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1 ISSN eissn Review Article Study on methodology for the assessment of internal and marginal adaptation on fixed dental prosthesis Se-Wook Pyo, Jun-Jae Lee, Jung-Suk Han, Young-Jun Lim* Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea This article is to review various methods used to investigate internal and marginal adaptation of fixed dental prostheses, and to summarize a merit, worth, and limitation of each method, using some results of previous studies. The methods of measuring internal and marginal gap are divided into two categories in this study; in vivo and in vitro. In vivo methods are clinical evaluations, including exploration, radiography, and impression technique. In vitro methods are laboratory evaluations such as direct view, crosssectioning, and silicone replica technique using microscope. Measuring by micro computed tomography (CT) or profilometer is also in vitro methods. In recent years, the development of scanning systems is able to analyze 3-dimensional internal and marginal space in detail. As measuring and analyzing technology become more advanced, the ability to thoroughly examine crown adaptation is becoming both simpler and more efficient. (J Dent Rehabil Appl Sci 2016;32(3):158-68) Key words: marginal fit; internal fit; crown adaptation; fit measurement 서론 치과의사가보철물을시적할때에는일반적으로인접면검사, 내면및변연적합도검사, 교합검사를반드시해야한다. 인접면이나교합면과같은외형적인요소들은보철물이제작된후어느정도조정이가능하지만, 내면과변연의적합도는보철물제작과정에서이미결정되는만큼그보철물의예후를결정하는가장중요한요소라고할수있다. 보철물의적합도는내면적합도부터평가하는데, 내면에먼저닿는부분이존재하는경우에보철물이완전히들어가지않아변연부를정상적으로평가할수없기때문이다. 따라서기공과정에서내면적합도향상을위한적절하고균일한시멘트공간에대한고려가필수적이며, 너무과도한내면공간은보철물의파절, 탈락등을야기할수있고, 1 너무작은내면공간은보철물 의장착을불완전하게할수있음을반드시숙지해야한다. 2 내면적합도가확인된후에는보철물과지대치경계부위의연속성을확인하여보철물의변연부위가임상적으로적합한지평가해야한다. 변연적합도가좋지않은경우보철물내면의시멘트용해를촉진시켜치아와치주조직에부정적인영향을주게되는데, 예를들면보철물주변으로치태가축적되고치은염증을유발할수있으며, 나아가서는지대치에 2차우식이나치수염을일으키게되어보철물이실패하는주된원인이된다. 3-6 하나의보철물을제작하기위해서는치아삭제및인상채득과정을거쳐모형을제작하고다이작업을통해지대치모형에원하는모양의납형을형성한다음이를매몰, 주조하여완성하는많은단계를거치게된다. 이런과정에서생기는작은오차들이모여보철물의최종적인정확도를결정하게된다. 따라서어떤단계에서어느방 *Correspondence to: Young-Jun Lim Professor, Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea Tel: , Fax: , limdds@snu.ac.kr Received: August 29, 2016/Last Revision: September 9, 2016/Accepted: September 19, 2016 Copyright 2016 The Korean Academy of Stomatognathic Function and Occlusion. cc It is identical to Creative Commons Non-Commercial License. 158

