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Long-term
Sinus & GBR
Narrow Implant
Clinical case Overdenture
Research Paper (OSTEON )
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Long-term Sinus & GBR Narrow Implant Overdenture Research Paper (OSTEON)
Contents 10 Dr. Tae-Hyeong Kim 32 Dr. Jong-Chan Park 44 Dr. Kyung-Man Min 56 Dr. Won-Kyu Kim 68 Evaluation of Different Combinations
Kim & Lee Dental Clinic Ye Dental Clinic Seoul Mai Dental Clinic Prime Dental Clinic of Biphasic Calcium Phosphate and
Growth Factors for Bone Formation
12 Dr. Gwan-Taek Jo 34 Dr. Lae-Jung Park 46 Dr. Hyun-Sik Park 58 Dr. Ha-Young Kim
in Calvarial Defects in a Rabbit Model
Yes Dental Clinic Trip Dental Clinic Haim Dental Clinic Korea University Guro Hospital
14 Dr. Yong-Ho Park

Namsuwon Well Dental Clinic
36 Dr. Dong-Wook Chang 48 Dr. Seung-Gun Lee
Gongreung Seoul Dental Clinic
60 Dr. Jun-Ha Gong
Eaton Dental Clinic
Clinical Cases (OSTEON)
Win Dental Clinic
16 Dr. Won-Bae Park 38 Dr. Seung-Min Han 50 Dr. Hyun-Suk Lee 62 Prof. Sang-Wan Shin 84 Dr. Dong-Wook Chang
Parkwonbae Dental Clinic Seoul Ichon Dental Clinic GwanghwamunYe Dental Clinic Korea University Guro Hospital Win Dental Clinic
18 Dr. Jong-Chan Park 40 Dr. Yung-Jin Cho 52 Prof. Ui-Won Jung 64 Prof. Jeong-Yul Lee 86 Dr. Seung-Min Han
PyeongchonYe Dental Hospital Seoul Ppusigipeon Dental Clinic Department of Periodontology, Korea University Guro Hospital Seoul Ichon Dental Clinic
Yonsei University College of Dentistry
20 Dr. Se-Ung Oh
Hwain Dental Hospital
22 Dr. Seung-Min Han

Seoul Ichon Dental Clinic
24 Dr. Il-Woo Jang

Seongwon well Dental Clinic
26 Dr. Joon-Young Jo
Jojoonyoung Dental Clinic
28 Prof. Young-Gyun Kim

Seoul National University Bundang Hospital
10 12 14
Dr. Tae-Hyeong Kim Dr. Gwan-Taek Jo Dr. Yong-Ho Park
Kim & Lee Dental Clinic Yes Dental Clinic Namsuwon Well Dental Clinic
16 18 20
Long-term Dr. Won-Bae Park
Parkwonbae Dental Clinic
Dr. Jong-Chan Park
PyeongchonYe Dental Hospital
Dr. Se-Ung Oh
Hwain Dental Hospital
22 24 26
Dr. Seung-Min Han Dr. Il-Woo Jang Dr. Joon-Young Jo
Seoul Ichon Dental Clinic Seongwon well Dental Clinic Jojoonyoung Dental Clinic
28
Prof. Young-Gyun Kim
Seoul National University
Bundang Hospital
10 Long-term Follow up Clinical Cases Long-term Follow up Clinical Cases 11
Implant restoration case on molar 47 yrs / Male
area using regular diameter implant

As a result of using Dentium implant for a long time, I am experiencing that
they are successfully functioning in many cases for 10 years or so,
and I figure that Dentium implant became well renowned implant that gives
a high level of satisfaction to both the dentist and patient.
Dr. Tae-Hyeong Kim / Kim & Lee Dental Clinic
C.C. 3/4/2004 Preoperative 4/8/2004 Postoperative

Pain in the posterior region in the left mandible and the right maxilla.
Surgical Approach
After waiting for 3 weeks after extracting #36, 37 early implant placement
was performed after soft tissue on the extraction socket healed to some
degree, and submerged type was placed. 7 week post-operatively,
2nd surgery was performed.
Prosthetic Approach
Combi abutment was tightened with 25 Ncm and was connected and then 6/24/2004 Final prosthesis 6/24/2004 Final prosthesis
provisional restoration was installed. 1 week later, combi abutment was
retightened with 25 Ncm, and 2nd impression was taken to finish and install
the final prosthesis.
Conclusion
On the molar area of male patient with no severe mastication force,
regular diameter Implantium implant functions excellently.
8/21/2013 9 years follow up 1/28/2014 10 years follow up

Alveolar bone augmentation in vertical 61 yrs / Male
dimension and implant placement,

using lateral window technique
During implant placement, it was difficult to gain initial stability of implant
due to the lack of residual bone volume at maxillary right molar.
However, I was completely satisfied that initial condition of implantation remained
at alveolar crest level until now.
Dr. Gwan-Taek Jo / Yes Dental Clinic
6/30/2004 Preoperative 11/3/2004 Postoperative
C.C.
Patient had problems with eating due to missing molar teeth.
Surgical Approach
Due to clinical limit of residual bone volume, a procedure of alveolar bone
augmentation in vertical dimension was performed for attaining initial stability
of implant It enabled putting minimum effort of drilling and self-tapping
for implantation.
6/20/2005 Final prosthesis 3/14/2007 2 years follow up
Prosthetic Approach
Showed equal mastication force with remaining teeth
Removed premature contact in case lateral movement had been made.
Conclusion
Now, after 10 years later of implantation, bone resorption has not been observed
through X-ray. Also, there was no screw-loosening of implant at both maxilla
and mandible. (SCRP Type)

External sinus lift with bone graft 59 yrs / Male
and simultaneous implantation

From 10 years ago, I started to use the IMPLANTIUM for failure cases of foreign brand
implants. The implant still shows a success rate of 99%, and now I use only Dentium
implant system. Although there are still demands on long term follow up, I am sure
that the result will be satisfying based on past experiences.
Dr. Yong-Ho Park / Namsuwon Well Dental Clinic
8/5/2002 Preoperative (Re I.S) 11/30/2002 Postoperative (Re l.S)
Surgical Approach
1) Chase allograft as the bone grafting material to be used for this
particular case
2) Simultaneous implantation based on the initial stability to reduce
treatment time
3) Minimal drilling and self-threading for initial fixation Place the implant
deeply into the bone due to the reduced residual bone from the
previous implant failure
Prosthetic Approach 8/2/2003 Final prosthesis 2/28/2006 3 years follow up

Crown design was taken into consideration to prevent prematurity
in lateral occlusal forces and to control food impaction
Conclusion
The implant has been well maintained without bone loss for 10 years.
It has been identified during the follow up that while a natural tooth
was extracted and replaced with an implant.
The bone condition of the original implant has been well maintained
without any problems.

10 Years of long term clinical 42 yrs / Male
evaluation on dental implant system

Initial fixation in the root-end was favourable even with adverse conditions
of the implant placement location.
For the case of performing an alveolar bone graft along with the placement,
the response with the grafted bone and the surrounding bone has been excellent.
Dr. Won-Bae Park / Parkwonbae Dental Clinic

C.C.
On 11/10/2002, he patient wanted to have implant placed due to
inconvenience with chewing.
Surgical Approach
1) Both second molars (hopeless teeth) in the left and right maxilla were extracted,
and four IMPLANTIUM (3.8 x 12 mm) of Dentium were placed after 1 month.
Bone graft was performed in the extraction and missing teeth area using a xenogenic
bone, and membrane was not used
2) After 4 months, the second stage surgery was performed, and the final prosthesis
was installed after 6 months
5/19/2003 Final prosthesis 5/23/2005 2 years follow up
3) The patient visited the clinic after 2 years and 10 years and was evaluated
with clinical testing and panoramic imaging. The result was shown satisfactory
since the gingiva near abutment was tightly sealed, and crestal bone was
stabilized with no change
Branemark affiliated implants have been the industry standard for over 30 years due to a large
amount of long-term clinical data that can be found. Long-term data offers important information
on the life of implant, improvement and development of the implant design, and the choice of the
implant. For the case of well-known implants by famous global brands, it is clear that there have
been a lot of data accumulated with published researches. This is how brands become famous
and recognized. In order to obtain long-term data, it requires great effort and time.
What can we say about lesser known domestic implants? There is short-term data available,
however, many new products had been released even before most short-term data were
presented. For the selection of an implant, it is necessary to observe the survival rate and the
changes in the crestal bone for at least 5 years. Survival rates of the implants currently in the
market vary from 90% to 98%. On the basis of Branemark data, Adell (1981) showed an absorption 1/17/2013 10 years follow up 1/10/2014 11 years follow up
of 1 - 1.5 mm for the first year and 0.1 - 0.2 mm each year afterwards, which is assumed to be in the
normal range. What about Dentium implants? Cases that lasted over 2 years from the 584 implants
used in 166 patients were collected. Follow-up of long-term clinical data of 10 years on those cases
were also performed. The average recall period was 67.04 months and 4 implants among those
failed. A very high survival rate of 99.32% was shown. Also, the frequency of bone resorption was
5.82% and the average of bone resorption rate was 0.21 mm/implant, which is very low.
Crestal bone resorption rate was much lower than revealed in the Branemark data.
The crestal bone response has been shown to be very stable.
Conclusion
In conclusion, Dentium implant showed an outstanding clinical efficiency
when it is compared with other overseas and domestic imlants.
If more resrearches are conducted, its credibility will be even strengthened.
10 Years of follow up case of 52 yrs / Female
Dentium S.L.A. surface implant

