Hyun-Suk Cha

Simultaneous sinus lift and implant installation: prospective study of consecutive two hundred seventeen sinus lift and four hundred sixty-two implants.

PURPOSE If less than 4 mm of residual bone is remained in posterior maxilla, two-stage operation is recommended for implant installation. However, if primary stability could be obtained using tapered designed implants, one-stage surgery could be performed with reliable success rate in severely resorbed maxilla. The purpose of this prospective study was to evaluate survival and success rates of the implants simultaneously placed into grafted sinus using rough-surfaced implant. MATERIALS AND METHODS A total of two hundred seventeen consecutive sinus lifting through lateral approach and four hundred sixty-two simultaneous implants were installed from November 2003 for 5.5 years. Xenogenic bone was used solely for bone graft materials. Second surgery was performed around 6 months after operation and porcelain fused metal or gold crown was used for definitive restorations. Cumulative survival and success rates were evaluated according to residual alveolar bone height (RABH), smoking status, and Schneiderian membrane perforation. RESULTS The mean follow-up was 57.1 ± 15.6 (36-98) months. Of the four hundred sixty-two implants, two hundred sixty-two implants (56.7%: group 1) were installed in posterior maxilla less than 4-mm RABH and two hundred implants (43.3%: group 2) were placed in over 5-mm RABH. The cumulative survival and success rates were 98.91% and 96.54%. There was no statistically significant difference in success rate between group 1 and group 2 (p = .3135). Perforation of the membrane was not related to success (p = .7162), but smoking status is significantly related with implant failure (p = .0003). CONCLUSIONS Sinus lifting with simultaneous implant placement could be used to treat atrophic maxilla in patients with minimal RABH when initial stability could be obtained by using taper designed implants with surgical techniques. Smoking is a possible factor for implant failure. Membrane perforation did not have an adverse effect on implant success if the membrane was repaired with absorbable membrane and fibrin glue.

Three-dimensional interpretation of intercanine width change in children: A 9-year longitudinal study

INTRODUCTION The immutability of intercanine width has long been the subject of discussion. The aims of this study were to describe the longitudinal intercanine width changes of children from 6 to 14 years of age and to interpret them with a 3-dimensional method. METHODS Complete dental stone casts were annually prepared for 66 subjects (50 girls, 16 boys) from 6 to 14 years of age. By using 3-dimensional laser scanning and reconstruction software, virtual casts were constructed. Intercanine width was measured as well as the related 3-dimensional measurements, such as the area of the intercanine triangle, the intercanine angle, the radius of the inscribed circle, and the angles formed by the virtual axes of the canines and the occlusal plane. The measurement changes over time were analyzed by using mixed-effects analysis for longitudinal data. RESULTS There were slight decreases in intercanine widths for both sexes and both arches. However, the amounts of change were relatively small when compared with the initial values and individual random variability. The values of area, the angles formed by the virtual axes of the canines and the occlusal plane, and the radius showed decreasing trends, whereas the intercanine angle exhibited increasing trends during the observation period. Although the intercanine width changed over time, it was not clinically significant, showing relative stability. CONCLUSIONS The intercanine width of an untreated subject after stabilization in the mouth is considered to be quite stable, even though individual variation is great.

Curing efficiency of various resin-based materials polymerized through different ceramic thicknesses and curing time

PURPOSE The aim of this in vitro study was to examine the curing efficiency of various resin-based materials polymerized through ceramic restorations with 3 different thicknesses. Curing efficiency was evaluated by determining the surface microhardness (VHN) of the resin specimens. MATERIALS AND METHODS Four kinds of resin materials were used. Z350 (3M ESPE Filtek™ Z350: A2 Shade), Z250 (3M ESPE Filtek™ Z250: A2 Shade) and Variolink® II (VL: Ivoclar vivadent, base: transparent) either with or without a self-curing catalyst (VLC: Ivoclar vivadent, catalyst: low viscosity/transparent) were filled into the silicone mold (10 mm diameter, 1 mm thick). They were cured through ceramic discs (IPS e.max Press MO-0 ingot ivoclar vivadent, 10 mm diameter, 0.5, 1 and 2 mm thicknesses) by LED light-curing units for 20 and 40 seconds. Vickers microhardness numbers (VHNs) were measured on the bottom surfaces by a microhardness tester. Data were analyzed using a 3- way analysis of variance (ANOVA) at a significance level of 0.05. RESULTS The thickness of ceramic disc increased, the VHNs of all four resin types were decreased (P<.05). The mean VHN values of the resins light cured for 40 seconds were significantly higher than that of LED for 20 seconds in all four resin materials (P<.05). VLC showed significantly higher VHN values than VL regardless of other conditions (P<.05). Z350 and Z250 showed higher values than VL or VLC (P<.01). CONCLUSION Thinner ceramic disc with increased curing time resulted higher VHN values of all resin materials. The use of a catalyst produced a greater hardness with all polymerization methods. Restorative resin materials (Z350, Z250) showed higher VHN values than resin cement materials (VL, VLC).

