Strains of abutment and bones on implant overdentures

임플란트 피개의치에서 지대주와 골의 변형률에 관한 연구

  • Kim, Myung-Seok (Department of Prosthodontics, College of Dentistry, Seoul National University) ;
  • Heo, Seong-Joo (Department of Prosthodontics, College of Dentistry, Seoul National University) ;
  • Koak, Jai-Young (Department of Prosthodontics, College of Dentistry, Seoul National University) ;
  • Kim, Sung-Kyun (Department of Prosthodontics, College of Dentistry, Seoul National University)
  • 김명석 (서울대학교 치과대학 보철학교실) ;
  • 허성주 (서울대학교 치과대학 보철학교실) ;
  • 곽재영 (서울대학교 치과대학 보철학교실) ;
  • 김성균 (서울대학교 치과대학 보철학교실)
  • Published : 2009.04.30

Abstract

Statements of the problem: Over the past decades, conventional complete dentures were used for various patients although they have incomplete function. Overdentures using dental implants could help the improvement of denture function. Purpose: The purpose of this study was to compare the strains of abutment and bone on implant overdenture between splinted and unsplinted type of prosthesis. Additionally, the strain values of parallel placed implant model and unparallel placed implant model were compared. Material and methods: Two acrylic resin model were prepared and two implants were placed at the canine positions in each model. In the first model, two implant were placed parallel. In the second model, two implants were placed with 10 degree labiolingual divergence. Two types of abutment were connected to the fixtures alternatively. One was splint type of Hader bar, the other was unsplint type of ball abutment. Overdentures were fabricated with corresponding attachment systems and seated on abutments. Strains of abutments and labial bone simulants were measured with electric resistance strain gauges when static load from 100 N to 200 N were applied to overdentures. Results: 1. Splinted type of overdentures using bar and clip showed higher absolute strain values. But the strain was compressive and the load was shared by two implants(P<.05). 2. Unsplinted type overdentures using ball and O-ring showed low absolute strain values(P<.05). 3. Labially inclined implant showed higher tensile strain values in unsplinted type of prosthesis than in splinted type of prosthesis. Lingually inclined implant showed rather low strain values under load(P<.05). 4. Non parallel implant model showed higher absolute strain values than parallel placed implant model comprehensively(P<.05).

연구목적: 임플란트 피개의치에서 연결고정형과 비연결고정형 보철물 지대주와 골의 변형률을 비교하고 임플란트 식립 경사에 따른 변형률을 비교 분석하고자 하였다. 연구 재료 및 방법: 2개의 아크릴릭 레진 모형의 좌측과 우측 견치 부위에 2개의 외부연결형 임플란트를 각각의 모형에 식립하였다. 한 모형에는 두 개의 임플란트를 평행하게 식립하였고, 다른 모형에는 순측과 설측으로 10도의 이개도(divergence)를 가지게 임플란트를 식립하였다. 모형에서 바를 이용한 연결고정형 지대주와 볼을 이용한 비연결고정형 지대주를 고정체에 번갈아 연결하고, 각각의 경우 대응하는 유지장치가 부착된 피개의치를 제작하여 지대주 상에 안착시켰다. 전기저항 스트레인 게이지(strain gauge)를 이용하여 피개의치에 100 N에서 200 N의 부하를 가하였을 때 지대주와 가상골 표면의 변형률(strain)을 측정하였다. 결과 및 결론: 측정된 값들을 통계분석하여 얻은 결과는 다음과 같다. 바를 이용한 연결고정형 보철물은 비연결형 보철물 보다 높은 변형률 값을 보였다. 그러나 방향은 주로 압축력이었으며 부하는 분산되었다(P<.05). 볼을 이용한 비연결고정형 보철물은 연결고정형보다 낮은 변형률 값을 보였다(P<.05). 순측경사된 임플란트에서는 비연결고정형 보철물이 연결고정형 보철물보다 더 높은 변형률 값을 보였다. 설측경사된 임플란트는 순측경사된 임플란트보다 낮은 변형률을 보였다(P<.05). 임플란트가 평행하게 식립된 경우보다 평행하지 않게 식립된 경우 지대주와 가상골의 변형률 값이 더 높았다(P<.05).