Marginal bone response near the implant area has remained stable.
10 years have passed and there are no particular issues.
Dr. Jong-Chan Park / Pyeongchon Ye Dental Hospital

The patient requested an implant to replace their missing teeth.
Surgical Approach
Since there were few residual bones in maxilla (residual ridge height
from alveolar crest was only 3 - 4mm), maxillary sinus lift was performed
after a tooth extraction. After approximately 7 months, an implant was
placed in a more accurate location using a pre-fabricated surgical guide.
As seen from the picture, the early stage of IMPLANTIUM had a mount,
which greatly helped in determination of a placement direction.
A protocol about the placement period at that time was to exert loading
6 months after the placement; however, in this case, loading by temporary 11/2/2005 Final prosthesis 8/22/2007 2 years follow up
crown was done at 4.7 months and the final prosthesis was installed
approximately after 2 months.
Prosthetic Approach
In order to reduce the number of placement, it was planned to use a bridge
type for both maxilla and mandible. In addition, abutments with various
gingival heights were used to avoid an exposure of metal collar.
Following the protocol practiced at that time, the distal side of the 2nd molar,
which was the most prone to the fracture, was treated with metal coverage
to give a protection against fracture.
10 years have passed and there is no fracture on porcelain tooth.
Conclusion
10 years report of Implantium treated with S.L.A. (Sandblasting with Large
grits and Acid etching) surface of Dentium was presented.
Radiographs have shown that bone response is excellent and it is maintained
well with no screw loosening up to the present moment.
Margin of prosthesis was not as accurate as today since it was difficult for the
initial impression coping to obtain a precise location within the impression
material; however, it has been maintained well without cement leakage.
Restoration of the loss of bilateral 51 yrs / Male
mandibular molars by using implants

As a clinician who enjoys experiencing diverse implant systems, I get to choose
Dentium Implantium preferably in challenging cases because of its stability.
Comparisons between long term follow ups are looked forward.
Dr. Se-Ung Oh / Hwain Dental Hospital

Consultation on implant prosthesis on the loss area.
Surgical Approach
Judging from the degree of abrasion of the residual teeth although there was
no bad habit, mastication force over medium level was expected, and wide
implant was thus planned. The bone width of the patient was appropriate.
1) Implant length is decided based on the measurement of the possible
bone height because implant gets more deeply positioned with its depth
being over 0.5 mm away from the bone crest as the diameter becomes wider.
2) Implant with appropriate depth is chosen, knowing the location and runway
angle of mental foramen on the 2nd premolar area under CT image. 11/1/2006 Final prosthesis 10/13/2009 6 years follow up
Prosthetic Approach
In an old bilateral loss condition, to compensate the change of the expected
height and mandibular position, ready-made combi abutment was connected,
and occlusion on the posterior teeth area was slightly raised in provisional
resin restoration condition, and the occlusion point that coincides with the
tooth axis was provided. After observing and reinforcing the sinking
phenomenon, final restoration was done with gold crown 6 weeks later.
Conclusion
Personally, I have experienced a huge difference of occurrence rate of 3/15/2012 8 years follow up 2/11/2014 10 years follow up
peri-implantitis which is characteristic is comparative observation between
so called luxury foreign implants and many domestically manufactured
implants having fragmentary but regular surgical procedures and criteria.
Compared to this, long term result of tissue reaction of Dentium implant
seems to be very positive.
Dentium for a family member 76 yrs / Male
Although it was a single case, the marginal bone response,

connection of fixture-abutment and gingival response was excellent.
Dr. Seung-Min Han / Seoul Ichon Dental Clinic
C.C.
The patient requested an implant placement.
Surgical Approach 6/2003 Preoperative 6/2003 Postoperative

This was an early case of an implant to further understand the characteristics
of IMPLANTIUM. It had the similar internal and conical connection type as
IMPLANTIUM. A severe progression of root caries led to an extraction. It was
an indication of an immediate placement. However, the placement was done
after approximately 3 months. The purpose was to perform the IMPLANTIUM
procedure exactly according to the manual since it was still early in the stage
of introduction to the IMPLANTIUM. At that time, an implant was placed so
that the implant top part was located at 0.5 mm downward from the bone
crest level. The second surgery was performed after submerged healing
for approximately 2 months.
9/2/2003 Final prosthesis
Prosthetic Approach
The final prosthesis was completed in 3 months after the surgery.
A firm connection without screw loosening between fixture and
abutment was considered an advantage of IMPLANTIUM.
The precise connection among the prosthetic parts was the main focus.
SCRP-type prosthesis was manufactured. Screw tightening was done
to avoid screw loosening two more times in 2 weeks intervals.
Conclusion
It is considered to be a successful case in the long term since cortical
bone near marginal bone is retained well and even gained 11/4/2005 2 years follow up 5/8/2013 10 years follow up
by functional remodeling. As a result of comparison of radiographs
taken immediately after installation of the prosthesis with radiographs
taken 10 years after the marginal bone gaining was observed.
Cortical bone around implants has been maintained in good condition.
It would be fair to expect positive results in the long run.
Bone overgrowth at 10 years 35 yrs / Female
after surgery in molar area

I have been using one product since using Dentium implant which is the only
implant showing no bone resorption among the fixtures that I have installed
since Astra implant. This helps minimizing error due to dexterous familiarity
and also helps management due to simplification of the inventory.
Dr. Il-Woo Jang / Seongwon Well Dental Clinic

Surgical Approach
On the area where extension bridge had been used for a long time,
#47 was installed slightly tilted anteriorly considering the opposing tooth.
Prosthetic Approach
After connecting dual AB, cement type porcelain crown was installed.
Since the patient was meticulous on oral hygiene, no special treatment
except for a regular check up and partial occlusal adjustment has been done
since 2003, and there is no finding of bone resorption.
Conclusion 12/30/2003 Final prosthesis 11/24/2005 2 years follow up

In the result of follow up through 2003, good long-term prognosis is shown
with compatibility with gum and overgrowth bone formation between 2 fixtures.

An example of alveolar bone 61yrs / Female
augmentation by functional
remodeling
Dr. Joon-Young Jo / Jojoonyoung Dental Clinic
C.C.
Patient requested for implant placement in mandibular left and right molar. 6/30/2003 Preoperative 7/4/2003 Postoperative (#35, 36)
Surgery Key Point

As #44, #45, and #46 had narrow bone width, the selection of implant size
and implantation site was important.
It had been decided during the surgery whether bone graft should be
performed or not
Surgery Aspect
After 2weeks of #36 and #37 implantation, #36 cover screw had been exposed
a little and so it was replaced with healing abutment.
4312 was implanted in #36 and 4310 was implanted in #37. 7/31/2003 Postopertive (#44, 45, 46) 7/31/2003 Final prosthesis
3412 was implanted in #44 and 3812 was implanted in #46.
Bone graft was not performed.
Prosthetic Aspect
Thin diameter implants were placed in #44, #45, and #46 due to narrow bone width.
Therefore, splint with prosthesis was considered.
Until now, for 10 years, there had been no problem with implant.
Conclusion
After 2 months prosthesis had been installed, patient has shown favorable
outcome until now. 10/4/2012 9 years follow up 4/1/2014 11 years follow up
Bone resorption was hardly observed. Gingival recession was happened
a little, but still it remains healthy.
Esthetic restoration with implant 61yrs / Female
for left maxillary lateral incisor

Having passed 10 years and 6 months since the implantation, gingival
retraction and resorption of marginal bone have been hardly noticed.
The esthetic prosthesis have been maintained well
Prof. Young-Gyun Kim / Seoul National University Bundang Hospital
6/17/2003 Preoperative 6/17/2003 Preoperative

