27. 노화에 따른 교합의 변화

심준성 연세대학교 치과대학 두개안면기형연구소 2013 연세임상교정 Vol.20 No.-

임플랜트 지지 고정성 국소의치의 임상적, 방사선학적 평가

서지영,심준성,이재훈,이근우,Seo Ji-Young,Shim June-Sung,Lee Jae-Hoon,Lee Keun-Woo 대한치과보철학회 2006 대한치과보철학회지 Vol.44 No.4

Statement of problem: A conventional 3-unit fixed partial denture design with a pontic between two retainers is the most commonly used. However in cases where the mental nerve is in close proximity to the second premolar, a cantilever design can be considered. As such, logical and scientific evidence is lacking for the number and position of implants to be placed for partially edentulous patients, and no clear-cut set of treatment principles currently exist. Purpose : The purpose of this study was to evaluate prognosis of implant-supported fixed partial dentures and to compare changes in bone level which may rise due to the different factors. Material and method : The present study examined radiographical marginal bone loss in patients treated with implant-supported fixed partial dentures (87 prostheses supported by 227 implants) and evaluated the influence of the span of the pontic, type of the opposing dentition. Clinical complications were studied using a retrospective method. Within the limitation of this study. the following result were drawn Result, 1. Seven of a total of 227 implants restored with fixed prostheses failed, resulting in a 96.9% success rate. 2. Complications encountered during recall appointments included dissolution of temporary luting agent (17 cases), porcelain fracture (8 cases), loosened screws (5 cases), gingival recession (4 cases), and gingival enlargement (1 case). 3. Marginal bone loss, 1 year after prosthesis placement, was significant(P<0.05) in the group that underwent bone grafting, however no difference in annual resorption rate was observed afterwards. 4. Marginal bono loss, 1 year post-placement, was greater in cantilever-type prostheses than in centric pontic protheses (P<0.05). 5. Marginal bone loss was more pronounced in posterior regions compared to anterior regions (P<0.05). 6. The degree of marginal bone loss was proportional to the length of the pontic (P<0.05). Conclusion: The success rate of implant-supported fixed partial dentures, including marginal bone loss, was satisfactory in the present study. Factors influencing marginal bone loss included whether bone graft was performed, location of the pontic (s), location of the surgical area in the arch pontic span. Long-term evaluation is necessary for implant-supported fixed partial dentures, as are further studies on the relationship between functional load and the number of implants to be placed.

임플란트 즉시 식립에 의한 연속된 상악 전치부의 심미적 수복 증례

이예찬,심준성,이재훈,이근우,Lee, Ye Chan,Shim, Jun Sung,Lee, Jae Hoon,Lee, Keun Woo 대한치과보철학회 2017 대한치과보철학회지 Vol.55 No.4

상악 전치부를 발치 해야 하는 경우, 즉시 식립을 통한 임플란트 고정성 보철물의 수복을 고려할 수 있다. 이 경우, 수술 횟수 및 치료기간의 감소, 흡수가 일어나지 않은 잔존 골상에 식립이 가능하다는 장점이 있으나, 연속된 상악 전치부인 경우 임플란트와 임플란트간 거리에 대한 고려 및 예지성 있는 치료를 위한 정확한 진단 및 치료계획의 수립이 추가적으로 고려되어야 한다. 본 증례에서는 63세 남환의 잔존치근을 발거 후 연장된 상악 전치부에 골이식을 동반한 2개의 임플란트 즉시 식립 및 임시 보철물을 장착 후, 임플란트 고정성 보철물로 수복하여 심미적, 기능적으로 만족할만한 임상 결과를 보였기에 이를 보고하는 바이다. In the case of an extraction in the maxillary anterior region, immediate placement of implant-supported fixed prosthesis can be considered as a treatment option. Fewer surgical operations, reduced treatment time, and optimal availability of existing bone are obvious advantages of the method; however, when applied in the continuous maxillary anterior region, inter-implant distance must be carefully considered, as well as accurate diagnosis and treatment planning for predictable outcome. In this case report, immediate placement of two implants in the continuous maxillary anterior along with bone graft following the extraction of root rests, and the restoration of provisional and implant-supported fixed prosthesis on a 63-year-old patient had resulted in both esthetically and functionally satisfactory clinical outcomes.

