• 대한치과보철학회지
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• 제44권5호
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• pp.561-573
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• 2006

Statement of the problem: In cases of low bone level in maxilla followed by extraction due to severe periodontitis or enlarged maxillary sinus, crown-root ratio of implant prosthesis will increase. The prognosis of these cases is not good as expected. Purpose : The purpose is to compare stress distribution due to crown-root ratio and effect of splinting between two implants in maxillary molar area under different loads Material and methods: Using ITI($4.1{\times}10$ mm) implant. two finite element models were made(model S: two parallel implants, model A: one of two is 20 degree inclined). Each model was designed in different crown-root ratio(0.7:1, 1:1, 1.25:1) and set cement type gold crown to make it splinted or non-splinted clinical situations. After that, 300 N force was loaded to each model in four ways.(load 1 : middle of occlusal table, load 2 : middle of buccal cusp, load 3 : middle of lingual cusp, load 4 : horizontal load to middle of buccal cusp), and stress distribution was analyzed. Results: On all occasions, stress was concentrated on neck of implant near cortical bone. In the case of inclined implant, stress was increased compared with parallel implants. Under load 1, 2, 3, stress was not increased even when crown-root ratio increases, but under load 4, when crown-root ratio increases, stress also increased. And more stress was concentrated under load 1 than load 2, 3. When crown-root ratio was same, stress under load 1, 2, 3 decreased when splinting, but under load 4, stress did not really decrease. Conclusion: Under vertical load, stress distribution related to crown-root ratio did not change. But under horizontal load, stress increased as crown-root ratio increases. Under vertical load, splinting decreased stress but under horizontal load, effect of splinting was decreased as condition of implant changes for the worse such as increase of crown-root ratio, inclined implant.

• 대한치과의사협회지
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• 제47권12호
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• pp.823-829
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• 2009

Purpose : The aim of this study was to evaluate the survival rate of sintered porous-surfaced implants placed in the edentulous posterior mandibles, in relation to implant length and diameter, crown-to-implant ratio, and types of prostheses, for a maximum of eight years of functioning. Material and Methods : The study group consisted of 43 partially edentulous patients who visited Catholic University Hospital of Daegu and one private dental clinic. A total of 122 sintered porous-surfaced implants n $Endopore^{(R)}$ (Inn ova Life Sciences, Toronto, Ontario, Canada) -- were placed in the edentulous posterior mandibles, Two diameter sizes (4.1 mm and 5.0 mm) and four lengths (5.0 mm, 7.0 mm, 9.0 mm, and 12.0 mm) were used. One hundred and three implants were splinted and 21 implants were nonsplinted. The survival rates of the implants in relation to length, diameter, crown-to-implant ratio, and types of prostheses were investigated. Statistical data were analyzed using SPSS Win.Ver 14.0 software with the Chi-square test. Results : The survival rate of the 4.1mm diameter implants was 100% and 91.2% for the 5.0mm diameter implants. The survival rates of the implants of differing diameters were found to be statistically different (p=0.005). The survival rates of both the 5.0mm and 7.0 mm length implants were 100%. The survival rate of the 9.0mm length implants was 97.9% and for the 12.0mm length implants was 95.1%. There was no statistical difference in survival rates for the differing lengths of implants. Of the 103 prostheses that were splinted, the survival rate was 98.0%. The survival rate of splinted prostheses was higher than that of the non-splinted prostheses, but was found to be not statistically different. There were no failed cases when the crown-to-implant ratio was under 1.0. When the crown-to-implant ratio was between 1.0 and 1.5, the failure rate of the implants was 6.7%. No failure was recorded with the ratio range of 1.5 to 2.0. Relative to the crown-to-implant ratio of 1.0, the failure rates were statistically different (p=0.048). Discussion and Conclusion : The cumulative survival rate of the porous-surfaced implants placed in the edentulous posterior mandibles was 97.5%. Short porous-surfaced implants showed satisfactory results after a maximum of nine years of functioning in the edentulous posterior mandibles.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권1호
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• pp.60-71
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• 2008