C.C.
The patient wanted esthetic restoration with implant in the maxillary anterior.
Surgical Approach
Installed small diameter implant (lmplantium 3.4D/ML) for the surgical
operation of ridge expansion on tooth #22.
To minimize damages on the cortical bone of the labial, I applied bone
graft material into the interior of the labial while flap reflectionwas minimized.
Prosthetic Approach
I maintained convexity for the gingival of the labial, while I was conducting the 7/15/2003 Implantation 7/15/2003 Postoperative
second surgery with the surgical method of palatal roll-in after six months
of the implantation. Temporary prosthesis using Combi Abutment
(2mm GH / 41.80) were placed for three months and then were ultimately
replaced with the final prosthesis. (prosthesis treatment: Prof. Jung-won Hwang)
Conclusion
Having passed 10 years and 6 months since the implantation, gingival
retraction and resorption of marginal bone have been hardly noticed.
The esthetic prosthesis have been maintained well.
1/13/2004 Second stage surgery 3/17/2005 1 year follow up 3/15/2015 11 years follow up
32 34 36
Dr. Jong-Chan Park Dr. Lae-Jung Park Dr. Dong-Wook Chang
Ye Dental Clinic Trip Dental Clinic Win Dental Clinic
Sinus & GBR

38 40
Dr. Seung-Min Han Dr. Yung-Jin Cho
Seoul Ichon Dental Clinic Seoul Ppusigipeon Dental Clinic
32 Sinus & GBR Clinical Cases Sinus & GBR Clinical Cases 33
Maxillary sinus case utilizing 61 yrs / Male
the OSTEON II Sinus

& OSTEON II Collagen
By avoiding the second molar region which had only 1mm of residual
bone depth, OSTEON II Sinus was used on the first molar region to perform
the bone grafting procedure.
As for the second molar region, OSTEON II Collagen was used to augment
the bone volume for case completion.
Dr. Jong-Chan Park / Ye Dental Clinic
Surgical Approach
AS can be seen in the bone graft procedure scene using the OSTEON II Sinus,
it is evident that the blood permeated well in between the bone graft material.
Judging from this behavior, it is provided that it allowed a favorable environment
for new bone growth.
Prosthetic Approach 4/19/2012 Sinus detaches using DASK 4/19/2012 OSTEON II Sinus
In case of implementing the alveolar process in the maxillary premolar
region, the augulation of the implant placement may be off.
Therefore, CCM abutment was utilized to create the full zirconia crown.
Conclusion
It was very dffective to utilize the OSTEON II Sinus, for bone graft procedure
in the maxilla with insufficient residual bone depth. Moreover, it was highly
effective when OSTEON II Collagen was used to increase the bone volume.
4/19/2012 OSTEON II Collagen 4/19/2012 Postoperative
10/30/2012 Final prosthesis 10/30/2012 Final prosthesis

GBR with OSTEON ll 28 yrs / Female
& Collagen Membrane

It is considered that OSTEON ll and Collagen Membrane are both effective
regeneration materials providing easy and convenient handling, useful
for GBR in clinical case.
OSTEON ll is synthetic bone which has excellent osteoconductivity
and Collagen Membrane is biocompatible barrier membrane.
Dr. Lae-Jung Park / Triple Dental Clinic

10/17/2012 Preoperative 1/19/2013 Implantation
Surgery Key Point

#36 implant placement was performed during recovery from GBR of buccal
bone deficiency.
Prosthetic Aspect
After fixture level impression had been made with a transfer coping,
customized abutment was restored with zirconia crown. 1/19/2013 OSTEON II 1/19/2013 Collagen Membrane
Conclusion
GBR was performed using OSTEON ll and Collagen Membrane for buccal bone
deficiency healing. As a result, excellent new bone formation with sufficient quantity
and appropriate bone contour healing were observed.
1/19/2013 Postoperative 9/9/2013 Second stage surgery

The case where the tooth with 48 yrs / Male
a severe alveolar bone loss due

to endo-perio combined lesion
recovered its esthetics by implant
placement through alveolar ridge
preservation and GBR technique
(using Collagen Membrane ) Oral Exam Flap reflection
Dr. Dong-Uk Chang / Win Dental Clinic
C.C.
Tooth mobility and pain on #23 due to endo-perio combined lesion.
Surgical Approach
A severe bone loss on #23 was observed in X-ray and buccal gingival recession Implantation Collagen Membrane
was severe to damage esthetics. To recover these, implant restoration accompanying
alveolar ridge preservation and GBR was planned to gain esthetics back.
Conclusion
For recovery of esthetics on upper canine which shows pain, Mobility, pus discharge
and a severe gingival recession due to endo-perio combined lesion, alveolar ridge
preservation during extraction by using soft tissue was performed and implant
installation was done with GBR after soft tissue healing.
Through these two processes, restoration with esthetics was able to be performed.
Suture Healing 4 months
Second stage surgery Final prosthesis

GBR with OSTEON II 56 yrs / Male
& Collagen Membrane

C.C.
Id like my teeth treated because they are wobbly.
Preoperative Implantation
Surgery Key Point
Critical size defect on lower 2nd molar area was recovered by immediate
implantation by using Collagen Membrane and OSTENON II combined with
autogenous bone.
Surgery Aspect
1) To position the implant at a right location and to recover the critical
size defect caused simultaneously, GBR technique was used.
2) The fact that choosing the right bio material(membrane, bone graft)
brings about a good result is confirmed. OSTEON II Collagen Membrane
3) For a good primary closure, proper healing period is provided.
Prosthetic Aspect
Appropriate occlusion of single implant on the most posterior
2nd molar is accomplished.
Conclusion
OSTEON II used to recover critical size defect was found to have been well
harmonized with newly formed bone when re-entry was tried, and it was
confirmed that the volume maintenance was also good. Also, excellent Suture Second stage surgery
manipulation, biocompatibility, and barrier function that sufficiently
protects the new tissue of Collagen Membrane were confirmed.
Healing Final prosthesis

The use of OSTEON II for recovering 50 yrs / Female
a large sized bony defect due to

periodontal disease on mandibular
molar area.
Dr. Yung-Jin Cho / Seoul Ppusigipeon Dental Clinic
11/19/2013 Preoperative 1/15/2014 Flap reflection
C.C.
All teeth are wobbly I have difficulties in eating.
Surgery Key Point

Since the defect size was large on #45 and #47, drilling was done leaning against
only one wall during inserting the implant so that the positioning could be secured,
and autogenous bone grafting and OSTEON II grafting and OSTEON II grafting were
done on the exposed fixture portion and the adjacent portion respectively.
1/15/2014 Implantation + OSTEON II 1/15/2014 Collagen Membrane
Prosthetic Aspect
Embrasure space was sufficiently opened, and apically positioned partial thickness
flap surgery was done on the buccal side during surgery so that the vestibule is not
lost for an easy hygiene control.
Conclusion
Although it was a contained defect, bone graft surgery using OSTEON II
and Genoss Collagen Membrane were confirmed to be successful on a large
defect with over 10 mm size.
2/19/2014 Postoperative 3/25/2014 Healing 1 month
7/14/2014 Second stage surgery 1/19/2015 Final prosthesis

44 46 48
Dr. Kyung-Man Min Dr. Hyun-Sik Park Dr. Seung-Gun Lee
Seoul Mai Dental Clinic Haim Dental Clinic Gongreung Seoul Den tal Clinic
Narrow Implant
50 52
Dr. Hyun-Suk Lee Prof. Ui-Won Jung
Gwanghwamun Department of Periodontology
Ye Dental Clinic Yonsei University
College of Dentistry
44 Narrow implant Clinical Cases Narrow implant Clinical Cases 45
Using the NR Line for a

single-tooth restoration in the
mandibular anterior
Dr. Kyung-Man Min / Seoul Mai Dental Clinic
C.C.
Teeth are wobbly and painful.
Surgery Key Point

To provide the patient with a periodontal and orthodontic treatment,
the tooth #31 was extracted and had implant placed 7 months later.
At the time of impant placement, there was a lateral bony defect labially.
The space given at the surgical site was insucient for implant placement
mesiodistally and also labiolingually. So, I placed the 3.0mm diameter NR Line
implant deeper slightly and grafted OSTEON II Collagen with Collagen Membrane.
Prosthetic Key Point 4/30/2014 Implantation (NR Line 3011S) 4/30/2014 Bone graft (OSTEON II Collagen)
Prior to nal impression, the Temporary cylinder was used to fabricate
provisional restoration for soft tissue modeling.
Furthermore, the customized abutment was milled to provide adequate
biologic width around the implant.
Conclusion
When we install implant at the very narrow alveolar ridge,the 3.0mm diameter
NR Line implant is the proper selection. Especially when the orientation of the
osteotomy and the restoration is dierent, a two-piece implant/abutment option
is better than the one-piece SlimLine implant. Moreover, when the space is limited 4/30/2014 Suture 9/24/2014 Final prosthesis
and the soft tissue level is irregular in shape, it is eective to use a customized
abutment to achieve adequate biologic width around the implant.
9/24/2014 Final prosthesis 6/24/2015 9 months follow up

