Full mouth rehabilitation of a patient with excessive worn dentition by increasing vertical dimension of occlusion: a case report / 대한치과보철학회지

Tooth wear refers to the loss of dental hard tissue caused by various physiological and pathological causes, and excessive pathological wear can cause complications such as pathological changes in dimensions, occlusal disharmony, loss of function, and aesthetic problems. The cause of tooth wear can be caused by attrition, abrasion, corrosion and abfraction, and it is known to act in a multifactorial etiology in interocclusal activity. In patients with excessive pathological wear, it is important to determine whether or not the vertical dimension of occlusion is reduced, and complete oral rehabilitation should be achieved with the adaptation of the neuromuscular and temporomandibular joint through accurate diagnosis and analysis. The patient in this case was a 63-year-old male patient, who presented discomfort to cold beverage due to severe tooth wear. After analysis of the patient’s vertical dimension of occlusion, a full mouth rehabilitation was performed with increasing vertical dimension of occlusion. The goal of treatment was to improve the occlusal plane with the equal-intensity contact of all teeth, harmonious anterior guidance and immediate disclusion of all posterior contacts. After rehabilitation, the patient was satisfied with function and esthetic appearance.

Reliability of implant stability measuring devices depending on various clinical conditions: an in vitro study

PURPOSE@#. The aim of this study was to evaluate the reliability of implant stability measuring devices depending on the location of the implant and the position of the patient. @*MATERIALS AND METHODS@#. Six implants were installed in different dentate sextants of six artificial bone models. Implant stability was measured in three conditions of the bone model (without mounting on a phantom head, mounted on a phantom head in supine position, and mounted on a phantom head in upright position). A resonance frequency analysis device (Osstell) and two damping capacity analysis devices (Periotest and Anycheck) were used to measure implant stability. The values measured outside the phantom head were treated as controls, and the values inside the phantom head were compared using an independent t-test. @*RESULTS@#. Osstell showed different results in two of the six divisions in both the supine and upright positions compared to outside of the mouth (P < .05). Periotest showed different results in all six parts in the supine position and in five parts in the upright position compared to outside of the mouth (P < .05). While Anycheck showed different results in five areas in the supine position compared to outside of the mouth, it showed different results in only one area in the upright position (P < .05). @*CONCLUSION@#. In the difficult implant position for the operator to access, the implant stability measuring devices show less reliability. The accessibility of implant is greatly affected in the order of Osstell, Anycheck, and Periotest. [J Adv Prosthodont 2023;15:126-35]

A case of removable partial denture restoration using implant supported surveyed crown in a maxillary edentulous patient / 대한치과보철학회지

When planning oral rehabilitation for maxillary edentulous patients, fixed prosthetic restoration using implants, complete denture restoration or overdentures using implants can be considered as treatment methods. In the case of complete denture restoration, it does not require additional surgery and is relatively economical. In the case of implant-supported fixed prostheses, the functional part is generally superior to that of complete denture restoration, but there are cases in which implant placement is clinically difficult. Recently in consideration of the patient’s needs and the condition of the remaining alveolar bone, after partial implant placement, a method of restoring with a removable partial denture using implant-supported surveyed crown is also being attempted. This case is a case of performing a removable partial denture restoration using implant-supported surveyed crown in the anterior maxilla, and showing satisfactory esthetic and functional results.

Pre-contoured reconstruction plate fabricated via three-dimensional printed bending support

A mandibular continuity defect can be repaired using either a prosthetic device or autogenous bone. A titanium reconstruction plate can be used with a localized or vascularized flap over the defect of the mandible. Unfortunately, the plate may fail due to plate exposure, screw loosening, fracture, or infection, and will need to be removed. Plate exposure though the skin or mucosa is one of the main reasons for failure. In the present work, the authors introduced a lingually positioned reconstruction plate fabricated via three-dimensional printed bending support. This custom reconstruction plate can avoid plate re-exposure as well as reduce surgical errors and operation time.

Horizontal alteration of anterior alveolar ridge after immediate implant placement:A retrospective cone beam computed tomography analysis

. Implants were placed immediately after tooth extraction on anterior alveolar ridges in the maxilla and mandible. The pinguide system was used to help determine the location and path of implants during the surgical process. The horizontal distance from implants to the outer border of alveolar bone was measured at the rim and middle of the implants in the cone beam computed tomography images. The alteration of alveolar bone was evaluated comparing the horizontal distances measured immediately after surgery and 3 months after surgery. RESULTS. The results show that more resorption occurred towards the labial bone than the lingual bone in the maxilla.A similar amount of labial and lingual bone resorption was observed in the mandible. CONCLUSION. Considering the horizontal alteration of alveolar bone, labio-lingual positioning of the implant towards the lingual bone in the maxilla and at the center of the alveolar ridge in the mandible is recommended when it is placed immediately after tooth extraction.