2 Study on methodology for the assessment of internal and marginal adaptation on fixed dental prosthesis 법을사용하는지결정하는것이중요하며, 오랜기간동안이와관련된여러가지실험들이이루어져왔다. 이실험들의목적은대부분지대치와보철물사이의변연적합도 (marginal fit) 및내면적합도 (internal fit) 를측정하여보철물을평가하고이를바탕으로어떤단계에서오차가생겼는지파악하는것이다. 이러한실험을계획하기위해서는가장먼저보철물의변연부위와내면부위가정확히어느지점을의미하는것인지그정의에대해알아볼필요가있다. 이론적으로는지대치표면과제작된보철물사이에어떠한간격도생기지않고정확하게적합되는것이가장이상적이다. 하지만실제로는제작과정에서발생한오차에의해내면에미세한틈이생길수밖에없다. 또한, 시적의편의성을위해지대치모형에다이스페이서를통한약간의공간을일부러부여하기도하는데이는보철물의합착에사용되는시멘트를위한공간이다. 이두가지원인에의해발생한보철물의내면으로부터지대치의표면까지의공간을보철물의내면간격 (internal gap) 이라고하며, 그중에서가장치은측에가까운부분을변연간격 (marginal gap) 이라고한다 년 Holmes 등은보철물과지대치의변연적합도평가에대해언급하면서내면간격, 변연간격, 수직변연간극 (vertical marginal discrepancy), 수평변연간극 (horizontal marginal discrepancy), 절대변연간극 (absolute marginal discrepancy) 이라는용어를다음 Fig. 1과같이설명하였다. 7 내면간격은보철물내면으로부터지대치축벽까지의수직거리 (a) 이고, 변연간격은같은방법으로변연부에서의수직거리 (b) 를의미한다. 과도한크기 (overextended margin) 나부족한크기 (underextended margin) 의보철물에서는정상크기보철물과달리변연부에서의과부족길이 (c, d) 가발생하게되는데, 이로인해변연간격 (b) 과절대변연간극 (g) 의차이가생기게되는것이다. 절대변연간극의수직벡터성분을수직변연간극 (e), 수평벡터성분을수평변연간극 (f) 이라고한다. 임상적으로받아들여질수있는내면간격과변연간격의크기에대한연구는이전부터계속시행되어왔다. 미국치과협회 (American Dental Association) 는 ADA specification No.8을통해보철물의내면간격이 ZPC (zinc polycarboxylate) 를기준으로 µm가적당하다고언급하였고, 8 Ostlund는이상적인내면간격이 25 µm이므로절대변연간극은 50 µm를넘지말아야한다고주장하였으나, 9 이수치들은사실상실현가능성이낮다고할수있다. 임상적으로적절한변연간격에대해언급한연구들을살펴보면 Sulaiman 등은 100 µm, 10 McLean 과 Frauenhofer는 120 µm, 11 Gulker는 200 µm까지도수용가능한수치라고보고하였고, 12 Moldovan 등은변연간격이 100 µm인것은 good 으로 µm인것은 acceptable 로분류하였다. 13 지금까지언급한변연및내면적합도를실험적으로어떻게측정할것인지에대해그동안많은연구를통한다양한방법들이제시되었지만, 아직까지어떤방법이가장좋은지에대해서는의견이분분하다. 따라서이논문에서는보철물의내면및변연적합도를측정하는여러가지방법에대해소개하고, 각방법의장단점은무엇인지알아보고자한다. Underextended casting a Overextended casting a Path of draw h g e b d f Region of tooth h e c f b g Region of tooth a. Internal gap b. Marginal gap c. Overextended margin d. Underextended margin e. Vertical marginal discrepancy f. Horizontal marginal discrepancy g. Absolute marginal discrepancy h. Seating discrepancy Fig. 1. Casting misfit terminology. J Dent Rehabil Appl Sci 2016;32(3):