Immediate implant installation and 51 yrs / Female
immediate loading accompanied by

alveolar bone grafting
Dr. Hyun-Sik Park / Haim Dental Clinic
C.C.
Teeth are wobbly and painful.
Surgery Key Point

After extracting #32 with severe mobility, immediate implantation
and alveolar bone grafting using OSTEON Collagen and provisional restoration
were done on the upper labial exposure portion of the implant.
Prosthetic Key Point

Due to esthetics issue on anterior area, screw retained provisional restoration
was installed after immediate implantation. Cement type porcelain crown using
11/22/2013 Implantation (NR Line 3011S) 11/22/2013 Provisional restoration
angled abutment was installed as a final restoration.
Conclusion
Alveolar bone grafting was performed because alveolar bone resorption was
severe, but interdental space problem was solved by prosthetis since alveolar
bone and gingival formation was insufficient on the distal side.
11/22/2013 OSTEON II Collagen 11/22/2013 Postoperative
4/11/2014 Final prosthesis 4/11/2014 Final prosthesis 6/13/2014 2 months Follow up

NR Line, Small but excellent 62 yrs / Female
on narrow space
Dr. Seung-Gun Lee / Gongreung Seoul Dental Clinic
C.C.
Fiber post&core and PFM crown restored on #12 fell off.
7/29/2014 Preoperative 7/29/2014 Extraction
Surgery Key Point
Fixed implant prosthesis was restored due to the loss of #13. To avoid the
formation of the incision line from surgery, immediate implantation with
flapless surgery was performed. Because the absorption of buccal alveolar
bone was expected, OSTEON II Collagen with excellent manipulation was
filled -together on the extraction socket to compensate it.

Since upper lateral incisor has narrow mesiodistal width, NR Line which is
favorable in narrow alveolar width was chosen from treatment planning 7/29/2014 Implantation (NR Line 3009S) 7/29/2014 Bone graft (OSTEON II Collagen)
stage in order to fabricate a prosthesis as similar as possible to natural tooth.
Conclusion
Because immediate implantation using NR Line implant was done, the tissue
that could be easily damaged was well saved and the procedures were
thus able to be successfully finished through implant restoration.
7/29/2014 Healing abutment connection 7/29/2014 Postoperative

Immediate implant placement 78 yrs / Female
and Temporarization in the

Maxillary central incisor using
the NR Line system
The new Dentium implant system, the NR Line,
has a new thread design that allows smooth yet stable implant fixation.
Dr. Hyun-Suk Lee / Gwanghwamun Ye Dental Clinic

5/13/2014 Preoperative 5/13/2014 Extraction
C.C.
Broken front tooth.
Surgery Key Point

Ensure initial stability for immediate temporarization and precise 3-dimensional
Fixture position.
5/13/2014 Implantation (NR Line 3613W) 5/13/2014 Gap filling (OSTEON II)
To achieve a natural emergence pro le and gingival color, a yellow color coated
Customized Abutment was used.
Conclusion
Through the aggresive thread, it was possible to achieve a high initial stability
and a smooth implant xation.
5/13/2014 Postoperative 8/29/2014 Final prosthesis

Simple replacement 54 yrs / Female
of single maxillary premolar

using the NR Line
The entire surgical procedure was simple and lasted only 10 minutes
because of the three step drilling sequence for implant placement.
.PSFPWFS BTVDJFOUJOJUJBMTUBCJMJUZPG/tDNXBTBDIJFWFE
Prof. Ui-Won Jung / Department of Periodontology,

Yonsei University College of Dentistry
6/13/2013 Preoperative (#25) 11/18/2013 Preoperative
C.C.
Patient wants to have implant placed where her premolar fractured.
Surgery Key Point

1) One stage implant surgery
2) Based on the preoperative CBCT analysis, there was a sucient amount of
bone mass for implantation. For that reason, the NR Line implant was placed.
11/18/2013 Implantation (NR Line 3609W) 11/18/2013 Healing abutment connection
The final crown was made without the concern for limited angulation
seen when using one-piece implants.
Conclusion
From the beginning to the nal prosthesis connection took 3 months.
The treatment resulted in a highly satisfactory outcome, both esthetically
and functionally.
11/18/2013 Suture 11/18/2013 Postoperative

56 58 60
Dr. Won-Kyu Kim Dr. Ha-Young Kim Dr. Jun-Ha Gong
Prime Dental Clinic Korea University Eaton Dental Clinic
Overdenture
Guro Hospital
62 64
Prof. Sang-Wan Shin Prof. Jeong-Yul Lee
Korea University Korea University
Guro Hospital Guro Hospital
56 Overdenture Clinical Cases Overdenture Clinical Cases 57
Implant supported overdenture 71 yrs / Female
with 2 magnetic abutments in the

edentulous lower jaw
Dr. Won-Kyu Kim / Prime Dental Clinic
C.C. 8/23/2013 Preoperative 8/23/2013 Preoperative

Loosening, food impaction, and pain of the existing lower complete denture
that is being used.
Surgery Key Point

Placement on the accurate position.
Surgery aspect
1) For an accurate implant positioning, surgical stent is made
2) Parallelism of the implants is maintained
3) Sufficient irrigation to avoid overheating 9/26/2013 Implantation 12/26/2013 Magnetic attachment
4) proper tapping considering bone density
5) Installation with appropriate torque to avoid compressive bone necrosis
Prosthetic aspect
1) Should have sufficient retentive force for denture retention
2) Should be stable against lateral force
3) Harmful force should not be applied to the implant fixture.
4) Should be able to choose an attachment with appropriate height
considering the thickness of the mucosa.
Considering the above aspects, dome type magnetic
attachment of Dentium was chosen finally.
Conclusion
As a result of applying magnetic attachment after a sufficient time period
(3 months) on a complete denture which had made in advance, it is proven
that it is a method with a high level of satisfaction since patient discomforts
such as denture loosening or pain disappeared.
12/26/2013 Final prosthesis 1/3/2014 2 weeks Follow up

Surgery for implant supported 67 yrs / Female
overdenture
Dr. Ha-Young Kim / Korea University Guro Hospital
C.C.
I would like a new denture made.
Surgery Key Point 9/28/2011 Preoperative 9/28/2011 Preoperative

By using surgical stent, 2 implants were installed, and the effort was made
so that both implants were located at the same distance away from the
midline and in the same depths.
Surgery aspect
Since Simpleline II is non-submerged type, it lessened the burden of 2nd surgery
on aged patient, and the treatment procedures were relatively simple.
Prosthetic aspect
Since the head part of the ball abutment is small, it could be utilized usefully,
and O-ring on the inner surface of metal housing had sufficient retention 11/30/2011 Implantation 11/30/2011 Postoperative
force that aged patients could place and remove with no problem, and smooth
placement and removal was felt as well from an operators point of view.
Since O-ring could be replaced when it becomes worn out, and this also
lessens the burden of maintenance and repair cost.
Conclusion
Implant overdenture using Simpline II and ball attachment is simple in its
procedures, and prosthetic treatment, repair and maintenance are also
easy, so it is expected that it will be actively utilized in the future.
2/8/2012 Ball attachment connection 10/18/2012 10 months follow up
Excellence of the mandibular 70 yrs / Male
overdenture using a positioner

Dr. Jun-Ha Gong / Eaton Dental Clinic
C.C.
Bottom teeth are wobbly.
Surgery Key Point
Since installation location could be freely chosen, the case which accompanies
a complex and challenging procedures such as bone grafting could be minimized,
and the possibility of the occurrence of complication such as inferior alveolar
nerve damage could be minimized.
Prosthetic key point

The possibility of an error occurrence is very low because there is no complex
prosthetic procedure, the cost is low, and an excellent convenience and
simplicity in maintenance is provided. Also, since the size of the positioner 5/2/2012 Positioner connection 5/2/2012 Final prosthesis
is very small, space invasion necessary for aligning the denture teeth could
be minimized.
Conclusion
In mandible, stability of implant used for (implant-tissue supported)
overdenture could be sufficiently secure without splinting the implants unlike
bar type where implants must be splinted. If positioner is used, a sufficiently
stable overdenture will be provided with minimum implant numbers and the
cost for fabrication and maintenance will be low. Also, the convenience of the 5/2/2012 Final prosthesis 1/4/2013 1 year Follow up
maintenance is excellent.
5/14/2015 3 years Follow up 5/14/2015 3 years Follow up

Implant supported overdenture 70 yrs / Male
using mini ball attachment

Prof. Sang-Wan Shin / Korea University Guro Hospital
C.C.
My denture falls off. 9/22/2011 Preoperative 9/22/2011 Implantation (SimpleLine II)
Surgery Key Point

