ABSTRACT
Stable posterior occlusal support is crucial for adequate masticatory function and facial aesthetics. In elderly patients over the age of 65, masticatory ability has a significant impact on nutritional intake and overall health. This case report presents a prosthetic treatment of an elderly patient with edentulous maxilla and bilateral posterior edentulous mandible. The upper jaw was restored with a complete denture to establish an ideal occlusal plane, and the three-dimensional positions of the mandibular implants were determined accordingly. The implants were placed through computer-guided implant surgery and were immediately loaded with fixed provisional restorations. The implant-fixed zirconia final restorations were inserted in the lower posterior region, and the occlusal surface of posterior artificial teeth in the upper denture was substituted with cobalt-chrome alloy to resist occlusal wear. The patient’s posterior occlusal support and masticatory function were promptly restored through this treatment process, and long-term stability against wear was also obtained.
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PURPOSE@#. This study evaluated the reliability of the chair-side CAD-CAM surgical guide (CSG) in the anterior maxilla by comparing its accuracy with the laboratory 3D-printed surgical guide (3DSG) and manual surgical guide (MSG) concerning different levels of dentists' surgical experience. @*MATERIALS AND METHODS@#. Ten surgical guides of each type (MSG, 3DSG, and CSG) were fabricated on a control study model with missing right and left central incisors. Sixty implants were placed in 30 study models by two dentists (one inexperienced and one experienced) using three different types of surgical guides. Horizontal deviations at shoulder and at apex, vertical, and angular deviations were measured after superimposing the planned and placed implant positions in the software. Kruskal-Wallis and Mann-Whitney U tests were used to compare the accuracy of three types of surgical guides in each dentist group and the accuracy of each surgical guide between two dentists (α = .05). @*RESULTS@#. There were no significant differences in any deviations between CSG and 3DSG, apart from angular deviation, for both dentists’ groups. Moreover, both CSG and 3DSG showed no significant differences in accuracy between the two dentists (P > .05). In contrast, MSG demonstrated significant differences from CSG and 3DSG and a significant difference in accuracy between the two dentists (P < .05). @*CONCLUSION@#. CSG provides superior accuracy to MSG in implant placement in the maxillary anterior region and is comparable to 3DSG at different levels of surgical experience, while offering the benefits of shorter manufacturing time and reduced patient visits.
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This report demonstrates a method of generating a chair-side and computer-aided template for implant surgery based on the Top-Down and restoration-driven concept. Compared to the traditional CAD-CAM process which requires multiple steps to be taken between dental clinic and laboratory, this alternative procedure, VARO guide system (VARO Guide, CAD, Pre-Guide, VARO-mill, NeoBiotech, Seoul, South Korea) enables accurate and patient-friendly implant surgery as well as immediate provisional restoration in a single visit. First, bite-registration at centric jaw relation and CBCT were taken using the Pre-Guide. The CBCT data was then reorganized directly through the chair-side CAD, and we could determine the most appropriate 3-dimensional position of implant. The STL file was extracted and put into the chair-side CAM (VARO-mill) to fabricate a VARO. This surgical guide allowed the implants to be accurately positioned into the planned sites within an hour.
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Purpose@#Here, we verified that the actin cytoskeletal gene expression of human gingival fibroblasts was altered by the administration of trichloroacetic acid (TCA) and epidermal growth factor (EGF) using the nano-controlled releasing system. @*Materials and methods@#The control and experimental groups were divided into 3 groups: the group with the TCA-only nano-controlled releasing system (EXP1), the group with the TCA- and EGF nano-controlled releasing system (EXP2), and the control group (CON) with 48-h incubation. Expression of 26 genes involved in the regulation of actin cytoskeleton were analyzed by real-time PCR followed by the determination of correlations and influential factors using the Pearson correlation analysis and multiple regression analysis. @*Results@#Among 23 genes upregulated in EXP1 and EXP2, expression of 14 genes were significantly increased in EXP2 compared to EXP1. On the other hand, LPAR1 was downregulated only in EXP1, GNA13 was upregulated only in EXP2, and F2R was downregulated only in EXP2. Three Rac1-related genes and CDC42 were identified as the influential factors of the actin gene upregulation. @*Conclusion@#The actin cytoskeleton genes in human gingival fibroblast were upregulated by the administration of TCA and EGF using HGC-based nano-controlled releasing system.
