Ho-Beom Kwon

Stress shielding and fatigue limits of poly‐ether‐ether‐ketone dental implants

The poly-ether-ether-ketone (PEEK) polymer is of great interest as an alternative to titanium in orthopedics because of its biocompatibility and low elastic modulus. This study evaluated the fatigue limits of PEEK and the effects of the low elastic modulus PEEK in relation to existing dental implants. Compressive loading tests were performed with glass fiber-reinforced PEEK (GFR-PEEK), carbon fiber-reinforced PEEK (CFR-PEEK), and titanium rods. Among these tests, GFR-PEEK fatigue tests were performed according to ISO 14801. For the finite element analysis, three-dimensional models of dental implants and bone were constructed. The implants in the test groups were coated with a 0.5-mm thick and 5-mm long PEEK layer on the upper intrabony area. The strain energy densities (SED) were calculated, and the bone resorption was predicted. The fatigue limits of GFR-PEEK were 310 N and were higher than the static compressive strength of GFR-PEEK. The bone around PEEK-coated implants showed higher levels of SED than the bone in direct contact with the implants, and the wider diameter and stiffer implants showed lower levels of SED. The compressive strength of the GFR-PEEK and CFR-PEEK implants ranged within the bite force of the anterior and posterior dentitions, respectively, and the PEEK implants showed adequate fatigue limits for replacing the anterior teeth. Dental implants with PEEK coatings and PEEK implants may reduce stress shielding effects. Dental implant application of PEEK polymer-fatigue limit and stress shielding.

Accuracy of dies captured by an intraoral digital impression system using parallel confocal imaging.

The purpose of this investigation was to measure the accuracy of digital impressions (DIs) compared to conventional impressions (CIs). Using the iTero system, a master cast was scanned to produce stereolithography dies. As a control group, silicone impressions were taken and poured using stone. The resulting stereolithography and stone dies were scanned and overlayed on the scanned reference image of the master cast. The mean (± standard deviation) dimensional difference to the master cast was 23.9 (± 17.6) ?m for DIs and 17.6 (± 45.6) μm for CIs. The results indicate that DIs also provides enough accuracy for clinical application.

Variation in the total lengths of abutment/implant assemblies generated with a function of applied tightening torque in external and internal implant–abutment connection

AIM Settling (embedment relaxation), which is the main cause for screw loosening, is developed by microroughness between implant and abutment metal surface. The objective of this study was to evaluate and compare the relationship between the level of applied torque and the settling of abutments into implants in external and internal implant-abutment connection. MATERIAL AND METHODS Five different implant-abutment connections were used (Ext, External butt joint + two-piece abutment; Int-H2, Internal hexagon + two-piece abutment; Int-H1, Internal hexagon + one-piece abutment; Int-O2, Internal octagon + two-piece abutment; Int-O1, Internal octagon + one-piece abutment). All abutments of each group were assembled and tightened with corresponding implants by a digital torque gauge. The total lengths of implant-abutment samples were measured at each torque (5, 10, 30 N cm and repeated 30 N cm with 10-min interval) by an electronic digital micrometer. The settling values were calculated by changes between the total lengths of implant-abutment samples. RESULTS All groups developed settling with repeated tightening. The Int-H2 group showed markedly higher settling for all instances of tightening torque and the Ext group was the lowest. Statistically significant differences were found in settling values between the groups and statistically significant increases were observed within each group at different tightening torques (P<0.05). After the second tightening of 30 N cm, repeated tightening showed almost constant settling values. CONCLUSIONS Results from the present study suggested that to minimize the settling effect, abutment screws should be retightened at least twice at 30 N cm torque at a 10-min interval in all laboratory and clinical procedures.

