2009년 12월 3일자 광고성 기사
- 돈 한푼 안 받았다^^ 정말 그 때 그생각 그대로, 그 이후로 이 임프란트 때문에 고생도 많이 했지만 그냥 일반적인 임프란트 합병증의수준을 벗어나지 않았고 나름 훌륭한 장점들을 많이 가지고 있다. 기술된 내용을 완벽히 충족할 만한 임프란트를 개발해주길 많은 과학자나 임상가들에게 바라고 싶다.  이 임프란트 사용환자들로 논문을 쓰고 있는데 accept될런지 모르겠다.

원문은 http://www.kda.or.kr/kda/modules/kdanews/news/newsview2.aspx?newsID=59244

2007년 9월호에 대치협회지에 썼던 내용들을 보강하여
2008년7,8월호에 군자출판사에서 만들었던 clinical implant( 현재 절판)라는 잡지에 썼던 내용입니다.
현재는 거의 이런 비슷한 류의 임플란트들이 많이 나오고 있네요.. 잡지도 절판되고 공유차원에서 올려봅니다.
두개의 파일로 되어 있습니다.

Ankylos implant는 85-87년 Nentwig교수가 개발한 이래 특별한 디자인 컨셉의 변화없이 근 20년을 롱런하고 있는 임플란트 입니다. blasting media가 별달리 특이하지도 않고, 보철또한 브로네막의 개념을 많이 벗어나 있지만, 회사에서 얘기하는 것과 달리 경험상 앵킬로스만이 가지는 특징을 분류해 봅니다.  

1, tapered abutment가 풀린적이 없다.(지난 5년간)
2, 1 for all의 개념으로서 모든 픽스쳐와 보철이 호환된다
3, abutment switching의 개념을 먼저 확보한 개념이다.

...등으로 요약할 수 있는 것 같습니다.

실제 앵킬로스 수술을 해보면, 드릴링 과정이 매우 단순하며, 삭제에 너무 주력하지 않고 골을 condensing, compressioning등, 남겨두려는 쪽으로의 드릴링을 추천합니다.

본환자는 발치 45일후 아직은 완전히 골화되지 않은 primary callus단계를 보여주며, 부드러운 trephining만으로도 드릴링이 완성되었고, osteotome을 통해 lateral condensing과 bicortical engagement를 시도한 것으로 상악동 점막을 천공시키지는 않았고 살며시 얻혀놓는 의도로 식립한 경우 입니다.

particulated auto-bone을 구개측의 dead space에 넣었으며, 무엇보다 중요한 것은 발치와에 대한 절개선의 디자인일 것으로 생각됩니다. 술후의 closure를 위해서요.

발치와의 인접한 곳에서는 항상 발치와의 함몰부위와 비슷한 레벨의 두께를 가지는 절개선을 가하는 것이 좋을 것 같습니다.  

최근 Dentsply Friadent의 합병회사로 인해 Cellplus표면으로 변화된다고 하나, 아직 개발국인 독일에서도 Ankylos Cellplus는 통과되지 않았다고 하네요. 아마 국내에는 향후 2년정도는 기존의 컨셉이 통용되지 않을까 생각합니다.

Ankylos implant는 반드시 2회법으로 가는 것을 추천합니다.

standard, balance, syncone abutment가 있긴하지만, 실제로 standard abutment만으로도 90% 이상의 케이스를 소화할 수 있습니다.

제가 가진 1999년부터의 케이스를 보면, 아직까지 골소실이 거의 없으며, bony overgrowth가 관찰될 정도로 좋은 경과를 보여주는 것 같습니다.

아마 이런 원인으로는 2차수술뿐만 아니라, 미리 체결된 cover screw를 기계적 마찰이나 자극을 주지 않는 원바디형이기 때문이라는 생각이 들며, 또한 surgical trauma가 최소한으로 가는 디자인의 이차수술이 가능하기 때문이라 생각합니다.

또, 힐링과 어버트먼트의 각이 동일해서 잇몸을 누르지 않는 것도 하나의 효과라고 생각합니다.


본환자의 경우 발치와의 구개측에서 퍼내는 동작으로 피판을 형성후 layer suture를 mattress로 해준경우 입니다. 미리 장력을 없애기 위해 반드시 시행하여야 할 과정입니다. 자가골이 아닌 것을 사용했을 경우 반드시 흡수사를 이용하는 것또한 잊지 말아야 할 것 입니다.

mattress를 할때는 정상 연조직과 신생연조직을 동시에 포함해야 찢어지지 않습니다.