The objective of this study is to evaluate the stress distribution according to the thread design and the marginal bone loss of a single unit dental implant under the axial and offset-axial loading by three dimensional finite element analysis. The implants used had the diameter of 5mm and 4mm with 13mm in length and prosthesis with a conical type which is 6mm in height and 12mm in diameter. The thread designs were triangular, square and buttress. In the three dimensional finite element model with $15\times15\times20mm$ hexahedron and 2mm cortical thickness, implants were placed with crown to root ratio 7:12, 10:9, 13:6 and 16:3. And additionally the axial force of 100N were applied into 0mm, 2mm and 4mm away from the center of the implants. The results were as follows 1. The maximum von-Mises stress in cortical bone was concentrated to cervical area of implant, and in cancellous bone, apical portion. 2. Comparing the von-Mises stresses in cortical bone of 2mm and 4mm offset loading with central axial loading, it were increased to 3 and 5 times in diameter 4mm implant, and 2 and 4 times, in diameter 5mm implant. 3. The square threads were more effective than the triangular and butress as the longer diameter, the offset loading, and the worse crown to root ratio. 4. The von-Mises stresses were relatively stable until crown to root ratio 13:6, but it was suddenly increased at 16:3. From the results of this study, minimum requirement of crown to root ratio of implant is 2:1, and in the respect of crown to root ratio, diameter and offset loading, square threads are more effective than triangular and buttress threads.

• The Journal of Advanced Prosthodontics
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• 제13권1호
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• pp.12-23
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• 2021

Purpose. The aim of the study was to compare the lingualized implant placement creating a buccal cantilever with prosthetic-driven implant placement exhibiting excessive crown-to-implant ratio. Materials and Methods. Based on patient's CT scan data, two finite element models were created. Both models were composed of the severely resorbed posterior mandible with first premolar and second molar and missing second premolar and first molar, a two-unit prosthesis supported by two implants. The differences were in implants position and crown-to-implant ratio; lingualized implants creating lingually overcontoured prosthesis (Model CP2) and prosthetic-driven implants creating an excessive crown-to-implant ratio (Model PD2). A screw preload of 466.4 N and a buccal occlusal load of 262 N were applied. The contacts between the implant components were set to a frictional contact with a friction coefficient of 0.3. The maximum von Mises stress and strain and maximum equivalent plastic strain were analyzed and compared, as well as volumes of the materials under specified stress and strain ranges. Results. The results revealed that the highest maximum von Mises stress in each model was 1091 MPa for CP2 and 1085 MPa for PD2. In the cortical bone, CP2 showed a lower peak stress and a similar peak strain. Besides, volume calculation confirmed that CP2 presented lower volumes undergoing stress and strain. The stresses in implant components were slightly lower in value in PD2. However, CP2 exhibited a noticeably higher plastic strain. CONCLUSION. Prosthetic-driven implant placement might biomechanically be more advantageous than bone quantity-based implant placement that creates a buccal cantilever.

• 구강회복응용과학지
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• 제34권4호
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• pp.280-289
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• 2018

목적: 이 연구의 목적은 임플란트의 길이 및 치관-임플란트 비율(crown-to-implant (C/I) ratio)이 임플란트의 안정성과 임플란트 변연골 소실량(MBL)에 영향을 주는지 알아보기 위함이다. 연구 재료 및 방법: 연구대상자로 하악 구치부에 단일치를 상실한 46명의 환자를 선별하였다. 대조군에는 총 19개의 직경 5.0 mm, 길이 10 mm의 임플란트(CMI IS-III $active^{(R)}$ long implant)를 식립하였고, 실험군에는 직경 5.5 mm, 길이 6.6, 7.3, 8.5 mm의 임플란트 총 27개(CMI IS-III $active^{(R)}$ short implant)를 식립하였다. 각각의 임플란트는 디지털 방식으로 술 전 제작한 수술가이드를 사용하여 식립하였고 임시보철물을 장착하여 즉시부하를 시행하였다. 술 후 3개월에 CAD-CAM 방식으로 제작한 지르코니아 크라운으로 최종 수복하였다. 술 후 48주에 ISQ 값과 변연골 소실량을 측정하여 치관-임플란트 비율과 ISQ 및 변연골 소실량 간의 상관관계를 비교하였다. 결과: 두 그룹 모두 안정도 및 변연골 소실량 면에서 성공적인 결과를 나타내었다. 술 후 48주에 측정한 두 그룹간 ISQ와 변연골 소실량 값은 통계적으로 유의미한 차이가 없었다(P > 0.05). 치관-임플란트 비율과 안정성 및 치관-임플란트 비율과 변연골 소실량 간에 어떤 상관관계도 관찰되지 않았다(P > 0.05). 결론: 두 그룹의 하악 단일 임플란트에서 치관-임플란트 비율은 안정성 및 변연골 소실량에 영향을 주지 않는 것으로 나타났다. 골높이가 부족한 하악에서 단일 임플란트 수복 시, 짧은 임플란트는 상대적으로 높은 치관-임플란트 비율에도 불구하고 제한된 조건 하에서 적절한 대안이 될 수 있다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.13.1-13.6
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• 2020

