• 대한치과보철학회지
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• 제45권1호
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• pp.71-84
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• 2007

Statement of problem: Implant surface characteristics plays an important role in clinical success and many studies have been made for improvement of success by changing surface roughness. Purpose: Appropriate increase of surface roughness increases the activity of osteoblast and enhance contact and retention between bone and implant. Material and method- Machined, SLA and RBM surface implants, which are the most commonly used implants were implanted into the tibia of rabbits and after 1 week, 4 weeks, 8 weeks and 12 weeks there were histologic and histomorphometric analysis and study for bone gradient and change of Ca/P ratio using EDS(Energy Dispersive X-ray Spectroscope). Results: Comparison of bone-implant contact showed no significant difference among each implant. In comparison of bone area rates, SLA showed higher value with significant difference at 1 week and 4 weeks, and SLA and RBM at 8 weeks than Machined implant (p<0.05). In analysis of bone constituents with EDS, titanium was specifically detected in new bones and the rates were constant by surface treatment method or period. In case of Ca/P ratio, according to surface treatment method, each group showed significant difference. Lots of old bone fragments produced during implantation remained on the rough surface of RBM implant surface and each group showed histological finding with active synthesis of collagen fibers until 12 weeks. In transmission electronic microscopic examination of sample slice after elapse of twelve weeks, tens nm of borderline (lamina limitans like dense line)was seen to contact the bone, on the interface between bone and implant. Conclusion: SLA and RBM implant with rough surface shows better histomorphometrical result and the trend of prolonged bone formation and maturation in comparison with Machined implant. In addition, implant with rough surface seems to be helpful in early stage bone formation due to remaining of old bone fragments produced in implantation. From the results above, it is considered to be better to use implant with rough surface in implantation.

• Journal of Periodontal and Implant Science
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• 제35권4호
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• pp.921-937
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• 2005

Mechanical and chemical methods are the two ways to treat the implant surfaces. By using mechanical method, it is difficult to eliminate bacteria and by-products from the rough implant surface and it can also cause the structural change to the implant surface. Therefore, chemical method is widely used in order to preserve and detoxicate the implant surface more effectively. The purpose of this study is to evaluate the effect of tetracylcline- HCl on the change of implant surface microstructure according to application time. Implants with pure titanium machined surface, SLA surface and $TiO_2blasted$ surface were used in this study. Implant surface was rubbed with sponge soaked in 50mg/ml tetracycline - HCl solution for $\frac{1}{2}$ min., 1min., $1\frac{1}{2}$ min., 2 min., and $2\frac{1}{2}min.$ respectively in the test group and with no treatment in the control group. The sponge was soaked in every 30 seconds. Then, the specimens were processed for scanning electron microscopic observation. Based upon the analysis of photographs by three dentists who are not related with this study, the results were obtained as follows; 1. In the pure titanium machined surfaces, the control specimen showed a more or less rough machined surface composed of alternating positive and negative lines corresponding to grooves and ridges. After treatment, machining line was more pronounced for the control specimens. but in general, test specimens were similar to control. 2. In the SLA surfaces, the control specimen showed that the macro roughness was achieved by large-grit sandblasting. Subsequently, the acid-etching process created the micro roughness, which thus was superimposed on the macro roughness. Irrespective of the application time of 50mg/ml tetracycline - HCl solution, in general, test specimens were similar to control. 3. In the $TiO_2blasted$ surfaces, the control specimen showed the rough surface With small pits. The irregularity of the $TiO_2blasted$ surfaces with 50mg/ml tetracycline - HCl solution was lessened and the flattened areas got wider after 1 minute.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권5호
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• pp.396-405
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• 2001

