이중관으로 연결된 자연치와 임플랜트의 악골 내응력분포에 관한 3차원 유한요소분석

이수옥,최대균,권긍록,우이형,Lee, Su-Ok,Choi, Dae-Gyun,Kwon, Kung-Rock,Woo, Yi-Hyung 대한치과보철학회 2008 대한치과보철학회지 Vol.46 No.4

서론: 임플랜트와 자연치가 혼재하는 증례에 있어서 보철물의 연결여부와 그 결과에 대해 논쟁이 많이 있어왔다. 본 연구에서는 임플랜트와 자연치를 이중관으로 연결했을 경우에 치조골 내에서 임플랜트 주변 조직의 하중에 대한 응력의 양상을 분석하여 자연 치와 임플랜트를 연결하는 보철물의 방식으로 이중관의 사용가능성을 비교 분석하고자 하였다. 연구재료 및 방법: 실험군으로서는 한 개의 자연치아와 한 개의 임플랜트를 이중관으로 연결한 모델을 사용하고, 대조군으로 두 개의 임플랜트를 이중관으로 연결한 모델을 사용하여 응력분포의 차이를 비교분석하였다. 임플랜트와 자연치 각각 통상적인 금합금을 사용하여 내,외관을 모델링한 후 각각의 외관을 연결한 구조를 형성한다. 내관과 외관은 $6^{\circ}$의 경사도 (taper)로 형성하고 내외관 사이의 공간을 인정하여, 하중을 가했을 경우 내외관 사이에 합금의 마찰력과 변위를 계산하여, 그 결과가 골내 임플랜트의 응력 분포에 영향을 줄 수 있도록 실험모델을 형성하였다. 하중은 일반적인 저작력의 크기로 임플랜트 부위와 자연치 부위에 각각 부여하여 응력의 차이를 비교하였으며, 최종적으로 대조군과의 차이를 비교하고자 하였다. 하중 조건은 임플랜트와 자연치아 사이, 임플랜트 후방, 전방부 자연치아의 사이에 하중을 가하였으며, Load case 1, 2, 3로 분류하였다. 실험을 위해서 ANSYS Version 8.1을 사용하여 3차원 유한 요소 분석을 시행하였다. 연구성적: 지대주에 가해지는 응력 - 최대 응력은 실험군이 대조군에 비해 각각 2.4 (Load Case1), 1.02 (Load Case2), 0.46 (Load Case3)배 높게 나타났으며,Load Case3의 경우 대조군의 최대응력이 더욱 높게 나타났는데, 이것은 전치부 치아의 경우 하중을 효과적으로 분산하기 때문인 것으로 보인다. 악골내에 가해지는 응력 - 악골내에서 최대 응력은 실험군이 대조군에 비해 각각 1.69 (Load Case1), 1.26 (Load Case2), 1.93 (Load Case3) 배 크게 나타났다 결론: 임플랜트와 자연치아가 혼재된 경우, 이중관으로 상부 보철물을 연결한 경우, 임플랜트만으로 구성된 대조군에 비해, 임플랜트 및 임플랜트 식립 부위의 악골에 가해지는 최대 응력은 1.02 에서 2.4배 가량 높게 나타났다. 자연치아의 움직임이 임플랜트의 경부 및 악골 내에 응력을 집중시킨 것으로 보이며, 자연치아가 있는 악골부위에서는 응력이 거의 발생하지 않았다. 본 실험의 경우 자연치아와 임플랜트에서 모든 하중을 받는 것으로 계산하였고, 실제 가철성 의치에서 나타나는 점막의 영향을 배제하였기 때문에, 실제 임상에서는 후방 임플랜트에 미치는 최대 응력의 크기는 2.4배 이하일 것으로 추정할 수 있다. 앞으로, 실제 임상에 적용하였을 경우, 임플랜트에 미치는 영향 및 자연치아에 미치는 결과에 대한 연구가 필요할 것이다. Purpoose: For decades dental implants have been used widely in the field of prosthetic dentistry. However there is confusion when establishing treatment plans in cases where some teeth are remained but an insufficient number of implants can be used due to limited anatomical status and ecomomical problems. Many clinicians have tried to connect natural teeth and implants, and it still has controversy. But, there have been few studies on mechanical analysis of connecting natural teeth and implants with konus telescopic removable partial dentures. The purpose of this study was to analyze the stress distribution of prosthesis, abutment and alveolar bone when teeth and implants were connected with the konus telescopic denture, by means of 3-dimensional finite element analysis. Material and methods: The assumption of this study was that there were 2 mandibular canine (11 mm in length, 4 mm in diameter) and 2 implants(10 mm in length, 4 mm in diameter) which are located in the second premolar region. The mandible, teeth, implants, abutments, and connectors are modeled, and analyzed with the commercial software, ANSYS Version 8.1(Swanson, Inc., USA). The control group used implants instead of natural teeth. 21038 elements, 23544 nodes were used in experimental group and 107595 elements, 21963 nodes were used in control group, Stress distribution was evaluated under 150 N vertical load on 3 experimental conditions - between teeth and implants (Load case 1), posterior to implants (Load case 2), between natural teeth (Load case 3). Results: 1. In all load cases, higher von mises stress value was observed in the experimental group. 2. Maximum von miss stress observed in all load cases and all locations were as follows ; a. 929.44 Mpa in the experimental group, 640.044 Mpa in the control group in outer crown and connector - The experimental group showed 1.45 times high value compared with the control group. b. 145,051 Mpa in the experimental group, 142.338 Mpa in the control group in abutment - The experimental group showed 1.02times high value compared with the control group. c. 32.489 Mpa in the experimental group, 25.765 Mpa in the control group in alveolar bone - The experimental group showed 1.26times higher value compared with the control group. 3. All maximum von mises stress was observed in load case 2, and maxim von mises stress in alveolar bone was 32.489 Mpa at which implant failure cannot occur. 4. If maximum von mises stress is compared between two groups, the value of the experimental group is 1.02 times higher than the control group in abutment, 1.26 times higher than the control group in alveolar bone. Conclusion: If natural teeth and implants are connected with the konus telescopic denture, maximum stress will be similar in abutment, 1.26 times higher in alveolar bone than the control group. With this result, there may be possible to make to avoid konus telescopic dentures where natural teeth and implants exist together.