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All the faculties at the prosthodontic department in Kyung Hee University Dental Hospital at Gangdong, have been implementing the Top-Down concept of treatment approach since 2006 in which the outcomes of the last prosthetic treatment are predicted in advance during the treatment planning stage of patients with dental tissue defects. Based on the Top-Down concept, this report is also an example of how the final prosthetic treatment was performed in advance before going into implant surgery for the missing teeth. Among the various methods of connecting implant fixture and restoration, the cement-retained method is relatively simple to manufacture restoration without being constrained by the angle of the implants placed, but difficult to remove remaining subgingival excess cement completely, and to detach it being when necessary. In the report, SB-locking method will be introduced which enables an aesthetic implant restoration without either a screw hole or residual excess cement.
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Background@#The effect of nano controlled sequential release of trichloroacetic acid (TCA) and epidermal growth factor (EGF) on the oral soft tissue regeneration was determined. @*Methods@#Hydrophobically modified glycol chitosan (HGC) nano controlled system was developed for the sequential release of TCA and EGF, and the release pattern was identified. The HGC-based nano controlled release system was injected into the critical-sized defects created in beagles’ palatal soft tissues. The palatal impression and its scanned body was obtained on various time points post-injection, and the volumetric amount of soft tissue regeneration was compared among the three groups: CON (natural regeneration control group), EXP1 (TCA-loaded nano controlled release system group), EXP2 (TCA and EGF individually loaded nano controlled release system). DNA microarray analysis was performed and various soft tissue regeneration parameters in histopathological specimens were measured. @*Results@#TCA release was highest at Day 1 whereas EGF release was highest at Day 2 and remained high until Day 3. In the volumetric measurements of impression body scans, no significant difference in soft tissue regeneration between the three groups was shown in two-way ANOVA. However, in the one-way ANOVA at Day 14, EXP2 showed a significant increase in soft tissue regeneration compared to CON. High correlation was determined between the histopathological results of each group. DNA microarray showed up-regulation of various genes and related cell signaling pathways in EXP2 compared to CON. @*Conclusion@#HGC-based nano controlled release system for sequential release of TCA and EGF can promote regeneration of oral soft tissue defects.
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Purpose@#This study was to determine the possible effects of trichloroacetic acid (TCA) and epidermal growth factor (EGF) through cell survival genes of the PI3K-AKT signaling pathway when applying an hydrophobically modified glycol chitosan (HGC)-based nanocontrolled release system to human gingival fibroblasts in oral soft tissue regeneration. @*Materials and Methods@#An HGC-based nano-controlled release system was produced, followed by the loading of TCA and EGF. The group was divided into control (CON), TCA-loaded nano-controlled release system (EXP1), and the TCA- and EGF- individually loaded nano-controlled release system (EXP2).A total for 29 genes related to the PI3K-AKT signaling pathway were analyzed after 48h of culture in human gingival fibroblasts.Real-time PCR, 1- way ANOVA and multiple regression analysis were performed. @*Results@#Cell survival genes were significantly upregulated in EXP1 and EXP2. From multiple regression analysis, ITGB1 was determined to be the most influential factor for AKT1 expression. @*Conclusion@#The application of TCA and EGF through the HGC-based nano-controlled release system can up-regulate the cell survival pathway.
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Purpose@#This study was to determine the possible effects of trichloroacetic acid (TCA) and epidermal growth factor (EGF) through cell survival genes of the PI3K-AKT signaling pathway when applying an hydrophobically modified glycol chitosan (HGC)-based nanocontrolled release system to human gingival fibroblasts in oral soft tissue regeneration. @*Materials and Methods@#An HGC-based nano-controlled release system was produced, followed by the loading of TCA and EGF. The group was divided into control (CON), TCA-loaded nano-controlled release system (EXP1), and the TCA- and EGF- individually loaded nano-controlled release system (EXP2).A total for 29 genes related to the PI3K-AKT signaling pathway were analyzed after 48h of culture in human gingival fibroblasts.Real-time PCR, 1- way ANOVA and multiple regression analysis were performed. @*Results@#Cell survival genes were significantly upregulated in EXP1 and EXP2. From multiple regression analysis, ITGB1 was determined to be the most influential factor for AKT1 expression. @*Conclusion@#The application of TCA and EGF through the HGC-based nano-controlled release system can up-regulate the cell survival pathway.