Osseointegrated implants are used for the fixation of dental prosthesis with good long-term clinical results. In an attempt to improve the quantity and quality of the bone-implant interface, numerous implant modification have been used. Implants surface modifications have been used such as titanium-plasma sprayed, hydroxyapatite-coating, sandblasted, sandblasted and acid-etched, acid-etched. Rough surface implants have greater implant surface area and enhance the bone-implant interface and improve stabilization. The purpose of present study was to evaluate light microscopic and scanning microscopic examinations and removal torque value of newly developed calcium phosphate blast and acid-etched implant in the femur of rabbits. Titanium plasma sprayed(TPS) implant served as controls. After 12 weeks of healing of the femurs of 12 rabitts, the implant-containing segments of femur were removed on bloc and bone block including sections. Histologic examination and histomorphometric and removal torque values comparision were made for two implants. Obtained results are follows: 1. Newly developed calcium phosphate blasted and acid-etched implants were in close contact with bone under light microscopic examinations. 2. New implants showed mean bone-to implant contact 59.8%, whereas TPS implants showed mean bone-to implant contact 54.5% (statistically no difference p<0.05). 3. New implants showed mean bone density 56.7%, whereas TPS implants showed mean bone density 49.2% (statistically difference p<0.05). 4. New implants demonstrated mean removal torque values 40.5Ncm, whereas the mean removal torque values of TPS implants ranged 39.3Ncm. No statistical differences(p<0.05) were observed between two groups of implants nor was there any difference between the two implants at the clinical level.

• 대한치과보철학회지
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• 제48권1호
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• pp.28-40
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• 2010

연구 목적: 임플란트의 성공과 실패는 숙주 관련 요인, 위치 관련 요인, 수술 관련 요인, 임플란트 관련 요인, 수복물 관련 요인 등 다양한 인자에 의해 결정된다. 본 연구는 그 중 임플란트의 식립 위치, 골질, 임플란트 표면, 길이 및 직경, 초기 안정성, 보철물 유형이 생존율에 미치는 영향을 평가하여, 임플란트의 예후를 예측하는데 도움을 주고자 한다. 연구 재료 및 방법: 1991년 2월부터 2009년 5월 사이에 연세대학교 치과대학병원에서 5인의 외과의가 임플란트 수술을 시행하고, 1인의 보철 전문의에 의해 보철 수복이 이루어져 적어도 6개월 이상 보철물에 대한 주기적인 검사가 이루어진 879명환자, 2796개의 임플란트에 대한 후향적 연구를 시행하였다. 진료 기록부 및 방사선 사진을 통해 환자의 식립 당시 나이와 성별, 임플란트의 제조회사, 표면, 직경 및 길이, 식립 부위 및 골질, 초기 안정성, 보철물의 유형, 생존 기간에 관한 자료를 수집하였다. 이를 통해, 임플란트의 성공과 실패에 영향을 미치는 국소 인자의 유형, 분포 및 국소 인자와 생존율 간의 관계를 연구하였다. 생존율 분석은 Kaplan-Meier 생존 분석법을 이용하였으며, 평가 인자 내 항목들의 생존율 비교는 Chi-square test를 사용하였다. 또한, 임플란트의 실패 위험성을 평가하기 위해 오즈비 (odds ratio)를 구하였다. 결과: 1. 총 879명에게 식립된 2796개의 임플란트 중 150개가 실패하여 누적 생존율은 94.64%로 나타났다. 그 중 기계 절삭 표면 임플란트의 누적 생존율은 91.76%, 거친 표면 임플란트의 누적 생존율은 96.02% 이었다. 2. 식립위치, 임플란트의 표면 특성, 기계 절삭 표면 임플란트의 직경, 초기 안정성, 보철물 유형, 환자의 연령 및 성별이 생존율에 미치는 영향은 통계학적으로 유의하였다 (P<.05). 3. 식립 부위의 골질, 임플란트 제조사별 거친 표면 특성, 임플란트의 길이 및 기계 절삭 표면을 제외한 거친 표면 임플란트의 직경이 생존율에 미치는 영향은 통계학적으로 유의하지 않았다 (P>.05). 4. 특히, 실패율이 높은 경우는 상악 구치부에 식립 시 (8.84%), 기계 절삭 표면의 임플란트 식립 시 (8.24%), 기계 절삭 표면 임플란트 중 wide 직경을 사용하는 경우 (14.47%), 초기 고정이 불량한 경우 (28.95%), 상악에 implant retained overdenture (기계 절삭 표면 26.69%; 거친 표면 10%) 및 telescopic denture (기계 절삭 표면 100%; 거친 표면 27.27%)로 수복하는 경우, 60-79세 환자에게 식립하는 경우 (6.90%), 남성에게 식립하는 경우 (6.36%) 이었다.

