• The Journal of Korean Academy of Prosthodontics
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• v.47 no.3
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• pp.301-311
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• 2009

Statement of problem: Flapless implant surgery using a soft tissue punch device requires a circumferential excision of the mucosa at the implant site. To date, Although there have been several reports on clinical outcomes of flapless implant surgeries, there are no published reports that address the appropriate size of the soft tissue punch for peri-implant tissue healing. Purpose: In an attempt to help produce guidelines for the use of soft tissue punches, this animal study was undertaken to examine the effect of soft tissue punch size on the healing of peri-implant tissue in a canine mandible model. Material and methods: Bilateral, edentulated, flat alveolar ridges were created in the mandibles of six mongrel dogs. After a three month healing period, three fixtures (diameter, 4.0 mm) were placed on each side of the mandible using 3 mm, 4 mm, or 5 mm soft tissue punches. During subsequent healing periods, the peri-implant mucosa was evaluated using clinical, radiological, and histometric parameters, which included Gingival Index, bleeding on probing, probing pocket depth, marginal bone loss, and vertical dimension measurements of the peri-implant tissues. Results: The results showed significant differences (P <0.05) between the 3 mm, 4 mm and 5 mm tissue punch groups for the length of the junctional epithelium, probing depth, and marginal bone loss during healing periods after implant placement. When the mucosa was punched with a 3 mm tissue punch, the length of the junctional epithelium was shorter, the probing depth was shallower, and less crestal bone loss occurred than when using a tissue punch with a diameter $\geq$ 4 mm. Conclusion: Within the limit of this study, the size of the soft tissue punch plays an important role in achieving optimal healing. Our findings support the use of tissue punch that 1 mm smaller than implant itself to obtain better peri-implant tissue healing around flapless implants.

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.1
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• pp.8-17
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• 2019

Purpose: The study analyzed the prevalence of peri-implantitis and factors which may have affected the disease. Materials and methods: This study based on medical records and radiographs of 422 patients (853 implant cases) who visited Ewha Womans University Mokdong Hospital Dental Center from January 1, 2012 to December 31, 2016. Generalized estimation equations (GEE) was utilized to determine the statistical relationship between peri-implantitis and each element, and the cumulative prevalence of peri-implantitis during the observation period was obtained by using the Kaplan Meier Method. Results: The prevalence rate of peri-implantitis at the patient level resulted in 7.3% (31 patients out of a total of 422 patients), and at the implant level 5.5% (47 implants out of a total of 853 implants). Sex, GBR, guided bone regeneration (GBR) and functional loading periods had statistical significance with the occurrence of peri-implantitis. Upon analysis of the cumulative prevalence of peri-implantitis in terms of implant follow-up period, the first case of peri-implantitis occurred at 9 months after the placement of an implant, and the prevalence of peri-implantitis showed a non-linear rise over time without a hint of a critical point. Conclusion: The prevalence of peri-implantitis at the patient level and the implant were 7.3% and 5.5%, respectively. Male, implant installed with GBR and longer Functional Loading Periods were related with the risk of peri-implantitis.

• The Journal of Korean Academy of Prosthodontics
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• v.52 no.4
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• pp.359-365
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• 2014

Successful results of treatments using double crown prostheses for the partially edentulous patients who have a few remaining teeth have been reported in several journals. A double crown removable partial denture can be an alternative treatment for the patients with a poor periodontal condition of remaining teeth. Since a double crown removable partial denture can be applied without the risk of surgical operation to the medically compromised patients with a poor periodontal condition which is inadequate for dental implants, it has psychological and economical advantages. In this case, there were sufficient remaining teeth to be restored with fixed prostheses in maxilla, while there were a few remaining teeth with a very poor periodontal condition so that it was almost impossible to restore with a clasp removable partial denture using these remaining teeth in mandible. In addition, the patient had the medical history of surgical operation due to osteomyelitis in the mandibular anterior areas a year ago, thus difficult to conduct an implant placement. The main objective of this report is to introduce our case because a double crown partial denture using a few mandibular remaining teeth showed satisfactory results in functional and esthetical aspects during more than two years follow-up period in this unfavorable condition.