Immediate free iliac bone graft after nonsegmental mandibular resection and delayed implant placement: a case series.

Background:Resection of mandibular tumors without proper reconstruction may lead to unfavorable esthetic and function results. The purpose of this case series was to describe clinical results and a technique to prevent tissue loss using nonvascular iliac grafts immediately following tumor resection and long-term stability of the implants. Materials and Methods:Three female patients presented with oral neoplasms (2 ameloblastoma and 1 ossifying fibroma). The mandibular reconstruction was performed with nonvascularized iliac grafts simultaneous with tumor removal. Subsequently, 10 dental implants were placed 6 to 9 months after reconstruction and restored. Survival and success of the implants were evaluated. Results:Marginal mandibulectomy in 1 patient and buccal bone resection in 2 patients was performed; the resection sites were reconstructed with an immediate nonvascularized iliac graft. All implants survived and were successful during follow-up periods between 44 and 105 months. Mean marginal bone loss of 10 implants was 0.09 mm. Conclusions:Immediate reconstruction with nonvascularized iliac grafts following tumor resection may be a viable treatment option for nonsegmental inlay osseous defects. In these case series, the resorption of the iliac bone was minimal after 6 to 9 months consolidation periods.

Osteonecrosis of the jaw after implant surgery in patients treated with bisphosphonates--a presentation of six consecutive cases.

BACKGROUND Osteonecrosis of the jaws in patients treated with bisphosphonates is mostly associated with intravenous bisphosphonates while the incidence associated with oral bisphosphonates is not significant. PURPOSE The purpose of this paper is to describe a series of cases of jaw osteonecrosis that may be associated with dental implant placement in patients who had taken nitrogen containing bisphosphonates via oral and/or intravenous route. PATIENTS Six female patients were treated for osteonecrosis of the jaw after implant placement. An average age was 71.8 ± 6.5 years old and they had a history of bisphosphonate use. Two patients suffered from cancer and the other patients had osteoporosis. Two osteoporosis patients had taken only oral bisphosphonate and the other patients received intravenous bisphosphonates. RESULTS Resection of necrotized bone, implant removal, and primary closure were performed in five patients and four patients showed uneventful healing. One patient presented recurrence at the maxilla and underwent further extraction and resection. One patient presented with an exposure of the bone after implant placement was treated with an advanced flap closure, and the implants were preserved. CONCLUSION Unusual jaw necrosis after dental implant surgery might be related with oral and/or intravenous bisphosphonates. Wide resection of necrotic bone, collagen graft, and primary closure are key factors for successful healing.

Three-dimensional finite element analysis of the deformation of the human mandible: a preliminary study from the perspective of orthodontic mini-implant stability

Objective The aims of this study were to investigate mandibular deformation under clenching and to estimate its effect on the stability of orthodontic mini-implants (OMI). Methods Three finite element models were constructed using computed tomography (CT) images of 3 adults with different mandibular plane angles (A, low; B, average; and C, high). An OMI was placed between #45 and #46 in each model. Mandibular deformation under premolar and molar clenching was simulated. Comparisons were made between peri-orthodontic mini-implant compressive strain (POMI-CSTN) under clenching and orthodontic traction forces (150 g and 200 g). Results Three models with different mandibular plane angles demonstrated different functional deformation characteristics. The compressive strains around the OMI were distributed mesiodistally rather than occlusogingivally. In model A, the maximum POMI-CSTN under clenching was observed at the mesial aspect of #46 (1,401.75 microstrain [µE]), and similar maximum POMI-CSTN was observed under a traction force of 150 g (1,415 µE). Conclusions The maximum POMI-CSTN developed by clenching failed to exceed the normally allowed compressive cortical bone strains; however, additional orthodontic traction force to the OMI may increase POMI-CSTN to compromise OMI stability.