3 Pyo SW, Lee JJ, Han JS, Lim YJ 문헌고찰 보철물의적합도실험과관련하여 1990년 Sorensen은직접보는방법, 절단하여보는방법, 인상채득을통한방법, 탐침에의한시각적검사로분류할수있다고하였다 년 Molin과 Karlsson 등은골드인레이와세라믹인레이의적합도비교를위해실리콘레플리카테크닉 (replica technique) 을처음으로사용하였고, 년 Pelekanos 등은지대치와보철물을마이크로 computed tomography (CT) 로촬영하여단면영상을통해변연및내면간격을측정하는방법을소개하였다. 16 최근에는스캐닝기법의발달로모형스캐너를이용하여내면공간을재현한실리콘복제물을 3차원적으로분석한연구도발표되었다. 17 이러한다양한연구들을바탕으로임상적평가법과실험실평가법으로나누어장단점을알아보고자한다. 1. 임상적평가법 (in vivo) 1) 탐침검사법임상적으로보철물의적합도를평가하는가장대표적인방법은뾰족한치과용익스플로러를이용하여변연부위의연속성을검사하는것이다. 2007년 Hickel 등은금속주조보철물을임상적으로평가할때일정한기준이필요하다고하였는데, 변연부오차가 µm인경우에는변연부위의폴리싱작업을통해어느정도이상적으로조정이가능하다고하였다. 변연부오차가 µm인경우에는익스플로러를통해쉽게탐지가가 능한데, 이경우보철물과치아경계부의미세누출과변색가능성은있지만장기적으로는크게부정적인결과를가져오지않는다고하였다. 반면, 변연부오차가 250 µm 이상인경우에는보철물을새로제작하는것이추천된다고하였다. 18 이탐침검사법은보철물의변연부를평가하는가장오래된방법이지만, 각검사자의주관적인평가가개입될수도있다는단점이있다. 이를최소화하기위하여검사자를 1명으로고정시켜그검사자의기준대로평가하거나 19 혹은 2명의검사자들이일정한기준에따라 A, B, C, D로점수를매기는방법을사용하기도하였다. 20 이와관련된가장대표적인평가기준으로는 1971 년 Cvar와 Ryge이언급한 United States Public Health Service (USPHS) 기준중 변연부평가항목 이있는데그내용은 Table 1과같다. 21 2) 방사선사진검사법보철물의평가는시진, 촉진이외에방사선사진촬영을통한검사도가능하다. 방사선사진검사는보철물의경계부위가치은연하에존재하여탐침이나육안으로확인할수없는경우에유용하다. 특히, 보철물이과도한길이의변연을가지는경우에지대치의마진부위가치은연하에존재하면탐침검사법이나인상채득법으로는발견이불가능하다. 또한, 보철물의변연이짧게제작되어지대치의마진까지충분히연장되지못한경우에도탐침이용법이나인상채득법으로발견하지못할수있으나, 방사선사진촬영법에서는발견이용이하다. 22 그밖에도방사선사진은남아있는시멘트나인상재를확인할수있으며, 치조골과보철물사이의위치관계및생물학적 Table 1. The first criteria for marginal adaptation Code Word Alfa (A) The explorer does not catch when drawn across the restoration-tooth margin either from tooth to restoration or from restoration to tooth. If a catch exists, there is no visible crevice along the periphery of the restoration. The edge of the restoration appears to adapt closely to the tooth structure along the entire periphery of the restoration. Bravo (B) The explorer does catch and there is visible evidence of a crevice into which the explorer will penetrate, indicating that the edge of the restoration does not closely adapt to the tooth structure. The dentin or base is not exposed, and the restoration is not mobile, fractured, or missing in part or in toto. Charlie (C) The explorer penetrates into crevice indicating that a space exists between the restoration and the tooth structure. The dentin or the base is exposed at the periphery, but the restoration is not mobile, fractured, or missing in part or in toto. Delta (D) Oscar The restoration is mobile, fractured, or missing in part or in toto. Marginal adaptation cannot be assessed due to an excess of restorative material at the margin. 160 J Dent Rehabil Appl Sci 2016;32(3):158-68

Study on methodology for the assessment of internal and marginal adaptation on fixed dental prosthesis 폭경길이를확인하여보철물의예후를평가하는데용이하다는장점이있다. 23 하지만이방법은치아근원심부위, 즉보철물의인접면변연부위만확인이가능하며협설측변연부위는확인할수없다.

