Comparative finite element analysis of mandibular posterior single zirconia and titanium implants: a 3-dimensional finite element analysis

PURPOSE@#Zirconia has exceptional biocompatibility and good mechanical properties in clinical situations. However, finite element analysis (FEA) studies on the biomechanical stability of two-piece zirconia implant systems are limited. Therefore, the aim of this study was to compare the biomechanical properties of the two-piece zirconia and titanium implants using FEA. @*MATERIALS AND METHODS@#Two groups of finite element (FE) models, the zirconia (Zircon) and titanium (Titan) models, were generated for the exam. Oblique (175 N) and vertical (175 N) loads were applied to the FE model generated for FEA simulation, and the stress levels and distributions were investigated. @*RESULTS@#In oblique loading, von Mises stress values were the highest in the abutment of the Zircon model. The von Mises stress values of the Titan model for the abutment screw and implant fixture were slightly higher than those of the Zircon model. Minimum principal stress in the cortical bone was higher in the Titan model than Zircon model under oblique and vertical loading. Under both vertical and oblique loads, stress concentrations in the implant components and bone occurred in the same area. Because the material itself has high stiffness and elastic modulus, the Zircon model exhibited a higher von Mises stress value in the abutments than the Titan model, but at a level lower than the fracture strength of the material. @*CONCLUSION@#Owing to the good esthetics and stress controllability of the Zircon model, it can be considered for clinical use.

Accuracy comparison between subtractive and additive methods in fabricating working model / 대한치과재료학회지

The purpose of this study was to compare the accuracy of the working models fabricated by the subtractive and additive processing methods based on the 3-dimensional reconstruction model. A total of 20 models were fabricated with subtractive processing method from polymethyl methacrylate (PMMA) blocks using the stereolithography (STL) file of master gypsum model and another 20 models were fabricated with additive processing method using 3D printer with 0.025 mm of a layer thickness. The CAD-reference-model (CRM) and CAD-test-model (CTM) were superimposed by a software for accuracy analysis (Geomagic Qualify 13), where the STL files were transformed to point cloud data and the surface data (CRM and CTM) were subjected to initial alignment and followed by re-alignmented according to best-fit superimposition. The distances between surface data and all points, in this process, were converted to the root mean square (RMS) and averaged. In the experimental results, It was shown that the accuracy is higher in work model fabricated by additive processing method compared to one fabricated by subtractive one (p < 0.05). In addition, it is considered that the working model fabricated by subtractive processing method is to be clinically applicable by improving the improper reproducibility of the tooth surface and depressed area.

Accuracy of a direct drill-guiding system with minimal tolerance of surgical instruments used for implant surgery: a prospective clinical study

PURPOSE: A recently introduced direct drill-guiding implant surgery system features minimal tolerance of surgical instruments in the metal sleeve by using shank-modified drills and a sleeve-incorporated stereolithographic guide template. The purpose of this study was to evaluate the accuracy of this new guided surgery system in partially edentulous patients using geometric analyses. MATERIALS AND METHODS: For the study, 21 implants were placed in 11 consecutive patients using the direct drill-guiding implant surgery system. The stereolithographic surgical guide was fabricated using cone-beam computed tomography, digital scanning, computer-aided design and computer-assisted manufacturing, and additive manufacturing processes. After surgery, the positional and angular deviations between planned and placed implants were measured at the abutment level using implant-planning software. The Kruskal-Wallis test and Mann-Whitney U test were used to compare the deviations (α=.05). RESULTS: The mean horizontal deviations were 0.593 mm (SD 0.238) mesiodistally and 0.691 mm (SD 0.344) buccolingually. The mean vertical deviation was 0.925 mm (SD 0.376) occlusogingivally. The vertical deviation was significantly larger than the horizontal deviation (P=.018). The mean angular deviation was 2.024 degrees (SD 0.942) mesiodistally and 2.390 degrees (SD 1.142) buccolingually. CONCLUSION: The direct drill-guiding implant surgery system demonstrates high accuracy in placing implants. Use of the drill shank as the guiding component is an effective way for reducing tolerance.

Does the maxillary anterior ratio in Korean adults follow the Golden Proportion?

PURPOSE: The purpose of this study was to determine the effect of changes in the horizontal plane angle on the mesiodistal width ratios of the maxillary anterior teeth during the acquisition of frontal view photographs, derive these ratios for Korean adults on the basis of the data obtained, and analyze them using the Golden Proportion as a reference. MATERIALS AND METHODS: In experiment I, 30 plaster casts were mounted on an articulator and positioned on the angle-measuring device with a center setting of 0°. The device was rotated to 10° in 1° increments in a counterclockwise direction. At each angle, photographs were obtained and analyzed. Experiment II was based on 60 patients who visited the Department of Prosthodontics at Kyungpook National University Dental Hospital from February 2012 to February 2015. The patients were divided into three groups [Male (M), Female (F), Total (M + F)]. Frontal views were obtained for all groups and analyzed. RESULTS: From 1° to 10°, the relative mesiodistal width ratios for the maxillary anterior teeth showed no significant differences from those at 0°. In all three groups, the relative width ratio of the maxillary central incisor was smaller than that specified in the Golden Proportion; the opposite was true for the canine. CONCLUSION: Our results suggest that the mesiodistal width ratios of the maxillary anterior teeth do not follow the Golden Proportion in Korean adults, and that a change in the horizontal plane angle from 1° to 10° during frontal photography does not affect these ratios.

