• The Journal of Advanced Prosthodontics
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• v.15 no.3
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• pp.114-125
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• 2023

PURPOSE. The aim of the study was to evaluate the optical properties of new generation (3Y-TZP) monolithic zirconia (MZ) with different abutment types and resin cement shades. MATERIALS AND METHODS. A1/LT MZ specimens were prepared (10 × 12 × 1 mm, N = 30) and divided into 3 groups according to cement shades as transparent (Tr), yellow (Y) and opaque (O). Abutment specimens were obtained from 4 different materials including zirconia (Group Z), hybrid (Group H), titanium (Group T) and anodized yellow titanium (Group AT). MZ and abutment specimens were then cemented. L^*, a^*, and b^* parameters were obtained from MZ, MZ + abutment, and MZ + abutment + cement. ∆E₀₀₁^* (between MZ and MZ + abutment), ∆E₀₀₂^* (between MZ and MZ + abutment + cement) and ∆E₀₀₃^* (between MZ + abutment and MZ + abutment + cement) values were calculated. Statistical analyses included 2-way ANOVA, Bonferroni, and Paired Sample t-Tests (P < .05). RESULTS. Abutment types and resin cements had significant effect on L^*, a^*, b^*, ∆E₀₀₁^*, ∆E₀₀₂^*, and ∆E₀₀₃^* values (P < .001). Without cementation, whereas zirconia abutment resulted in the least discoloration (∆E₀₀₁^* = 0.68), titanium abutment caused the most discoloration (∆E₀₀₁^* = 4.99). The least ∆E₀₀₂^* = 0.68 value was seen using zirconia abutment after cementation with yellow shaded cement. Opaque shaded cement caused the most color change (∆E₀₀₃^* = 5.24). Cement application increased the L^* values in all groups. CONCLUSION. The least color change with/without cement was observed in crown configurations created with zirconia abutments. Zirconia and hybrid abutments produced significantly lower ∆E₀₀₂^* and ∆E₀₀₃^* values in combination with yellow shaded cement. The usage of opaque shaded cement in titanium/anodized titanium groups may enable the clinically unacceptable ∆E₀₀^* value to reach the acceptable level.

• The Journal of Advanced Prosthodontics
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• v.11 no.5
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• pp.271-279
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• 2019

PURPOSE. The newest technologies for digital implant impression (DII) taking are developing rapidly and showing acceptable clinical results. However, scientific literature is lacking data from clinical studies about the accuracy of DII. The aim of this study was to compare digital and conventional dental implant impressions (CII) in a clinical environment. MATERIALS AND METHODS. Twenty-four fixed zirconia restorations supported by 2 implants were fabricated using conventional open-tray impression technique with splinted transfers (CII group) and scan with Trios 3 IOS (3Shape) (DII group). After multiple verification procedures, master models were scanned using laboratory scanner D800 (3Shape). 3D models from conventional and digital workflow were imported to reverse engineering software and superimposed with high resolution 3D CAD models of scan bodies. Distance between center points, angulation, rotation, vertical shift, and surface mismatch of the scan bodies were measured and compared between conventional and digital impressions. RESULTS. Statistically significant differences were found for: a) inter-implant distance, b) rotation, c) vertical shift, and d) surface mismatch differences, comparing DII and CII groups for mesial and distal implant scan bodies ($P{\leq}.05$). CONCLUSION. Recorded linear differences between digital and conventional impressions were of limited clinical significance with two implant-supported restorations.

• The Journal of Korean Academy of Prosthodontics
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• v.55 no.1
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• pp.26-31
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• 2017