A Study on the Narrative of Anne Bronte : The Tenant of Wildfell Hall

최대해 현대영미어문학회 2004 현대영미어문학 Vol.22 No.1

앤 브론테의 내러티브 연구 : 와일더펠 홀의 소작인을 중심으로

회음부 외상후 발생한 음경지속발기증 1례

최대해,최우익 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.6

Priapism is the pathologic prolongation of penile erection, accompanied by pain and tenderness but not by sexual exitement and not relieved orgasm. Priapism is a urologic emergency and treatment should not be delayed. The overall incidence and prevalence of priapism are u n k n o w n . Priapism can be classified as high flow or low flow depending on the status of th penile arterial blood flow. The initial evaluation of the priapic patient should attempt to differentiate the high from low flow state. A complete history should be obtained. Early determination of the state of corporal oxygenation is essential and will define the optimal management approach. Early intervention and prompt, appropriate therapy improves outcome. Through greater understanding of the pathophysiology of priapism, the clinician may become armed with etiologyspecific medical alternatives providing timely detumescence for men with prolonged erections. The authors report the experience of case of high flow priapism after perineal trauma with review of the literature.

위장관 출혈을 주소로 내원한 소아의 임상적 고찰

최대해,최우익 대한응급의학회 2005 大韓應急醫學會誌 Vol.16 No.1

재난에 대한 의료기관의 대응태세

최대해 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

재난 대응은 복잡하며,수많은 기관의 적극적인 협조를 필요로 한다. 재난 대응에서의 응급의료체계의 역할은 병원 전단계에서 적절한 의료적 처치를 통한 환자의 생명의 보호에 있고 특히 초등조치팀의 역할은 아주 중요하다. 초등조치팀의 적절한 대응은 모든 형태의 재난에서 환자의 예후를 좋게 만들 수 있고 병원에서의 적절한 대응 또한 추가적인 손상을 최소화 시킬 수 있다. 재난 대응 준비의 부실은 국가적인 재앙으로 확산될 수 있으므로 재난에 대한 초등조치 및 병원 의료 대응의 현 상태를 개선하기 위해서는 관련 지침 마련 등에 필요한 예산의 확보와 정부의 적극적인 지원이 필요할 것이다. Disaster mitigation is coordinated chaos. Response operations are complex and demand delicate interagency coordination coupled with aggressive integrated action. The role of emergency medical service (EMS) in disaster is to provide effective prehospital casualty care, prevent further life-threatening or acute illnesses and facilitate resolution of the medical component of the event. First responders, usually fire or police units, are typically activated simultaneously with ambulance personnel. The suggestion of this article was to improve role of first responder and hospital medical response in biologic disaster.