Pre-contoured reconstruction plate fabricated via three-dimensional printed bending support

A mandibular continuity defect can be repaired using either a prosthetic device or autogenous bone. A titanium reconstruction plate can be used with a localized or vascularized flap over the defect of the mandible. Unfortunately, the plate may fail due to plate exposure, screw loosening, fracture, or infection, and will need to be removed. Plate exposure though the skin or mucosa is one of the main reasons for failure. In the present work, the authors introduced a lingually positioned reconstruction plate fabricated via three-dimensional printed bending support. This custom reconstruction plate can avoid plate re-exposure as well as reduce surgical errors and operation time.

Horizontal alteration of anterior alveolar ridge after immediate implant placement:A retrospective cone beam computed tomography analysis

. Implants were placed immediately after tooth extraction on anterior alveolar ridges in the maxilla and mandible. The pinguide system was used to help determine the location and path of implants during the surgical process. The horizontal distance from implants to the outer border of alveolar bone was measured at the rim and middle of the implants in the cone beam computed tomography images. The alteration of alveolar bone was evaluated comparing the horizontal distances measured immediately after surgery and 3 months after surgery. RESULTS. The results show that more resorption occurred towards the labial bone than the lingual bone in the maxilla.A similar amount of labial and lingual bone resorption was observed in the mandible. CONCLUSION. Considering the horizontal alteration of alveolar bone, labio-lingual positioning of the implant towards the lingual bone in the maxilla and at the center of the alveolar ridge in the mandible is recommended when it is placed immediately after tooth extraction.

Oral rehabilitation of excessive tooth wear patient usingzirconia fixed prosthesis with increased vertical dimension / 대한치과보철학회지

From the point of view of oral rehabilitation, the treatment of extensive tooth wear requires a prosthetic approach. Physiological tooth wear is considered as a normal processand generally does not require treatment, but excessive tooth wear causes problems like inadequate occlusion and esthetics. Changes of occlusal vertical dimension should bemade through accurate diagnosis and analysis. Also, the patient’s adaptation to the changed occlusal vertical dimension should be assessed over time. This case was a60-year-old male patient who complained of a decrease in chewing function and esthetics due to severe tooth wear. Full-mouth rehabilitation was performed with a tooth supportedfixed prosthesis. An occlusal stabilization splint and provisional restoration were used to evaluate the adaptation to increased occlusal vertical dimension and induce astable centric relation position. After that, monolithic zirconia prosthesis was delivered. We report this as a satisfactory functional recovery and esthetics. (J Korean AcadProsthodont 2020;58:121-9)

Full mouth rehabilitation with Implant-Guided Surgery and Fixed prosthesis / 대한치과보철학회지

The development of cone beam computerized tomography (CBCT) allows three-dimensional analysis of the patient's anatomy. The surgical guide is a combination of CBCT, computer-aided design/computer-aided manufacturing (CAD/CAM) and implant diagnostics software, which allows well planned prostheses design and ideal implant placement. Guided surgery minimizes possible anatomical damage and allows for more reproducible treatment planning. In this case, the operation time was shortened by using a surgical guide for multiple implants placement in a fully edentulous patient. Immediate loading were performed more easily using preliminary preparation of provisional prosthesis. The patient was satisfied with improved esthetics and chewing function.

Effect of non-thermal plasma on the shear bond strength of resin cements to Polyetherketoneketone (PEKK)

