• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.2
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• pp.209-222
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• 2011

Missing anterior teeth can be replaced using any of a number of methods. Patients may choose to replace missing teeth with a prosthesis that is either removable, fixed, or retained with implants. For patients faced with financial, anatomical, and/or esthetic limitations, the edentulous region can be restored successfully and esthetically with a properly designed and fabricated rotational path RPD. The rotational path RPD is a partial removable dental prosthesis that incorporates a curved, arcuate, or variable path of placement allowing one or more of the rigid components of the framework to gain access to and engage an undercut area. The rigid retainer must gain access to the infrabulge portion of the tooth by rotating into place. Either a minor connector or proximal plate provides retention through its intimate contact with a proximal tooth surface. A specially designed dovetails or asymmetric rest seats provides support and embracing effects. Correctly designed and fabricated rotational path RPD can provide improved esthetics, cleanliness, and retention. But rotational path RPDs are technique sensitive since the rotational path RPD has little margin of laboratory error that rigid retainers cannot be adjusted like conventional clasps can, RPD framework must be remade once the retention is lost. The sufficient understanding of the concept for the rotational path RPD is required for clinically successful treatment. This clinical report describes in detail the theoretical, laboratory considerations and the treatment of a patient with an anterior maxillary edentulous area treated by an AP path rotational RPD that had a difficulty in long term maintenance and describes another clinical case in which more reasonable treatment procedures were approached after analyzing the former case.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.8 no.1
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• pp.10-14
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• 2012

Self-injurious behavior (SIB) has been defined as the deliberate destruction or alteration of body tissue without conscious suicidal intent. It occurs in conjunction with a variety of psychiatric disorders as well as various developmental disabilities and some syndromes. The behavior is destructive and causes concern and distress to all involved in the care and treatment of the affected individual. A 13-year-old girl with autism, mental retardation and delayed development was reffered from her pediatrician because of severe and painful lower lip biting. An intraoral examination revealed a diffuse swelling of lower lip. It was covered with necrotic slough and the ulcer and scarring of the lower lip was observed. We chose to use an oral removable prosthesis for Conservative treatment. It was decided to use a soft silicone mouthguard in the maxillary arch. Initially, she could not tolerate the appliance inside her mouth but soon adapted with the appliance. After one month, she lost the mouth guard and started lip biting. So we made mouth guard again. There are no standard methods for preventing self-injurious behavior in a patient who is developmentally disabled. Appropriate preventive methods must be developed for each individual patient based on close observation and clinical findings. Behavior modification techniques, pharmacological treatment, extraction of teeth, orthognathic surgery and intra/extra oral appliances can be performed for adjust self-injurious behavior. A suitable oral guard could be tried initially before employing more invasive approaches.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.6
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• pp.569-576
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• 2008

STATEMENT OF PROBLEM: While patient-centered outcomes are usually not reported, these may represent major aspects of the implant success for the patient. Use of a well-designed patient survey form can be an invaluable asset to the implant practitioners. PURPOSE: The objective of this study was to investigate patient satisfaction after implant therapy by means of a questionnaire. MATERIAL AND METHODS: South Korean patients (n = 100), who visited the dental examination center of Soon Chun Hyang university hospital, were asked to fill out the satisfaction questionnaire regarding aspects of cost, comfort, esthetics, chewing, gingival health, food impaction, phonetic aspect, screw loosening, and general satisfaction. Responses to statements were given on the Likert response scale. Four experimental groups of patients were distinguished with various location ($A_1,\;A_2,\;A_3$), year ($B_1,\;B_2,\;B_3$), number of implant replacements ($C_1,\;C_2,\;C_3$), and treatment cost ($D_1,\;D_2,\;D_3$). The reliability of the response scales was measured by calculation of its internal consistency, expressed as Cronbach's ${\alpha}$. The scales were distinguished by means of factor analysis method. Possible differences in scale scores among the groups were assessed by One-way ANOVA (${\alpha}$= 0.05). RESULTS: Patients responded to most of the statements with high satisfaction. But the mean scale score of statement about cost was low. After the verification of internal consistency and factor analysis, five components, e.g. general satisfaction, comfort, chewing efficiency, esthetics, and phonetic aspect were grouped together. These components could be explained with common meaning and the first factor was named as 'general satisfaction'. Differences in patient satisfaction on the scale with esthetics were present between patients who have been wearing the implant prosthesis less than three years and those more than seven years ($B_1<B_3$). CONCLUSION: The patients were generally satisfied with the outcome of implant treatment. But the patients' major complaint was high cost and while the statistically significant difference was not shown, the satisfaction scale about food impaction and esthetics was low. So the continuing efforts to make improvements about these problems are needed for the implant practitioners.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.4
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• pp.263-273
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• 2016

In the implant prosthetic procedure, the soft tissue reaction was varied with the material and surface treatment of the abutment. It may be the cause of the peri-implantitis, and hence it can affect the long-term prognosis of the implant prosthesis. Titania and zirconia abutment presented superior biocompatibility and stable soft tissue reaction, while gold alloy abutment showed unfavorable reaction sometimes. A soft tissue reaction can be differed by the surface characteristics even in the same material type. Because rougher surface induces a bacterial attachment, the part contacting a soft tissue should have smooth surface. Additional surface treatment can enhance the cellular response without increasing bacterial attachment. Repeated removal and insertion of the abutment and the shape of the abutment may affect the soft tissue reaction, also. Ultrasonic cleaning and argon plasma cleaning are effective way to clean the retained micro-dust on the customized abutment.

