치과 CAD/CAM 시스템의 가공 방식에 따른 코발트-크롬계 금속-도재관용 코핑의 적합도 평가 :Evaluation of marginal and internal gap according to manufacturing methods of dental CAD/CAM system for metal ceramic crown of Cobalt-Chromium based alloy

김동연

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자료유형: 학위논문

저자정보: 김동연 (고려대학교, 고려대학교 대학원)

지도교수: 김웅철

발행연도: 2016

저작권: 고려대학교 논문은 저작권에 의해 보호받습니다.

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이 논문의 연구 히스토리 (3)

2016

치과 CAD/CAM 시스템의 가공 방식에 따른 코발트-크롬계 금속-도재관용 코핑의 적합도 평가

김동연 보건과학과 2016.01 학위논문

2015

치과 캐드캠 시스템의 가공 방식에 따른 금속 코핑의 적합도 비교

김동연 , 전진훈 , 박진영 외 3명 치위생과학회지 2015.01 학술저널

치과 CAD/CAM 시스템으로 제작한 코발트-크롬 소결 금속 코핑의 변연 및 내면 적합도 평가

김동연 , 신천호 , 정일도 외 2명 치위생과학회지 2015.01 학술저널

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목적: 본 연구의 목적은 치과 CAD/CAM 시스템의 몇 가지 가공 방식에 따라 제작한 코발트-크롬계 금속 도재관용 금속 코핑의 변연 및 내면 적합도를 비교 평가하는 것이다.

방법: 본 실험에 있어서 master die를 제작하기 위한 대상으로 국제 표준 형태의 치형 모델(ANA-4; Frasaco, Tettnang, Germany)을 선정하였다. 이 모델 가운데 하악 우측 제 1대구치를 선택하고, 기존 문헌을 참고하여 금속-도재관을 위한 지대치의 일정하게 삭제를 하고, silicone rubber의 인상을 채득하였다. 이 인상체에 왁스를 녹여 주입하고 주조과정을 거쳐 금속의 master die를 제작하였다. 제작된 금속 master die로부터 인상을 채득하여 10개의 실리콘 고무인상체를 얻었다. 이 인상체에 초경석고(Type Ⅳ)를 주입하여 10개의 연구 모형을 제작하였다. 이렇게 10개의 연구모형을 모델 스캐너로 스캔하고 코핑의 디자인을 실시하였다.
대조군은 통법에 따라 납형을 매몰 주조하는 lost wax technique(LW)의 방식으로 제작한 10개 코발트-크롬 금속 코핑으로 하였다. 실험군 다음과 같이 4가지 캐드캠의 가공방식(Wax block milling (WBM), Soft metal block milling (SMB), Micro-stereolithography(μ-SLA), Selective laser melting(SLM)에 따라 제작한 각 집단별 10개의 코발트-크롬 금속 코핑으로 설정 하였다.
제작이 완료된 금속 코핑의 변연 및 내면 적합도의 측정법은 silicone replica technique을 이용하였다. Silicone replica는 협·설, 근·원심 방향으로 절단하고 디지털 현미경을 사용하여 160배율로 간격을 측정하였다. 측정된 데이터 값은 통계 소프트웨어인 IBM SPSS ver. 22.0을 사용하여 비 모수 검정법인 Kruskal-Wallis H 검정을 실시 하였으며, 유의수준은 제 1종 오류 수준인 0.05로 설정하였다. 사후 검정은 Mann-Whitney U test with Bonferroni corrected 로 시행하였다.
결과: 변연 및 내면 적합도를 측정한 결과 LW 집단은 94.02±52.62 ㎛, WBM 집단은 104.18±76.92 ㎛, SMB 집단은 79.02±33.64 ㎛, μ-SLA 집단은 158.75±98.68 ㎛, SLM 집단은 235.62±152.67 ㎛로 나타났으며, 이들 사이에 통계적으로 유의한 차이가 나타났다(P<0.05).
변연 적합도가 가장 우수한 집단은 SMB 집단의 62.54±29.66 ㎛이었으며, 가장 우수하지 못한 집단은 SLM 집단으로 248.58±123.05 ㎛이었다. 축벽 적합도에 있어서 가장 우수하게 나타난 집단은 SLM 집단으로 70.73±23.55 ㎛이었으며, 가장 우수하지 못한 집단은 SBM 집단으로 84.47±26.29 ㎛이었다. 교합면 적합도에서는 가장 우수하게 나타난 집단은 SMB 집단의 90.06±38.05 ㎛이었고 가장 우수하지 못한 집단은 SLM 집단의 387.55±60.81 ㎛로 나타났으며 통계적으로 유의한 차이를 나타났다(P<0.05).
변연 적합도 부위의 세밀하게 분석하기 위하여 buccal marginal gap, lingual marginal gap, digital marginal gap, mesial marginal gap 지점을 측정하였는데, 그 결과는 대체적으로 μ-SLA 집단만 제외하고 다른 모든 집단은 buccal marginal gap이 가장 크게 나타났다.
결론: 코발트-크롬계 금속-도재관용의 변연 적합도는 수작업 방식인 LW 집단, 절삭 가공 방식인 WBM 집단과 SMB 집단에 있어서 임상적인 허용 수치인 120 ㎛ 이내에 존재하였다. 그러나 적층 가공 방식인 μ-SLA 집단과 SLM 집단에 있어서는 임상적인 허용 수치 이내에 존재하지 못하였다. 따라서 적층 가공 방식의 적합도가 임상적으로 허용 가능 하도록 하기 위해서 지속적인 연구가 필요할 것으로 사료된다.