The Scarlet Letter 에 나타난 Symbolism 의 현대적 조명

최대해 한국호손학회 2000 미국소설 Vol.7 No.1

The purpose of this paper is to examine Hawthorne's symbolism in The Scarlet Letter. Nathaniel Hate tells his truths in symbolism. The novel repeatedly claims some deep meaning and of its symbolism. The pupose of such method is obviously to introduce multiple possibilities and hence to keep meaning. Symbols an range from the most obvious substitution of one thing for another. In Hawthorne's use of symbols in The Scarlet Letter, we observe the author mating one of his most distinctive and significa caotributiams to the growth of American fiction. The symbolism in this novel implies many thins. Among such symbols is the letter A itself. In its initial form, it is a red cloth letter which is a literal symbol of the sin of adultery. But Hawthorne maces the A it mode variously symbolic before the novel ends. The letter A appears in a variety of forms and places. The letter A begins to become the symbol of $quot;helpfulness$quot; to some people, zest Adultery, but Able, Affection, Angel, Alpha, Abel, Adam, America. In describing nature and persons in The Scarlet Letter, Author often uses $quot;light and shadow$quot;: the most prominent of these is contrast of light mid dark Night is used as a symbol for concealment, and day is a symbol for exposure. Dimmesdal's mounting the scaffold and standing with I-les and Pearl at night will not suffice: he (mows that his symbolic acceptance of his guilt nest take place in the daylight. The colors that are employed in this literary work are diverse. All the colors in the novel ace associated with one of mere natural of moral values, positive a negative. The most frequent colors are rad, black, gray, green, scarlet, crimson, purple, ruddy. The colors ted in these types of images are associated with natural good, moral good and spiritual good, natural evil and moral evil. $quot;Red$quot; stand for $quot;sin, passion, adultery, and the deep heart of Nature' and $quot;Black$quot; symbolizes $quot;evil, sin$quot; and represents emotions such as $quot;sad, inauspicious, sorrow, unhappiness.$quot; The colors of $quot;green, yellow, brown$quot; the colors as often find in Nature, are also used for representing the betty of vivid Nadine. The scaffold scene is equally symbolical. Hawthorne plans this scene to insane the dramatic equality of minister's revelation. The minister strands revealed by light of day. This final scene is completed by the presence of the missing sinner, his guilt, and the world, symbolized by die people around the scaffold. The forest is also symbolic in a variety of way. The symbolic meanings of the forest can be analyzed from different points of view. The moral law does not coincide with the natural law. From this viewpoint, the forest is depicted as a place where witches gather, and where souls are signed away to devil. The forest represents the $quot;heathen$quot; forest. It is however the four major characters that Hawthorn's pours as symbolist are brought into fullest play. Each of his major s symbolizes a certain view of sin and its effects on the human heat. Modem people may say that this literary work is indeed the work of symbolic romance, as it begins with, and ends with symbols.

Anne Bronte의 The Tenant of Wildfell Hall에 나타난 서술기법연구

최대해 한국영미어문학회 1998 영미어문학 Vol.- No.52

Hawthorne 의 종교적 죄의식 : The Scarlet Letter 를 중심으로

최대해 한국호손학회 2001 미국소설 Vol.8 No.1

The objective of this paper is to analyze the sense of religious sin in Nathaniel Ha. This paper is to represend diverse approaches to the main Characters in The Scarlet Letter. Hawthorne was brought up in the family of Puritan tradition. He sets three characters on the stage and he is interested in moral, religious view. Hawthorne's main material is the religious view and ethical point of Calvinistic life in New England. He believes that Love your enemies, do good to those who hate you, bless those who curse you, and pray for those who mistreat you. Three kinds of religious sin can be divided in The scarlet Letter. Hester Prynne commits sin of adultery with minister Dimmesdale, and she repents his sins. She is forced to tear 'A' on her breast as a sign of adulteress. She heartily tries to overcome her sufferings. Finally, she has changed the meaning of adultery into Angel. Dimmesdale didn't confess himself to guilty. His moral cowardice results in his sufferings. Eventually he confess his sin on the scaffold and dies. Even thou he confesses late, he also reaches his redemption. In Roger Chillingworth, Hawthorne deals with his malice. Chillingworth transformed himself into devil and 'Unparadonable sinner'. He broke against the nature's providence. Finally he can also get salvation by repenting. In elusion, Hawthorne, in The Scarlet Letter, represents that people are forced to take their right step because 'They beings have an original sin.

『주홍글자』에 나타난 종교와 도덕과의 관계

최대해 미국소설학회 2004 미국소설 Vol.11 No.2

The objective of this paper is to analyze religious and moral sense in Nathaniel Hawthorne's The Scarlet Letter. Nathaniel Hawthorne succeeds in analyzing the sense of guilt in the human mind through his puritan religion and sense of morality. As Hawthorne had been educated in religious tradition of Puritanism, he was interested in morality, religious faith and the human will.He sets three characters on the stage and is interested in religious perspective. Hawthorne's main material is the psychology of guilt and the ethics of the Calvinistic life in New England. He believes that love your enemies, do good to those who hate you, bless those who curse you, and pray for those who mistreat you. Three distinct kinds of religious sin can be isolated in The Scarlet Letter.Hester Prynne commits the sin of adultery with minister Dimmesdale, and she repents her sins. She is forced to wear an 'A' on her breast as a sign of an adulteress. She heartily tries to overcome her sufferings. Finally, she has changed the meaning of adultery into that of an angel. Dimmesdale didn't confess himself as guilty. His moral cowardice results in his sufferings. Eventually, he confesses his sin on the scaffold and dies. Even though he confesses late, he also reaches his redemption. Hawthorne regards Roger Chillingworth as the embodiment of malice. Chillingworth transformed himself into a devil and an 'Unparadonable sinner'. He broke away from nature's providence. Finally, he can also receive salvation by repentance. In conclusion, Hawthorne, in The Scarlet Letter, illustrates that people are forced to take their right step because they have original sin.

Crowd crush의 현장의료 대응과 사상자 관리

최대해 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.1