Keywords

References

  1. van Waas MA. The influence of clinical variables on patients' satisfaction with complete dentures. J Prosthet Dent 1990;63:307-10 https://doi.org/10.1016/0022-3913(90)90202-N
  2. Heckmann SM, Winter W, Meyer M, Weber HP, Wichmann MG. Overdenture attachment selection and the loading of implant and denture-bearing area. Part 2: A methodical study using five types of attachment. Clin Oral Implants Res. 2001;12:640-7 https://doi.org/10.1034/j.1600-0501.2001.120613.x
  3. Jemt T, Book K, Karlsson S. Occlusal force and mandibular movements in patients with removable overdentures and fixed prostheses supported by implants in the maxilla. Int J Oral Maxillofac Implants 1993;8:301-8
  4. Chung KH, Chung CY, Cagna DR, Cronin RJ Jr. Retention characteristics of attachment systems for implant overdentures. J Prosthodont 2004;13:221-6 https://doi.org/10.1111/j.1532-849X.2004.04042.x
  5. Van Steenberghe D, Quirynen M, Calberson L, Demanet M. A prospective evaluation of the fate of 697 consecutive intra-oral fixtures modum Branemark in the rehabilitation of edentulism. J Head Neck Pathol 1987;6:53-58
  6. Mericske-Stern R, Steinlin Schaffner T, Marti P, Geering AH. Peri-implant mucosal aspects of ITI implants supporting overdentures. A five-year longitudinal study. Clin Oral Implants Res 1994;5:9-18 https://doi.org/10.1034/j.1600-0501.1994.050102.x
  7. Jemt T, Chai J, Harnett J, Heath MR, Hutton JE, Johns RB, McKenna S, McNamara DC, van Steenberghe D, Taylor R, Watson RM, Herrmann I. A 5-year prospective multi-center follow-up report on overdentures supported by osseointegrated implants. Int J Oral Maxillofac Implants 1996;11:291-8
  8. Naert I, Gizani S, Vuylsteke M, Van Steenberghe D. A 5-year prospective randomized clinical trial on the influence of splinted and unsplinted oral implants retaining a mandibular overdenture: prosthetic aspects and patient satisfaction. J Oral Rehabil 1999;26:195-202 https://doi.org/10.1046/j.1365-2842.1999.00369.x
  9. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais J, Naert I, Payne AG, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Montreal, Quebec, May 24-25, 2002. Int J Oral Maxillofac Implants 2002;17:601-2
  10. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Heydecke G, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais JA, Naert I, Payne AG, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Gerodontology 2002;19:3-4 https://doi.org/10.1111/j.1741-2358.2002.00003.x
  11. Visser A, Meijer HJ, Raghoebar GM, Vissink A. Implant-retained mandibular overdentures versus conventional dentures: 10 years of care and aftercare. Int J Prosthodont 2006;19:271-8
  12. Wiemeyer AS, Agar JR, Kazemi RB. Orientation of retentive matrices on spherical attachments independent of implant parallelism. J Prosthet Dent 2001;86:434-7 https://doi.org/10.1067/mpr.2001.118365
  13. Prieskel HW. Overdentures made easy: a guide to implant and root supported prostheses. London: Quintessence; 1996. pp. 89
  14. Merickske-Stern RD, Zarb GA. Clinical protocol for treatment with supported overdentures. In: Zarb GA, Bolender CL, Carlsson GE, editors. Boucher's prosthodontic treatment for edentulous patients. 11th ed. St. Louis: Mosby; 1997. pp. 527
  15. Landa LS, Cho SC, Froum SJ, Elian N, Tarnow DP. A prospective 2-year clinical evaluation of overdentures attached to nonsplinted implants utilizing ERA attachments. Pract Proced Aesthet Dent. 2001;13:151-6
  16. Burns DR. The mandibular complete overdenture. Dent Clin North Am 2004;48:603-23 https://doi.org/10.1016/j.cden.2004.03.002