Purpose: This study was to assess clinically the success rates and technical complications of cement-retained implant-supported single crowns and splinted crowns with zirconia frameworks. Materials and methods: 75 (single crowns: 51, splinted crowns: 24) cement-retained implant-supported single crowns and splinted crowns with zirconia frameworks which were restored in 67 patients were investigated for the evaluation of the success rates and technical complications. All restorations were cemented with temporary cement. Age, gender, restoration position, opposing teeth, restoration type were assessed as possible factors affecting technical complications. Results: During the mean observation period of 22.2 months, cumulative success rates of all restorations were 66.9 (73.2 - 60.6)%. Retention loss was found in 16 restorations (single crowns: 14, splinted crowns: 2), abutment screw loosening and veneer porcelain fracture were found in each 2 single crowns, respectively. According to a Kaplan-Meier survival analysis of single crowns and splinted crowns, the cumulative success rates were 58.9 (66.6 - 51.2)%, 87.5 (96.1 - 78.9)%, respectively. There was a statistically significant difference. The other possible factors did not have a significant effect on the technical complications. Conclusion: Retention loss was the most frequent technical complication. Abutment screw loosening and veneer porcelain fracture were found rarely in single crowns only. Age, gender, restoration position, and antagonist did not have significant effect on the technical complications. Splinted crowns had a higher success rate than single crowns.

• The Journal of Korean Academy of Prosthodontics
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• v.50 no.2
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• pp.128-134
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• 2012

Purpose: The purpose of this study was to compare the screw joint stability between the CADCAM custom-made implant abutment and the prefabricated implant abutment by measuring the reverse torque value after cyclic loading. Materials and methods: Twelve screw type implants (Implantium, Dentium Co., Seoul, Korea) were embedded in aluminum cylinder with acrylic resin. The implant specimens were equally divided into 3 groups, and connected to the prefabricated titanium abutments (Implantium, Dentium Co., Seoul, Korea), CADCAM custom-made titanium abutments (Myplant, Raphabio Co., Seoul, Korea) and CADCAM custom-made zirconia abutments (Zirconia Myplant, Raphabio Co., Seoul, Korea). The CAD-CAM milled titanium crown (Raphabio Co., Seoul, Korea) was cemented on each implant abutment by resin cement. Before cyclic loading, each abutment screw was tightened to 30 Ncm and the reverse torque value was measured about 30 minutes later. After the crown specimen was subjected to the sinusoidal cyclic loading (30 to 120 N, 500,000 cycles, 2 Hz), postloading reverse torque value was measured and the reverse torque loss ratio was calculated. Kruskal-Wallis test was used for statistical analysis of the reverse torque loss ratio. Results: The CADCAM custom-made titanium abutments presented higher values in reverse torque loss ratio without statistically significant differences than the prefabricated titanium abutments ($P$>.05). Reverse torque loss ratio of the custom-made zirconia abutments was significantly higher compared to that of the prefabricated titanium abutments ($P$=.014). Conclusion: Within the limitation of the present $in-vitro$ study, it was concluded that there was no significant difference in screw joint stability between the CADCAM custom-made titanium abutments and the prefabricated titanium abutments. On the other hand, the CADCAM custom-made zirconia abutments showed lower screw joint stability than prefabricated titanium abutments.

• Journal of Dental Rehabilitation and Applied Science
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• v.33 no.4
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• pp.252-259
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• 2017

Purpose: The purpose of this study was to compare and analyze the wear of a prosthesis for 6 months after restoration with implant-supported fixed dental prosthesis made of either zirconia or gold. Materials and Methods: This study was conducted on patients requiring implant-supported fixed dental prostheses on first or second molar from January, 2015 to January, 2016. A total of 47 prostheses and antagonists were examined. Occlusal surface was recorded by impression of each prosthesis and antagonist 1 week and 6 months after prosthesis delivery. The digital files were created by impression scan. Occlusal shapes of 1 week and 6 months were compared and wear of prostheses and antagonists was analyzed. The Mann-Whitney test was used to analyzed the result data underwent normality test using SPSS (Version 23.0, IBM Corporation) Results: Mann-Whitney test revealed that there was no statistically significant difference in the median amount of mean vertical wear for 6 months in zirconia ($50.84{\mu}m$) and gold ($42.84{\mu}m$) prostheses (P > 0.05). When the opposing teeth were natural, the median amount of mean vertical wear of zirconia and gold prostheses was $47.72{\mu}m$ and $41.97{\mu}m$, respectively, and the median amount of mean vertical wear of enamel was $47.26{\mu}m$ and $44.59{\mu}m$, respectively. Statistical analysis showed no significant difference (P > 0.05). Conclusion: Despite the short study period and the small number of experimental groups, zirconia and gold showed no significant difference in wear during the first 6 months. Opposing natural enamel also showed no significant difference in the wear.

