Implant-supported milled bar overdenture with two implant surgical guides / 대한치과보철학회지

For fully edentulous patients, implant-supported overdenture can be considered to enhance chewing efficiency and denture stability. Implant planning software can be used to fabricate a surgical guide for a more precise consideration of anatomic factors and prediction of the shape of definitive prosthesis. Though there are many possible attachments for implant overdenture, milled bar can be useful due to its splinting effect of implants and rigid support of overdenture. This report presents a case of implant-supported milled bar overdenture after guided implant surgery performed with two surgical guide that was fabricated before and after bone reduction.

Comparison of treatments for maxillary full denture and mandibular implant-supported fixed prosthesis in completely edentulous patients: A case report / 대한치과보철학회지

There are various approaches to treatment for patients with fully edentulous jaw. In maxilla, it is easy to obtain sufficient stability, support, and retention with the traditional full denture method. In mandible, however, there are difficulties caused by anatomical limitations. In this case, treatment with implants can be considered. If it is difficult to place implants in posterior area, a fixed complete denture can be considered, using 4 - 5 implants anterior to mental foramen. This approach has changed in many ways, such as surgical methods and materials used, over the years. This case report compares two approaches and their changes over time, especially in the cases of mandibular fixed prostheses using implants, paired with maxillary complete denture.

Aesthetic implant restoration with alveolar bone graft and digital method on maxillary central incisor: a case report / 대한치과보철학회지

In case of gingival recession or bone defect in maxillary anterior implant treatment, it is not easy to obtain satisfactory clinical results. In this case, loss of the labial alveolar plate was diagnosed in the maxillary right central incisor, so after tooth extraction, soft tissue was secured and implant placement with bone graft was planned. In addition, digital guide surgery was performed for the ideal implant position, and GBR (Guided Bone Regeneration) was accompanied with the xenogeneic bone and the autologous bone collected from the mandibular ramus since alveolar bone defects were extensive. After a sufficient period of osseointegration of the implant, a temporary prosthesis was fabricated through secondary stage surgery and impression taking, and through periodic external adjustment, the shape of soft tissue was improved. In the final prosthesis fabrication, a color tone of natural teeth was induced by an gold anodized customized abutment, and an aesthetic and functional zirconia prosthesis with reproducing the shape of the temporary prosthesis through intraoral scan was delivered.

Rehabilitation of posterior support and vertical dimension in a class 3 malocclusion patient: A case report / 대한치과보철학회지

A crossed occlusion resulting from the presence of posterior teeth in one arch but no opposing teeth in the opposite arch results in collapse of the vertical dimension. In this case, the patient has a class III malocclusion with crossed occlusion and anterior crossbite. In order to evaluate the proper vertical dimension, provisional denture was used to stabilize the vertical occlusal dimension for 3 months. After, provisional fixed restoration was used for the stabilizing occlusal relationship and aesthetic improvement for lip support. Definitive prosthesis in implants in the mandible and abutments in the maxillary were using Porcelain-fused-to-metal crown (PFM) crown and the maxillary unilateral edentulous area was treated with removable partial dentures. Through this, proper support of the posterior region and normal anterior occlusal relationship were formed, and the patient was able to obtain aesthetically and functionally satisfactory treatment results.

Multidimensional Biomarker Analysis Including Mitochondrial Stress Indicators for Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is accompanied by a complex and multifactorial pathogenesis with sequential progressions from inflammation to fibrosis and then to cancer. This heterogeneity interferes with the development of precise diagnostic and prognostic strategies for NAFLD. The current approach for the diagnosis of simple steatosis, steatohepatitis, and cirrhosis mainly consists of ultrasonography, magnetic resonance imaging, elastography, and various serological analyses. However, individual dry and wet biomarkers have limitations demanding an integrative approach for the assessment of disease progression. Here, we review diagnostic strategies for simple steatosis, steatohepatitis and hepatic fibrosis, followed by potential biomarkers associated with fat accumulation and mitochondrial stress. For mitochondrial stress indicators, we focused on fibroblast growth factor 21 (FGF21), growth differentiation factor 15 (GDF15), angiopoietin-related growth factor and mitochondrial-derived peptides. Each biomarker may not strongly indicate the severity of steatosis or steatohepatitis. Instead, multidimensional analysis of different groups of biomarkers based on pathogenic mechanisms may provide decisive diagnostic/prognostic information to develop a therapeutic plan for patients with NAFLD. For this purpose, mitochondrial stress indicators, such as FGF21 or GDF15, could be an important component in the multiplexed and contextual interpretation of NAFLD. Further validation of the integrative evaluation of mitochondrial stress indicators combined with other biomarkers is needed in the diagnosis/prognosis of NAFLD.