• Journal of Periodontal and Implant Science
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• 제38권sup2호
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• pp.309-316
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• 2008

Purpose: The aim of this study was to determine the survival rates of implants placed in grafted maxillary sinuses and compare the results obtained with graft materials, implant surfaces and timing of implant placement. Materials and Methods: Between January 1996 and December 2005, 391 implants were placed in 161 patients who underwent sinus grafting treatment simultaneously or separately at Ewha Womans University Hospital. According to inclusion criteria, 272 implants were placed in 102 patients with 112 sinus grafts (30 females, 72 males), aged 26 to 88 years (mean age $49.0{\pm}9.7$). The follow-up period ranged from 12 to 134 months (mean F/U $47{\pm}32$). Survival rates were evaluated according to graft material, implant surface and timing of implant placement. The Kaplan-Meier procedure and the log rank (Mantel-Cox) test were used to estimate survival rates and test for equality of survival rates between different groups of patients. Results: Ten-year cumulative survival rate for implants placed in the grafted sinuses was 90.1%. The survival rates for autogenous bone, combination and bone substitutes were 94.6%, 85.9% and 100%, respectively (p > 0.05). According to implant surface, survival rates were 84.8% in machined group and 97.5% in rough group (p < 0.05). The survival rates were 92.9% in delayed group and 86.0% in simultaneous group (p > 0.05). Conclusion: Ten-year cumulative survival rate for implants placed in the grafted sinuses was 90.1%. Rough-surfaced implants have a higher survival rate than machined-surfaced implants when placed in grafted sinuses (p < 0.05).

• Journal of Periodontal and Implant Science
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• 제38권sup2호
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• pp.385-394
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• 2008

Purpose: The aim of this study was to evaluate the factors affecting healing patterns of surgically created circumferential gap defects around implants in dogs. Materials and Methods: In four mongrel dogs, all mandibular premolars were extracted. After 8 weeks of healing periods, implants were submerged. According to the surface treatment, turned surface was designated as a group A and rough surface as a group B. In each dog, surgical defects on the left side were made with a customized tapered step drill and on the right with a customized paralleled drill. Groups were also divided according to the width of the coronal gaps: 1.0mm, 1.5mm, or 2.0mm. The dogs were sacrificed following 8 weeks and the specimens were analyzed histologically and histomorphometrically. Results: During the postoperative period, healing was uneventful and implants were well-maintained. As the size of the coronal gap was increased, the amount of bone-to-implant contact was decreased. The bone healing was greater in rough surface implants compared to the turned ones. About the defect morphology, tapered shape showed much bone healing and direct bone to implant contact even in the smooth surface implants. Conclusion: Healing of the circumferential defect around dental implant is influenced by the implant surface, defect width and the morphology of the defect. When using rough surface implants, circumferential gap defects within 2 mm do not need any kinds of regenerative procedures and the healing appeared to be faster in the tapered defect morphology than the paralleled one.

• Journal of Periodontal and Implant Science
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• 제24권1호
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• pp.131-143
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• 1994