-출처 : 이우임상커뮤니티-

ANKYLOS Clinical Studies

AICRG; Part I: A 6-Year Multi-Centered, Multi-Disciplinary Clinical Study of a New and Innovative Implant Design - H.F. Morris, S. Ochi, P. Crum, I. Orenstein, S. Winkler.
Over 1,500 implants were placed and followed over a period of 3-5 years – 44% of the centers reported 100% survival and 63% of the centers reported only one failure. Overall survival was 97.5%.

AICRG; Part II: Crestal Bone Loss Associated with The ANKYLOS Implant: Loading To 36 Months - Chou, H.F. Morris, S. Ochi, L. Walker, D. DesRosiers.
Bone loss varied among the research centers, from 0.5mm to 2.0 mm. Following loading, the mean loss was about 0.2 mm per year.

AICRG; Part III: The Influence of Antibiotic Use on the Survival of a New Implant Design - H.F. Morris, S. Ochi, R. Plezia, H. Gilbert, C.D. Dent, J. Pikulski, P. Lambert.
The results of this study suggest that the use of antibiotics for ANKYLOS implant placement is not necessary

AICRG; Part IV: Patient Satisfaction Reported for ANKYLOS Implant Prosthesis - H.F. Morris, S. Ochi, A. Rodrequez, P. Lambert.
Patients with ANKYLOS implant/prostheses indicated: 1) that they were highly satisfied with their restorations [99.4%], 2) would recommend this form of treatment to their friends and relatives [99.1%] and 3) would not hesitate to seek the same treatment, if necessary in the future [98.0%].

AICRG; Part V: Factors Influencing Implant Stability at Placement and Survival of ANKYLOS Implants - H. F. Morris, S. Ochi, I. Orenstein, V. Petrazzuolo.
About 2.8% of the implants placed were found to be mobile following placement. While mobility can be attributed to “surgical errors” all implants mobile at placement were stable at uncovering.

The crown margin on the abutment can be extended apically to a distance of about 1 mm from the implant shoulder to provide additional space for the soft tissue. Even with a small thickness of soft tissue covering the crestal bone, it is possible to achieve a natural emergence profile with this implant. The implant must be inserted slightly below or even with the crestal-bone level to allow development of a mucosal layer that is as thick and wide as possible. Journal of Oral Implantology Volume 30, Number 3 June 2004 New Prosthetic Restorative Features of the Ankylos Implant System Paul Weigl, DMD 2005/07/19 x  

Several requirements need to be present to ensure long-term success of immediately-loaded implants.
These include:
(1) excellent stability of the implant,
(2) excellent bone density for the implant bed, and
(3) elimination of micromotion in the bone-implant interface during the healing period.
Journal of Oral Implantology: Vol. 30, No. 3, pp. 189–197. PRESENT STATUS OF IMMEDIATE LOADING OF ORAL IMPLANTS G. E. Romanos, 2005/07/19 x  

have also shown that small-diameter implants (3.5 mm in diameter) with a 14-mm length had a total surface similar to multirooted teeth.
Nentwig G-H, Reichel M. Vergleichende Untersuchungen zur Mikromorphologie und Gesamtoberfläche enossaler Implantate. Z Zahnärztl Implantol. 1994;10:150–154. 2005/07/19 x  

Early loading can be advantageous to healing in fractured areas.36–39 A significant increase in blood vessel formation, as well as active remodeling in fractured zones, has been shown under loading.40 36.
Sarmiento A, Schaeffer JF, Beckermann L, Latta LL, Enis JE. Fracture healing in rat femora is affected by functional weight-bearing. J Bone Joint Surg Am. 1977;59:369–375. 37. Goodship AE, Kenwright J.

The influence of induced micromovement upon the healing of experimental tibial fractures.
J Bone Joint Surg. 1985;67B:650–655. 38. Kenwright J, Richardson JB, Cunningham JL. et al.
Axial movement and tibial fractures. A controlled randomised trial of treatment. J Bone Joint Surg. 1991;73B:654–659. 39. Goodman S, Aspenberg P. Effects of mechanical stimulation on the differentiation of hard tissues. Biomaterials. 1993;14:563–569. 40. Hert J, Pribylova E, Liskova M. Reaction of bone to mechanical stimuli. 3. Microstructure of compact bone of rabbit tibia after intermittent loading. Acta Anat (Basel). 1972;82:218–230.    