Background: The aim of this study was to evaluate the factors that may affect implant fixture fractures. Methods: Patients who experienced implant fixture removal at Seoul National University Bundang Hospital from 2007 to 2015 due to implant fixture fracture were included. Implant/crown ratio, time of implant fracture, clinical symptoms before implant fracture, treatment of fractured implants, and the success and survival rate of the replaced implants were evaluated retrospectively. Results: Thirteen implants were fractured in 12 patients. Patient mean age at the time of fracture was 59.3 years. Of the 13 implants, 7 implants were placed at our hospital, and 6 were placed at a local clinic. The mean crown/implant ratio was 0.83:1. The clinical symptoms before fracture were screw loosening in five implants, marginal bone loss in five implants, and the presence of peri-implant diseases in five implants. All the fractured implants were removed, and 12 out of the 13 sites were re-implanted. Parafunctions were observed in two patients: one with bruxism and one with attrition due to a strong chewing habit. Conclusions: Several clinical symptoms before the fracture of an implant can predict implant fixture failure. Therefore, if these clinical symptoms are observed, appropriate treatments can be taken before more serious complications result.

• 대한치과보철학회지
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• 제44권1호
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• pp.85-102
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• 2006

Statement of problem: Currently, there are some 20 different geometric variations in implant/abutment interface available. The geometry is important because it is one of the primary determinants of joint strength, joint stability, locational and rotational stability. Purpose: As the effects of the various implant-abutment connections and the prosthesis height variation on stress distribution are not yet examined this study is to focus on the different types of implant-abutment connection and the prosthesis height using three dimensional finite element analysis. Material and method. The models were constructed with ITI, 3i TG, Bicon, Frialit-2 fixtures and solid abutment, TG post, Bicon post, EstheticBase abutment respectively. And the super structures were constructed as mandibular second premolar shapes with 8.5 mm, 11 mm, 13.5 mm of crown height. In each model, 244 N of vertical load and 244 N of $30^{\circ}$ oblique load were placed on the central pit of an occlusal surface. von Mises stresses were recorded and compared in the crowns, abutments, fixtures. Results: 1. Under the oblique loading, von Mises stresses were larger in the crown, abutment, fixture compared to the vertical loading condition. 2. The stresses were increased proportionally to the crown height under oblique loading but showed little differences with three different crown heights under vertical loading. 3. In the crown, the highest stress areas were loading points under vertical loading, and the finish lines under oblique loading. 4. Under the oblique loading, the higher stresses were located in the fixture/abutment interface of the Bicon and Frialit-2 systems compared to the ITI and TG systems. Conclusions: The stress distribution patterns of each implant-abutment system had difference among them and adequate crown height/implant ratio was important to reduce the stresses around the implants.

• 대한치과보철학회지
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• 제46권5호
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• pp.479-489
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• 2008