Being maxillary and mandibular edentulous state as a result of clinical
and radiographical exams, upper and lower dentures were being used.
Especially, mandible showed a medium level of alveolar bone resorption.
Considering the patients preference and treatment cost, maxillary complete
denture and mandibular overdenture using two implants were planned.
Prosthetic aspect
1 week after implant installment, the inner surface of the denture was adjusted 10/31/2011 Postoperative 11/8/2011 Healing 2 weeks (#43, #33)
so that the patient could use the denture.
2 months later, ball attachment was connected with 35 Ncm force, and to
connect the female attachment to the denture, pick-up impression was
taken with indirect method by using ball impression coping for pick-up
impression after forming holes on the existing denture. The female matrix
of the ball attachment was connected to the attachment, and the undercut
on the lower part was blocked-out by using fit-checker, and self curing resin
was added, and then relining was done by using priorly made occlusal index
After trying in the overdenture to the patient, its inner surface was adjusted
by using fit-checker. After installing the overdenture, patient satisfaction
1/9/2012 Mini ball attachment 1/9/2012 Final prosthesis
level was high, and it was found that the denture was well maintained
in several regular follow-ups.
Conclusion
Mandibular overdnture by using 2 implants has many advantages such as clinical
success rate, patient satisfaction, cost, lessening of the burden of the surgery on
the patient etc.
1/10/2012 Final prosthesis 5/4/2012 6 months Follow up

Surgery for implant supported 53 yrs / Male
overdenture
Prof. Jeong-Yul Lee / Korea University Guro Hospital
C.C.
Id like to participate in clinical experiment of implant overdenture.
Surgery Key Point

Installation was done in general surgical procedural order. With the bone quality
being type I, installation was done with 35Ncm insertion torque after full depth
final drilling & tapping.
Surgery aspect
Installation was done with the length being measured according to the highest
bony tuberosity portion due to irregularities of tuberosity on the alveolar crest.
5/8/2012 Implantation (#43, #33) 5/2/2012 Postoperative
Prosthetic aspect
Because the condition of the denture was good, and the fit was also good, the
female was attached to the denture in direct method without relining procedure.
Conclusion
Overdenture was functioning well without any significant note, and bone loss
around implant or periodontal condition showed a successful result. Patient
satisfaction level was high as well.
11/12/2013 Ball attachment(#43, #33) 11/12/2012 Ball attachment connection
11/12/2012 Final prosthesis 10/14/2013 1 year follow up

Evaluation of Different Combinations
of Biphasic Calcium Phosphate
Research Paper
and Growth Factors for Bone Formation
in Calvarial Defects in a Rabbit Model
The International Journal of Periodontics

& Restorative Dentistry
68 Research Paper (OSTEON) Research Paper (OSTEON) 69
Evaluation of Different
Evaluation of Different Combinations of Biphasic Calcium Phosphate
and Growth Factors for Bone Formation in Calvarial Defects in a Rabbit Model
Combinations of Biphasic Calcium Phosphate The aim of the present preclinical study was to investigate the capability of a new formulation
and Growth Factors for Bone Formation of biphasic calcium phosphate (BCP) in achieving new bone formation either by itself or in
combination with different concentrations of growth factors. Twenty- four 3-month-old male
in Calvarial Defects New Zealand white rabbits (weight range, 2.5 to 3.0 kg) that had been bred exclusively for
biomedical research purposes and obtained from a licensed vendor were used. Four calvarial
in a Rabbit Model defects were created in each animal, for a total of 96 defects. Each defect received alloplastic
BCP (Osteon III, Genoss) that was composed of 60% hydroxyapatite and 40% -tricalcium
phosphate) (porosity, ~80%; macropore size, 200 to 400 m; crystallinity, 95%) combined with
different concentrations of recombinant human plateletderived growth factor BB
(rhPDGF-BB), human recombinant basic broblast growth factor-2 (rhFGF-2), or recombinant
human bone morphogenetic protein-2 (rhBMP-2). A custom-made polycarbonate tube was
xed to each defect site by applying slight pressure, and a mixture of bone graft and growth
factor was implanted into the tubes. Data were collected 2, 4, and 8 weeks after creation of the
In Kwon Jung / PhD2
defects to assess early and late healing. Various amounts of newly formed bone and remnant
Byung-Ho Yoon / PhD3 BCP particles formed inside of the tube throughout the study period. The BCP + 0.5 mg/mL
Bok Ryul Choi / PhD4 rhBMP-2 group exhibited the most bone formation. At 8 weeks, more new bone formation was
David M. Kim / DDS, DMSc5 noted in the Osteon III + rhBMP-2 combined group than in other groups. The present study
Jung Sun Jang / MS6 results indicate that BCP can be combined with different concentrations of rhBMP-2, rhFGF-2,
and rhPDGF-BB to produce new bone formation within a polycarbonate tube in calvarial
defects in a rabbit model. Int J Periodontics Restorative Dent 2016;36(suppl):s49s59. doi:
10.11607/prd.2633
1 Assistant Clinical Professor, Department of Restorative Dentistry,
Loma Linda University School of Dentistry, Loma Linda, California, USA.
2 Chief Executive Of cer, Genoss, South Korea. Tooth loss due to periodontal disease, as well as prevalence of peri- implant disease, has
3 Biomaterials Team Manager, Genoss, South Korea. prompted the development of a wide array of bone graft substitutes for use in dentistry.
4 Growth Factor Team Manager, Genoss, South Korea. Clinicians practicing implant dentistry need to understand the advantages and disadvantages
5 Assistant Professor, Division of Periodontology, Department of Oral Medicine,
of available bone graft substitutes to achieve a predictable regenerative outcome. Alloplastic
Infection andImmunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
6 Medical Device Evaluation Team Manager, Genoss, South Korea.
biomaterials and growth factors offer an alternative to autogenous bone har- vest morbidity
and the unrealized fear of disease transmission with allograft.14 Biphasic calcium phosphate
(BCP), composed of hydroxyapatite (HA) and -tricalcium phosphate (-TCP), is a bone graft
Correspondence to: Dr David M. Kim, Harvard School of Dental Medicine,
substitute that resembles the inorganic phase of human bone tissue.16 The insolu- ble HA re-
188 Longwood Ave, Boston, MA 02115-5819. Fax: 617-432-1872. tains its form and structure to maintain space, while the -TCP stimulates new bone formation
Email: [email protected] by dissolving into calcium and phosphate ions.56 A number of preclinical and clinical studies
2016 by Quintessence Publishing Co Inc. examining animal and human biopsy specimens of BCP composed of various concentrations
of HA and -TCP have reported promising results in repairing large alveolar ridge defects.13 In
addition to the os- teoconductive property of BCP, these studies have demonstrated an active
remodeling of the bone with the presence of osteoclast- like multinucleated giant cells lining
resorbed graft particles, as well as osteoblasts lining the layers of osteoid matrix deposited General and local anesthesia
around the graft particles.13 Thus, BCP has been shown to be safe, biocompatible, biore- All surgical procedures were performed with the rabbits under general and local
sorbable, and able to ef- fectively serve as a scaffold for new bone formation. anesthesia in sterile conditions. An intramuscular injec- tion of a mixture of Zoletil
Various bone augmentation procedures are required in patients with past dental trauma (0.3 mL/kg; Virbac Laboratories) and xylazine hydrochloride (0.15 mg/kg; Rompun)
or severe periodontal disease. These procedures are a substantial clinical challenge because was administered, and the head of the rabbit was shaved and disin- fected with
of their lack of predictability and their surgical demands. One preclinical study observed povidone iodine. Local anesthesia (2% lidocaine hydrochloride [Xylocaine] with
new bone formation in a bone conduction chamber model.7 However, an arti cially created 1:100,000 epi- nephrine) was administered to the surgical site.
critical-size defect model that has been commonly used in other studies may not be able to
guide the bone formation in a designated direction.7 Surgical defect creation and bone augmentation
The present preclinical study was designed to investigate the capability of a new formulation An incision was made along the mid- sagittal plane, and the full-thickness ap was elevated
of BCP (comprising 60% HA and 40% -TCP) in achieving new bone formation either by to expose the calvaria. Four round circular slits (6.9 mm in diameter and 1 mm in depth)
itself or in combination with different concentrations of growth factors. The effect of growth were created using a trephine bur (Dentium). To promote angiogenesis, nine decortications
factors in accelerating the rate of new bone formation was also in- vestigated. The design were made within the circular slit using a round bur 1 mm in diameter. A custom-made
of this study allowed for the comparison of different concentrations of growth factors that plastic tube (height, 5; inner diameter, 6.1 mm; and outer diameter, 7.1 mm)
have been previously investi- gated in guided bone regeneration procedures, as well as in made of polycarbonate (Genoss) was xed to each defect site by applying light pressure,
periodontal regeneration procedures. 811 and the mixture of bone graft (0.15 cc) and growth factor (0.15 mg) was implanted into the
tubes. A 15-minute binding time was allowed before insertion. A polycarbonate cap (Genoss)
Materials and methods
was placed over the tube to prevent soft-tissue ingrowth (Fig 1). The aps were then adapted
for tension-free wound closure with multiple 4-0 resorbable interrupted sutures (Surgicel),
This prospective, randomized con- trolled preclinical trial used male New Zealand white and intramuscular injections of genta- micin (0.15 mL/3 kg) (Kumwha Phar- maceutical)
rabbits to deter- mine the osteogenic impact of BCP in combination with different and diclofenac sodium (0.1 mL/3 kg) (GUJU Pharmaceutical) were administered for 3 days.
concentrations of growth factors. Study animals and biomaterials Twenty-four
3-month-old male New Zealand white rabbits (weight range, 2.53.0 kg) that had been
Microcomputed tomography (CT), light microscopic,
and histomorphometric analyses
bred exclusively for biomedical research purposes were obtained from a licensed vendor.
They were accli- mated for 1 week before research commencement and were fed an Animals were humanely killed at 2, 4, and 8 weeks after the bone augmentation procedure.
appropriate diet with ad libitum access to water. The calvaria were dissected, xed in a 10% formalin solution for 2 weeks, and then evaluated
Four calvarial defects were created in each animal, for a total of 96 defects. Each defect using CT (SKY- SCAN 1173, Bruker-CT; 130 kV, 60 A, and 12.07 m). Reconstruc- tion of
received an alloplastic BCP (Osteon III, Genoss) that was composed of 60% HA two-dimensional projection images into a three-dimensional (3D) volumetric image stack
and 40% -TCP (porosity, ~80%; macropore size, 200400 m; crystallinity, 95%) was performed using NRecon software (version 1.6.9.8; Bruker-CT), and a CT-analyzer soft-
combined with different concentrations of recombinant human plateletderived ware (version 1.14.4.1; Bruker-CT) was used for morphometric analysis evaluat- ing
growth factor BB (rhPDGF-BB), human recombinant basic broblast growth factor-2 the percentage of mineralized bone and residual graft particles.
(rhFGF-2), or recombinant human bone morphogenetic protein-2 (rh- BMP-2).
After specimens were rinsed, dehydrated in ascending grades of ethanol, and embedded
Data were collected 2, 4, and 8 weeks after creation of the defects to assess early and
in a light- curing one-component composite resin (Technovit 7200 VLC, Heraeus Kulzer),
late healing.12 Each defect site was randomly assigned to one of the following groups,
light microscopic evaluation was conducted. Polymerized blocks were ground to bring
with no two adjacent sites receiving the same material:
the tissue components closer to the cutting surface. The nal thickness of 35 m was
achieved by grinding and nal polishing. Sections from each block were used for Goldner
trichrome stain. Light microscopic overview images of the cores were obtained with an
t0TUFPO***POMZ DPOUSPMO
t0TUFPO***NHN- optical micro- scope (BX51, OLYMPUS) equipped with a CCD camera (SPOT Insight 2Mp
t0TUFPO***NHN- SI'(' (FOPTTO
scienti c CCD digital camera system, DIAGNOSTIC Instruments) and analyzed using SPOT
SI1%('## (FOPTTO
t0TUFPO***NHN- (version 4.0, DIAGNOSTIC Instruments) and Image-Pro Plus (Media Cybernet- ics) software.
t0TUFPO***NHN- SI#.1 (FOPTTO