Panoramic radiographic evaluation of the mandibular morphological changes in elderly dentate and edentulous subjects

OBJECTIVE The aim of the present study was to analyze the changes in the gonial angle, ramus height, condyle height and cortical bone thickness in relation to gender and dental status in elderly patients. MATERIALS AND METHODS The study population comprised 240 patients (age ranged from 60-69 years) who had digital panoramic radiographs taken for various purposes. One group consisted of 120 patients, 60 men and 60 women, who had all natural teeth present except for third molars. The second group consisted of the remaining 120 patients (60 men and 60 women) who were in a completely edentulous state (maxilla and mandible). The gonial angle, ramus height, condylar height and cortical bone thickness of the mandible were measured by computer software on their panoramic radiographs. RESULTS Women showed larger gonial angles than men, while men had greater cortical bone thickness and ramus height (p < 0.05). However, no significant difference in condylar height was found between both genders (p > 0.05). Edentulous subjects had a larger gonial angle than dentate subjects, while dentate subjects had greater cortical bone thickness on both sides and left side of condylar height (p < 0.05). The gonial angle had statistically negative correlations with cortical bone thickness and ramus height, regardless of gender. CONCLUSIONS The outcomes of the present study indicate that the edentulous women undergo morphological changes of the mandible influenced by the dental status more than men.

Self-cutting blades and their influence on primary stability of tapered dental implants in a simulated low-density bone model: a laboratory study

OBJECTIVE This study tested the hypothesis that there would be differences in primary stability due to the presence of self cutting blades. We investigated the effect of a self-cutting blade implant design on the primary stability of tapered dental implants in a simulated low-density bone model. STUDY DESIGN Implant fixtures with 2 different designs, one with self-cutting blades and the other without self-cutting blades, were fabricated in the same implant system. Insertion torque, resonance frequency analysis, reverse torque, and pull-out and push-in tests were evaluated in grade no. 10 solid rigid polyurethane foam. RESULTS All 5 assessments of the group without self-cutting blades were significantly higher than those of the self-cutting group (P < .001). CONCLUSIONS The implants without self-cutting blades create a lateral compression with increased contact surface area and consequently improve the primary stability in a simulated low-density bone model.

Gender differences in dentofacial characteristics of adult patients with temporomandibular disc displacement.

PURPOSE The purpose of this study was to assess gender differences in dentofacial characteristics of adult patients according to temporomandibular joint (TMJ) disc displacement (DD) status. MATERIALS AND METHODS The sample consisted of 293 adult patients (80 male and 213 female). Male and female patients were divided into 3 groups based on magnetic resonance images of bilateral TMJs: bilateral normal disc position (BN), bilateral DD with reduction (DDR), and bilateral DD without reduction (DDNR). Seventeen variables from lateral cephalograms were analyzed by 2-way analysis of variance to identify differences in dentofacial morphologies with respect to gender and TMJ DD status. RESULTS Patients with TMJ DD had short ramus height, short mandibular body length, and backward positioning of the ramus and mandible. These dentofacial characteristics became more severe as TMJ DD progressed to DDNR. In addition, dentofacial characteristics associated with TMJ DD were not significantly different between men and women except for effective mandibular length (Articulare to pogonion). Effective mandibular length even tended to decrease as TMJ DD progressed, but male patients showed a larger difference in effective mandibular length between BN and DDR than female patients. CONCLUSIONS This studys findings suggest that dentofacial morphology is strongly associated with TMJ DD status and that skeletal Class II hyperdivergent pattern with a short ramus and mandible may be a potential indicator of TMJ DD regardless of gender.

Current status of dental caries diagnosis using cone beam computed tomography.

Purpose The purpose of this article is to review the current status of dental caries diagnosis using cone beam computed tomography (CBCT). Materials and Methods An online PubMed search was performed to identify studies on caries research using CBCT. Results Despite its usefulness, there were inherent limitations in the detection of caries lesions through conventional radiograph mainly due to the two-dimensional (2D) representation of caries lesions. Several efforts were made to investigate the three-dimensional (3D) image of lesion, only to gain little popularity. Recently, CBCT was introduced and has been used for diagnosis of caries in several reports. Some of them maintained the superiority of CBCT systems, however it is still under controversies. Conclusion The CBCT systems are promising, however they should not be considered as a primary choice of caries diagnosis in everyday practice yet. Further studies under more standardized condition should be performed in the near future.