To reduce excessive loading forces during mastication, a soft diet is advised for the first 4–6 weeks of healing.  

Friberg et al4 reported that implants placed in extremely soft bone and/or lacking initial stability, as evidenced by “lack of resistance during final tightening of the cover screw or mobility of the fixture mount when still on the implant,” constituted 32% of the implant failures recorded.
Friberg B, Jemt T, Lekholm U. Early failures of 4641 consecutively placed Branemark dental implants: a study from stage 1 surgery to the connection of completed prostheses. Int J Oral Maxillofac Implant. 1991;6:142–146.

An implant removed because of mobility, chronic pain, discomfort, or infection at any time was recorded as a failure. For the purposes of this study, stage I is defined as the period from implant placement to implant uncovering. Stage II is the time of uncovering (abutment connection) of the implant(s). Stage III is the period from uncovering and abutment connection to just before prosthesis insertion. Stage IV is the period from prosthesis insertion to the end of the evaluation period.
Journal of Oral Implantology: Vol. 30, No. 3, pp. 162–170. Harold F. Morris  

Bone training installation -> 6wks ( uncovering - temporary splinting) -> soft diet -> 12wks (final prosthesis)

Slightly microrough surfaces have a beneficial effect on the deposition of connective issue cells.9 Furthermore, when plaque is deposited on microrough surfaces, the tendency toward inflammation is no greater than with smooth surfaces.16

9. Klinge B, Meyle J. Clin Oral Implants Res 2006;17:93–96.
16. Zitzmann et al. J Clin Periodontol 2002;29:456–461.



Inadequate screw preload, the misfit of the mating components and rotationa characteristics of the
screws are considered to be the reasons leading to screw loosening or fracture.26

Biologic width around an implant is apical to the fixture/abutment connection, one of the
reasons that maintaining or reforming a papilla between two implants presents with such difficulty.
32

The collar design (Fig. 8) that defines the shape of the abutment/fixture interface determines
the quality of the soft tissue attachment as well the osteolytic impact of hygiene and function on
crestal bone levels.

Clinical Oral Implants Research

Simulation Modelling Practice and Theory
Volume 16, Issue 8, September 2008, Pages 971-987

Stress-based performance evaluation of osseointegrated dental implants by finite-element simulation

Luigi Baggi^a, Ilaria Cappelloni^b, Franco Maceri^c and Giuseppe Vairo^{c, ,}

Abstract

In this paper biomechanical interaction between osseointegrated dental implants and bone is numerically investigated through 3D linearly elastic finite-element analyses, when static functional loads occur. Influence of some mechanical and geometrical parameters on bone stress distribution is highlighted and risk indicators relevant to critical overloading of bone are introduced. Insertions both in mandibular and maxillary molar segments are analyzed, taking into account different crestal bone loss configurations. Stress-based performances of five commercially-available dental implants are evaluated, demonstrating as the optimal choice of an endosseous implant is strongly affected by a number of shape parameters as well as by anatomy and mechanical properties of the site of placement. Moreover, effectiveness of some double-implant devices is addressed. The first one is relevant to a partially edentulous arch restoration, whereas other applications regard single-tooth restorations based on non-conventional endosteal mini-implants. Starting from computer tomography images and real devices, numerical models have been generated through a parametric algorithm based on a fully 3D approach. Furthermore, effectiveness and accuracy of finite-element simulations have been validated by means of a detailed convergence analysis.

Experimental and Numerical Analysis of the Mobility of Immediately Loaded Dental
Implants Using a Pig Model

Volume	Volume 114
학술도서	Advances in Medical Engineering

Alex Meier1, Alireza Rahimi2, Christoph Bourauel2, Thorsten M. Buzug3,
Susanne Reimann2 and Dennis Giantoro2

1 RheinAhrCampus Remagen, Department of Mathematics and Technology,
E-mail: ameier@rheinahrcampus.de
2 Department of Oral Surgery, University of Bonn, Germany
E-mail: bourauel@uni-bonn.de
3 Institute of Medical Engineering, University of Luebeck, Germany

Abstract. The aim of this study was to model a system of implant and bone using the finite
elements analysis (FEA). For this purpose immediately loaded dental implants were used.
In an experimental analysis of preparations from pig jaws the force-displacement behaviour
was measured using a self development set-up. With the aid of a micro computer
tomograph (μCT) three dimensional surface models were reconstructed. These surface
models were imported into the finite elements (FE) software package Marc/Mentat. Then
the three dimensional surface models were transformed into FE-models, that mirror the
geometry of implant and bone in detail. Comparison of the experimental achieved data and
the numerical calculated data showed the magnitude of relative movements between
implant and bone.