구강내 노출된 임프란트를 건강한 상태로 유지하기 위해서는 임프란트 매식체 표면을 처치하여 주위조직과 잘 적합할 수 있는 표면구조를 만들어 주어야 한다. 실패한 임프란트의 처리방법으로 구연산이나 air-abrasive system과 같은 여러 가지 방법이 소개 되었으나 HA 피막 처치된 임프란트와 같은 거친 표면이 구강내로 노출된 경우에는 구연산이나 air-abrasive system을 이용한 표면 처리방법을 세균독소 제거에는 효과적이나 HA 피막 처리된 매식체의 거친 표면 제거는 어렵기 때문에 계속되는 치태침착을 방지하기에는 효과적이지 못하므로 세균독소를 제거하는 한편 표면성상을 변화시키지 않고 평활한 표면을 만들기 위한 처리방법들을 알아보고자 하였다. IMZ사에서 제작한 HA 피막 처리된 disc에 high speed diamond bur, low speed diamond bur, stone bur, rubber point, jetpolisher를 처치하고 표면평활도를 알아보기 위하여 표면조도측정 및 주사전자현미경으로 표면상태를 관찰하고 표면성분 변화 유무를 알아보기 위하여 EDX를 이용하여 표면성분을 분석한 결과 다음과 같은 결과를 얻었다. 각 시편에 대한 표면조도 측정 결과는 실험 I군 $2.11{\mu}m$, 실험 II군 $4.17{\mu}m$, 실험 III군 $7.28{\mu}m$, 실험 IV군 $8.61{\mu}m$, 실험 V군 $39.44{\mu}m$의 최대높이값을 나타내므로써, I, II, III, IV, V군 순으로 표면이 평활하게 나타났다. 주사전자현미경 관찰에서는 실험 I군은 비교적 평활한 면을 보였고, 실험 II군은 HA 입자가 거의 삭제되었으나 잔존하는 일부의 HA 입자로 인하여 I군보다 약간 거친 표면을 보였다. 실험 III군과 IV군은 삭제되지 않고 잔존하는 HA 입자가 많아 거친 양상을 보였으며 실험 V군인 HA 피막 처리된 면의 경우는 깊은 홈과 돌출된 부분을 가진 매우 불규칙한 표면 구조를 보였다. 시편의 단면 관찰에서는 실험 I군은 균일한 면을 보였으며 실험 III군과 IV군에서는 삭제되지 않고 잔존하는 다량의 HA 입자로 인해 거친 표면을 보였으나 HA 피막의 두께는 상당량 감소되어 나타났다. 또한 실험 II군과 I군과 유사한 양상을 보였다. 실험 V군의 경우는 일정하지는 않지만 약 $40{\mu}m$의 두께를 보였다. EDX에 의한 표면성분 분석 결과, 삭제가 가장 우수한 실험 II군에서는 calcium과 phosphorus가 소량 나타났고, 삭제가 완전하지 않은 실험 III, IV군에서는 calcium peak와 phosphorus peak를 보였다. 모든 군에 나타난 aluminum은 제조과정 중의 혼입으로 사료된다. 모든 실험군에서 titanium, aluminum, calcium, phosphorus 이외의 다른 성분은 나타나지 않았다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권6호
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• pp.514-523
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• 2006

The purpose of the present study was to evaluate the effects of several implant surface treatments to the bone formation, by placing Machined implants, 75${\mu}m$ Calcium phosphate-blasted implants and $Al_2O_3$-blasted and acid-etched implants in rabbit tibia through histomorphometric study. Two animals of each group were sacrificed at 2, 4, 8 weeks. The specimens containing the implants were dehydrated and embedded into hard methylmethacrylate plastic. Thereafter, the sections were ground to 50${\mu}m$. The specimens were stained with Villanueva bone stain for a light microscopic study. The results were as follows; 1. When the surface roughness of three different implants was measured by Surfcorder, the Ra of the Machined group, the RBM group and the SLA group was 0.16${\mu}m$, 0.44${\mu}m$, and 1.08${\mu}m$. 2. When examining the surfaces of the implants in the scanning microscope, Machined implant has the smooth surface with a few scratches, RBM implant has the rough surface with curled ridges and valleys, and SLA implant has the rough surface structures such as sharp protruding parts and micropits measuring 1-2${\mu}m$ in diameter. 3. After 2 weeks of implantation, the percentage of bone-to-implant contact of the Machined group, the RBM group and the SLA group was 26.86%, 35.40% and 45.99%. However, its differences between each group decreased during the healing periods. 4. After 2 weeks of implantation, the percentage of bone area inside the threads of the Machined group, the RBM group and the SLA group were 21.55%, 30.43% and 41.18%. However, its difference of bone area between machined group and surface treatment groups was maintained but the difference within the surface treatment groups decreased during the healing periods. In summary, the amount of bone formation in RBM and SLA group was greater than Machined group in early healing stage. These results suggest that RBM and SLA implants can reduce the healing period for osseointegration and may be suitable for early function.