지각과민 처치제 도포 후 칫솔질에 의한 마모가 상아질 투과도에 미치는 영향

이종욱,심준성,이근우,Lee Jong-Wook,Shim June-Sung,Lee Keun-Woo 대한치과보철학회 2001 대한치과보철학회지 Vol.39 No.2

To study the effect of dentin permeability on a tooth with wear from tooth brushing after application of desensitizing agent, extracted teeth free from caries were chosen. Coronal dentin discs with thickness of 1mm were prepared. Using the split chamber device developed by Pashely, hydraulic conductance, scanning electron microscope images(SEM) and atomic force microscope images(AFM) were compared and contrasted before and immediately after the application of desensitizing agent and after equivalent tooth brushing of 1 week, 2 weeks, and 6 weeks. Four commercially available desensitizing agents were used in this study ; they were Gluma, Seal & Protect, All-Bond 2 and MS Coat. The results of this study are as follows. 1. On all specimens, the hydraulic conductance decreased after the application of tooth desensitizing agent. 2. Except the specimens treated with MS Coat, the remaining specimens had an increase in dentin permeability after tooth brushing for 1 and 2 weeks but a decrease after 6 weeks. 3. The specimens treated with MS Coat had statistically significant increase in the dentin permeability regardless with the duration of tooth brushing. 4. On examination of SEM and AFM, the dentinal tubule diameter had decreased after treatment of desensitizing agents. The specimens other than those treated with MS Coat, smear layers were noted after tooth brushing. It is not always consistant but the hydraulic conductance correlated with the images from SEM and AFM.

색 온도 및 술자의 숙련도에 따른 비색 능력 평가

김지현,심준성,윤준호,김선재,이근우 대한치과보철학회 2012 대한치과보철학회지 Vol.50 No.4

Purpose: The aim of this study is to investigate the effect of different experience level and different light source on shade selection ability comparing prosthodontist group and dental student group under 4,000 K and 5,500 K light. Materials and methods: After color difference of Vitapan 3D-master shade guides was measured, 3 sets of 5 shade tabs were selected with similar value but have different chroma (set a, b, c). Also 3 sets of 5 shade tabs were selected with similar chroma but have different values (set d, e, f). Under 4,000 K and 5,500 K light sources, ten prosthodontists and ten dental students were allowed to match in one set of 5 tabs the same shade tab with the tab which was originally selected in the other set of 5 tabs. Color differences of original tab and matched tab were measured by spectrophotometer and the shade selection ability was evaluated with those data. Evaluation of color difference value was performed in regard to different light conditions and different level of experience, followed by t-test with 95% confidence interval. Results: Color difference values under 4,000 K and 5,500 K light source were 1.62 ± 2.0, and 1.33 ± 1.7 respectively. In addition, color difference values of prosthodontist group and dental student group were 1.34±1.7, and 1.61±2.0 respectively. Difference of shade selection ability was not found under either different light sources (P=.398), or different experience level (P=.221). Conclusion: Level of experience did not affect on the shade selection ability when prosthodontists and dental students matched the shades with the same shade tab under the same light source. 연구 목적: 4,000 K와 5,500 K의 색 온도를 가진 광원 하에서 치과 보철과 의사 및 치과대학 학생의 색조 비교 및 선택 능력을 평가하여 술자의 경험이 색조 선택에 영향을 주는지를 알아보고자 한다. 연구 대상 및 방법: 분광 광도계를 사용하여 색 견본을 측색한 후, 명도 값이 비슷하고 채도 값이 차이 나는 5개 탭을 선택하여 3개의 세트(a, b, c)를, 채도값이 유사하고 명도값이 차이가 나는 5개 탭을 선택하여 3개의 세트(d, e, f)를 만들었다. 각각 4,000 K, 5,500 K 색 온도의 광원 하에서 무작위로 선택된 한 개의 색 견본을 치과 보철과 의사 10명과 치과대학 학생 10명에게 제시하고 동일한 색 견본을 동일한 세트 내에서 고르게 한 다음, 제시된 색조 탭과 피험자가 선택한 색조 탭 간의 색차(ΔE) 값을 계산하여 비색 능력의 차이를 비교하였다. 광원의 색 온도 및 술자의 숙련도에 따른, 각각의 색 견본에서의 색차 값을 계산하고 95%의 신뢰 수준에서 t-test 를 시행하여 결과의 유의성을 검정하였다. 결과: 4,000K와 5,500K 광원 하에서 색차 값은 각각 1.62 ± 2.0, 1.33 ± 1.7로 색 온도 조건에 따른 색조 선택의 차이는 나타나지 않았다(P=.398). 숙련자군과 비 숙련자군 간의 색차 값은 각각 1.34 ± 1.7, 1.61 ± 2.0으로 각 군 간 색조 선택의 차이 또한 나타나지 않았다(P=.221). 결론: 동일한 색 견본을 동일한 광원 조건 하에서 비색하는 경우, 술자의 숙련도에 따른 색조 선택 능력에 차이가 없다.