SI1%('## (FOPTTO
t0TUFPO***NHN- Statistical analysis
SI#.1 (FOPTTO
t0TUFPO***NHN- Mean values of newly formed bone and remnant BCP particles at each
SI'(' (FOPTTO
data collection period were compared using analysis of variance table of the linear model
t among all the experimental groups. The Tukey test was used for post hoc two-group anal-
yses. Repeated measures for each experimental group at the three data collection periods
were assessed using the analysis of variance model. All sta- tistics were performed using the
R statistical software package. P values less than .05 were considered statistically significant.
Fig 2 Representative histologic sections 2 weeks after the creation of calvarial defects in rabbits
(Goldner trichrome stain, magni cation 12.5)
a) Osteon III only (control).
b) Osteon III + 0.15 mg/mL recombinant human plateletderived growth factor BB (rhPDGF-BB).
c) Osteon III + 0.3 mg/mL rhPDGF-BB.
d) Osteon III + 0.5 mg/mL human recombinant basic broblast growth factor-2 (rhFGF-2).
e) Osteon III + 1.0 mg/mL rhFGF-2.
f) Osteon III + 0.5 mg/mL recombinant human bone morphogenetic protein-2 (rhBMP-2).
g) Osteon III + 1.0 mg/mL rhBMP-2.
Fig 1 Polycarbonate caps placed over tubes to prevent soft-tissue ingrowth in calvarial defects in rabbits.
particles formed inside the tube throughout the study period (Figs 2 to 7). Initial bone
Results formation appeared to start from the periph- ery of the remaining calvarial bone and
Clinical evaluation move toward the center of the tube and then gradually toward the polycarbonate cap.
No early exposure of the polycarbonate cap or adverse soft-tissue responses were
observed during the healing period in any groups. CT and histologic evaluations
Various amounts of newly formed bone as well as remnant BCP 2-week specimens
Limited bone formation and slight bony ingrowth originating from the border of the
native bone were observed (Fig 2). Remaining BCP particles were easily distinguishable
from the native bone and connec-tive tissue because of differences in staining and
morphologic properties. In some specimens, BCP particles seemed to act as an os-
teoconductive scaffold for bone regeneration, as newly formed bone was observed
around the graft particles. No obvious between-group differences in bone regeneration
were found.
a b 4-week specimens
t week 4, new bone tissue was more de nite in all specimens compared with that of week
2 (Figs 3 and 4). Newly formed bone was seen from the external surface of the calvarial
bone to approximately one-third to one-half the height of the tube in the control and both
rh- BMP-2 groups. Formation of bone at the central area of the tube was a common nding
in the control and both rhBMP-2 groups. In the areas with new bone formation, intimate
contact was observed between the graft particles and newly formed bone, and graft
particles were bridged by the newly formed bone. In some specimens, the surface of the
c d
BCP showed signs of resorption. Vascular and bone ingrowth
e f
g
into the pores of the biomaterial was also noted in the control and both rhBMP-2 groups, and
the BCP particles were embedded in woven bone and in dense connective tissue and mar-
row space. Compared with that of other specimens, robust new bone formation was noted
in both rhBMP-2 groups, with the pat- tern of bone regeneration different from that of other
specimens. rh- BMP-2 appeared to have induced bone more uniformly over the surgical
defects, whereas other growth factors induced bone mainly from the margins of the defects
and pro- ceeding toward the center. Both rh- PDGF-BB groups appeared to have a weaker
a b
bone formation response than the other groups. Bone depo- sition appeared to be delayed
in these two groups, whereas uniform bone formation was observed for the rhBMP-2 groups.
8-week specimens
New bone growth was observed around the graft particles as well as within the structure of
the graft particulate for all groups (Figs 5 and 6). A clear demarcation was not observed be-
tween the grafted area and the native bone in many specimens because uniform and mature
c d bone formation were observed at this point. Quality of new bone appeared to be similar to
the surrounding native bone. The rhBMP-2 groups appeared to have generated substantially
more newly formed bone than the other groups, and some specimens had bone formation
extending to the inner aspect of the polycarbonate cap. Histomorphometric analysis
Histomorphometric analysis was performed to compare the amount of newly formed bone
and remaining graft materials (Fig 8). The analysis of variance table revealed no differences
in the remaining bone graft percentages in different experimental groups at 2, 4, or 8 weeks.
No signi cant difference was found in any two-group comparison. Regarding new bone
e f area percentage, signi cant differences were found among different experimental groups
1BUXFFLT1BUXFFLT
*OUIFUXPHSPVQDPNQBSJTPOBOBMZTFTBUXFFLT
the rhBMP-2 groups exhibited statistically signi cantly more new bone formation than the
other experimental groups, except for the Osteon III + 1.0 mg/mL rhFGF-2 group (P .01).
For each experimental condition at the three data collection periods, a signi - cant increase
JOOFXCPOFBSFBXBTJOEFOUJFEJOUIFDPOUSPM 1
0TUFPO***NHN-SI'(' 1