1. Introduction
Immediately loaded implants have been introduced to clinical practice in the last
years. An immediate prosthodontics care takes place without prior healing phase.
The mode of healing initially relies on the biomechanical stress of the bone
surrounding the implant and especially on the specific quality of this bone and the
geometry of the implant. Our aim was to construct a relation between the
distortion of the bone and the reaction of the surrounding tissue. This relation can
then be used to numerically simulate and predict the rebuilding processes of the
bone itself.

2. Experimental Methods
In total three implant of the ANKYLOS® type (Dentsply-Friadent) were used for
implantation into pig jaw segments. The dimensions of these implants were A11,
A14 (diameter of 3.5mm, length of 11 and 14mm) and B14 (diameter of 4.5mm)
respectively. In a high resolution opto-mechanical set-up the samples were loaded
with up to 70 N axial and the implant deflection was measured. Afterwards the

1044 Oral implants with different thread designs. A histometrical evaluation

G.E. ROMANOS1, M. DAMOURAS2, A. VEIS3, F. SCHWARZ4, and N. PARISIS3, 1New York University, USA, 2Dental School Frankfurt, Germany, 3University of Thessaloniki, Greece, 4University of Düsseldorf, Germany Primary stability of oral implants is an important criterion for the long-term success. Bone-to-implant contact (BIC) % may determine the osseointegration based on light microscopical examination. Objectives: The aim of this study was to find out the BIC and bone volume (in %) at the coronal (BVc) and apical (BVa) of surrounding trabecular bone in different implant systems with various thread designs immediately after their insertion. Methods: 5 implants of each one of the following implant systems with comparable sizes (11.00/3.5mm, progressive threads-Ankylos(A), thread cylinder-Frialit-2(F) and condensation threads-XiVE(X); 13.00/3.5 mm diameter for Replace (R) Select tapered) were inserted in rip bone of freshly slaughtered cows. The implants were placed using the exact surgical protocol suggested by the manufacturer. Immediately after surgery, the implants with the surrounded bone tissues were examined histologically and histomorphometrically using a grinding technique (Donath and Breuner, 1982). Results: The histomorphometrical evaluation (Mann-Whitney test) presented significantly better results in the BIC (A/F, A/R, A/X), the BVa (F/A, X/A) and the BVc (X/A, X/R, X/F). Implant                                 BIC%                                BVc                                     BVa Ankylos                           37.00 ± 13.08                 22.00 ± 5.45                        17.00 ± 4.84   (n=11) Frialit-2                           19.00 ±   8.62                 26.00 ± 3.75                        23.00 ± 5.42   (n=11) XiVE                               22.16 ±   3.70                 34.50 ± 6.20                        22.50 ± 4.73    (n=5) Replace Select Tapered    24.40 ± 7.86                    22.80 ± 6.86                        18.22 ± 6.30   (n=10)  Based on these data only the primary BIC% of the tested implant systems seems to be dependent on the thread design. Conclusions: We concluded that the special progressive and condensation macrodesigns present significantly higher primary stability than other implant thread geometries.

Seq #119 - Imaging and Histological Analysis 3:30 PM-4:45 PM, Thursday, March 22, 2007 Ernest N. Morial Convention Center Exhibit Hall I2-J

Back to the Implantology Research Program Back to the IADR/AADR/CADR 85th General Session and Exhibition (March 21-24, 2007)