목적: 상악 구치부에서 자연치와 임플란트 보철시, 보철치관/고정체 비율에 따른 응력분포 양상을 비교하고자 했다. 재료 및 방법: 자연치 모델의 경우는 획득한 3차원 인체모델을 상악 좌측 제2소구치 및 제 1대구치가 포함된 상악골을 Box 형태의 3차원 유한요소모델로 변환하였고, 임플란트 모델은 3차원 인체모델에서 치아 부분을 제거하고 동일 부위에 임플란트 모델을 연결하는 과정을 거쳐서 임플란트가 삽입된 유한요소모델을 구성하였다. 치관/고정체 비율을 0.7:1, 1:1, 1.25:1이 되도록 골수준 (bone level)을 조정하였으며 각 모델의 치관 부위에 300 N의 수직 하중과 수평하중을 각각 가했다. 결과: 1. 모든 하중 조건하에서 자연치와 임플란트 모두에서 피질골과 인접하는 경부에 응력이 집중되는 양상을 보였다. 2. 치관/치근 (고정체) 비가 증가함에 따라 자연치와 임플란트 모두에서 교합면에 수직적 하중을 가한 경우에는 응력의 변화가 뚜렷하지 않았으나, 수평적 하중을 가한 경우에서는 응력이 증가하는 양상을 보였다. 3. 자연치의 경우에 치관/치근비가 증가함에 따라 splinting이 응력감소 효과를 보였고, 임플란트의 경우에는, 치관/고정체 비가 증가함에 따라 splinting이 수직 하중조건에 응력감소효과를 보였으나, 중심에서 벗어난 하중조건에는 최대응력이 오히려 증가하는 양상을 보였다. 4. 임플란트의 경우, 치관/고정체 비가 증가함에 따라 splinting이 수평하중조건 4에서 뚜렷한 응력감소 효과를 보이나, 수평 하중조건 5에서는 응력감소 효과가 감소되고, 특히 치관/고정체 비가 1.25:1인 경우에서는 오히려 응력의 증가를 보였다. 결론: 임플란트 보철물은 치관/고정체 비가 커질수록 더 큰 응력을 받게 되고, splinting의 효과도 감소하게 된다. 또한 교합하중이 임플란트의 장축을 벗어나거나 중심에서 벗어난 경우 응력이 커지는 것으로 사료된다.

• Journal of Periodontal and Implant Science
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• 제42권6호
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• pp.231-236
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• 2012

Purpose: The aim of this study was to evaluate the influence of the crown-to-implant (C/I) ratio on the change in marginal bone level around the implant and to determine the site-related factors influencing the relationship between the C/I ratio and periimplant marginal bone loss. Methods: A total of 259 implants from 175 patients were evaluated at a mean follow-up of five years. Implants were divided into two groups according to their C/I ratios: ${\leq}$ 1, and >1. Site-related factors having an influence on the relationship between C/I ratio and periimplant marginal bone loss were analyzed according to the implant location, implant diameter, implant manufacturer, prosthesis type, and guided bone regeneration (GBR) procedure. Results: It was found that 1) implants with a C/I ratio below 1 exhibited greater periimplant marginal bone loss than implants with a C/I ratio more than 1, 2) site-related factors had an effect on periimplant marginal bone loss, except for the implant system used, 3) the C/I ratio was the factor having more dominant influence on periimplant marginal bone loss, compared with implant diameter, prosthesis type, implant location, and GBR procedure, 4) implants with a C/I ratio below 1 showed greater periimplant marginal bone loss than implants with a C/I ratio greater than 1 in the maxilla, but not in the mandible, 5) and periimplant marginal bone loss was more affected by the implant system than the C/I ratio. Conclusions: Within the limitations of this study, implants with a higher C/I ratio exhibited less marginal bone loss than implants with a lower C/I ratio in the posterior regions. The C/I ratio was a more dominant factor affecting periimplant marginal bone loss in the maxilla than the mandible. Meanwhile, the implant system was a more dominant factor influencing periimplant marginal bone loss than the C/I ratio.

• Journal of International Society for Simulation Surgery
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• 제4권1호
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• pp.13-16
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• 2017

Fibular free flap reconstruction is the flap of the choice in long-span mandibular bone reconstruction. The most common disadvantage of the fibular flap is short bone height to install dental implant. Double barrel fibular flap has been tried, however, bulky flap in the oral cavity hinder its use. Titanium reconstruction plate has been used simultaneously with the free fibular flap to stabilize occlusion and to fix the fibular flap. In this study, titanium reconstruction plate was fixed in the lower border of the mandible and the fibular free flap was fixed in the superior border of the titanium plate to improve implant-crown ratio. This new technique improved the longevity of the dental prosthodontics with dental implants.