An analysis on satisfaction level of clinicians on implant surgical guidance system based on computed tomography

PURPOSE: The purpose of this study was to conduct a comparative assessment on the satisfaction level for the two interfaces of surgical guide system (SimPlant and R2GATE), the design and convenience of manufactured surgical guides and the importance of using the surgical guides thereof by means of survey. MATERIALS AND METHODS: Hereupon, they simulated the implant surgical process by mounting the two manufactured systems of surgical guide on a dental mold, respectively. The study subjects were instructed to complete the questionnaire as to the satisfaction level upon completion of the simulated surgery. This study summarized the data of each question after collecting the completed questionnaires. Then, this study analyzed the summarized data by utilizing statistical program SPSS 20.0 (IBM). RESULTS: R2GATE had a higher value of the satisfaction level on the design and convenience of manufactures surgical guides. R2GATE group (7.33 +/- 1.26) was found to have a higher value in terms of the overall satisfaction level compared to SimPlant group (6.67 +/- 1.26) (alpha = 0.05). CONCLUSION: The user satisfaction level on the surgical guide manufactured for R2GATE system was to such an extent as it can be widely used in clinical environment. Moreover, the surgical guide manufactured as R2GATE system can guide both the length and direction of a drill simultaneously. As a result, it is highly recommended for those beginners who do not have a lot of experience in implant placement.

Clinical case of implant restoration using customized healing abutment / 대한치과보철학회지

Aesthetic impression is emphasized in the recent field of implant restoration. However, there is limitation of creating proper shape of soft tissue as well as cervical emergence profile due to the use of pre-existing healing abutment in the process of initial post-operative soft tissue healing period. Designing the shape of abutment into the final customized abutment instead of its original shape helped to achieve more aesthetic implant restoration by applying healing abutment which could minimize the malposition and recession of soft tissue. In this study, soft tissue healing was promoted using the post-operative customized healing abutment and thereby obtained the result of more aesthetic and functional restoration by minimizing displacement of soft tissue in the process of applying final customized abutment.

Improvement of osteogenic potential of biphasic calcium phosphate bone substitute coated with two concentrations of expressed recombinant human bone morphogenetic protein 2

PURPOSE: The aim of this study was to determine whether biphasic calcium phosphate (BCP) bone substitute with two different concentrations of Escherichia coli-expressed recombinant human bone morphogenetic protein 2 (ErhBMP-2) enhances new bone formation in a standardized rabbit sinus model and to evaluate the concentration-dependent effect of ErhBMP-2. METHODS: Standardized, 6-mm diameter defects were made bilaterally on the maxillary sinus of 20 male New Zealand white rabbits. Following removal of the circular bony windows and reflection of the sinus membrane, BCP bone substitute without coating (control group) was applied into one defect and BCP bone substitute coated with ErhBMP-2 (experimental group) was applied into the other defect for each rabbit. The experimental group was divided into 2 subgroups according to the concentration of ErhBMP-2 (0.05 and 0.5 mg/mL). The animals were allowed to heal for either 4 or 8 weeks and sections of the augmented sinus and surrounding bone were analyzed by microcomputed tomography and histologically. RESULTS: Histologic analysis revealed signs of new bone formation in both the control and experimental groups with a statistically significant increase in bone formation in experimental group 1 (0.05 mg/mL ErhBMP-2 coating) after a 4-week healing period. However, no statistically significant difference was found between experimental group 1 and experimental group 2 (0.5 mg/mL ErhBMP-2 coating) in osteoinductive potential (P<0.05). CONCLUSIONS: ErhBMP-2 administered using a BCP matrix significantly enhanced osteoinductive potential in a standardized rabbit sinus model. A concentration-dependent response was not found in the present study.

Improvement of osteogenic potential of biphasic calcium phosphate bone substitute coated with synthetic cell binding peptide sequences

PURPOSE: The aim of this study was to evaluate the improvement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with synthetic cell-binding peptide sequences in a standardized rabbit sinus model. METHODS: Standardized 6-mm diameter defects were created bilaterally on the maxillary sinus of ten male New Zealand white rabbits, receiving BCP bone substitute coated with synthetic cell binding peptide sequences on one side (experimental group) and BCP bone substitute without coating (control group) on the other side. Histologic and histomorphometric analysis of bone formation was carried out after a healing period of 4 or 8 weeks. RESULTS: Histological analysis revealed signs of new bone formation in both experimental groups (4- and 8-week healing groups) with a statistically significant increase in bone formation in the 4-week healing group compared to the control group. However, no statistically significant difference in bone formation was found between the 8-week healing group and the control group. CONCLUSIONS: This study found that BCP bone substitute coated with synthetic cell-binding peptide sequences enhanced osteoinductive potential in a standardized rabbit sinus model and its effectiveness was greater in the 4-week healing group than in the 8-week healing group.