reduction and low speed polishing (p<.05). But, the difference between connection types was not shown. Conclusion: The reduction procedure of abutment without using proper coolant leads to serious damage of oral tissues around the implant irrespective of external and internal connection type.

• 구강회복응용과학지
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• 제21권1호
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• pp.1-14
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• 2005

The purpose of this study was to assess the loading distributing characteristics of implant prosthesis of internal connection system(ITI system) according to position and direction of load, under vertical and inclined loading using finite element analysis (FEA). The finite element model of a synOcta implant and a solid abutment with $8^{\circ}$ internal conical joint used by the ITI implant was constructed. The gold crown for mandibular first molar was made on solid abutment. Each three-dimensional finite element model was created with the physical properties of the implant and surrounding bone. This study simulated loads of 200N at the central fossa in a vertical direction (loading condition A), 200N at the outside point of the central fossa with resin filling into screw hole in a vertical direction (loading condition B), 200N at the centric cusp in a $15^{\circ}$ inward oblique direction (loading condition C), 200N at the in a $30^{\circ}$ inward oblique direction (loading condition D) or 200N at the centric cusp in a $30^{\circ}$ outward oblique direction (loading condition E) individually. Von Mises stresses were recorded and compared in the supporting bone, fixture, and abutment. The following results have been made based on this study: 1. Stresses were concentrated mainly at the ridge crest around implant under both vertical and oblique loading but stresses in the cancellous bone were low under both vertical and oblique loading. 2. Bending moments resulting from non-axial loading of dental implants caused stress concentrations on cortical bone. The magnitude of the stress was greater with the oblique loading than with the vertical loading. 3. An offset of the vertical occlusal force in the buccolingual direction relative to the implant axis gave rise to increased bending of the implant. So, the relative positions of the resultant line of force from occlusal contact and the center of rotation seems to be more important. 4. In this internal conical joint, vertical and oblique loads were resisted mainly by the implant-abutment joint at the screw level and by the implant collar. Conclusively, It seems to be more important that how long the distance is from center of rotation of the implant itself to the resultant line of force from occlusal contact (leverage). In a morse taper implant, vertical and oblique loads are resisted mainly by the implant-abutment joint at the screw level and by the implant collar. This type of implant-abutment connection can also distribute forces deeper within the implant and shield the retention screw from excessive loading. Lateral forces are transmitted directly to the walls of the implant and the implant abutment mating bevels, providing greater resistance to interface opening.

• 구강회복응용과학지
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• 제24권3호
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• pp.283-298
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• 2008

이 연구의 목적은 내측연결 임플랜트 시스템의 고정체-지대주-나사간의 계면 적합도를 알아보기 위한 것이다. 실험에 이용된 임플랜트 시스템은 Certain, Xive, Replace, Ankylos, SSII 이다. 이 시스템의 고정체와 지대주를 제조사의 권장 토크로 조인후 액상의 불포화 폴리에스터 용액에 고정한 후 절단하였다. 모든 표본은 절단, 연마후 주사전자 현미경으로 관찰하였다.내측연결 시스템의 적합도를 관찰한 결과, 각 제조사들 사이에 차이는 있으나 대부분의 내측연결 시스템의 경우엔 고정체와 지대주의 접촉은 긴밀히 접촉하는 경향을 가지고 있음을 알 수 있었다. 그러나 지대주와 나사, 고정체와 나사 간에는 다양한 형태의 틈이 존재하였다. 이러한 틈들이 나사의 불안정, 미생물의 군집, 악취 등에 어떠한 영향을 미칠지는 앞으로 계속적인 연구가 필요할 것으로 사료된다.

• The Journal of Advanced Prosthodontics
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• 제10권6호
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• pp.415-421
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• 2018

PURPOSE. This study investigated the effects of abutment screw lengths on screw loosening and removal torque in external connection implants after oblique cyclic loading. MATERIALS AND METHODS. External connection implants were secured with abutment screws to straight abutments. The abutment-implant assemblies were classified into seven groups based on the abutment screw length, with each group consisting of five assemblies. A cyclic load of 300 N was applied at a $30^{\circ}$ angle to the loading axis until one million cycles were achieved. Removal torque values (RTVs) before and after loading, and RTV differences were evaluated. The measured values were analyzed using repeated measures of analysis of variance with the Student-Newman-Keuls multiple comparisons. RESULTS. All assemblies survived the oblique cyclic loading test without screw loosening. There was a significant decrease in the RTVs throughout the observed abutment screw lengths when the abutment-implant assemblies were loaded repeatedly (P<.001). However, the abutment screw length did not show significant difference on the RTVs before and after the experiment when the abutment screw length ranged from 1.4 to 3.8 mm (P=.647). CONCLUSION. Within the limit of this experiment, our results indicate that the abutment screw length did not significantly affect RTV differences after oblique cyclic loading when a minimum length of 1.4 mm (3.5 threads) was engaged. These findings suggest that short abutment screws may yield stable clinical outcomes comparable to long screws in terms of load resistance.

• The Journal of Advanced Prosthodontics
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• 제11권3호
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• pp.147-154
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• 2019

PURPOSE. This study aimed to evaluate the effect of two different implant-abutment connection structures with identical implant design on peri-implant bone level. MATERIALS AND METHODS. This clinical study was a patient-blind randomized controlled trial following the CONSORT 2010 checklists. This trial was conducted in 24 patients recruited between March 2013 and July 2015. Implants with internal friction connection were compared to those with external hex connection. One implant for each patient was installed, replacing the second molar. Implant-supported crowns were delivered at four months after implant insertion. Standardized periapical radiographs were taken at prosthesis delivery (baseline), and one year after delivery. On the radiographs, distance from implant shoulder to first bone-to-implant contact (DIB) and peri-implant area were measured, which were the primary and secondary outcome, respectively. RESULTS. Eleven external and eleven internal implants were analyzed. Mean changes of DIB from baseline to 1-year postloading were 0.59 (0.95) mm for the external and 0.01 (0.68) mm for the internal connection. Although no significant differences were found between the two groups, medium effect size was found in DIB between the connections (Cohen's d = 0.67). CONCLUSION. Considering the effect size in DIB, this study suggested the possibility of the internal friction connection structure for more effective preservation of marginal bone.