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Background@#The effect of nano controlled sequential release of trichloroacetic acid (TCA) and epidermal growth factor (EGF) on the oral soft tissue regeneration was determined. @*Methods@#Hydrophobically modified glycol chitosan (HGC) nano controlled system was developed for the sequential release of TCA and EGF, and the release pattern was identified. The HGC-based nano controlled release system was injected into the critical-sized defects created in beagles’ palatal soft tissues. The palatal impression and its scanned body was obtained on various time points post-injection, and the volumetric amount of soft tissue regeneration was compared among the three groups: CON (natural regeneration control group), EXP1 (TCA-loaded nano controlled release system group), EXP2 (TCA and EGF individually loaded nano controlled release system). DNA microarray analysis was performed and various soft tissue regeneration parameters in histopathological specimens were measured. @*Results@#TCA release was highest at Day 1 whereas EGF release was highest at Day 2 and remained high until Day 3. In the volumetric measurements of impression body scans, no significant difference in soft tissue regeneration between the three groups was shown in two-way ANOVA. However, in the one-way ANOVA at Day 14, EXP2 showed a significant increase in soft tissue regeneration compared to CON. High correlation was determined between the histopathological results of each group. DNA microarray showed up-regulation of various genes and related cell signaling pathways in EXP2 compared to CON. @*Conclusion@#HGC-based nano controlled release system for sequential release of TCA and EGF can promote regeneration of oral soft tissue defects.
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At the department of prosthodontics, the elderly patients with severely atrophied alveolar ridge who have been wearing complete dentures for a long period frequently visit the clinic. In general, the open-mouth impression technique for manufacturing a mandibular complete denture to secure primary support on buccal shelf area has been prevalent. In addition, for securing retention and stability of mandibular denture, we should consider diagnosis, oral function, denture border, occlusal plane, teeth arrangement, and patient training, etc.. But in edentulous patients with severe alveolar bone atrophy, it may hardly secure retention and stability of mandibular complete denture. To promote these, some of clinicians are making an attempt manufacturing the mandibular complete dentures using closed-mouth impression technique based on several reports that compare various impression techniques including open-mouth and closed-mouth impression technique. This case report suggests closed-mouth impression technique may promote retention and stability of mandibular complete denture and compares between the two impression techniques clinically.
Subject(s)
Aged , Humans , Alveolar Bone Loss , Alveolar Process , Dental Occlusion , Denture, Complete , Dentures , Diagnosis, Oral , Jaw, Edentulous , Prosthodontics , ToothABSTRACT
Orthognathic surgery of skeletal Class III malocclusion improves oral function and facial appearance. The greater amount of skeletal discrepancy, the greater amount of teeth movement required for decompensation, and this often causes pathological changes in periodontal tissue especially in lower anterior dentition. We made a Top-Down treatment plan with personalized analysis using Face Hunter, Plane System and ARCUS Digma II, in order to resolve severe mobility and cross-bite of lower anterior teeth for 49-year-old female patient who had undergone orthognathic surgery 20 years ago due to skeletal Class III malocclusion and mandibular prognathism. Lower anterior teeth were extracted and alveoloplasty was done. After healing of the wound, immediate loading was conducted immediately after implant placement. Final restorations were fabricated Zirconia using CAD/CAM, and inserted intraorally screw-retained type. During 6-month follow-up, no abnormal episodes of restorations were observed, and obtained satisfactorily both of functional and esthetic outcomes.
Subject(s)
Female , Humans , Middle Aged , Alveoloplasty , Dentition , Follow-Up Studies , Malocclusion , Orthognathic Surgery , Prognathism , Tooth , Wounds and InjuriesABSTRACT
BACKGROUND: Trichloroacetic acid (TCA) is an agent widely applied in dermatology for skin regeneration. To test whether TCA can offer an advantage for the regeneration of oral soft tissue defects, the cellular events following TCA application were explored in vitro and its influence on the oral soft tissue wound healing was evaluated in a canine palate model.METHODS: The cytotoxicity and growth factor gene expression in human gingival fibroblasts were tested in vitro following the application of TCA at four concentrations (0.005%, 0.05%, 0.5% and 1%) with different time intervals (0, 3, 9 and 21 h). One concentration of TCA was selected to screen the genes differentially expressed using DNA microarray and the associated pathways were explored. TCA was injected in open wound defects of the palatal mucosa from beagle dogs (n = 3) to monitor their healing and regeneration up to day 16-post-administration.RESULTS: While the 0.5–1% concentration induced the cytoxicity, a significantly higher expression of growth factor genes was observed after 3 and 9 h following the 0.5% TCA application in comparison to other groups. DNA microarray analysis in 0.5% TCA group showed 417 genes with a significant 1.5-fold differential expression, involving pathways of cell cycle, FoxO signaling, p53 signaling, ubiquitin mediated proteolysis and cAMP signaling. In vivo results showed a faster reepithelialization of TCA-treated wounds as compared to spontaneous healingCONCLUSION: TCA promoted the healing and regeneration of oral soft tissue wound defects by up-regulating the cell cycle progression, cell growth, and cell viability, particularly at a concentration of 0.5%.