• The Journal of Korean Academy of Prosthodontics
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• v.59 no.4
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• pp.431-441
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• 2021

Full-mouth rehabilitation with increasing vertical dimension can be used for patients with severely worn teeth. In severely worn teeth also, the alveolar process can be elongated to compensate for the reduced vertical dimension, and the patient's vertical dimension of occlusion can be kept constant. However, full-mouth rehabilitation with increasing vertical dimension must be carefully chosen, because the vertical dimension can be reduced by tooth wear. It is important to establish a treatment plan with the systematic diagnosis of the change in the vertical dimension and gain space for the prosthesis. It is necessary to change the vertical dimension to secure the restoration space and select the minimum vertical dimension elevation for the esthetic and functional goal. In this case report, the patient complained of difficulty during chewing due to a worn dentition and wanted esthetic improvement of the short mandibular anterior teeth. After systematic evaluation and diagnosis, we performed full-mouth rehabilitation with minimum vertical dimension elevation to obtain the space for restoration. This resulted in a stable and harmonious occlusion, and the functional and esthetic problems of the patient were solved after treatment. The patient was satisfied with the results of the treatment and maintained stable occlusion during the follow-up period.

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.2
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• pp.160-170
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• 2019

The anterior guidance is one of the important factors in prosthodontic treatment of anterior teeth. The lingual surface shape of anterior restorations is so critical that small errors of treatment procedure can cause discomfort of the patient and disharmony of the dentition. If the anterior restorations are achieved harmonious anterior guidance through the fabrication and adjustment of provisional restorations, it is important to accurately reproduce the lingual surface shape of provisional restorations as the final prosthesis. In this case report, it was used the modified Dahl principle and copy-milled technique of computer-aided design/computer-aided manufacturing (CAD/CAM) system for systematic diagnosis and treatment. Therefore, we tried to reconstruct the restoration shape more precisely by setting the appropriate anterior guidance and superimposing the digital image of the abutment teeth and the provisional restorations. Thus, by promoting functional and esthetic recovery, this case report demonstrates satisfying results to both the patients and dentist.

• Journal of Dental Rehabilitation and Applied Science
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• v.37 no.4
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• pp.186-198
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• 2021

As the increased certainty of osseointegration, new parameters are now being used to assess implant success. Accordingly, patients' and clinicians' high demands and expectation for esthetics have expanded and implant-supported restorations show better esthetic outcomes. The pre-implant treatment planning process, the implant surgical steps and the post-surgery prosthetic process can affect all esthetic outcomes. Prevention of esthetic implant failures can be achieved by appropriate treatment at each stage, considering the 3 factors of alveolar bone, soft tissue, and implants. It is necessary to achieve the esthetic implant prostheses followings: minimal invasive surgery, bone augmentation, ideal 3-dimensional implant position, peri-implant soft tissue management, and provisional restorations to optimize peri-implant soft tissue architecture.

• The Journal of Korean Academy of Prosthodontics
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• v.60 no.4
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• pp.395-403
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• 2022

In the fracture operation of pan facial fracture, there are many cases where the shape and position of the occlusal and oral structures are abnormally changed because the index for repositioning to the original position is insufficient. And trismus and gag reflex in patients with pan facial fractures increase the difficulty of dental treatment, and the difference in the position of the jaw bone makes it difficult to restore aesthetically and functionally. In this case, digital workflows for minimal intraoral work could be selected to reduce patient discomfort and the difficulty of dental treatment. This case is using a digital workflow from implant planning to final prosthesis production in a patient with acquired skeletal grade III, trismus, and gag reflex due to pan facial fracture 15 years ago. In this case report, the use of digital workflow in a patient who has difficulty in dental treatment was able to minimize patient discomfort and obtain esthetic and functionally appropriate results.

• Journal of Dental Rehabilitation and Applied Science
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• v.40 no.3
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• pp.179-188
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• 2024

To enhance the predictability of aesthetic treatment outcomes in aesthetic prosthetic restorations, considerations must include analysis of facial features, the relationship between teeth and lips, proportions of tooth width/length, gingival form, and more. Traditional diagnostic wax-ups have limitations in considering the patient's facial features and are unable to facilitate rapid form modifications. With recent advancements in digital technology, it is now possible to digitize the patient's facial features in three dimensions, enabling the design of restorations that harmonize with facial features. These digital workflows not only improve efficiency but also provide patients with faster visualization of treatment outcomes, thereby enhancing motivation. Therefore, in this case, a treatment plan is devised to utilize digital diagnostic wax-ups considering the patient's facial features for the final prosthetic design.