Changes in stress relaxation property and softness of soft denture lining materials after cyclic loading

OBJECTIVES Soft denture lining materials show varied and changeable stress relaxation property and softness under cyclic loading conditions. The purpose of this study was to determine the changes in the stress relaxation property and the softness of commercial soft lining materials after cyclic loading. METHODS One plasticized acrylic-based material (Coe Soft: COS) and two silicone-based materials (Mucosoft: MUS; Sofreliner S: SFL) were investigated. For each material, 10 cylinder-shaped specimens were subjected to 29 days of cyclic loading, 1800 times per day; other 10 unloaded specimens were used as control groups. Stress relaxation ratio and softness were measured after 1, 4, 8, 15, 22 and 29 days of cyclic loading or storage. RESULTS During 29 day period, the stress relaxation ratios of the cyclic loaded and unloaded COS, MUS and SFL specimens were 28.5-31.6% and 30.9-32.6%, 6.4-15.1% and 1.8-15.4%, 14.0-38.2% and 19.8-40.6%, respectively. The softness values of the cyclic loaded and unloaded COS, MUS and SFL specimens were 42.6-60.6% and 56.4-61.8%, 47.6-52.5% and 46.9-51.5%, 56.6-58.4% and 58.0-65.1%, respectively. Based on repeated-measures, 3-way ANOVA, the stress relaxation ratio was influenced by the loaded or stored period and the type of material (p<0.05), but not by the application of cyclic loading; the softness value was influenced by the loaded or stored period and the application of cyclic loading (p<0.05), but not by the type of material. SIGNIFICANCE Soft lining materials showed the loaded or stored period and the material type dependent stress relaxation properties regardless of the application of cyclic loading. Softness value was influenced by the loaded or stored period and the application of cyclic loading.

Dexamethasone Delivery by an Implant-Mediated Drug Delivery System in the Canine Mandible

BACKGROUND A newly introduced implant-mediated drug delivery system (IMDDS) showed promising results in a rabbit tibia model. The aim of the present study is to evaluate whether dexamethasone administered by the IMDDS has sustained effects in the canine mandible - a different anatomic location, in a different species. METHODS IMDDS was installed at the mesial root of the second premolar site in the mandibles of six beagle dogs. After complete healing, 10 mg dexamethasone was administered through the IMDDS. The same amount of drug was administered to five control animals by intramuscular injection. The release pattern was monitored for 2 weeks by measuring plasma drug concentrations. RESULTS A sustained plasma dexamethasone concentration was detected after a peak at 6 hours until the end of the observation period, despite individual variations. The concentration was lower than reported in the rabbit tibia model. In contrast, plasma concentration of the control group showed an early peak at 2 hours and decreased rapidly. CONCLUSION Dexamethasone was effectively released from the IMDDS for a prolonged time in the canine mandible model.

Effect of silane activation on shear bond strength of fiber-reinforced composite post to resin cement.

PURPOSE Among the surface treatment methods suggested to enhance the adhesion of resin cement to fiber-reinforced composite posts, conflicting results have been obtained with silanization. In this study, the effects of silanization, heat activation after silanization, on the bond strength between fiber-reinforced composite post and resin cement were determined. MATERIALS AND METHODS Six groups (n=7) were established to evaluate two types of fiber post (FRC Postec Plus, D.T. Light Post) and three surface treatments (no treatment; air drying; drying at 38℃). Every specimen were bonded with dual-curing resin cement (Variolink N) and stored in distilled water for 24 hours at 37℃. Shear-bond strength (MPa) between the fiber post and the resin cement were measured using universal testing device. The data were analyzed with 1-way ANOVA and by multiple comparisons according to Tukeys HSD (α=0.05). The effect of surface treatment, fiber post type, and the interactions between these two factors were analyzed using 2-way ANOVA and independent sample T-tests. RESULTS Silanization of the FRC Postec Plus significantly increased bond strength compared with the respective non-treated control, whereas no effect was determined for the D.T. Light Post. Heat drying the silane coupling agent on to the fiber-reinforced post did not significantly improve bond strength compared to air-syringe drying. CONCLUSION The bond strength between the fiber-reinforced post and the resin cement was significantly increased with silanization in regards to the FRC Postec Plus post. Bond strength was not significantly improved by heat activation of the silane coupling agent.

Full mouth rehabilitation on a bilateral condylar fractured patient using orthognathic surgery and dental implant

BACKGROUND Mandibular displacement is a common complication of condylar fracture. In the mandibular displacement due to condylar fracture, it is difficult to restore both esthetics and function without using orthognathic surgery. CASE DESCRIPTION This clinical report described a full mouth rehabilitation in the patient with bilateral condylar fractures and displaced mandible using bilateral sagittal split ramus osteotomy (BSSRO) and simultaneous dental implant surgery. Mandibular position was determined by model surgery through the diagnostic wax up and restoration of fractured teeth. The precise amount of the mandibular shift can be obtained from the ideal intercuspation of remaining teeth. CLINICAL IMPLICATION Mandibular displacement by both condylar fractures can be successfully treated by orthognathic surgery. Determination of occlusal plane and visualization from diagnostic wax up are mandatory for mandibular repositioning of model surgery. Stable occlusion and regular recall check up are needed for long-term outcome.