DOI QR코드

DOI QR Code

The influence of intentional mobilization of implant fixtures before osseointegration

골유착전 임플란트 고정체의 의원성 동요가 골결합에 미치는 영향

  • Cho, Jin-Hyun (Department of Prosthodontics, School of Dentistry, Kyungpook National University) ;
  • Jo, Kwang-Heon (Department of Prosthodontics, School of Dentistry, Kyungpook National University) ;
  • Cho, Sung-Am (Department of Prosthodontics, School of Dentistry, Kyungpook National University) ;
  • Lee, Kyu-Bok (Department of Prosthodontics, School of Dentistry, Kyungpook National University) ;
  • Lee, Cheong-Hee (Department of Prosthodontics, School of Dentistry, Kyungpook National University)
  • 조진현 (경북대학교 치의학전문대학원 치과보철학교실) ;
  • 조광헌 (경북대학교 치의학전문대학원 치과보철학교실) ;
  • 조성암 (경북대학교 치의학전문대학원 치과보철학교실) ;
  • 이규복 (경북대학교 치의학전문대학원 치과보철학교실) ;
  • 이청희 (경북대학교 치의학전문대학원 치과보철학교실)
  • Received : 2012.03.27
  • Accepted : 2012.07.04
  • Published : 2012.07.31

Abstract

Purpose: The purpose of this study was to investigate the influence of mobilization on bone-implant interface prior to osseointegration of fixtures. Materials and methods: The experimental implants (3.75 mm in diameter, 4.0 mm in length) were made of commercially pure (Grade IV) titanium, and were treated with RBM ($MegaGen^{(R)}$: Ca-P). The 80 implants (two in each tibia) were inserted into the monocortical tibias of 20 rabbits which each weighed more than 3.5 kg (Female, New Zealand White). According to the removal torque interval, the groups were divided into 10 groups, Group I (6 wks), Group II (4 days+6 wks), Group III (4 days+1 wk+6 wks), Group IV (1 wk+6 wks), Group V (1 wk+1 wk+6 wks), Group VI (2 wks+6 wks), Group VII (2 wks+ 1 wk+6 wk), Group VIII (3 wks+6 wks), Group IX (3 wks+1 wk+6 wks) and Group X (10 wks). The control groups were Group I and X, the removal torque was measured at 6 wks and 10 wks with a digital torque gauge (Mark-10, USA). In the experimental groups, the removal torque was given once or twice before the final removal torque and the value was measured each time. After which, the implants were put back where they had been except the control groups. All the experimental groups were given a final healing time (6 wks) before the final removal torque test, in which values were compared with the control groups and the 1st and/or 2nd removal torque values in each experimental group. Results: In the final removal torque tests, the removal torque value of Group X (10 wks) was higher than that of Group I (6 wks) in the control groups but not statistically different. There were no significant differences between the experimental groups and control groups (P>.05). In the first removal torque comparison, the experimental groups (4 days or 1 wk) values were significantly lower than the other experimental groups (2 wks or 3 wks). In the comparison of each experimental group according to healing time, the final removal torque value was significantly higher than the 1st torque test value. Conclusion: Once or twice mobilization of fixture prior to osseointegration did not deter the final bone to implant osseointegration, if sufficient healing time was given.