0TUFPO***NHN-SI'(' 1
BOE0TUFPO***NHN-SI#.1 1
.003) groups. At 2 weeks, the mean standard deviation (SD) percent of new bone was 8.34%
g 5.16% for the control group, 4.37% 2.48% for the Osteon III + 0.15 mg/mL rhPDGF-BB
group, 5.45% 1.90% for the Osteon III + 0.3 mg/mL rhPDGF-BB group, 6.15% 3.43% for the
Fig 3 Representative histologic sections 4 weeks after the creation of calvarial defects in rabbits (Goldner trichrome Osteon III + 0.5 mg/mL rhFGF-2 group, 4.53% 2.06% for the Osteon III + .0 mg/mL rhFGF-2
stain, magni cation 12.5). (a) Osteon III only (control). (b) Osteon III + 0.15 mg/mL recombinant human platelet group, 4.55% 1.68% for the Osteon III + 0.5 mg/mL rhBMP-2 group, and 4.72% 2.83% for
derived growth factor BB (rhPDGF-BB). (c) Osteon III + 0.3 mg/mL rhPDGF-BB. (d) Osteon III + 0.5 mg/mL human
the Osteon III + 1.0 mg/mL rhBMP-2 group. The remaining graft particle percentage ranged
recombinant basic broblast growth factor-2 (rhFGF-2). (e) Osteon III + 1.0 mg/mL rhFGF-2. (f) Osteon III + 0.5 mg/mL
from 17.66% to 27.84% for all groups. No statistically signi cant differences were noted in
recombinant human bone morphogenetic protein-2 (rhBMP-2). (g) Osteon III + 1.0 mg/mL rhBMP-2.
terms of new bone formation at this period. At 4 weeks, the mean SD percent of new bone
was 11.49% 5.70% for the control group, 5.26% 1.24% for the Osteon III + 0.15 mg/mL
OC
NB rhPDGF-BB group, 8.90% 3.41% for the Osteon III + 0.3 mg/mL rhPDGF-BB group, 11.06%
5.77% for the Osteon III + 0.5 mg/mL rhFGF-2 group, 11.25% 2.82% for the Osteon III + 1.0
BG
mg/mL rhFGF-2 group, 17.68% 9.45% for the Osteon III + 0.5 mg/mL rhBMP-2 group, and
OCT
OB
BG
NB 15.10% 4.33% for the Osteon III + 1.0 mg/mL rhBMP-2 group. The remaining graft particle
BG
NB
OCT

percentages ranged from 21.20% to 29.72%. Increased new bone formation was exhibited
OB
OC by the Osteon III + 1.0 mg/mL rhFGF-2 and both rhBMP-2 groups compared with week 2.
OC OB
a c
At 8 weeks, the mean SD percent of new bone was 16.67% 7.60% for the control group,
b OCT
7.28% 2.51% for the Osteon III + 0.15 mg/mL rhPDGF-BB group, 6.09% 1.55% for the Os-
teon III + 0.3 mg/mL rhPDGF-BB group, 8.14% 5.99% for the Osteon III + 0.5 mg/mL rhFGF-2
Fig 4 High-magni cation images of a specimen from (a) the control group depicting the presence of an osteoblast, group, 18.35% 8.50% for the Osteon III + 1.0 mg/mL rhFGF-2 group, 32.75% 6.95% for the
an osteocyte, and new bone; (b) the Osteon III + 0.5 mg/mL rhBMP-2 group demonstrating active bone formation;
and (c) the Osteon III + 1.0 mg/mL rhBMP-2 group depicting bone formation and fragmentation of graft particles
Osteon III + 0.5 mg/mL rhBMP-2 group, and 33.46% 8.67% for the Osteon III + 1.0 mg/mL
(PMEOFSUSJDISPNFTUBJO
0#PTUFPCMBTU0$PTUFPDZUF0$5PTUFPDMBTU/#OFXCPOF#(CPOFHSBGU rhBMP-2 group. The
BG
BG
NB OB OB OCT
NB NB
OCT BG
OC

OCT OC
a b a OC b c
Fig 6 High-magni cation images of specimens from (a) the Osteon III + 0.5 mg/mL rhBMP-2 group, (b) the
Osteon III + 0.5 mg/mL rhBMP-2 group, and (c) the Osteon III + 1.0 mg/mL rhBMP-2 group from Fig 5
(PMEOFSUSJDISPNFTUBJO
0#PTUFPCMBTU0$PTUFPDZUF0$5PTUFPDMBTU/#OFXCPOF#(CPOFHSBGU
c d
a b
e f
g
c d
Fig 5 Representative histologic sections 8 weeks after the creation of calvarial defects in rabbits (Goldner trichrome
stain, magni cation 12.5). (a) Osteon III only (control). (b) Osteon III + 0.15 mg/mL recombinant human
plateletderived growth factor BB (rhPDGF-BB). (c) Osteon III + 0.3 mg/mL rhPDGF-BB. (d) Osteon III + 0.5 mg/mL
human recombinant basic broblast growth factor-2 (rhFGF-2). (e) Osteon III + 1.0 mg/mL rhFGF-2. (f) Osteon III + 0. 5
mg/mL recombinant human bone morphogenetic protein-2 (rhBMP-2). (g) Osteon III + 1.0 mg/mL rhBMP-2.
e f
g
Fig 7 Representative microcomputed tomography images 8 weeks after the creation of calvarial defects in rabbits. rhPDGF-BB enhanced bone augmentation when combined with al- lografts or
(a) Osteon III only (control). (b) Osteon III + 0.15 mg/mL recombinant human plateletderived growth factor BB xenografts.13,14 A minimal amount of the growth factor should be considered because
(rhPDGF-BB). (c) Osteon III + 0.3 mg/mL rhPDGF-BB. (d) Osteon III + 0.5 mg/mL human recombinant basic broblast a high dose does not necessarily generate more bone than a low dose but may increase
growth factor-2 (rhFGF-2). (e) Osteon III + 1.0 mg/mL rhFGF-2. (f) Osteon III + 0.5 mg/mL recombinant human bone potential adverse effects and costs.15,16 Thus, the release pro le of the carrier, as well as
morphogenetic protein-2 (rhBMP-2). (g) Osteon III + 1.0 mg/mL rhBMP-2. the size and con guration of the bone defect, may be important considerations for a
growth factorcombined strategy. The present study results indicate that BCP can be
percentage of remaining graft particles ranged from 23.56% to 27.92%. Compared with combined with different concentrations of rh- BMP-2, rhFGF-2, and rhPDGF-BB to produce
4-week values, less new bone formation was noted in the Osteon III + 0.3 mg/mL new bone formation within a polycarbonate tube in calvarial defects in a rabbit model.
rhPDGF-BB and the Osteon III + 0.5 mg/mL rhFGF-2 groups. This preclinical model is commonly used to test the osteogenic potential of b
iomaterials.7,17,18 A 4-week observation period has been determined to be adequate
Discussion for the observation of angiogenesis and bone formation in several animal models when
Advances in recombinant tech- niques have allowed for the com- mercialization of growth biomaterials have been implemented into the defect areas.7,17,19 A healing period
factors such as rhBMP-2, rhPDGF-BB, and rhF- GF-2, which can be used to enhance patient of 8 weeks has been determined to be adequate for the assessment of late healing,
care. In particular, growth factors provide advantages when treating large defects with such as bone incor- poration, resorption of materials, bone remodeling, or the amount
com- promised remaining alveolar bone. They can also shorten treatment time and of bone regeneration in a rabbit cranial model.12 Decortication of the calvaria was
minimize postoperative complications.10 Recent preclinical and clinical studies have performed to allow pro- genitor cell migration from the bone marrow and to facilitate
demonstrated that growth factors such as angiogenesis. As the study progressed, the percentage of new bone formation increased
in all groups except for the Osteon III + 0.3 mg/mL rhPDGF-BB and Osteon III + 0.5 mg/mL
rhFGF-2 groups. In all specimens, newly generated tissue and mineralized bone were
observed within the con ne- ment of the polycarbonate tube at 4 weeks. Super cial
disintegration or fragmentation of BCP particles into small grains have been previously
reported,20 whereas osteoclasts were responsible for material resorption in another
human study.21,22 The high percentage of vital bone in regener- ated sites indicated
that bone cells might still be actively replacing BCP, and additional time may increase
the amount of vital bone formation while reducing the residual graft amount.22
Biomaterial by itself (as in the present control group) has been demonstrated to improve
bone regeneration and similar histologic behavior (as reported in other similar studies).
14 At all data collection periods, the control group (Osteon III only) had more new bone
formation than both Osteon III + rhPDGF-BB groups. Porosity and pore intercon- nectivity
have an effect on the BCPs rate of biodegradation, as well as new bone formation,
vascularization, and graft stability.1 An optimum bal- ance between the stable phase
of HA and the soluble phase of -TCP may have enhanced new bone formation.1
The importance of carrier effect for the growth factor was highlighted by the present
ndings as well as those of Kao et al, who reported a negative effect on bone formation
when rhBMP-2 was added to xenografts.23 In the present study, BCP with a composition
of 60% HA and 40% -TCP may not have been a compatible or effective carrier for rhFGF-2
Fig 8 Bar graph demonstrating mean standard deviation of new bone percentage 2 weeks, 4 weeks, and rhPDGF-BB. In the present study, BCP that was combined with 0.5 mg/mL rh- BMP-2
and 8 weeks after the creation of calvarial defects in rabbits who received biphasic calcium phosphate (Osteon III) resulted in the most new bone formation; at 8 weeks, more new bone formation was noted
BOEEJFSFOUDPODFOUSBUJPOTPGHSPXUIGBDUPSTSI1%('##SFDPNCJOBOUIVNBOQMBUFMFUoEFSJWFEHSPXUI in both rhBMP-2 groups than in other groups. Several preclinical studies have previously
GBDUPS## SI'('IVNBOSFDPNCJOBOUCBTJDCSPCMBTUHSPXUIGBDUPS SI#.1SFDPNCJOBOUIVNBO demonstrated ef - cacy of rhBMP-2 and alloplasts such as HA and -TCP in the treatment
bone morphogenetic protein-2.
of critical-sized defects.18,24,25
Conclusions
Results of the present study support the use of BCP graft particulates to stimulate new bone
formation by itself or in mixture with a growth factor, such as rhBMP-2. This combination
appeared to be biocompatible and histologically successful in forming new bone at an
acceler- ated rate. Early and uniform onset of bone formation was noted in both rhBMP-2
groups. Low concentrations of rhBMP-2 (0.5 mg/mL) appeared to be as effective as high
concentrations (1.0 mg/mL). How- ever, the concentrations of these growth factors for use
with BCP need to be tested in an animal study with a larger sample size.
Acknowledgments 16. Ha E, Lemonnier J, Fromigu O, Gunou H, Marie PJ. Bone morphogenetic protein
receptor IB signaling mediates apop- tosis independently of differentiation in
The authors reported no con icts of interest related to this study. This study was spon- osteoblastic cells. J Biol Chem 2004;279: 16501658.
sored by a grant from Genoss. 17. Schmid J, Wallkamm B, Hmmerle CH, Gogolewski S, Lang NP. The signi cance of
angiogenesis in guided bone regeneration. A case report of a rabbit experiment.
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struction with a composite alloplastic biomaterial. Int J Periodontics Restorative properties of rhBMP-2 loaded porous calcium phosphate cement implants in cranial
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84 86
OSTEON III Dr. Dong-Wook Chang Dr. Seung-Min Han
Win Dental Clinic Seoul Ichon Dental Clinic
84 OSTEON Clinical Cases OSTEON Clinical Cases 85
GBR with using OSTEON III 62 yrs / Female
& Collagen Membrane in implant