0714 Evaluation of the Sealing Capability of Different Dental Implant Systems

P.A. SUDACK, P.G. COELHO, N.R.F.A. SILVA, and G.E. ROMANOS, New York University, New York, NY Several implant-abutment connection designs are commercially available for different implant systems. These different implant-abutment connections, depending on the design and manufacturing precision, may lead to implant-abutment gaps of different magnitudes. Objectives: The purpose of this study is to evaluate the sealing capability of the implant-abutment connection of different dental implants under cyclic loading. Methods: Five Nobel Biocare(NB), Straumann, Intra-lock(IL), and Ankylos implants of ~4.5mm diameter with their respective abutments were provided by the manufacturers. A calibration curve was determined by placing Toluidine Blue(TB) increments of 0.1μL into 1.5 ml of distilled water and recording its absorbance in a spectrophotometer until reaching 0.7μL(set by the Ankylos internal connection volume). Following the establishment of a calibration curve, 0.7μL of TB was placed in each implant's connection, the abutment was adapted to the implant as recommended by the manufacturer, and placed in vials with 1.5ml of distilled water(the non-loaded condition). Spectrophotometric analysis was performed at 1,3,6,24,48,72,96, and 144 hours. Statistical analysis were performed by one-way ANOVA at a 95% level of significance. Results: The calibration curve absorption is linear with respect to TB amount (Figure 1, left). The 95% absorbance confidence intervals are presented in Figure 2, right.  Smaller amounts of TB in the liquid was observed for the IL, Straumann, and NB implants. However, while low TB levels were kept by IL implants, the Straumann and NB implants' release of TB increased as incubation time elapsed. Conclusions: Different implant-abutment connection types resulted in different amounts of TB release as a function of time in-vitro. It should be noted that since the maximum amount of TB placed into the implants was close to the Ankylos internal connection volume, this system may have been disadvantaged during the testing. An experiment looking at TB release, normalized by the connection volume, should be investigated.

Seq #112 - Implant Materials Testing and Mechanical Performance 1:30 PM-2:30 PM, Friday, April 4, 2008 Hilton Anatole Hotel Trinity I - Exhibit Hall

Back to the Implantology Research Program Back to the AADR 37th Annual Meeting and Exhibition

050080267
40/M
2008-10-02

mobility #27

#26 - B14, sinus osteotomy, Bio-Oss graft to buccal side, Biogide
#37 발치
#36 - PE 4.0/10 Bio-Oss graft to buccal side 1mm supra
#37 - B8 Bio-Oss graft to occlusal side 1mm supra

치의신보 (2008-11-20)		제1691호
Real세미나>학술

제목	한·중·일 임플랜트 학술 공유 PPIS 종합학술대회
Pan Pacific Implant Society(회장 박준우·이하 PPIS)가 주최하고 한림대학교 임상치의학대학원이 주관하는 제7회 종합 학술대회가 성황리에 펼쳐졌다. 지난 1일과 2일 양일간에 걸쳐 제주 그랜드호텔에서 펼쳐진 이번 학술대회는 국내 치과의사를 비롯해 일본, 중국, 타이완 등에서 등록한 40여명을 포함해 약 200여명이 참석, 임플랜트 관련 최신 학술지견을 공유했다. 이번 학술대회는 첫날인 1일에는 이홍찬 원장(시카고 램브란트 치과의원)의 ‘On-site Sinus Compaction Technique’을 시작으로 20명의 한국, 중국, 일본, 타이완 등의 연자들이 20분 간격으로 강연을 빠르게 진행했다. 둘째 날인 2일에는 양병은 교수(한림대학교 성심병원 구강외과)의 ‘Evaluation of platform switching and its clinical application’ 외에도 10명의 연자들이 강연을 진행했으며 ▲린예 교수(베이징 대학)의 ‘Approaches and Problems of Alveolar Reconstruction in Severe Defect Cases for Dental Implants’와 ▲마스로 마츠후라 교수(후코오카 대학)의 ‘New CAD-CAM Surgical Guide Plate for an Access Window into the Maxillary Sinus for Sinus Floor Elevation’ 등이 큰 주목을 끌었다. 한편 PPIS는 한국, 일본, 중국의 구강악안면외과를 전공한 치과의사들과 뜻을 같이하는 개원의들이 모여서 만든 학회로서 올해부터 한중일 3개국이 순회하면서 개최하기로 합의했다. 공식 언어는 영어이며 제8차 PPIS학술대회(대회장 이즈미 마타가)는 일본 사가에서 제13차 Japan Academy of Maxillofacial Implants학술대회(대회장 마사키고토)와 같이 오는 12월 11일부터 13일까지 개최키로 합의했다. 이어 제10차 PPIS학술대회(대회장 왕후이밍)는 중국항저우에서 개최하기로 합의하고 일자 및 장소는 추후 결정키로 했다. 김용재 기자 yonggari45@kda.or.kr