연구 목적: 이 논문은 임플란트 고정체가 골융합이 이루어지기전 의원성 동요가 있을 경우 골결합에 어떤 영향을 미치는지를 알아 보고자 한다. 연구 재료 및 방법: 실험에 사용한 임플란트는 직경 3.73 mm, 길이 4 mm의 순수한 타이타늄과 RBM ($MegaGen^{(R)}$: Ca-P) 처리된 임플란트(Grade IV)를 사용하였다. 몸무게 3.5kg 이상의 토끼(Female, New Zealand White)의 한쪽 경골에 2개씩 양쪽 다리에 임플란트를 식립하여 모두 80개의 임플란트가 식립되었다. 비틀림 제거력(Removal torque)의간격에 따라 그룹 I (6주), 그룹 II (4일+6주), 그룹 III (4일+1주+6주), 그룹 IV (1주+6주), 그룹 V (1주+1주+6주), 그룹 VI (2주+6주), 그룹 VII (2주+1주+6주), 그룹 VIII (3주+6주), 그룹 IX (3주+1주+6주), 그룹 X (10주)으로 10개의 그룹으로 나누었다. 본 실험에서 그룹 I과 그룹X가 대조군이며, 비틀림 제거력은 digital torque gauze (Mark-10, USA)를 사용하여 6주와 10주에 측정하였다. 실험군에서는 마지막 비틀림 제거력을 측정하기 전에 의원성 동요를 가하여 한 번 혹은 두 번 비틀림 제거력을 측정하여 그 수치를 기록하였다. 그 후, 대조군을 제외하고 비틀림 제거력을 측정한 임플란트는 가급적 원래의 위치로 돌려 놓고 봉합을 하였다. 모든 실험군은 마지막 비틀림 제거력 측정전까지 6주간의 치유기간을 주었으며, 마지막 비틀림 제거력은 실험군 첫 번째 또는 두 번째 비틀림 제거력값과 비교하여 결과를 분석하였다. 결과: 마지막 비틀림 제거력 측정값에서 그룹X (10주)의 값이 대조군인 그룹 I (6주)의 값보다 높았으나, 통계적으로는 유의하지 않았다. 실험군과 대조군 사이의 통계적으로 유의한 차이를 보이지 않았다(P>.05). 첫 번째 비틀림 제거력 측정치에서, 실험군(4일혹은1주)에서 다른 실험군(2주혹은3주)의 수치보다 낮은 값을 보였다. 치유기간에 따른 각 실험군의 비교에서, 최종 비틀림 제거력 값이 첫 번째 비틀림 제거력 값 보다 현저히 높은 값을 보였다. 결론: 골유착이 형성되기 전 한 번 또는 두 번 의원성으로 동요는, 만약 충분한 치유기간을 가지게 될 경우 임플란트의 골유착에 영향을 주지 않는다.