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.555-565
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• 2006

The purpose of the present study is to evaluate the biological stability of the zirconia/alumina composite abutment by histologic and radiographic examination in clinical cases. 17 partially edentulous patients (5 men and 12 women, mean age 47) were treated with 37 implants. The implants were placed following the standard two-stage protocol. After a healing period of 3 to 6 months, zirconia/alumina composite abutments were connected. All radiographs were taken using paralleling technique with individually fabricated impression bite block, following insertion of the prosthesis and at the 3-, 6-, 12 month re-examinations. After processing the obtained images, the osseous level was calculated using the digital image in the mesial and distal aspect in each implant. An ANOVA and t-test were used to test for difference between the baseline and 3-, 6-, 12 months re-examinations, and for difference between maxilla and mandible. Differences at P <0.05 were considered statistically significant. For histologic examination, sample was obtained from the palatal gingiva which implant functioned for 12 months. Sections were examined under a light microscope under various magnifications. Clinically, no abutment fracture or crack as well as periimplantitis was observed during the period of study. The mean bone level reduction(${\pm}standard$ deviation) was 0.34 rom(${\pm}\;0.26$) at 3-months, 0.4 2mm(${\pm}\;0.30$) at 6-months, 0.62 mm(${\pm}\;0.28$) at 12-months respectively. No statistically significant difference was found between baseline and 3-, 6-, 12-months re-examinations (p > 0.05). The mean bone level reduction in maxilla was 0.33(${\pm}0.25$) at 3-months, 0.36(${\pm}0.33$) at 6-months, 0.56(${\pm}0.26$) at 12-months. And the mean bone level reduction in mandible was 0.35(${\pm}0.27$) at 3-months, 0,49(${\pm}0.27$) at 6-months, 0.68(${\pm}0.30$) at 12-months. No statistical difference in bone level reduction between implants placed in the maxilla and mandible. Histologically, the height of the junctional epithelium was about 2.09 mm. And the width was about 0.51 mm. Scattered fibroblasts and inflammatory cells, and dense collagen network with few vascular structures characterized the portion of connective tissue. The inflammatory cell infiltration was observed just beneath the apical end of junctional epithelium and the area of direct in contact with zirconia/alumina abutment. These results suggest the zirconia/alumina composite abutment can be used in variable intraoral condition, in posterior segment as well as anterior segment without adverse effects.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.4
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• pp.314-321
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• 2016

Conventional removable partial dentures (RPDs) with distal extensions are associated with some problems, including lack of stability that calls for frequent relining, and cantilever actions of claps that can produce excessive loading to abutment teeth, and the need for unesthetic retentive arm clasps. Therefore, IARPDs (Implant-assisted RPD) that use implants to support or retain RPDs has been reported to improve stability, esthetics and masticatory performance of RPDs. Also, an IARPD that has zirconia occlusal table can prevent the incongruity of occlusal plane and the extrusion of antagonistic tooth. In this case of partially edentulous patient with crossed occlusion, each edentulous area was restored with implant fixed prosthesis and implant retained partial denture to suit each situation. Through the procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.

• The Journal of Korean Academy of Prosthodontics
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• v.55 no.2
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• pp.151-155
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• 2017

