Purpose. The purpose of this study was to analyze stress distribution of all ceramic posterior fixed partial denture using a three dimensional finite element method. Material and method. A three dimensional finite element model was created to demonstrate all-ceramic posterior fixed partial denture and then this computer model measured the stress distribution of the all ceramic bridges which has a ceramic core materials such as Zirconia, IPS Empress. 2. In-Ceram zirconia, Metal-Ceramic. Also the stress distribution was examined according to loading sites when force was applied to sites such as the central area of second premolar the mesial connector of pontic, the central fossa of pontic, the distal connector of pontic, and the central fossa of second molar. Results. 1. In all the materials of the core in this study, von Mises stress indicated that the stress increased as force was applied to loaded sites, just at those points, on the connector, and the margin in the area adjacent to the connectors. 2. The maximum principal stress was much higher in the lower part of the connectors than in any other region. 3. As the load was applied to the different locations, the research showed a consistent increase of stress in the lower connectors. The maximum value of the von Mises stress was two or three times greater when the load was applied directly to the connectors rather than indirectly through another stressed region. 4. In the case of In-Ceram zirconia, the stress in lower connectors was the highest of all the reference points, the stress showed 75% of all the maximum stress. Ziconia showed 72%, Metal Ceramic 67% and IPS Empress 2 50%. 5. In the case of Ziconia, the stress was well dispersed in each reference point that the stress differences were smaller when compared to In-Cream ziconia.
There has been increasing use of IPS Empress $2^{(R)}$ owing to easy fabrication method, high esthetics similar to natural teeth, good marginal accuracy, and sufficient fracture strength. However, in clinical application, although a luting agent and the tooth cementation bonding procedure influence the marginal accuracy and fracture strength restoration, there has been a controversy in the selection of proper luting agent. This study was to measure the marginal fidelites and fracture strength of IPS Empress crowns according to three cement types, Protec $cem^{(R)}$, Variolink $II^{(R)}$ and Panavia $21^{(R)}$. After construction of 12 experimental dies for each group, IPS Empress $2^{(R)}$ crowns were fabricated and luted the metal master die prepartion of the maxillary right premolar. Marginal gaps before cementation and after cementation were measured. Buccal incline on the functional cusp of specimens were loaded until the catastrophic failure and fracture strength was measured. The results of this study were as follows: 1. The range of gap was $34.04{\pm}4.84{\mu}m$ before cementation and $37.88{\pm}5.00{\mu}m$ after cementation, which showed significant difference by paired t-test (p<0.05). The difference in the results from marginal accuracy according to measuring point proved to be not statistically significant by two-way ANOVA test (p>0.05). 2. The difference in the results from marginal accuracy according to three cement types Proved that The Variolink $II^{(R)}$ cement group had the least gap, $35.43{\pm}5.03{\mu}m$, and showed superior marginal accuracy while there existed statistic significance in Protec $cem^{(R)}$ cement group, $39.06{\pm}4.41{\mu}m$ or Panavia $21^{(R)}$ cement group, $39.16{\pm}4.39{\mu}m$ by two-way ANOVA test & multiple range test (p<0.05). 3. The difference in the results from fractures strength testing according to three cement type groups proved to be statistically significant (p<0.05). The Variolink $II^{(R)}$ cement group shows highest fracture strength of $1257.33{\pm}226.77N$, Panavia $21^{(R)}$ cement group has $1098.08{\pm}138.45N$, and Protec $cem^{(R)}$ cement group represents the lowest fracture strength of $926.75{\pm}115.75N$. 4. Three different cement groups of different components showed acceptable marginal fidelity and fracture strength. It is concluded that IPS Empress $2^{(R)}$ crowns luted using Variolink $II^{(R)}$ cement group had stronger fracture strength and smaller marginal gap than the other cement groups. Although Variolink $II^{(R)}$ resin cement seemed acceptable to clinical applications in IPS Empress $2^{(R)}$ system, the IPS Empress $2^{(R)}$ system still requires long-term research due to the lack of data in clinical applications.