Axial displacement in single-tooth implant restoration:Case report / 대한치과보철학회지

Axial displacement of an implant-supported prosthesis is frequently reported in clinical and laboratory studies. However, limited information is available about the behavior of the axial displacement of implant-supported prostheses functioning in intraoral situations. The present case report evaluated the three-dimensional displacement of posterior single implant-supported prostheses in 2different patients. Internal connection type implants were placed, and screw and cement-retained prosthesis (SCRP) type prosthesis were delivered after an appropriate healing period. Intraoral digital scans were performed using an intraoral scanner (Cerec Omnicam, Dentsply Sirona, USA) on the day of crown delivery and one week, one month, and one year after delivery. The amount of 3-dimensional displacement of the prosthesis was evaluated by using a digital inspection software (Geomagic Control X, 3D systems, USA). The axial displacement of implant-supported prosthesis occurred in both patients. Furthermore, the amount of displacement increased over time.

Association Between Low Muscle Mass and Non-alcoholic Fatty Liver Disease Diagnosed Using Ultrasonography, Magnetic Resonance Imaging Derived Proton Density Fat Fraction, and Comprehensive NAFLD Score in Korea / 예방의학회지

Objectives@#Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent metabolic disease. Muscle is known to influence NAFLD development. Therefore, this study aimed to determine the relationships among low muscle mass, NAFLD, and hepatic fibrosis using various definitions of low muscle mass and NAFLD diagnostic methods, including magnetic resonance imaging-based proton density fat fraction (MRI-PDFF). @*Methods@#This cross-sectional study included 320 participants (107 males, 213 females) from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population cohort. Muscle mass was assessed using whole-body dual-energy X-ray absorptiometry and adjusted for the height squared, body weight, and body mass index (BMI). NAFLD was diagnosed using ultrasonography (US), MRI-PDFF, and the comprehensive NAFLD score (CNS). Hepatic fibrosis was assessed using magnetic resonance elastography. Multivariable logistic and linear regression analyses were performed to determine the aforementioned associations. @*Results@#According to US, 183 participants (57.2%) had NAFLD. Muscle mass adjusted for body weight was associated with NAFLD diagnosed using US (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.70 to 5.31), MRI-PDFF (OR, 2.00; 95% CI, 1.13 to 3.53), and CNS (OR, 3.39; 95% CI, 1.73 to 6.65) and hepatic fibrosis (males: β=-0.070, p<0.01; females: β=-0.037, p<0.04). Muscle mass adjusted for BMI was associated with NAFLD diagnosed by US (OR, 1.71; 95% CI, 1.02 to 2.86) and CNS (OR, 1.95; 95% CI, 1.04 to 3.65), whereas muscle mass adjusted for height was not associated with NAFLD. @*Conclusions@#Low muscle mass was associated with NAFLD and liver fibrosis; therefore, maintaining sufficient muscle mass is important to prevent NAFLD. A prospective study and additional consideration of muscle quality are needed to strengthen the findings regarding this association.