Glass Fiber Post와 Composite Resin Core의 전단결합강도

김태형,심준성,이근우,Kim Tae-Hyoung,Shim June-Sung,Lee Keun-Woo 대한치과보철학회 2005 대한치과보철학회지 Vol.43 No.4

Statement of problem : Fracture of composite resin core will be occulted by progress of crack. Bonding interface of different materials has large possibility of starting point of crack line. Therefore, the bond strength of glass fiber post to composite resin core is important for prevention of fracture. Purpose: This in vitro study tried to find out how to get the higher strength of glass fiber post to composite resin core through surveying the maximum load that fractures the post and cote complex. Materials and methods: 40 specimens made with glass fiber Posts(Style $post^{(R)}$, Metalor, Swiss) and composite resin core ($Z-100^{(R)}$, 3M, USA) were prepared and loaded to failure with push-out type shear-bond strength test in a universal test machine. The maximum fracture load and fracture mode were investigated in the specimens that were restored with four different surface treatments. With the data. ANOVA test was used to validate the significance between the test groups, and Bonferroni method was used to check if there is any significant statistical difference between each test group. Evely analysis was approved with 95% reliance. Results: On measuring the maximum fracture load of specimens, both the treatments of sandblasted and acid-etched one statistically showed the strength increase rather than the control group (p<0.005). The scanning electric microscope revealed that sand blasting made more micro-retention form not only on the resin matrix but on the glass fiber, and acid-etching contributed to increase in surface retention form, eliminated the inorganic particles in resin matrix. Specimen fracture modes investigation represented that sand blasted groups showed lower bonding failure than no-sand blasted groups. Conclusion: Referring to the values of maximum fracture load of specimens, the bonding strength was increased by sand blasting and acid-etching.