Calcium sulfate has a long history of medical use as an implant material. The biocompatibiliry of the material has been clearly established. Bone ingrowth concomitant with resorption occurs rapidly with efficient conduction of bone from particle to particle. Calcium sulfate also has a potential for functioning as a good bamer membrane. The purpose of this study was to compare the biocompatibility of different types of calcium sulfate grafting materials including an expelimental calcium sulfate compound on periodontal ligament cells in vitro as a preliminary test towards the development of a more convenient and useful form of grafting material which could promote regeneration of periodontal tissue. Human periodontal ligament cells were collected from the premolar teeth extracted for orthodontic treatment. cells were cultured in a.MEM culture medium containing 20% FBS, at $37^{\circ}C$ and 100% humidity, in a 5% CO2 incubator. Cells were cultured into 96 well culture plate $1{\times}104$ cells per well with $\alpha$-MEM and incubated for 24 hours. After discarding the medium, those cells were cultured in $\alpha$-MEM contained with 10% FBS alone (control group), in medcal-grade calcium sulfate(MGCS group), in plaster(plaster group), experimental calcium sulfate paste(CS paste group) for 1, 2, 3 day respectively. And then each group was characterized by examining of the cell counting, MTI assay, collagen synthesis. The results \vere as follows. 1. In the analysis of cell proliferation by cell counting, both medical-grdde calcium sulfate group and plaster group showed no stastically significant difference at day 1, 2, 3 accept for plaster group at day 1 compared to control group, but there was stastically significant difference between CS paste group and all other groups at day 1, 2, 3(P<0.05). 2. In the analysis of cytotoxicity by MIT assay, both medical-grade calcium sJlfate group and plaster group showed no stastically significant difference compared to control group at day 1, 2, 3 but there was stastically significant difference between CS paste group and all other groups at day 1, 2, 3(P<0.OS). 3. In the analysis of collagen synthesis by immunoblotting assay, high level was detected for medical-grade calcium sulfate group and plaster group at day 1, 2, 3 compared to CS paste group. On the basis of these results, medical-grade calcium sulfate and plaster was shown to possess biocompatibility whereas the CS paste had unfavourable outcome. This observation shows a need for modification of the materials contained in calcium sulfate paste.
Numerous bone graft materials have been used in Periodontics, in an attempt to reach the main goal of periodontal therapy, i.e. the regeneration of periodontal tissue lost due to destructive periodontal diseases. The present study investigates the effect of composite graft of DFDB and Calcium sulfate with and without Calcium sulfate barrier in Periodontal 1-wall intrabony defects in dogs. Following the initiation of general anesthesia by I.V. administration of 40mg/Kg of Pentobabital, second premolar was extracted and full thickness flap elevated. The crown portion of premolars was removed. Exposed root canals were sealed with Caviton and covered completely with flap. After the healing period of 8 weeks, the surgical sites were re-opened and 1-wall intrabony defects were created, and treated with flap operation alone(control group), with composit graft of 80% DFDB and 20% Calcium sulfate(Experimental group 1), with composite graft of DFDB and calcium sulfate with calcium sulfate membrane( Experimental group 2). Healing response was histologically observed after 8 weeks and the results were as follows : 1. New bone formation was 70 % in the control group, 93 % in the Experimental group I, 89 % in the Experimental group II. There was a no differences between Experimental groups. 2. New cementum formation was not significantly different between control and two Experimental groups. 3. The length of connective tissue adhesion was 30 % in the control, 7% in the Experimental group I and 11 % in the Experimental group II. 4. After 8weeks, calcium sulfate was completely resorbed, while DFDB particle remained. These results suggest that the use of composite graft of allogenic DFDB and Calcium sulfate with and without Calcium sulfate barrier in periodontal 1 wall intrabony defects have little effect on connective tissue adhesion, but has beneficial effect on new alveolar bone and new cementum formation, and prevent downgrowth of epithelium and connective tissue effectively.
Surgical intervention in the posterior maxillary region requires detailed knowledge of maxillary sinus anatomy and the possible anatomical variations. This study evaluated the incidence, location of maxillary sinus septa by using radiographic (panoramic radiography and computed tomography) findings and comparison of panoramic radography with CT in antral anatomical variation. This study was based on data from 70 sinuses in partial dentate maxilla. The sample consisted of 61 patients(25 women and 36 men, with ages ranging between 19 and 77 years and a mean age of $49.4{\pm}11.3$ years) who were being treatment-planned to receive implant-supported restorations. First, the panoramic images were examined for the presence of antral septa by radiologist and examiner who don't know about CT findings. And incidence of antral septa was evaluated using an axial plane of CT image. The incidence of septa was compared between panoramic radiography and CT. The accuracy of the incidence was compared between radiologists and dentists. A total of 20 septa were found in 70 sinuses on CT image and the prevalence of one or more septa per sinus was found to be 28.6%. The assumed incidence of septa on panoramic radiography was $27.6%{\pm}2.2%$ in radiologist and $31.9%{\pm}5.8%$ in dentists. Erroneous diagnosis rate was 11.42% in radiologist and 15.96% in dentists. 40% of antral septa were located in the anterior(premolar) region, 30% of septa were located in the middle(first molar) and posterior(second molar) region separately. Prior to implant placement, it seems appropriate to consider panoramic radiography as a standard radiographic examination and periapical radiographs may be used to complete the findings in regions not sharply depicted in the panoramic radiograph. And cross-sectional imaging should be used in sites with severe bone loss and close proximity of the maxillary sinus.