The Association between Excessive Internet Gaming Behavior and Immersive Tendency, Mediated by Attention Deficit/Hyperactivity Disorder Symptoms, in Korean Male University Students

Objective@#Problematic online gaming (POG) and problematic Internet use (PIU) have become a serious public mental health problem, with Internet gaming disorder (IGD) included in “Conditions for further study” section of DSM-5. Although higher immersive tendency is observed in people affected by POG, little is known about the simultaneous effect of immersive tendency and its highly comorbid mental disorder, attention deficit/hyperactivity disorder (ADHD). This study aimed to assess the relationship between immersive tendency, ADHD, and IGD. @*Methods@#Cross-sectional interview study was conducted in Seoul, Korea with 51 male undergraduate students; 23 active gamers and 28 controls. @*Results@#Current ADHD symptoms showed partial mediation effect on the path of immersive tendency on POG and PIU. The mediation model with inattention explained variance in both POG and PIU better than other current ADHD symptom models (R2=69.2 in POG; 69.3 in PIU). Childhood ADHD symptoms models demonstrated mediation effect on both POG and PIU which explained less variance than current ADHD symptom models (R2=53.7 in POG; 52.1 in PIU). Current ADHD symptoms, especially inattention, appear to mediate the effect of immersive tendency on POG/PIU. @*Conclusion@#Immersive tendencies may entail greater susceptibility to IGD, and comorbidity with ADHD may mediate the effect of immersive tendency on IGD.

Increased Serum Angiopoietin-Like 6 Ahead of Metabolic Syndrome in a Prospective Cohort Study

BACKGROUND: Despite being an anti-obesity hepatokine, the levels of serum angiopoietin-like 6 (ANGPTL6) are elevated in various metabolic diseases. Thus, ANGPTL6 expression may reflect metabolic burden and may have compensatory roles. This study investigated the association between serum ANGPTL6 levels and new-onset metabolic syndrome. METHODS: In total, 221 participants without metabolic syndrome were randomly selected from a rural cohort in Korea. Baseline serum ANGPTL6 levels were measured using an enzyme-linked immunosorbent assay. Anthropometric and biochemical markers were analyzed before and after follow-up examinations. RESULTS: During an average follow-up period of 2.75 (interquartile range, 0.76) years, 82 participants (37.1%) presented new-onset metabolic syndrome and had higher ANGPTL6 levels before onset than those without metabolic syndrome (48.03±18.84 ng/mL vs. 64.75±43.35 ng/mL, P=0.001). In the multivariable adjusted models, the odds ratio for the development of metabolic syndrome in the highest quartile of ANGPTL6 levels was 3.61 (95% confidence interval, 1.27 to 10.26). The use of ANGPTL6 levels in addition to the conventional components improved the prediction of new-onset metabolic syndrome (area under the receiver operating characteristic curve: 0.775 vs. 0.807, P=0.036). CONCLUSION: Increased serum ANGPTL6 levels precede the development of metabolic syndrome and its components, including low high density lipoprotein, high triglyceride, and high glucose levels, which have an independent predictive value for metabolic syndrome.

Feasibility of the Korean version of the Bipolar Depression Rating Scale in Adolescents with Early-Onset Bipolar Disorder

OBJECTIVE: This study explores the feasibility and psychometric properties of the Korean version of the Bipolar Depression Rating Scale (BDRS) in adolescents with Early-onset bipolar disorders. METHODS: Fifty-three participants (aged 13–18) with early-onset bipolar disorders (40 depressed and 18 euthymic, 5 patients were assessed at depressed state and reassessed after remission) were recruited. All participants were assessed using the BDRS, the Hamilton Depression Rating Scale (HAM-D), the Montgomery-Asperg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Modified Overt Aggression scale (MOAS). RESULTS: BDRS exhibited good internal validity and significant correlations with the HAM-D and the MADRS. In item to scale correlations, all items on the BDRS were significantly correlated with the BDRS total scores except for ‘increased motor drive’ and ‘increased speech’, ‘depressed mood’ and ‘worthlessness’ showed the highest mean scores and endorsement rates. BDRS score of the depressed group was significantly higher compared with the euthymic group. Three factors (i.e., psychosomatic, mood, and mixed) were identified in the principal component analysis and hierarchical cluster analysis of the BDRS. CONCLUSION: In this study, we report that the Korean version of BDRS is a feasible and reliable tool for the assessment of depression in adolescents with Early-onset bipolar disorders.