Purpose: The aim of this study was to evaluate screw removal torque of the two-piece zirconia abutment with the novel titanium component compared to the conventional one-piece titanium abutment in the internal connection implant before and after dynamic cyclic loading. Materials and methods: Two types of the abutment assemblies with internal connection were prepared and divided into the groups; titanium abutment-titanium abutment screw assemblies as control, and zirconia abutment-titanium socket-titanium abutment screw assemblies as experimental group. A total of 12 abutments and implants were used of six assemblies each group. Each assembly was tightened to 30 Ncm. A cyclic load of 300 N at an angle of 30 degrees in reference to the loading axis was applied until one million cycles or failure. The removal torque values (RTVs) of the abutment screws were measured with a digital torque gauge before and after cyclic loading. The RTVs of the pre load and post load were analyzed with t-test, and P-values < .05 were considered statistically significant. Results: The assemblies of both groups survived all after the dynamic cyclic loading test without screw loosening. The statistically significant differences were found between the mean RTVs before and after the cyclic loading in both groups (P < .05). The RTV differences for the control and the experimental group were $-7.25{\pm}1.50Ncm$ and $-7.33{\pm}0.93Ncm$, respectively. Statistical analysis revealed that the RTV differences in both groups were not significantly different from each other (P > .05). Conclusion: Within the limitation of this study, the two-piece zirconia abutment with the titanium component did not show a significant RTV difference of the abutment screw compared to the titanium abutment after dynamic cyclic loading.

• Journal of Periodontal and Implant Science
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• v.33 no.1
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• pp.1-11
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• 2003

Hydroxyapatite(HA) has been extensively used as bone graft materials and tooth implant surface coating materials because of its biocompatibility and osteoconductive properties. However, as HA is intrinsically poor in mechanical properties, zirconia($ZrO_2$) was incorporated with HA as reinforcing phases for improvement of mechanical properties. The purpose of this study was to investigate the biological activities of HA-coated zirconia through the cell proliferation test, measurements of alkaline phosphatase activity, and histologic examination. Four kinds of tested blocks were prepared according to the pore size (300-500${\mu}m$/500-700${\mu}m$) and the porosity (70%/90%). Cell proliferation and alkaline phosphatase activity was measured at 1, 7, 14 days. The number of cells proliferate after 7, 14 days were significantly increased in all groups when compared with that of the first day, but there was no significant difference between the 4 groups at each time period. At the 7 day, alkaline phosphatase activities of cells cultured in 4 groups were higher than that of the first day, but there was no significant difference between the 4 groups at each time period. The human gingival fibroblast and MG 63 cell was used to evaluate the cell cytotoxicity using MTT test. The materials tested in the current study turned out to be non-cytotoxic. In histologic examination(SEM), at 1 day there were many cells attached on the surfaces of all kinds of tested blocks. The number of cells were increased over time. At the 14 day, there were more cells proliferated than 1 day and some of the pores of blocks were partially filled with the proliferated cells. The in vitro response of osteoblast-like cells to the HA-coated zirconia showed comparable effect on transformation comparable to hydroxyapatite.

• Journal of Korean Dental Science
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• v.11 no.1
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• pp.14-20
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• 2018

Purpose: The purpose of this study is to measure and compare the removal torques of different cements applied in attachments of zirconia restorations on titanium (Ti) abutments fitted with retrievable cement-type slot (RCS) on the lingual side for the better retrievablity by use of a slot driver. Materials and Methods: Three types of cements were used in the experiment: two permanent cements in $RelyX^{TM}$ U200 (RU) (3M ESPE) which is a resin cement and $FujiCem^{TM}$ (FC) (GC) which is a resin-modified glass ionomer cement, and a temporary cement in $Freegenol^{TM}$ temporary cement (TC) (GC). Measurements of removal torques were conducted as follows; an attached sample was fixed on the equipment customized for the experiment; a slot driver was connected to a MGT12 (Mark-10 Corp.), a torque measurement instrument; the sample had the driver fitted to its RCS and then was rotated until the it was removed; and finally, the maximum torque value was recorded. Result: As for the removal torque measurement results, the average values were $47.9{\pm}2.6Ncm$ for RU, $43.4{\pm}1.5Ncm$ for FC, and $20.9{\pm}1.0Ncm$ for TC. The statistical analysis using Kruskal-Wallis test yielded the significance probability of P<0.05 (P=0.002), which confirmed the presence of significant differences between the three groups. Conclusion: All three cements exhibit clinically acceptable levels of removal torque when applied to an upper zirconia implant restoration fitted with a lingual slot, with RU and FC, the two permanent cements, having the significantly higher values than that of TC, the temporary cement.