PURPOSE: This study aimed to assess the effect of non-thermal plasma on the shear bond strength of resin cements to polyetherketoneketone (PEKK) in comparison to other surface treatment methods. MATERIALS AND METHODS: Eighty PEKK discs were subjected to different surface treatments: (1) Untreated (UT); (2) Non-thermal plasma (NTP); (3) Sandblasting with 50 µm Al2O3 particles (SB); and (4) Sandblasting + Non-thermal plasma (SB+NTP). After each surface treatment, the contact angle was measured. Surface conditioning with Visio.Link was applied in all groups after pre-treatment. RelyX Unicem resin cement was bonded onto the PEKK specimens. After fabrication of the specimens, half of each group (n=10) was initially tested, while the other half was subjected to thermocycling (5℃ to 55℃ at 10,000 cycles). Shear bond strength (SBS) testing was performed using a universal testing machine, and failure modes were assessed using stereomicroscopy. The SBS results were analyzed statistically using one-way ANOVA followed by Tukey's post hoc test. Independent t-test was used to examine the effect of thermocycling (P < .05). RESULTS: The highest SBS values with or without thermocycling were observed with PEKK specimens that were treated with SB+NTP followed by the SB group. The lowest SBS results were observed in the UT groups. CONCLUSION: The shear bond strength between PEKK and resin cements was improved using non-thermal plasma treatment in combination with sandblasting.

Effects of relining materials on the flexural strength of relined thermoplastic denture base resins

PURPOSE: The aim of this study was to evaluate the effects of relining materials on the flexural strength of relined thermoplastic denture base resins (TDBRs). MATERIALS AND METHODS: For shear bond strength testing, 120 specimens were fabricated using four TDBRs (EstheShot-Bright, Acrytone, Valplast, Weldenz) that were bonded with three autopolymerizing denture relining resins (ADRRs: Vertex Self-Curing, Tokuyama Rebase, Ufi Gel Hard) with a bond area of 6.0 mm in diameter and were assigned to each group (n=10). For flexural strength testing, 120 specimens measuring 64.0×10.0×3.3 mm (ISO-1567:1999) were fabricated using four TDBRs and three ADRRs and were assigned to each group (n=10). The thickness of the specimens measured 2.0 mm of TDBR and 1.3 mm of ADRR. Forty specimens using four TDBRs and 30 specimens using ADRRs served as the control. All specimens were tested on a universal testing machine. For statistical analysis, Analysis of variance (ANOVA) with Tukey's test as post hoc and Spearman's correlation coefficient analysis (P=.05) were performed. RESULTS: Acry-Tone showed the highest shear bond strength, while Weldenz demonstrated the lowest bond strength between TDBR and ADRRs compared to other groups. EstheShot-Bright exhibited the highest flexural strength, while Weldenz showed the lowest flexural strength. Relined EstheShot-Bright demonstrated the highest flexural strength and relined Weldenz exhibited the lowest flexural strength (P < .05). Flexural strength of TDBRs (P=.001) and shear bond strength (P=.013) exhibited a positive correlation with the flexural strength of relined TDBRs. CONCLUSION: The flexural strength of relined TDBRs was affected by the flexural strength of the original denture base resins and bond strength between denture base resins and relining materials.

The influence of bone graft procedures on primary stability and bone change of implants placed in fresh extraction sockets / 대한악안면성형재건외과학회지

BACKGROUND: This study was to evaluate the effect of bone graft procedure on the primary stability of implants installed in fresh sockets and assess the vertical alteration of peri-implant bone radiographically. METHODS: Twenty-three implants were inserted in 18 patients immediately after tooth extraction. The horizontal gap between the implant and bony walls of the extraction socket was grafted with xenografts. The implant stability before and after graft procedure was measured by Osstell Mentor as implant stability quotient before bone graft (ISQ bbg) and implant stability quotient after bone graft (ISQ abg). Peri-apical radiographs were taken to measure peri-implant bone change immediately after implant surgery and 12 months after implant placement. Data were analyzed by independent t test; the relationships between stability parameters (insertion torque value (ITV), ISQ abg, and ISQ bbg) and peri-implant bone changes were analyzed according to Pearson correlation coefficients. RESULTS: The increase of ISQ in low primary stability group (LPSG) was 6.87 ± 3.62, which was significantly higher than the increase in high primary stability group (HPSG). A significant correlation between ITV and ISQ bbg (R = 0.606, P = 0.002) was found; however, age and peri-implant bone change were not found significantly related to implant stability parameters. It was presented that there were no significant peri-implant bone changes at 1 year after bone graft surgery. CONCLUSIONS: Bone graft procedure is beneficial for increasing the primary stability of immediately placed implants, especially when the ISQ of implants is below 65 and that bone grafts have some effects on peri-implant bone maintenance.