다용도 프라이머가 레진 시멘트와 수복재의 전단 결합 강도에 미치는 영향

김나홍,심준성,문홍석,이근우 대한치과보철학회 2012 대한치과보철학회지 Vol.50 No.2

연구 목적: 이 연구의 목적은 실란과 인산 모노머를 혼합한 프라이머인 Monobond plus (Ivoclar Vivadent, Schaan, Liechtenstein)를 사용했을 때 레진 시멘트와 수복물 간의 전단 결합 강도가 귀금속, 비귀금속, 글라스 세라믹과 지르코니아 네 가지 재료 모두에서 기존의 프라이머를 사용했을 때의 결합 강도와 비교하여 유의한지 평가하는 것이다. 연구 재료 및 방법: 디스크 모양(9 mm × 3 mm)의 귀금속(Argedent Euro) 시편 16개, 비귀금속(T-4) 시편 20개, 지르코니아(Cercon) 시편 20개, 글라스 세라믹(IPS e.max press) 시편 20개를 제작한 후 아크릴릭 레진(15 mm × 15 mm)에 포매하였다. 귀금속 시편에 airborne-particle abrasion을 시행하고 대조군으로 사용한 8개 시편에는 귀금속용 프라이머(Metal primer II)를, 나머지 8개 시편에는 Monobond plus를 도포하였다. 비귀금속 시편과 지르코니아 시편은 airborne-particle abrasion 후 각각 두 그룹으로 나누어 대조군 10개 시편에는 비귀금속 및 지르코니아용 프라이머(Alloy primer)를, 나머지 10개에는 Monobond plus를 도포하였다. 글라스 세라믹 시편은 4% 불산으로 부식한 후, 대조군 10개 시편에는 실란(Monobond-S)을, 나머지 10개에는 Monobond plus를 적용했다. 표면 처리된 시편 위에 디스크 형태(5 mm × 2 mm)로 레진 시멘트(Multilink N)를 위치시키고 중합하였다. 제작된 모든 시편을 열순환(5℃와 55℃, 1분씩 2060회)시킨 후 전단 결합 강도를 측정하였다. 전단 결합 강도의 유의차를 살펴보기 위해 Shapiro-Wilk test를 이용하여 모집단의 분포에 대한 검정을 하고 그 결과에 따라 Two sample t-test 또는 Mann-Whitney U test를 실시하였다(α=.05). 파절된 시편을 확대경으로 관찰하여 그 양상을 분류하였다. 결과: 귀금속과 글라스 세라믹 군에서는 두 프라이머간의 전단 결합 강도에 유의한 차이가 존재하지 않았으나(P> .05) 비귀금속 군과 지르코니아 군에서는 기존 프라이머(Alloy primer)를 사용했을 때 레진 시멘트와 수복물간의 전단 결합 강도가 Monobond plus를 사용한 군보다 통계적으로 유의하게 높았다(비귀금속 군 P=.004, 지르코니아 군 P=.001). 결론: 실란과 인산 모노머를 혼합한 다용도 프라이머는 귀금속과 글라스 세라믹 군에서는 기존의 프라이머를 대신하여 사용할 수 있을 것이다. 그러나 비귀금속과 지르코니아 세라믹에서는 10-MDP 프라이머에 비해 접착 강도가 낮아 기존 프라이머를 대신하여 적용하기 위해서는 좀 더 연구가 필요할 것이다. Purpose: The purpose of this study was to evaluate the difference in shear bonding strength between resin cements to dental materials when a universal primer (Monobond plus) was applied in place of a conventional primer. Materials and methods: Four groups of testing materials: gold alloy (Argedent Euro, n = 16), non precious metal (T-4, n = 20), zirconia (Cercon, n = 20) and glass ceramic (IPS e.max press, n = 20), were fabricated into discs, which were embedded in an acrylic resin matrix. The gold alloy specimens were airborne-particle abraded, 8 of the specimens were coated with Metal primer II, while the remaining 8 specimens were coated with Monobond plus. The non precious and zirconia specimen were airborne-particle abraded then, the control group received Alloy primer coating, while the other was coated with Monobond plus. Glass ceramic specimens were etched. 10 specimens were coated with Monobond-S and the remaining specimens were coated using Monobond plus. On top of the surface, Multilink N was polymerized in a disc shape. All of the specimens were thermal cycled before the shear bonding strength was measured. Statistical analysis was done with Two sample t-test or Mann-Whitney U test (α=.05). Results: There were no significant differences in bonding strength depending on the type of primer used in the gold alloy and glass ceramic groups (P>.05), however, the bonding strengths of resin cements to non precious metal and zirconia groups, were significantly higher when the alloy primer was used (P<.05). Conclusion: Within the limitations of this study, improvement of universal primers which can be applied to all types of restorations is recommended to precious metals and zirconia ceramics. But, the bond strengths of non precious metals and zirconia ceramics were significantly lower when compared to a 10-MDP primer. More research is needed to apply universal primers to all types of restorations.

A new minimally invasive guided endodontic microsurgery by cone beam computed tomography and 3-dimensional printing technology

김종은,심준성,신유석 대한치과보존학회 2019 Restorative Dentistry & Endodontics Vol.44 No.3

Endodontic microsurgery is defined as the treatment performed on the root apices of an infected tooth, which was unresolved with conventional root canal therapy. Recently, the advanced technology in 3-dimensional model reconstruction based on computed tomography such as cone beam computed tomography has opened a new avenue in application of personalized, accurate diagnosis and has been increasingly used in the field of dentistry. Nevertheless, direct intra-oral localization of root apex based on the 3-dimensional information is extremely difficult and significant amount of bone removal is inevitable when freehand surgical procedure was employed. Moreover, gingival flap and alveolar bone fenestration are usually required, which leads to prolonged time of surgery, thereby increasing the chance of trauma as well as the risk of infection. The purpose of this case report is to present endodontic microsurgery using the guide template that can accurately target the position of apex for the treatment of an anterior tooth with calcified canal which was untreatable with conventional root canal therapy and unable to track the position of the apex due to the absence of fistula.

치과용 도재의 재소성 과정중 수분 함량이 강도에 미치는 영향

박혜양,심준성,이근우,Park Hye-Yang,Shim June-Sung,Lee Keun-Woo 대한치과보철학회 2003 대한치과보철학회지 Vol.41 No.5