Purpose: The purpose of this study was to evaluate the marginal and internal gap of Cobalt(Co)-Chromium(Cr) based metal coping fabricated using by dental computer-aided design (CAD)/computer-aided manufacturing (CAM) systems.
Materials and methods: An abutment tooth 46(ANA-4; Frasaco, Tettnang, Germany) of universal numbering system was selected for the study. The fabricating the abutment preparation and then duplicating the abutment with silicone rubber was made. This master die was then replicated in silicone and injected with molten wax. The resulting wax die was then used to cast metal alloy. By replicating the metal master die through a silicone impression, a study die of ten was subsequently obtained by pouring stone(type Ⅳ) mixed to the manufacturer’s recommended water:powder ratio. Ten co-cr metal copings of control group were fabricated using lost technique wax and forty metal copings of four experimental groups were fabricated using CAD/CAM system(wax block milling with casting processing, soft metal block with sinter processing, micro-stereolithography with casting processing, selective laser melting). Marginal and internal gap of Co-Cr metal copings of fifty were measured by digital microscope(x160) with silicone replica technique. The data obtained was analysed by the non-parametric Kruskal-Wallis H-test(α=0.05), post-hoc Mann-Whitney U-test and Bonferroni correction.
Results: Total gap of marginal and internal measurement results LW group 94.02±52.62 ㎛, WBM group 104.18±76.92 ㎛, SMB group 79.02±33.64 ㎛, μ-SLA group 158.75±98.68 ㎛, SLM group 235.62±152.67 ㎛, All groups are a statistic significant different(P<0.05).
Marginal gap show that the best result SMB group 62.54±29.66 ㎛, while the poorest result of SLM group 248.58±123.05 ㎛. Axial wall gap show the best result SLM group 70.73±23.55 ㎛, while the poorest result of SBM group 84.47±26.29 ㎛. Occlusal gap that the best result SMB group 90.06±38.05 ㎛, while the poorest result of SLM group 387.55±60.81 ㎛, Marginal, axial wall, occlusal gap of all groups are a statistic significant different(P<0.05).
The marginal gap of the resin copings was evaluated by measuring the buccal marginal gap, mesial marginal gap, lingual marginal gap and digital marginal gap of 4 separated parts. Buccal marginal gap of LW, WBM, SMB, SLM group show poorest result.
Conclusion: Marginal gap of Co-Cr based metal copings of LW, WBM, SMB group was found clinical acceptable range. The continuous research in the future to be applied clinically for the marginal gap of μ-SLA, SLM group are needed.

#치과 CAD/CAM 시스템 #변연 적합도 #내면 적합도 #코발트-크롬 합금 #금속 코핑

목 차
국문요약··························································································································Ⅰ
목차······································································································································ Ⅵ
LIST OF FIGURES······················································································ ⅧLIST OF TABLES························································································· XI
Ⅰ. 서론
1. 연구 배경··············································································································· 1
1) 치과 CAD/CAM 시스템의 소개··············································· 1
2) 절삭 가공································································································· 6
3) 적층 가공································································································· 9
4) 코발트-크롬계 금속도재관용 코핑········································ 12
5) 금속도재관용 코핑 적합도··························································· 15
2. 연구 목적················································································································ 16
Ⅱ. 연구 재료 및 방법································································································ 17
1. 연구 설계··············································································································· 17
1) 연구 설계 설명····························································································· 17
2) 코발트-크롬 합금 재료·········································································· 20
2. 연구 방법··············································································································· 21
1) 주 모형(Master die) 제작······························································· 21
2) 연구모형(study die) 제작································································ 24
3) 코발트-크롬계 금속 코핑 제작··················································· 25
4) 변연 및 내면 적합도 측정································································ 42
5) 통계 분석······································································································ 49
Ⅲ. 연구 결과···················································································································· 50
Ⅳ. 고찰································································································································· 59
Ⅴ. 결론································································································································· 67
REFERENCES······················································································································ 70
ABSTRACT·························································································································· 76

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