Full mouth rehabilitation of a patient with severe periodontitis using immediate loading after computer aided flapless implant surgery

Oral rehabilitation of a patient having severe periodontitis with alveolar bone resorption and periodontal inflammation presents a challenge to clinicians. However, if appropriate implant placement according to the bone shape is selected, unnecessary bone grafting or soft tissue surgery can be minimized. In recent years, using cone beam CT and software, it has become possible to operate the planned position with the surgical guide made with 3D printing technology. This case was a 70 years old female patient who required total extraction of teeth due to severe periodontitis and performed a full-mouth rehabilitation with an implant-supported fixed prosthesis. During the surgery, the implant was placed in a flapless manner through a surgical guide. Immediate loading of the temporary prosthesis made by CAD/CAM method before surgery was done. Since then, we have produced customized abutments and zirconia prostheses, and have reported satisfactory aesthetic and functional recovery.

Maxillary full-arch fixed dental prosthesis of the elderly patient with worn dentition

Tooth wear, one of the physiological changes in the elderly patient's mouth, generally does not require treatment, but requires prosthodontic restoration when occlusal disharmony, poor masticatory function, pulp exposure occurs. One of the primary considerations in prosthodontic restoration for tooth wear is vertical dimension. It is necessary to make an accurate diagnosis and analysis, correct judgement of the interdental relationship for predictive treatment plan. A step-by-step approach considering dental care for aged is also required. In this case, a 93-year-old male patient presented with worn dentition and mobility of existing fixed dental prosthesis. After diagnosis and evaluation, maxillary rehabilitation without any change in the occlusal vertical dimension was performed and this shows satisfactory results both functionally and morphologically.

Flexibility of resin splint systems for traumatized teeth / 대한치과보철학회지

PURPOSE: The aim of this study is to evaluate the flexural strength of flexible resins and the flexibility of different resin splint (RS) systems in comparison with resin wire splint (RWS) system. MATERIALS AND METHODS: Three different resin materials (G-aenial flo, GA, GC; Superbond, SB, Sun medical; G-fix, GF, GC) were tested flexural strength test in accordance with ISO-4049:2000. For the flexibility test of splint systems, a artificial model with resin teeth was used to evaluate three types of resin splint systems (GA, SB, and GF) and one resin wire splint system. The left central incisor was simulated ‘injured teeth’ with third degree mobility. Three consecutively repeated measurements of periotest value were taken in horizontal direction, before and after splinting to access tooth mobility. The splinting effect was calculated through the periotest value. Differences were evaluated through One-way Anova and Tukey HDS post-hoc tests for pair-wise comparison (α= .05). RESULTS: Although GA group showed significant higher flexural strength than SB and GF groups, all of three different resin splint systems produced a significantly higher and rigid splinting effect compared with 016" resin-wire splint system (P < .05). CONCLUSION: Within the limits of an in vitro study, it can be stated that resin splint systems are too rigid and may not be acceptable to treat tooth avulsion.

Shear bond strength of composite resin to high performance polymer PEKK according to surface treatments and bonding materials

PURPOSE: The object of the present study was to evaluate the shear bonding strength of composite to PEKK by applying several methods of surface treatment associated with various bonding materials. MATERIALS AND METHODS: One hundred and fifty PEKK specimens were assigned randomly to fifteen groups (n = 10) with the combination of three different surface treatments (95% sulfuric acid etching, airborne abrasion with 50 µm alumina, and airborne abrasion with 110 µm silica-coating alumina) and five different bonding materials (Luxatemp Glaze & Bond, Visio.link, All-Bond Universal, Single Bond Universal, and Monobond Plus with Heliobond). After surface treatment, surface roughness and contact angles were examined. Topography modifications after surface treatment were assessed with scanning electron microscopy. Resin composite was mounted on each specimen and then subjected to shear bond strength (SBS) test. SBS data were analyzed statistically using two-way ANOVA, and post-hoc Tukey's test (P<.05). RESULTS: Regardless of bonding materials, mechanical surface treatment groups yielded significantly higher shear bonding strength values than chemical surface treatment groups. Unlike other adhesives, MDP and silane containing self-etching universal adhesive (Single Bond Universal) showed an effective shear bonding strength regardless of surface treatment method. CONCLUSION: Mechanical surface treatment behaves better in terms of PEKK bonding. In addition, self-etching universal adhesive (Single Bond Universal) can be an alternative bonding material to PEKK irrespective of surface treatment method.