Statement of problem : Long-term exposure of dental porcelain to saliva during temporary cementation of a porcelain-fused to metal (PFM) restoration could affect mechanical strength of dental porcelain if the restoration is refired. Purpose : This work was performed to verify the effect of water on the mechanical strength in aged dental porcelain. Material and method : 63 specimens(Vintage Metalbond opaque and opal powder) were distributed to three experimental groups ; non-water immersed control, immersed and pedried, and immersed and non-predired groups. The changes in flexural strength and fracture toughness after specimen refiring related to Fourier Transform Infrared (FT-IR) spectroscopy. Results : 1. The FT-IR reflectances assigned to molecular bonds of $H_2O$ were noted as significantly different between the first-fired group and three refired groups and between two water-immersed groups and control group after refiring(p<0.05). They were also significantly different between predried group and non-predried group after refiring(p<0.05) 2. For opal specimens, FT-IR absorbances for hydrogen bond of $H_2O$ and silanols were significantly higher in non-predried group than in predreid group(p<0.05). 3 Predried opal group showed the highest mean flexural strength(p<0.05). Non-predried group indicated higher mean flexural strength than control group(p<0.05). 4. The mean fracture toughness for predired group was higher than non-predried group(p<0.05). 5. The difference of leucite crystal size is noted between control group and water-immersed, predried group in scanning electron microscopic study(${\times}10000$).

CAD/CAM으로 제작된 monolithic zirconia crown의 시적 전후 교합양상에 대한 비교

용기훈,심준성,Yong, Ki-Hoon,Shim, Jun-Sung 대한치과보철학회 2014 대한치과보철학회지 Vol.52 No.3

CAD/CAM을 이용하여 보철물을 제작할 경우 교합 접촉점의 위치, 면적, 형태를 원하는 대로 조절할 수 있으므로 보다 기능적인 교합의 부여가 가능하다. 또한 전통적인 Casting 기법을 이용한 주조금속 보철물이나, Porcelain의 축성을 통해 제작된 보철물에 비하여 제작과정 중의 오차가 감소하여 우수한 교합 정확도를 얻을 수 있을 것으로 기대되고 있다. 그리고 최근 소개되고 있는 CAD/CAM system에는 가상 교합기 기능이 추가되어 단일 수복물의 설계에서도 상악에 대한 하악의 운동을 재현함으로써 폐구 운동 뿐만 아니라 전/측방 운동시의 교합간섭을 고려할 수 있게 되었다. 그 동안 zirconia를 이용한 보철물의 변연 및 내면 적합도에 대한 연구는 많이 이루어졌으나 CAD/CAM을 이용해 설계된 zirconia crown의 교합 적합도에 대한 연구는 많이 이루어지지 않았다. 따라서 본 증례에서는 총 5명의 환자에서 CAD/CAM을 이용하여 제작된 7개의 지르코니아 크라운을 대상으로, 처음 설계된 zirconia crown의 교합 접촉점과 조정과정을 거쳐 구강 내 시적 후에 제작된 모델을 스캔하여 획득된 교합 접촉점을 비교하여 보철물의 정확도를 평가하고 교합조정의 양상을 파악해 보고자 하였다. 지르코니아 크라운에서 이루어진 교합조정은 대부분 기능교두 및 사면부위에서 이루어졌으며 15 - $60{\mu}m$의 분포를 보였다. CAD/CAM을 이용하여 제작된 지르코니아 크라운에서 어느정도의 교합조정은 불가피한 과정이며 이에 따른 물성저하를 보상하기 위한 추가적인 과정이 필요할 것이다. In case of prosthesis fabrication by CAD/CAM, location, area and contour of occlusal contacts can be adjusted so more functional occlusion can be acquired. Also, errors in a manufacturing process is reduced compared to cast metal prostheses and porcelain fused metal prostheses fabricated by conventional methods such as casting and porcelain build up. Therefore, prostheses by CAD/CAM show superior occlusion accuracy. Recently, virtual articulator function has been introduced to CAD/CAM system, which reproduces mandibular movement against maxilla. Thus, it is possible to consider occlusal interference in anterior/lateral movement as well as closing movement. There have been many studies on the marginal and internal fit of prostheses using zirconia but the occlusal fit of zirconia crown fabricated by CAD/CAM has not been researched as much. In this case report, 7 zirconia crowns were designed and fabricated by CAD/CAM for total 5 patients. The models of zirconia crowns before and after occlusal adjustment during intraoral try-in were scanned for occlusal contacts, which were compared to evaluate accuracy of prostheses and understand patterns of occlusal adjustment. Most of the occlusal adjustments were done on functional cusps and slopes of zirconia crown, and the magnitude of occlusal adjustment ranged from $15{\mu}m$ to $60{\mu}m$. In the zirconia crown fabricated with CAD/CAM systems, the occlusal adjustment is a necessary procedure, so additional procedures will be needed for compensating reduced mechanical properties.