Hemodynamic Adaptations to Regular Exercise in People With Spinal Cord Injury

OBJECTIVE: To investigate the real-time cardiovascular response to the progressive overload exercise in different levels of spinal cord injury (SCI), and to find out whether regular exercise has effect on these cardiovascular responses. METHODS: The study enrolled 8 able-bodied individuals in the control group plus 15 SCI subjects who were divided into two groups by their neurological level of injury: high-level SCI group (T6 or above) and low-level SCI group (T7 or below). Also, subjects were divided into exercise group and non-exercise group by usual exercise habits. We instructed the subjects to perform exercises using arm ergometer according to the protocol and checked plethysmograph for the real time assessment of blood pressure, heart rate, and cardiac output. RESULTS: Six subjects were included in high-level SCI group (3 cervical, 3 thoracic injuries), 9 subjects in low-level SCI group (9 thoracic injuries), and 8 able-bodied individuals in control group. During arm ergometer-graded exercise, mean arterial pressure (MAP) was significantly lower in high-level SCI subjects of non-exercise group, compared with high-level SCI subjects of exercise group. In addition, HR was significantly higher in low-level SCI group compared with control group. CONCLUSION: There are significant differences in mean arterial pressure of high-level SCI group according to usual exercise habits. We discovered that even in non-athlete high-level SCI, regular exercise can bring cardiac modulation through blood pressure control.

Rehabilitation of edentulous maxilla with implant-supported milled bar overdenture using CAD/CAM customized abutment: A case report / 대한치과보철학회지

In patients with fully edentulous maxilla, fabrication of implant-supported overdenture can be a viable treatment option, when a minimum of six implants were strategically placed. Among several attachment systems used for implant-supported overdentures, milled-bars prevent rotational movement of denture, thus showing great stability, and have the advantage of splinting multiple implants with each other. In this case report, a milled-bar supported overdenture was fabricated for a patient suffering from condition of fully edentulous maxilla with severe ridge resorption in the anterior residual ridge. Seven implants composed of three different systems were effectively utilized by CAD/CAM customized abutment and cement-retained milled bar.

Effect of Regular Exercise on Cardiopulmonary Fitness in Males With Spinal Cord Injury

OBJECTIVE: To evaluate the cardiopulmonary endurance of subjects with spinal cord injury by measuring the maximal oxygen consumption with varying degrees of spinal cord injury level, age, and regular exercise. METHODS: We instructed the subjects to perform exercises using arm ergometer on healthy adults at 20 years of age or older with spinal cord injury, and their maximal oxygen consumption (VO2max) was measured with a metabolic measurement system. The exercise proceeded stepwise according to the exercise protocol and was stopped when the subject was exhausted or when VO2 reached an equilibriu RESULTS: Among the 40 subjects, there were 10 subjects with cervical cord injury, 27 with thoracic cord injury, and 3 with lumbar cord injury. Twenty-five subjects who were exercised regularly showed statistically higher results of VO2max than those who did not exercise regularly. Subjects with cervical injury showed statistically lower VO2max than the subjects with thoracic or lumbar injury out of the 40 subjects with neurologic injury. In addition, higher age showed a statistically lower VO2max. Lastly, the regularly exercising paraplegic group showed higher VO2max than the non-exercising paraplegic group. CONCLUSION: There are differences in VO2max of subjects with spinal cord injury according to the degree of neurologic injury, age, and whether the subject participates in regular exercise. We found that regular exercise increased the VO2max in individuals with spinal cord injury.

Submucosal zirconia implant prosthesis fabricated with CAD/CAM / 대한치과보철학회지

They have been recently introduced many aesthetic implant prosthesis using with zirconia and CAD/CAM. However, there are many limitations in their gingival and occlusal region. In this case, submucosal zirconia implant prosthesis were fabricated with CAD/CAM system. The connection of these screw cement retained prosthesis and titanium abutment was designed to 1mm above the fixture. The clinical results were satisfactory on the aesthetics and function.