• Journal of Dental Rehabilitation and Applied Science
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• v.24 no.1
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• pp.67-76
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• 2008

Implant requires long lasting, strong osseointegration using bio-mechanical interlocking by bone ingrowth. In regarding the size level for bone ingrowth, the micro-patterning would enhance bone response. Micro-patterning can increase the area contacting the bone tissues. Therefore, it may distribute the load to the surrounding bone tissue, more effectively. This study compared and analyzed the load distributing effect with the shape and number of micro-patterning. For the optimal comparison of threads, the assumptions different from general finite element analysis model were made. It was assumed that the implant was axisymmetric and infinitely long. The implant was assumed to be completely embedded in the infinitely long cortical bone and to have 100% bone apposition. The implant-bone interface had completely fixed boundary conditions and received an infinitely big axial load. The condition of threads were as follows. The reference model 1 had conventional thread. Model 2 had 2 micro-patterns on the upper flank of the thread. Model 3 had 2 micro-patterns on the lower flank of the thread. Model 4 had 2 micro-patterns on the upper and lower flanks of the thread. Model 5 had 3 micro patterns on the upper and lower flanks of the thread. The results were as follows: 1. The thread with micro-patterns distributed stress better than the conventional thread. 2. The thread with micro-patterns on the lower flank distributed stress better than that with micro-patterns on the upper flank. 3. The thread with 3 micro-patterns distributed stress better than that with 2 micro-patterns, However, an area with stress concentration occurred.

• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.1
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• pp.51-61
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• 2011

Recently, restoring implants in the esthetically demanding region, zirconia-based materials are widely used due to their superior mechanical properties, accuracies, and esthetics. The purpose of this study was to investigate the load transfer and mechanical stability of zirconia and titanium implant abutments by using the three-dimensional finite element analysis model. The internal conical joint type and external butt joint type implant system was selected as an experimental model. Finite element models of bone/implant/prosthesis complex were constructed. An load of 250N was applied vertically beside 3mm of implant axis. Stress distribution of zirconia and titanium implant abutment is similar. The maximum equivalent stress of titanium implant abutment is lower than zirconia implant abutment about 15%. Howevere considering a high mechanical strength that exceed those of titanium implant abutment, zirconia implant abutment had similar mechanical stability of titanium implant abutment clinically.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.1
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• pp.16-23
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• 2016

Purpose: The aim of this study was to evaluate whether fluorides at various pH cause changes in the surface roughness of titanium implants that alter the adherence of bacterial biofilms. Materials and Methods: The titanium disks were assigned randomly to the following seven groups according to the fluoride agents and application time (1 minute or 30 minute) used: control (no treatment); group 1 (1.23% acidulated phosphate fluoride [APF] at pH 3.5 for 1 minute); group 2 (1.23% APF at pH 3.5 for 30 minute); group 3 (1.23% APF at pH 4.0 for 1 minute); group 4 (1.23% APF at pH 4.0 for 30 minute); group 5 (2% NaF gel at pH 7.0 for 1 minute); group 6 (2% NaF gel at pH 7.0 for 30 minute). The surface roughness of the titanium disks and the amount of adherent bacteria were measured. Results: Group 2 showed a significantly greater surface roughness than the control group (P < 0.0001). No significant differences in the amount of surface bacteria were observed between the treated samples and the controls. In addition, there were no significant differences in bacterial adherence relative to the incubation period between the treated samples and the controls. Conclusion: The surface roughness of the titanium disks was significantly greater after treatment with APF at pH 3.5 for 30 min compared with that of the controls. In addition, we found that the amount of Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibactor actinomycetemcomitans was similar among all groups

• Polymer(Korea)
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• v.39 no.3
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• pp.418-425
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• 2015

Polycaprolactone (PCL) and biphasic calcium phosphate (BCP) have been considered as useful materials for orthopedic devices and osseous implants because of their biocompatibility and bone-forming activity. However, PCL-based scaffolds have hydrophobic surfaces reducing initial cell adhesion or proliferation. To overcome the limitation, we fabricated surface-modified PCL/BCP nanofibers using gamma-irradiation for bone tissue engineering. PCL/BCP nanofibers were prepared by electrospinning and then we supplemented hydrophilicity by introducing acrylic acid (AAc) through gamma-irradiation. We confirmed the surface of nanofibers by SEM, and then the initial viability of MG63 was significantly increased on the AAc grafted nanofibers, and alkaline phosphatase activity($1.239{\pm}0.226nmole/{\mu}g/min$) improved on the modified nanofibers than that on the non-modified nanofibers($0.590{\pm}0.286nmole/{\mu}g/min$). Therefore, AAc-grafted nanofibers may be a good tool for bone tissue engineering applications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.5
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• pp.392-401
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• 2010