• Journal of Periodontal and Implant Science
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• 제31권4호
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• pp.749-763
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• 2001

Osseointegrated titanium implants have become an integral therapy for the replacement of teeth lost. For dental implant materials, titanium, hydroxyapatite and alumina oxide have been used, which of them, titanium implants are in wide use today. Titanium is known for its high corrosion resistance and biocompatability, because of the high stability of oxide layer mainly consists of $TiO_2$. With the development of peri-implantitis, the implant surface is changed in surface topography and element composition. None of the treatments for cleaning and detoxification of implant surface is efficient to remove surface contamination from contaminated titanium implants to such extent that the original surface elemental composition. In this sights, the purpose of this study was to evaluate rough surface titanium implants by means of scanning electron microscopy(SEM) and X-ray photoelectron spectroscopy(XPS) with respect to surface appearance and surface elemental composition. Moreover, it was also the aim to get the base for treatments of peri-implantitis. For the SEM and XPS study, rough surface titanium models were fabricated for control group. Six experimental groups were evaluated: 1) long-time room exposure, 2 ) air-powder abrasive cleaning for 1min, 3) burnishing in citric acid(pH1) for 1min, 4) burnishing in citric acid for 3min, 5) burnishing in tetracycline for 1min, 6) burnishing in tetracycline for 3min. All experimental treatments were followed by 1min of rinsing with distilled water. The results were as follows: 1. SEM observations of all experimental groups showed that any changes in surface topography were not detected when compared with control group. (750 X magnification) 2. XPS analysis showed that in all experimental groups, titanium and oxygen were increased and carbon was decreased, when compared with control group. 3. XPS analysis showed that the level of titanium, oxygen and carbon in the experimental group 3(citric acid treatment for 1min, followed by 1min of distilled water irrigation) reached to the level of control group. 4. XPS analysis showed that significant differences were not detected between the experimental group 1 and the other experimental groups except of experimental group 3. The Ti. level of experimental group 2, airpowder abrasive treatment for lmin followed by 1min of saline irrigation, was lower than the Ti. level of tetracycline treated groups, experimental group 5 and 6. From the result of this study, it may be concluded that the 1min of citric acid treatment followed by same time of rinsing with distilled water gave the best results from elemental points of view, and can be used safely to treat peri-implantitis.

• Journal of Periodontal and Implant Science
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• 제32권3호
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• pp.615-630
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• 2002

Various long-term studies have shown that titanium implants as abutments for different types of prostheses have become a predictable adjunct in the treatment of partially or fully edentulous patients. The continuous exposure of dental implants to the oral cavity with all its possible contaminants creates a problem. A lack of attachment, together with or caused by bacterial insult, may lead to peri-implantitis and eventual implant failure. Removal of plaque and calculus deposits from dental titanium implants with procedures and instruments originally made for cleaning natural teeth or roots may cause major alterations of the delicate titanium oxide layer. Therefore, the ultimate goal of a cleaning procedure should be to remove the contaminants and restore the elemental composition of the surface oxide without changing the surface topography and harming the surrounding tissues. Among many chemical and mechanical procedure, air-powder abrasive have been known to be most effective for cleaning and detoxification of implant surface. Most of published studies show that the dental laser may be useful in the treatment of pen-implantitis. $CO_2$ laser and Soft Diode laser were reported to kill bacteria of implant surface. The purpose of this study was to obtain clinical guide by application these laser to implant surface by means of Non-contact Surface profilometer and X-ray photoelectron spectroscopy(XPS) with respect to surface roughness and atomic composition. Experimental rough pure titanium cylinder models were fabricated. All of them was air-powder abraded for 1 minute and they were named control group. And then, the $CO_2$ laser treatment under dry, hydrogen peroxide and wet condition or the Soft Diode laser treatment under Toluidine blue O solution condition was performed on the each of the control models. The results were as follows: 1. Mean Surface roughness(Ra) of all experimental group was decreased than that of control group. But it wasn't statistically significant. 2. XPS analysis showed that in the all experimental group, titanium level were decreased, when compared with control group. 3. XPS analysis showed that the level of oxygen in the experimental group 1, 3($CO_2$ laser treatment under dry and wet condition) and 4(Soft Diode laser was used under toluidine blue O solution) were decreased, when compared with control group. 4. XPS analysis showed that the atomic composition of experimental group 2($CO_2$ laser treatment under hydrogen peroxide) was to be closest to that of control group than the other experimental group. From the result of this study, this may be concluded. Following air-powder abrasive treatment, the $CO_2$ laser in safe d-pulse mode and the Soft Diode laser used with photosensitizer would not change rough titanium surface roughness. Especially, $CO_2$ laser treatment under hydrogen peroxide gave the best results from elemental points of view, and can be used safely to treat peri-implantitis.