  17. Gulizio MP, Agar JR, Kelly JR, Taylor TD. Effect of implant angulation upon retention of overdenture attachments. J Prosthodont 2005;14:3-11 https://doi.org/10.1111/j.1532-849X.2005.00005.x
  18. Krennmair G, Ulm C. The symphyseal single-tooth implant for anchorage of a mandibular complete denture in geriatric patients: a clinical report. Int J Oral Maxillofac Implants 2001;16:98-104
  19. Menicucci G, Lorenzetti M, Pera P, Preti G. Mandibular implant-retained overdenture: finite element analysis of two anchorage systems. Int J Oral Maxillofac Implants 1998;13:369-76
  20. Menicucci G, Lorenzetti M, Pera P, Preti G. Mandibular implant-retained overdenture: a clinical trial of two anchorage systems. Int J Oral Maxillofac Implants 1998;13:851-6
  21. Kenney R, Richards MW. Photoelastic stress patterns produced by implant-retained overdentures. J Prosthet Dent 1998;80:559-64 https://doi.org/10.1016/S0022-3913(98)70032-0
  22. Meijer HJ, Kuiper JH, Starmans FJ, Bosman F. Stress distribution around dental implants: influence of superstructure, length of implants, and height of mandible. J Prosthet Dent 1992;68:96-102 https://doi.org/10.1016/0022-3913(92)90293-J
  23. Mericske-Stern R, Piotti M, Sirtes G. 3-D in vivo force measurements on mandibular implants supporting overdentures. A comparative study. Clin Oral Implants Res 1996;7:387-96 https://doi.org/10.1034/j.1600-0501.1996.070413.x
  24. Burns DR. Mandibular implant overdenture treatment: consensus and controversy. J Prosthodont 2000;9:37-46 https://doi.org/10.1111/j.1532-849X.2000.00037.x
  25. Merickske-Stern R. Overdentures supported by ITI implants. In: Schroeder A, Sutter F, buser D, Krekler G, eds. Oral Implantology: basics, ITI hollow cylinder system. 2nd ed. Stuttgart: Thieme; 1996. pp 330-67
  26. Chao YL, Meijer HJ, Van Oort RP, Versteegh PA. The incomprehensible success of the implant stabilised overdenture in the edentulous mandible: a literature review on transfer of chewing forces to bone surrounding implants. Eur J Prosthodont Restor Dent 1995;3:255-61
  27. Sadowsky SJ, Caputo AA. Effect of anchorage systems and extension base contact on load transfer with mandibular implant-retained overdentures. J Prosthet Dent 2000;84:327-34 https://doi.org/10.1067/mpr.2000.109378
  28. Akca K, Cehreli MC, Iplikcioglu H. A comparison of three-dimensional finite element stress analysis with in vitro strain gauge measurements on dental implants. Int J Prosthodont 2002;15:115-21
  29. Dally LW, Riley WF. Experimental Stress Analysis. Singapore, Japan, McGraw-Hill, 1985, pp 217-72
  30. Glantz PO, Rangert B, Svensson A, Stafford GD, Arnvidarson B, Randow K, Linden U, Hulten J. On clinical loading of osseointegrated implants. A methodological and clinical study. Clin Oral Implants Res 1993;4:99-105 https://doi.org/10.1034/j.1600-0501.1993.040206.x
  31. Pearson OM, Lieberman DE. The aging of Wolff s law : ontogeny and responses to mechanical loading in cortical bone. Am J Phys Anthropol 2004;39:63-99 https://doi.org/10.1002/ajpa.20155
  32. Jemt T. Three-dimensional distortion of gold alloy castings and welded titanium frameworks. Measurements of the precision of fit between completed implant prostheses and the master casts in routine edentulous situations. J Oral Rehabil 1995;22:557-64 https://doi.org/10.1111/j.1365-2842.1995.tb01049.x
  33. Martin RB, Burr DB. Structure, function, and adaptation of compact bone. New York, 1989, pp 143-85
  34. Frost HM. Perspectives: bone's mechanical usage windows. Bone Miner. 1992;19:257-71 https://doi.org/10.1016/0169-6009(92)90875-E
  35. Frost HM. Wolff's Law and bone's structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod 1994;64:175-88