Subject(s)
Animals , Dogs , Humans , Cell Cycle , Cell Survival , Dermatology , Fibroblasts , Gene Expression , In Vitro Techniques , Mouth Mucosa , Mucous Membrane , Oligonucleotide Array Sequence Analysis , Palate , Proteolysis , Regeneration , Skin , Trichloroacetic Acid , Ubiquitin , Up-Regulation , Wound Healing , Wounds and InjuriesABSTRACT
PURPOSE: The marginal bone loss of implants with laser treated surface was investigated after six weeks of loading after implant installation to the mandible molar area. MATERIALS AND METHODS: A total of 23 implants were placed in the edentulous molar area of the mandible: 13 implants were immediately loaded and 10 implants were early loaded. The implants used were made of titanium grade 23, screw shaped, 4.2 mm in diameter, and 10 mm in length. Patients were evaluated with resonance frequency analysis at implant fixture installation and 1, 2 (final prosthesis installation), 3, 5, 8, and 14 months later. X-rays were taken at 2 months after fixture installation and 1, 2, 3 years after to measure the marginal bone loss. RESULTS: The mean ISQ value measured at the implant installation was over 70 at all-time points. The average of marginal bone loss was average 0.33 mm. CONCLUSION: Immediate implant loading for laser treated implants would be possible.
Subject(s)
Humans , Mandible , Molar , Prostheses and Implants , Retrospective Studies , TitaniumABSTRACT
PURPOSE: The purpose of this study was to evaluate the effect of healing abutment height and measurement angle on implant stability when using Periotest and AnyCheck. MATERIALS AND METHODS: 60 implants were placed into artificial bone blocks. After implant insertion, 2, 3, 4 and 5 mm healing abutments were installed on 15 specimens, respectively. Insertion torque value, implant stability test, Periotest value were measured. Insertion torque value was controlled between 45 – 55 Ncm. AnyCheck was used for measuring implant stability test and Periotest M was used for measuring Periotest value. Implant stability test and Periotest value were measured at the angles of 0 and 30 degrees to the horizontal plane. Measured values were analyzed statistically. RESULTS: Insertion torque value had no significant difference among groups. When healing abutment height was higher, implant stability test and Periotest value showed lower stability. Also when measurement angle was decreased, implant stability test and Periotest value showed lower stability. CONCLUSION: When measuring stability of implants with percussion type devices, measured values should be evaluated considering height of healing abutments and measurement angle.
Subject(s)
Percussion , TorqueABSTRACT
BACKGROUND: We aimed to determine the effect of fibronectin (FN)-immobilized microgrooved titanium (Ti) on human gingival fibroblast proliferation, gene expression and protein expression. METHODS: Photolithography was used to fabricate the microgrooved Ti, and amine funtionalization (silanization) was used for FN immobilization on titanium surfaces. Cell proliferation, gene expression and protein expression were analyzed, followed by multiple regression analysis for determining the influential factors on cell proliferation. RESULTS: FN-immobilized microgrooved Ti significantly enhanced the fibroblast proliferation in various timelines of culture, among which a burst of fivefold increase is induced at 96 h of culture compared to that on the control smooth Ti. We suggest a presence of the synergistic promotion effect of microgrooves and FN immobilization on fibroblast proliferation. Through a series of analyses on the expression of various genes and proteins involved in cell adhesion and proliferation, cyclin-dependent kinase 6, cyclin D1, integrin α5, oncogene c-Src, osteonectin, paxillin and talin-2 were determined as influential factors on promoting fibroblast proliferation induced by FN-immobilized microgrooved Ti. CONCLUSION: FN-immobilized microgrooved Ti can act as an effective surface for enhancing fibroblast proliferation, and can be used for promoting soft tissue response on the connective tissue attachment zone of biomaterial surfaces.