Subclinical Hypothyroidism in Patients with Bipolar Disorders Managed by Lithium or Valproic Acid

OBJECTIVES: To investigate the pattern of subclinical hypothyroidism (SCH) in patients with bipolar disorders managed by lithium or valproic acid. METHODS: The study participants were 106 patients with DSM-IV bipolar disorders receiving planned maintenance treatment at the Mood Disorders Clinic of Seoul National University Bundang Hospital (aged between 17 and 64, mean duration of follow-up = 875.65 days). Using the bipolar disorder registry, thyroid function data were analyzed to assess the frequency of and the risk factors for SCH in patients managed by lithium (n = 64) or valproic acid (n = 42) for more than 5 months. RESULTS: Overall frequencies of SCH were 20.3% (13/64) in the lithium group, 14.3% (6/42) in the valproic acid group, and between the two groups there is no difference (p = 0.43). No differences were observed in the potential risk factors for SCH between the two groups including age, sex, subtype of bipolar disorder, baseline TSH, and concomitant antipsychotic use. In cases with SCH, thyroid-stimulating hormone (TSH) showed a tendency to increase at 3 month after the initiation of lithium or valproic acid. A gradual increase in the number of patients showing SCH was found within the first 3 years of medication. CONCLUSIONS: With regular monitoring and careful assessment, there was no difference in the risk of SCH between lithium and valproic acid maintenance. The risk of mood stabilizer-associated SCH may gradually increase within 3 years following the commencement of medication, thereby mandating close monitoring for the first 3 years of treatment. Further studies with large sample size would be needed to confirm these findings.

Sex-Related Differences of EEG Coherences between Patients with Schizophrenia and Healthy Controls

OBJECTIVES: Alteration of epigenetic effects of testosterone during early development was suggested as an ancillary mechanism for the genesis of schizophrenia. EEG coherence was thought to be a marker for cerebral laterality of which important determinant was testosterone during early development. We studied sex-related differences of EEG coherences between patients with schizophrenia and controls to examine the sex effects in the genesis of schizophrenia. METHODS: EEG was recorded in 35 patients with schizophrenia and 46 healthy controls in the eyes closed resting state. Pair-wise EEG coherences were calculated over delta, theta, alpha, beta and gamma frequency bands. To examine the differences of EEG coherence according to sex in each group, ANCOVA was performed using Statistical Analysis system (SAS, Ver 9.3) and R (Ver 2.15.2). RESULTS: Healthy control males showed more increased right intrahemispheric coherences than healthy control females in delta, theta, alpha and beta frequency bands. In patients with schizophrenia, this male dominant pattern in right intrahemispheric coherences was attenuated especially in alpha and beta bands. Healthy control females showed more increased interhemispheric coherences than healthy control males in delta, theta, beta and gamma frequency bands. In patients with schizophrenia, these female dominant patterns in interhemispheric coherences were attenuated especially in delta, theta, and beta bands, which were commonly observed in frontal to central areas. CONCLUSION: Sex differences in resting EEG coherences were attenuated in schizophrenia patients. These results imply that sex-related aberrant cerebral lateralization might exist in patients with schizophrenia, which are partly due to sex hormones via epigenetic mechanisms.

Verbal and Visual Memory Impairments in Bipolar I and II Disorder

OBJECTIVE: To compare verbal and visual memory performances between patients with bipolar I disorder (BD I) and patients with bipolar II disorder (BD II) and to determine whether memory deficits were mediated by impaired organizational strategies. METHODS: Performances on the Korean-California Verbal Learning Test (K-CVLT) and the Rey-Osterrieth Complex Figure Test (ROCF) in 37 patients with BD I, 46 patients with BD II and 42 healthy subjects were compared. Mediating effects of impaired organization strategies on poor delayed recall was tested by comparing direct and mediated models using multiple regression analysis. RESULTS: Both patients groups recalled fewer words and figure components and showed lower Semantic Clustering compared to controls. Verbal memory impairment was partly mediated by difficulties in Semantic Clustering in both subtypes, whereas the mediating effect of Organization deficit on the visual memory impairment was present only in BD I. In all mediated models, group differences in delayed recall remained significant. CONCLUSION: Our findings suggest that memory impairment may be one of the fundamental cognitive deficits in bipolar disorders and that executive dysfunctions can exert an additional influence on memory impairments.