Statement of the problem. The interest in all-ceramic restorations has increased as more techniques have become available. With the introduction of machinable dental ceramics and CAD/CAM systems or Copy-milling systems there is a need for evaluating the quality levels of these new fabrication techniques. Purpose. This study was to evaluate the fitting accuracy of machined all-ceramic crowns made out of an industrially prefabricated feldspathic porcelain. Material and Methods. Three master models with different cutting depth (0.8mm/1.0mm/1.2mm)were produced using a palladium-silver alloy. A total of 36 working dies, 12 of each form, was used for the modellation of prototype resin copings and 36 additional crowns, 12 of each cutting depth, were produced by using the $CEREC^{(R)}2$ system for all crowns. The maginal fit of all 72 crowns was then evaluated on their respective master die at 54 circularly staggered points of measurement per crown under a fixation pressure of 30 N by using a computerized video image system. Results. The medians of the copy-milled $CELAY^{(R)}$ crowns ranged from 29 to $36{\mu}m$. The highest value for the marginal gap was found in group B (cutting depth 1.0mm) at $107{\mu}m$. The median for the $CEREC^{(R)}2$ crowns was found between 43.5 and $70{\mu}m$. The maximum values for all three groups ranged from $181{\mu}m$ to $286{\mu}m$. With $286{\mu}m$ the highest value for marginal gap was found in group C. the Kruskal-Wallis test and multiple comparisons analysis procedure revealed a significant influence of the production technique on the marginal fit in all three groups (p<0,02). Conclusion. 1. The $CELAY^{(R)}$ system is capable to produce all-ceramic crowns with a significantly better marginal fit than the $CEREC^{(R)}2$ system. 2. As far as premolar crowns produced with the $CEREC^{(R)}2$ system are concerned, the cutting depth has a significant influence on fitting accuracy. 3. The production of crowns with an acceptable marginal fit is possible with both systems. However, adhesive luting is recommended for milled feldspathic porcelain crowns.
The Palatal masticatory mucosa was widely used as a donor site in periodontal and implant surgery. but there were relatively few studies investigating the thickness of the palatal mucosa in dentate subjects. The purpose of this study was to study the thickness of palatal masticatory mucosa in korean subjects by direct clinical technique. Forty systemically and periodontally healthy subjects(20 males:20 females) participated in this study. A bone sounding method using a periodontal probe with minimal anesthesia and a prepared clear acrylic stent was utilized to assess the thickness of palatal mucosa at 24 measurement points defined according to the gingival margin and mid palatal suture. The results are as follows; 1. Mean thickness of palatal masticatory mucosa was $3.5{\pm}0.4mm$. and no gender differences were identified in the thickness of palatal masticatory mucosa. 2. The thickness of palatal masticatory mucosa increased from canine to second molar area(with the exception of the first molar area). canine and first molar areas were significantly thinner than other areas(P<0.05). 3. The thickness of palatal masticatory mucosa significantly increased in the sites farther from the gingival margin towarding the mid-palate(P<0.05). The results suggest that within the limits of the present study, premolar area appears to be the most appropriate donor site for soft tissue grafting procedures.
Current acceptable methods for promoting periodontal regeneration are based on removal of diseased soft tissue. root treatment, guided tissue regeneration, introduction of new graft materials and biological mediators. Insulin-like growth factor-I(IGF-I) and Platelet-derived growth factor-BB(PDGF-BB), the members of the polypeptuyde growth factor family have been reported as the biological mediators which regulate a variety cellular matrix biologic activities of wound healing process including the cell proliferation, migration and extracellular matrix synthesis.The purposes of this study is to evaluate the combination effects of IGF-I and PDGF-BB on the cellular activity of the periodontal ligament cells to act as a regeneration promoting agent of periodontal tissue. Human periodontal ligament cells were prepared from the first premolar tooth extracted for the orthodontic treatment and were cultured in DMEM containing 10% FBS at the $37^{\circ}C$, 5% CO2 incubator. Author measured the DNA synthetic activity, and total protein, collagen and noncollagenous protein synthetic activities according to the concentration of 10,100ng/ml IGF-I and1,10 ng/ml PDGF-BB in combination. The results were as follows: Significantly increased in the 1 ng/ml PDGF-BB alone compared to the 10 ng/ml PDGF-BB alone(P<0.01) and in the 1 ng/ml PDGF-BB and 10, 100ng/ml IGF-I in combination compared to the 1 ng/ml PDGF-BB alone(P<0.05, P<0.0l). The synthetic activity of the total protein and collagen is significantly increased like to the synthetic activity of the DNA(P<0.05). The synthetic activity of the noncollagenous protein is increased according to the concentration of IGF_I, but not statistically statistically significant(P>0.05). The percent of the collagen is significantly in the 1ng/ml PDGF-BB and 10ng/ml IGF-I in combination compared to the 1ng/ml PDGF-BB alone(P<0.05) and in the 10ng/ml IGF-I in combination compared to the 10ng/ml PDGF-BB alone(P<0.05). The synthetic activity of the DNA is In conclusions, the percent study shows that PDGF-BB and IGF-I in combination have a potentiality to enhance the DNA synthesis and the total protein and collagen synthesis of The periodontal ligament cells, especially it is more significant in the low concentration of PDGF-BB compared to the high one. Thus, the PDGF-BB and IGF-I in combination may have important roles in promotion of periodontal litgment healing, and consequently, may useful for clinical application in periodontal regenerative procedures.