Subject(s)
Humans , Cell Adhesion , Cell Proliferation , Connective Tissue , Cyclin D1 , Cyclin-Dependent Kinase 6 , Fibroblasts , Fibronectins , Gene Expression , Immobilization , Oncogenes , Osteonectin , Paxillin , TitaniumABSTRACT
Generally dentures are manufactured by conventional method, however the frequency of fabricating denture using digital method is increasing due to the recent development of digital technology in dentistry. The digital method of manufacturing denture is classified into two systems; 3D scan of the impression to arrange the artificial teeth on the CAD (Computer-aided design) and 3D printing to produce the resin-based complete denture, or 3D scan of the model to design of the framework using CAD, resin pattern formation by 3D printing and casting of metal framework of complete denture or removable partial denture. In this case report, electronic surveying and design the metal framework of the dentures were performed using CAD program, and plastic resin patterns fabricated by 3D printing were casted for upper full denture and lower removable partial denture. During follow-up periods, dentures using digital method have provided satisfactory results esthetically and functionally.
Subject(s)
Computer-Aided Design , Dentistry , Denture, Complete , Denture, Partial, Removable , Dentures , Follow-Up Studies , Methods , Plastics , Printing, Three-Dimensional , Tooth, ArtificialABSTRACT
When attempting to restore the oral function of a partially edentulous patient, there are a number of prosthetic treatment options available, depending on the structure of remaining teeth. For example, when only one set of maxillary and mandibular teeth are diagonally in place across from each other, it is difficult to gain stable occlusion. In this case, implants can be put in place at the corresponding edentulous area to achieve balance. By doing so, a stable occlusion can be achieved. For this case report, a patient with crossed occlusion after extraction was treated with maxillary RDP (removable dental prosthesis) and mandibular implant-supported RDP (removable dental prosthesis). Moreover, an implant fixture was placed under the posterior molar of the distal extension base diagonally across from the remaining maxillary teeth. Then, magnetic attachment was implemented. According to the patient who received the treatment, the result was functionally and aesthetically satisfactory.
Subject(s)
Humans , Dental Prosthesis , Molar , ToothABSTRACT
The retaining methods of implant prosthesis were classified into a screw-retained and a cement-retained type. A screw-retained prosthesis has many advantages, such as retrievability, preventing residual cement, while their disadvantages include the possibility of screw loosening and fracture, on the contrary advantages of cement-retained prosthesis are relatively low cost, but they are difficult to retrieve. To combine the advantages of both type, screw-cement retained prosthesis (SCRP) type have been introduced. But they still require ideal implant placement. So we introduce fiber post retained prosthesis without residual cement for preventing soft tissue trouble due to excessive cement.
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PURPOSE: We aimed to investigate the gene expression of human gingival fibroblasts on microgroove surface using DNA microarray. MATERIALS AND METHODS: Microgrooves were applied on grade II titanium discs to have 0/0 µm (NE0, control group), 60/10 µm (E60/10, experimental group) of respective width/depth by photolithography. The entire surface of the microgrooved Ti substrata was further acid etched and used as the two experimental groups in this study. Human gingival fibroblasts were cultured in the experimental group and the control group, and total RNA was extracted. The oligonucleotide microarray was performed to confirm the changes of various gene expression levels between experimental group and control group. Changes of gene expression level were determined at the pathway level by mapping the expression results of DNA chips, using the KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analysis. RESULTS: Gene expression levels on E60/10 and NE0 were analyzed, there were 123 genes showing significant differences in expression more than 1.5 times on E60/10 microgrooved surface compared to NE0 surface, and 19 genes showing significant differences in expression more than 2 times. The KEGG pathway analysis confirmed the changes in gene expression levels under experimental conditions. Cell signaling, proliferation, and activity among the various gene expression results were identified. CONCLUSION: Microgrooved surfaces induce gene expression changes and related cell signaling. According to the results of this study, microgrooves can be used as the surface of various biomaterials which need to improve cell activity through gene expression changes and activation of cell signaling.
Subject(s)
Humans , Biocompatible Materials , DNA , Fibroblasts , Gene Expression , Oligonucleotide Array Sequence Analysis , RNA , TitaniumABSTRACT
In the past, computer-aided design/computer-aided manufacturing (CAD/CAM) technology was the closed system that users had to use the components of only one manufacturer. At present, it has changed to the open system with the flexibility to select and use the components of various manufacturers' components according to their needs. Despite the development of dental materials and prostheses manufacturing methods, denture manufacturing has followed conventional manufacturing methods for nearly 100 years. However, studies on CAD/CAM fabricated denture have been recently carried out to overcome the disadvantages of conventional denture manufacturing. Some commercialized products using milling or 3D printing have already been applied clinically. This case report confirms the possibility of CAD/CAM dentures using 3D face scan and compared them to conventionally fabricated dentures.