Cumulative survival rate and associated risk factors of Implantium implants: A 10-year retrospective clinical study

PURPOSE: The objective of this study was to determine the cumulative survival rate (CSR) and associated risk factors of Implantium implants by retrospective clinical study. MATERIALS AND METHODS: Patients who received Implantium implants (Dentium Co., Seoul, Korea) at Korea University Guro Hospital from 2004 to 2011 were included. The period between the first surgery and the last hospital visit until December 2015 was set as the observation period for this study. Clinical and radiographic data were collected from patient records, including all complications observed during the follow-up period. Kaplan-Meier analysis was performed to examine CSR. Multiple Cox proportional hazard model was employed to assess the associations between potential risk factors and CSR. RESULTS: A total of 370 implants were placed in 121 patients (mean age, 56.1 years; range, 19 to 75 years). Of the 370 implants, 13 failed, including 7 implants that were lost before loading. The 10-year cumulative survival rate of implants was 94.8%. The multiple Cox proportional hazard model revealed that significant risk factor of implant failure were smoking and maxillary implant (P<.05). CONCLUSION: The 10-year CSR of Implantium implants was 94.8%. Risk factors of implant failure were smoking and maxillary implant.

Demineralized dentin matrix combined with recombinant human bone morphogenetic protein-2 in rabbit calvarial defects

OBJECTIVES: The aim of this study was to compare the osteogenic effects of demineralized dentin matrix (DDM) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) in rabbit calvarial defects with DDM and anorganic bovine bone (ABB) combined with rhBMP-2. MATERIALS AND METHODS: Four round defects with 8-mm diameters were created in each rabbit calvaria. Each defect was treated with one of the following: 1) DDM, 2) ABB/rhBMP-2, or 3) DDM/rhBMP-2. The rhBMP-2 was combined with DDM and ABB according to a stepwise dry and dip lyophilizing protocol. Histological and microcomputed tomography (µCT) analyses were performed to measure the amount of bone formation and bone volume after 2- and 8-week healing intervals. RESULTS: Upon histological observation at two weeks, the DDM and ABB/rhBMP-2 groups showed osteoconductive bone formation, while the DDM/rhBMP-2 group showed osteoconductive and osteoinductive bone formation. New bone formation was higher in DDM/rhBMP-2, DDM and ABB decreasing order. The amounts of bone formation were very similar at two weeks; however, at eight weeks, the DDM/rhBMP-2 group showed a two-fold greater amount of bone formation compared to the DDM and ABB/rhBMP-2 groups. The µCT analysis showed markedly increased bone volume in the DDM/rhBMP-2 group at eight weeks compared with that of the DDM group. Notably, there was a slight decrease in bone volume in the ABB/rhBMP-2 group at eight weeks. There were no significant differences among the DDM, ABB/rhBMP-2, and DDM/rhBMP-2 groups at two or eight weeks. CONCLUSION: Within the limitations of this study, DDM appears to be a suitable carrier for rhBMP-2 in orthotopic sites.

Mandibular implant supported overdentures with two different mini-implant systems: A case report / 대한치과보철학회지

This case report describes the treatment of two fully edentulous patients with mini-implant overdentures using different implant systems on narrow mandibular alveolar bone ridge. They were complaining about discomfort and pain wearing mandibular conventional complete dentures caused by insufficient retention. Each patient received four mini-implants in the interforaminal area of the mandible using the non-submerged flapless surgical approach. One-body type implant (Slimline, Dentium, Seoul, Korea) was used for a patient and loaded immediately after surgery. Metal housings of O-ring were attached by direct technique. For the other patient, two-piece type implant (LODI, Zest Anchors, Escondido, CA, USA) was used and impressions were made for attachment connection of the Locator's metal housings after 8 weeks of surgery. Within this case report, mandibular mini-implant overdentures using different implant systems showed improvement of patient satisfaction with favorable peri-implant tissue response 6 months after attachment connection. However, long-term follow-up is needed for further evaluation.

Oral rehabilitation of a patient with severely worn dentition using monolithic zirconia / 대한치과보철학회지

Severe tooth wear may lead to pathological changes of pulp, imbalance in occlusion as well as functional and esthetic problems. In this case, 34-year-old male came to the hospital because of generally worn dentition due to attrition and erosion. After evaluation, a full mouth restoration with elevation of the vertical dimension of occlusion was planned. After occlusion was stabilized by an occlusal stabilization appliance, centric relation position was recorded and subsequent provisional restorations were fabricated. After evaluation, a CAD-CAM (computer aided design-computer aided manufacturing) prosthetic restoration was carried out using monolithic zirconia. After 12 months of follow up observation, the patient was satisfied with function and esthetic appearance.