placement on missing molar area
OSTEON III was applied for treating bony defect in Implant placement and
then Collagen membrane was covered over the bone graft material.
During the surgical procedure, OSTEON III was easy to handle and wettability
was good. when the flap was opened in the second stage surgery,
it was shown that new osteoid tissue was well formed and sufficiently hard.
OSTEON III was also well blended with the existing alveolar bone. 1/13/2015 Preoperative 7/10/2015 Preoperative
Therefore, it is considered that OSTEON III would be used efficiently as an
appropriate bone graft material for GBR procedure by clinicians.
Dr. Dong-Wook Chang / Win Dental Clinic
C.C.
I have severe pain on the right lower molars.
7/10/2015 Flap reflection 7/10/2015 OSTEON III
Surgery Key Point
When installing implants on lower molar(#46, #47) area,
OSTEON III was applied to treat the bone loss area around the implant
and buccal hard tissue, and the outcome was examined.

Customized abutment was used and PFM crown was restored.
Conclusion
When we install implantat the very narrow alveolar ridge, the 3.0mm 7/10/2015 Postoperative 10/20/2015 Second stage Surgery
diameter NR Line implant is the proper selection.
Especially when the orientation of the osteotomy and the restoration
is dierent, a two-piece implant/abutment option is better than the
one-piece SlimLine implant. Moreover, when the space is limited and the
soft tissue level is irregular in shape, it is eective to use a customized
abutment to achieve adequate biologic width around the implant.

86 OSTEON Clinical Cases OSTEON Clinical Cases 87
The excellent outcome after 59 yrs / Female
GBR and sinus graft using

OSTEON III
1) When OSTEON III was used, newly formed showed an equal quality
to that of OSTEON II.
2) An excellent surface of Superline implant(particularly in situation
where bone augmentation is needed, an excellent initial stability
even when the remaining bone below the sinus is insufficient.
3) Efficiency of DASK drill (grinding) in preparing sinus lateral window 6/8/2015 Preoperative 6/8/2015 Bone defect
when sepal bone exists.
C.C.
Bleeding and difficulty in biting on the left side.
Surgery Key Point 6/8/2015 Installation (SuperLine) 6/8/2015 OSTEON lll, OSTEON ll
The regenerative surgery case by SuperLine implant and GENOSS
regenerative material in case where sinus with 1~2 residual alveolar
bone on #26 sites and localized dehiscence defect on #24 site exist.

Although 1 tooth versus 1 implant restoration is desirable in general,
implant supported fixed bridge was chosen as a treatment
of choice due to the patients wish and financial problem.
Long-term follow up will be necessary about this prosthetic option.
6/8/2015 Postoperative 12/17/2015 4 months follow up
Conclusion
When newly developed OSTEON III was used, satisfactory newly
formed tissue was observed on the site where sinus elevation
and GBR were performed. As this newly formed tissue lead to an intimate
contact with implant surface, a successful osseointegration of implants
was observed despite unfavorable bone condition.

DENTIUM Co., Ltd.
501 Gyeonggi R&DB Center, 105 Gwanggyo-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea [443-270]
T +82-31-888-5431 F +82-31-888-5430 E-mail [email protected] / www.dentium.com POD-1607 [Rev.2]
Specifications are subject to change without notice. Some products listed in this catalog are not available in the market due to pending approval.

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Users Clinical Cases

Proving the value and reliability of the products

14 Dr. Yong-Ho Park

22 Dr. Seung-Min Han

24 Dr. Il-Woo Jang

28 Prof. Young-Gyun Kim

Implant restoration case on molar 47 yrs / Male

area using regular diameter implant

Dr. Tae-Hyeong Kim / Kim & Lee Dental Clinic

C.C. 3/4/2004 Preoperative 4/8/2004 Postoperative

8/21/2013 9 years follow up 1/28/2014 10 years follow up

Alveolar bone augmentation in vertical 61 yrs / Male

dimension and implant placement,

Dr. Gwan-Taek Jo / Yes Dental Clinic

6/30/2004 Preoperative 11/3/2004 Postoperative

8/28/2013 8 years follow up 5/11/2015 11 years follow up

External sinus lift with bone graft 59 yrs / Male

and simultaneous implantation

Dr. Yong-Ho Park / Namsuwon Well Dental Clinic

8/5/2002 Preoperative (Re I.S) 11/30/2002 Postoperative (Re l.S)

Prosthetic Approach 8/2/2003 Final prosthesis 2/28/2006 3 years follow up

4/26/2010 7 years follow up 4/3/2013 10 years follow up

10 Years of long term clinical 42 yrs / Male

evaluation on dental implant system

Dr. Won-Bae Park / Parkwonbae Dental Clinic

11/10/2002 Preoperative 11/28/2002 Postoperative

10 Years of follow up case of 52 yrs / Female

Dentium S.L.A. surface implant

Dr. Jong-Chan Park / Pyeongchon Ye Dental Hospital

C.C. 2/17/2002 Preoperative 10/9/2003 Postoperative

Restoration of the loss of bilateral 51 yrs / Male

mandibular molars by using implants

Dr. Se-Ung Oh / Hwain Dental Hospital

C.C. 9/16/2003 Preoperative 9/16/2003 Postoperative

Dentium for a family member 76 yrs / Male

Although it was a single case, the marginal bone response,

Dr. Seung-Min Han / Seoul Ichon Dental Clinic

Surgical Approach 6/2003 Preoperative 6/2003 Postoperative

Bone overgrowth at 10 years 35 yrs / Female

after surgery in molar area

Dr. Il-Woo Jang / Seongwon Well Dental Clinic

5/14/2003 Preoperative 5/23/2003 Postoperative

Conclusion 12/30/2003 Final prosthesis 11/24/2005 2 years follow up

7/5/2011 8 years follow up 10/23/2013 10 years follow up

An example of alveolar bone 61yrs / Female

Surgery Key Point

Esthetic restoration with implant 61yrs / Female

for left maxillary lateral incisor

Prof. Young-Gyun Kim / Seoul National University Bundang Hospital

6/17/2003 Preoperative 6/17/2003 Preoperative

Sinus & GBR

Maxillary sinus case utilizing 61 yrs / Male

the OSTEON II Sinus

4/19/2012 OSTEON II Collagen 4/19/2012 Postoperative

10/30/2012 Final prosthesis 10/30/2012 Final prosthesis

GBR with OSTEON ll 28 yrs / Female

& Collagen Membrane

Dr. Lae-Jung Park / Triple Dental Clinic

Surgery Key Point