Designing Clinical Studies and Keeping Research Ethics

Data from clinical studies are needed for psychiatrists to make quick and scientific decisions based on the best available evidence in clinical settings. Various methods of clinical studies are useful for clinicians to have reliable answers to unmet clinical needs. Although randomized controlled trials may provide high-quality information about major issues, well-designed, naturalistic and observational studies often give us unbiased explanation for real-world phenomena. Adequate selection of clinical variables and appropriate number of participants are key factors of well-designed clinical studies. Statistical methods can add an extra dimension to initial design of clinical studies. Given ethical issues in clinical studies on psychiatric disorders, special regards should be paid to participants' ability to provide informed consents. New strategies of clinical studies need to be developed to meet clinical needs and protect the rights and welfare of study participants.

Development and Validation of the Patient Mood Chart / 신경정신의학

OBJECTIVES : The aim of this study was to report the developmental process of the patient mood chart (named the Patient Mood Chart, PMC), and to test its validity and utility. METHODS : One hundred twenty nine subjects with bipolar disorder, as diagnosed using DSM-IV criteria, completed the PMC. A trained clinician administered the Hamilton Depression Rating Scale (HDRS), the Montgomery A sberg Depression Rating Scale (MADRS), the Inventory of Depressive Symptomatology (IDS), the Young Mania Rating Scale (YMRS) and the Global Assessment of Functioning (GAF).Mood ratings on the PMC were compared with clinician-rated measures taken at initial visits and 6- month follow-ups. To examine the utility of the PMC, a patient questionnaire-type survey was done. RESULTS : Depressive symptom ratings on the PMC were highly correlated with the HAMD, MADRS and IDS scores. Manic symptom ratings on the PMC were correlated with the YMRS scores. Similarly, a strong correlation was found between mood chart scores and the GAF scores. Most patients considered the PMC to be useful and helpful. CONCLUSION : These findings support the validity and utility of the PMC. The PMC can be used for prospective assessment of symptom changes, treatment response, and long-term course for subjects with bipolar disorder

The change of rotational freedom following different insertion torques in three implant systems with implant driver

STATEMENT OF PROBLEM: Implant drivers are getting popular in clinical dentistry. Unlike to implant systems with external hex connection, implant drivers directly engage the implant/abutment interface. The deformation of the implant/abutment interface can be introduced while placing an implant with its implant driver in clinical situations. PURPOSE: This study evaluated the change of rotational freedom between an implant and its abutment after application of different insertion torques. MATERIAL AND METHODS: Three kinds of internal connection implants were utilized for the current study (4.5 x 12 mm Xive, 4.3 x 11.5 mm Inplant Magicgrip, 4.3 x 12 mm Implantium MF). An EstheticBase, a 2-piece top, a Dual abutment was used for its corresponding implant system. The rotational freedom between an implant and its abutment were measured before and after applying 45, 100 Ncm insertion torque. Repeated measures ANOVA was used for statistical analysis. RESULTS: Under 45 Ncm insertion torque, the rotational freedom between an implant and its abutment was significantly increased in Xive (P = .003). However, no significant change was noted in Inplant Magicgrip and Implantium MF. Under 100 Ncm torque, both in Xive (P = .0005) and Implatium MF (P = .03) resulted in significantly increased rotational freedom between the implant and its abutment. DISCUSSION: The design of the implant/implant driver interface effectively prevented the deformation of implant/abutment interface. Little change was noted in the rotational freedom between an implant and its abutment, even though the insertion torque was far beyond clinical application. CONCLUSIONS: The implant/abutment joint of internally connecting implants were quite stable under insertion torque in clinical situation.