The effect of various thread designs on the initial stability of taper implants

STATEMENT OF PROBLEM Primary stability at the time of implant placement is related to the level of primary bone contact. The level of bone contact with implant is affected by thread design, surgical procedure and bone quality, etc. PURPOSE The aim of this study was to compare the initial stability of the various taper implants according to the thread designs, half of which were engaged to inferior cortical wall of type IV bone (Group 1) and the rest of which were not engaged to inferior cortical wall (Group 2) by measuring the implant stability quotient (ISQ) and the removal torque value (RTV). MATERIAL AND METHODS In this study, 6 different implant fixtures with 10 mm length were installed. In order to simulate the sinus inferior wall of type IV bone, one side cortical bone of swine rib was removed. 6 different implants were installed in the same bone block following manufacturers recommended procedures. Total 10 bone blocks were made for each group. The height of Group 1 bone block was 10 mm for engagement and that of group 2 was 13 mm. The initial stability was measured with ISQ value using Osstell mentor® and with removal torque using MGT50 torque gauge. RESULTS In this study, we found the following results. 1. In Group 1 with fixtures engaged to the inferior cortical wall, there was no significant difference in RTV and ISQ value among the 6 types of implants. 2. In Group 2 with fixtures not engaged to the inferior cortical wall, there was significant difference in RTV and ISQ value among the 6 types of implants (P < .05). 3. There was significant difference in RTV and ISQ value according to whether fixtures were engaged to the inferior cortical wall or not (P < .05). 4. Under-drilling made RTV and ISQ value increase significantly in the NT implants which had lower RTV and ISQ value in Group 2 (P < .05). CONCLUSIONS Without being engaged to the inferior cortical wall fixtures had initial stability affected by implant types. Also in poor quality bone, under-drilling improved initial stability.

Gender difference in speech intelligibility using speech intelligibility tests and acoustic analyses.

PURPOSE The purpose of this study was to compare men with women in terms of speech intelligibility, to investigate the validity of objective acoustic parameters related with speech intelligibility, and to try to set up the standard data for the future study in various field in prosthodontics. MATERIALS AND METHODS Twenty men and women were served as subjects in the present study. After recording of sample sounds, speech intelligibility tests by three speech pathologists and acoustic analyses were performed. Comparison of the speech intelligibility test scores and acoustic parameters such as fundamental frequency, fundamental frequency range, formant frequency, formant ranges, vowel working space area, and vowel dispersion were done between men and women. In addition, the correlations between the speech intelligibility values and acoustic variables were analyzed. RESULTS Women showed significantly higher speech intelligibility scores than men and there were significant difference between men and women in most of acoustic parameters used in the present study. However, the correlations between the speech intelligibility scores and acoustic parameters were low. CONCLUSION Speech intelligibility test and acoustic parameters used in the present study were effective in differentiating male voice from female voice and their values might be used in the future studies related patients involved with maxillofacial prosthodontics. However, further studies are needed on the correlation between speech intelligibility tests and objective acoustic parameters.

Three-dimensional finite element analysis of implant-supported crown in fibula bone model

PURPOSE The purpose of this study was to compare stress distributions of implant-supported crown placed in fibula bone model with those in intact mandible model using three-dimensional finite element analysis. MATERIALS AND METHODS Two three-dimensional finite element models were created to analyze biomechanical behaviors of implant-supported crowns placed in intact mandible and fibula model. The finite element models were generated from patients computed tomography data. The model for grafted fibula was composed of fibula block, dental implant system, and implant-supported crown. In the mandible model, same components with identical geometries with the fibula model were used except that the mandible replaced the fibula. Vertical and oblique loadings were applied on the crowns. The highest von Mises stresses were investigated and stress distributions of the two models were analyzed. RESULTS Overall stress distributions in the two models were similar. The highest von Mises stress values were higher in the mandible model than in the fibula model. In the individual prosthodontic components there was no prominent difference between models. The stress concentrations occurred in cortical bones in both models and the effect of bicortical anchorage could be found in the fibula model. CONCLUSION Using finite element analysis it was shown that the implant-supported crown placed in free fibula graft might function successfully in terms of biomechanical behavior.