Introduction: Diabetes mellitus, as a major health problem for the elderly has been shown to alter the properties of the bone and impair bone healing around a titanium implant in both humans and animals. The aim of this study was to examine the effect of adipose-derived stem cells on the healing process around a titanium implant in streptozotocin-induced diabetic rats. Materials and Methods: Thirteen rats were divided into two groups: adipose-derived stem cells injected group and a control group. A titanium screw implant (diameter: 2.0 mm, length: 3.5 mm) was placed into both tibia of 13 rats: 13 right tibia as the control group and 13 left tibia as the experimental group. The rats were sacrificed at different intervals (1, 2, and 4 weeks) after implantation for histopathology observations and immunohistochemistric analysis. Results: The histopathological findings revealed earlier new formed bone in the experimental group than the control group. In particular, at 1 week after implantation, the experimental group showed more newly formed bone and collagen around the implant than the control group. In immunohistochemistric analysis, osteoprotegerin (OPG) expression in the experimental group increased early compared to that of the control group until 2 weeks after implantation. However, after 2 weeks, OPG expression in the experimental group was similar to OPG expression in the control group. The receptor activator of nuclear factor ${\kappa}B$ ligand (RANKL) expression in the experimental group increased early compared to that of the control group, and then decreased at 2 weeks. After 2 weeks, the level of RANKL expression was similar in both groups. Conclusion: These results suggest that adipose-derived stem cells in implantation can promote bone healing around titanium, particularly in diabetes mellitus induced animals.

• Journal of Periodontal and Implant Science
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• v.30 no.3
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• pp.491-504
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• 2000

In clinical therapy, the current goal of dental implants is to enhance quantity and quality of osseointegration. Surface roughness and oxide structure are considered to influence the behavior of adherent cells. The purpose of this study is to evaluate the effect of different surface treatment on cellular response. The attachment and proliferation of osteoblast-like cell on sandblasted, sandblasted and etched, thermal oxidated surfaces have been compared. Sandblasting was done with $Al_2O_3$ particles(grain size of $50{\mu}m$), etching was processed with $NH_4OH$ : $H_2O_2$ : $H_2O(1:1:5)$ at $90^{\circ}C$ for 1 minute. Thermal oxidation was followed sandblasting and etching at $400^{\circ}C$, $600^{\circ}C$, $800^{\circ}C$ for 2 hours. Measurement of surface roughness after the different treatment did not show any differences of Ra value between terated surfaces. Cell attachment and proliferation were increased during experiment period, but no difference was observed. SEM evaluation revealed a similar pattern of osteoblast-like cells, well attached with dendritic extension and producing numerous matrix vesicles on cell surface. The results of this study showed that oxide layer alteration by thermal oxidation did not affect the attachment and proliferation of osteoblast-like cells. This suggests the possibility that the cellular responses are further influenced by surface roughness than titaniun oxide structure.

• Journal of Dental Rehabilitation and Applied Science
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• v.23 no.1
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• pp.55-68
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• 2007

The purpose of this study was to analyze the distribution of stress in the surrounding bone around implant placed in the first and second molar region. Two different three-dimensional finite element model were designed according to vertical bone level around fixture ($4.0mm{\times}11.5mm$) on the second molar region. A mandibular segment containing two implant-abutments and a two-unit bridge system was molded as a cancellous core surrounded by a 2mm cortical layer. The mesial and distal section planes of the model were not covered by cortical bone and were constrained in all directions at the nodes. Two vertical loads and oblique loads of 200 N were applied at the center of occlusal surface (load A) or at a position of 2mm apart buccally from the center (load B). Von-Mises stresses were analyzed in the supporting bone. The results were as follows; 1. With the vertical load at the center of occlusal surface, the stress pattern on the cortical and cancellous bones around the implant on model 1 and 2 was changed, while the stress pattern on the cancellous bone with oblique load was not. 2. With the vertical load at the center of occlusal surface, the maximum von-Mises stress appeared in the outer distal side of the cortical bone on Model 1 and 2, while the maximum von-Mises stress appeared in the distal and lingual distal side of the cortical bone with oblique load. 3. With the vertical load at a position of 2 mm apart buccally from the center, there was the distribution of stress on the upper portion of the implant-bone interface and the cortical bone except for the cancellous bone, while there was a distribution of stress on the cancellous bones at the apical and lingual sides around the fixture and on the cortical bone with oblique load. 4. With the changes of the supporting bone on the second molar area, the stress pattern on the upper part of the cortical bone between two implants was changed, while the stress pattern on the cancellous bone was not. The results of this study suggest that establishing the optimum occlusal contact considering the direction and position of the load from the standpoint of stress distribution of surrounding bone will be clinically useful.