Regeneration of periodontal tissue after a loss of attachment due to disease or trauma repesents an important issue in dentistry, and various bone graft materials have been used to regenerated lost periodontal tissue and restore proper fuctions. Among those, allografts have been extensively researched and widely used clinically, since they are known to possess an excellent osteoinduction capability and result in proper topography of alveolar bone. Regeneration of periodontal tissue in supraalveolar defects may be technically difficult. However, a large amount of regeneration has been observed by complete tissue coverage of involved teeth. In this study, supraalveolar defects in adult dogs were treated with periodontal surgery, decalcified freez-dried bone allograft, complete tissue coverage was attained, and effects on repair and regeneration of alveolar bone, cementum and periodontal ligament were studied. Exposure of premolar furcation of adult dogs was attained by removing marginal alveolar bone down to 5mm from CEJ, and root surfaces were planed with curettes. On the left side, defects were treated without any allograft(Control Group). On the right side, a DFDB was used(Experimental Group). In all groups, flaps were coronally positioned and sutured, completely submerging the treated defects. At two weeks, the crown were exposed 2-3mm. Healing progresses were histologically observed after eight weeks and the results were as follows : 1. Distance from CEJ to AJE was : $2.82{\pm}0.66mm$ in the control group, $1.71{\pm}0.51mm$ in experimental group, with significant differences between groups.(P<0.01) 2. Periodontal repair was : $2.18{\pm}0.66mm$ in the control group, $3.29{\pm}0.51mm$ in experimental group, with significant differences between groups.(P<0.01) 3. Connective tissue repair was : $1.43{\pm}0.52mm$ in the control group, $0.76{\pm}0.47mm$ in experimental group, with significant differences between groups.(P<0.01) Orientation of connective tissue fibers in relation to root surfaces was : mostly parallel in the control group, vertical or parallel or irregular in experimental group. 4. The amount of cementum formation was : $1.66{\pm}0.58mm$ in the control group, $2.86{\pm}0.66mm$ in experimental group, with significant differences between groups. 5. The amount of alveolar bone formation was : $0.76{\pm}0.72mm$ in the control group, $2.53{\pm}0.56mm$ in experimental group, with significant differences between groups.(P<0.01)
Purpose: An animal periodontitis model is essential for research on the pathogenesis and treatment of periodontal disease. In this study, we have introduced a lipopolysaccharide (LPS) of a periodontal pathogen to the alveolar bone defect of experimental animals and investigated its suitability as a periodontitis model. Methods: Alveolar bone defects were made in both sides of the mandibular third premolar region of nine beagle dogs. Then, the animals were divided into the following groups: silk ligature tied on the cervical region of tooth group, Porphyromonas gingivalis LPS (P.g. LPS)-saturated collagen with silk ligature group, and no ligature or P.g. LPS application group as the control. The plaque index and gingival index were measured at 0 and 4 weeks postoperatively. The animals were then euthanized and prepared for histologic evaluation. Results: The silk ligature group and P.g. LPS with silk ligature group showed a significantly higher plaque index at 4 weeks compared to the control (P<0.05). No significant difference was found in the plaque index between the silk ligature group and P.g. LPS with silk ligature group. The P.g. LPS with silk ligature group showed a significantly higher gingival index compared to the silk ligature group or the control at 4 weeks (P<0.05). Histologic examination presented increased inflammatory cell infiltration in the gingival tissue and alveolar bone of the P.g. LPS with silk ligature group. Conclusions: An additional P.g. LPS-saturated collagen with silk ligature ensured periodontal inflammation at 4 weeks. Therefore, P.g. LPS with silk ligature application to surgically created alveolar bone defects may be a candidate model for experimental periodontitis.
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