Keywords

References

  1. Branemark PI, Breine U, Asell R, Hanson BO, Lindstrom J, Ohlsson A. Intraosseous anchorage of dental prosthesis I. Experimental studies. Scand J Plast Reconstr Surg Suppl 1969;3:81-100. https://doi.org/10.3109/02844316909036699
  2. Branemark PI, Hansson BO, Adell R, Breine U, Lindstrom J, Hallen O, Ohman A. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 1977;16:1-132.
  3. Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. J Biomed Mater Res 1998;43:192-203. https://doi.org/10.1002/(SICI)1097-4636(199822)43:2<192::AID-JBM14>3.0.CO;2-K
  4. Randow K, Ericsson I, Nilner K, Petersson A, Glantz PO. Immediate functional loading of Branemark dental implants. An 18-month clinical follow-up study. Clin Oral Implants Res 1999;10:8-15. https://doi.org/10.1034/j.1600-0501.1999.100102.x
  5. Lefkove MD, Beals RP. Immediate loading of cylinder implants with overdentures in the mandibular symphysis: the titanium plasma-sprayed screw technique. J Oral Implantol 1990;16:265-71.
  6. Misch CE. Implant design considerations for the posterior regions of the mouth. Implant Dent 1999;8:376-86. https://doi.org/10.1097/00008505-199904000-00008
  7. Coelho PG, Granjeiro JM, Romanos GE, Suzuki M, Silva NR, Cardaropoli G, Thompson VP, Lemons JE. Basic research methods and current trends of dental implant surfaces. J Biomed Mater Res B Appl Biomater 2009;88:579-96.
  8. Albrektsson T, Wennerberg A. Oral implant surface: Part I--review focusing on topographic and chemical properties of different surfaces and in vivo responses to them. Int J Prosthodont 2004;17:536-43.
  9. Coelho PG, Lemons JE. Physico/chemical characterization and in vivo evaluation of nanothickness bioceramic depositions on alumina-blasted/acid-etched Ti-6Al-4V implant surfaces. J Biomed Mater Res A 2009;90:351-61.
  10. Roberts WE, Turley PK, Brezniak N, Fielder PJ. Implants: Bone physiology and metabolism. CDA J 1987;15:54-61.
  11. Szmukler-Moncler S, Reingewirtz Y, Weber HP. Bone response to early loading: the effect of surface state. Davidovitch Z, Norton LA, Eds. Biological Mechanisms of Tooth Movement & Craniofacial Adaptation. Boston: Harvard Society for the Advancement of Orthodontics; 1996. p. 611-6.
  12. Ivanoff CJ, Sennerby L, Lekholm U. Reintegration of mobilized titanium implants. An experimental study in rabbit tibia. Int J Oral Maxillofac Surg 1997;26:310-5. https://doi.org/10.1016/S0901-5027(97)80878-8
  13. Jang JH, Cho JH, Lee CH. Study of re-osseointegration of implant fixture after mechanical unscrewing. J Korean Acad Prosthodont 2010;48:209-14. https://doi.org/10.4047/jkap.2010.48.3.209
  14. Hwang YJ, Cho JH, Lee CH. Investigation of osseointegration according to the healing time after having iatrogenic mobility of implant fixture. J Korean Acad Prosthodont 2010;48:308-14. https://doi.org/10.4047/jkap.2010.48.4.308
  15. Ye SH. An investigation of reosseointegration according to time course after intentional mobilization of implant fixture. MS Thesis. In: Graduate School, Kyungpook National University. 2009.
  16. Albrektsson T, Hansson HA, Kasemo B, et al. The interface zone of inorganic implants in vivo; titanium implants in bone. Ann Biomed Eng 1983;11:1. https://doi.org/10.1007/BF02363944
  17. De Bruyn H, Kisch J, Collaert B, Linden U, Nilner K, Dvarsater L. Fixed mandibular restorations on three early-loaded regular platform Branemark implants. Clin Implant Dent Relat Res 2001;3:176-84. https://doi.org/10.1111/j.1708-8208.2001.tb00139.x
  18. Chiapasco M, Abati S, Romeo E, Vogel G. Implant-retained mandibular overdentures with Branemark System MKII implants: a prospective comparative study between delayed and immediate loading. Int J Oral Maxillofac Implants 2001;16:537-46.
  19. Ganeles J, Rosenberg MM, Holt RL, Reichman LH. Immediate loading of implants with fixed restorations in the completely edentulous mandible: report of 27 patients from a private practice. Int J Oral Maxillofac Implants 2001;16:418-26.
  20. Branemark PI, Engstrand P, Ohrnell LO, Grondahl K, Nilsson P, Hagberg K, Darle C, Lekholm U. Branemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res 1999;1:2-16. https://doi.org/10.1111/j.1708-8208.1999.tb00086.x
  21. Ericsson I, Randow K, Nilner K, Peterson A. Early functional loading of Branemark dental implants: 5-year clinical follow-up study. Clin Implant Dent Relat Res 2000;2:70-7. https://doi.org/10.1111/j.1708-8208.2000.tb00108.x
  22. Colomina LE. Immediate loading of implant-fixed mandibular prostheses: a prospective 18-month follow-up clinical study-preliminary report. Implant Dent 2001;10:23-9. https://doi.org/10.1097/00008505-200101000-00008
  23. Sennerby L, Thomsen P, Ericson LE. Early tissue response to titanium implants inserted in rabbit cortical bone. Part II light microscopic observations. J Mater Sci Mater Med 1993;4:240-50. https://doi.org/10.1007/BF00122275
  24. Sennerby L, Thomsen P, Ericson LE. A morphometric and biomechanic comparison of titanium implants inserted in rabbit cortical and cancellous bone. Int J Oral Maxillofac Implants 1992;7:62-71.
  25. Sennerby L, Gottlow J. Clinical outcomes of immediate/early loading of dental implants. A literature review of recent controlled prospective clinical studies. Aust Dent J 2008;53:S82-8. https://doi.org/10.1111/j.1834-7819.2008.00045.x
  26. Castellon P, Blatz MB, Block MS, Finger IM, Rogers B. Immediate loading of dental implants in the edentulous mandible. J Am Dent Assoc 2004;135:1543-9; quiz 1621-2. https://doi.org/10.14219/jada.archive.2004.0080
  27. Oleinick AJ. Osseointegration versus fibro-osseointegration: review of endosseous dental implant systems. Gen Dent 1993;41:406-8.
  28. Brunski JB. Avoid pitfalls of overloading and micromotion of intraosseous implants. Dent Implantol Update 1993;4:77-81.