4 Study on methodology for the assessment of internal and marginal adaptation on fixed dental prosthesis 폭경길이를확인하여보철물의예후를평가하는데용이하다는장점이있다. 23 하지만이방법은치아근원심부위, 즉보철물의인접면변연부위만확인이가능하며협설측변연부위는확인할수없다. 또한촬영각도에따라획득되는영상이다르므로절대적인변연간격의수치나오차의양을확인하는것은불가능하고, 금속보철물인경우에는보철물의내면을전혀확인할수없는단점이있다. 24 방사선사진검사법을이용할경우평행촬영법을통한영상의표준화가필요하며, 높은해상도를가진장비가우선되어야할것이다. 3) 인상채득법인상채득법을통한변연부위의평가는 1980년 Cardash 등에의해당시 Silicone Putty Wash impression 방법이라는이름으로처음소개되었다. 일단보철물이장착된지대치를퍼티를이용하여인상채득을한뒤, 흐름성이좋은실리콘인상재로한번더인상채득을하여보철물의변연부위에오차가있는경우그부위로실리콘인상재가흘러들어가서경화되는원리를이용한것이다. Fig. 2는실리콘을이용한인상채득법의모식도를보여준다. 임상에서가장대표적으로사용되는세가지방법인탐침검사법, 방사선사진검사법, 인상채득법을비교한실험에서특별한경우를제외하고는인상채득법을통한변연부평가가가장우수하게나타나는것으로확인되었다 실험실평가법 (in vitro) 임상적평가방법은실제자연치지대치와보철물의관계를직접적으로비교하는방법이다. 반면, 실험실평가방법은지대치모양을복제한마스터모형과이를통해 제작한보철물의관계를비교하여연구목적에따라어떤결과를보이는지정밀하게확인하기위한방법이다. 여기에는보철물과마스터모형사이의공간을직접적으로계측하는직접측정법이있고, 내면공간을실리콘인상재로복제하거나마이크로 CT로촬영한단면영상을이용하여측정하는간접측정법이있다. 직접측정법은가장직관적인방법으로오래전부터실험에이용되었던방법이며, 간접측정법에비해비교적정확도가떨어지고측정과평가에있어서여러가지한계점이있다. 1) 직접측정법 (1) 변연부측정법 (Direct view technique) 변연부측정법은마스터모형에보철물을시적하여합착시킨후, 변연부위의오차를직접고해상도현미경으로보고분석하는방법이다. 보철물을부착하는과정이외에는별도의다른과정이필요없기때문에시간과비용이가장절약되는장점이있으며, 그만큼부가적인오차발생확률이줄어든다는점이다른방법에비해유리하다고할수있다. 하지만이방법은고해상도현미경으로관찰해야하므로실험실평가법으로만가능하고내면간격의측정이불가능하며, 치아와색깔이비슷한시멘트를사용할경우치아와시멘트경계부에서구별이어렵다는단점이있다. 또한, 측정시변연부위중어느지점을선택해야하는가를결정해야하는데측정부위마다수치의편차가클수있어서집단의표본수에따라결과가상이하게나올수있다. Groten 등에의하면최소 50개이상의지점을대상으로조사를해야변연간격의정의에따른편차나시멘트합착상태에의한오차를최소화하는통계를얻을수있다고하였다. 25 뿐만아 Fig. 2. The schematic of silicone putty wash impression. J Dent Rehabil Appl Sci 2016;32(3):

5 Pyo SW, Lee JJ, Han JS, Lim YJ 니라이방법의가장큰문제는투사각도에따른오차 (projection error) 이다. 관찰하는각도에따라변연간격의수치가상대적으로달라질수있기때문이다. 변연부측정법은일반적으로광학현미경이나전자현미경으로측정하는데, 1997년 Groten 등의실험에서는광학현미경과전자현미경 (SEM) 으로변연부오차를측정한결과를비교하여둘사이에유의할만한차이가없음을확인하였다. 26 최근에는입체현미경 (stereomicroscope) 이나고성능디지털현미경을통한영상을바탕으로디지털프로그램상에서변연오차를측정하는방법으로변화하고있다. 27 (2) 절단면측정법 (Cross-sectioning technique) 절단면측정법은마스터모형에보철물을시적하여합착시킨후내면공간및변연공간을측정하기위해시편의원하는부위를절단하고절단면을현미경으로확인하여계측하는방법이다. 변연간격만확인할수있는다른방법들에비해서이방법은변연및내면공간을모두알아보고자할때유용하다. 브릿지연결부와같은방해가되는구조물에관계없이원하는부위는어디든지절단하여확인할수있는장점이있지만, 아무리조심스럽게절단하더라도시편을절단하는데가해지는힘에의해눈에보이지않는변형이생길수있다는단점이있으면, 절단하는면이한정되어있기때문에여러부위에서측정할수없다는한계가있다. 그리고한번절단을시행하면그시편을재사용할수없으므로장기적인결과의비교나분석이어렵고, 비용과시간적인면에서불리하다. 절단된시편은보통변연부위, 변연과지대치축벽의이행부, 지대치축벽부위, 지대치교합면부위에서측정하며, 광학현미경상에서 50배율로확대하여관찰하는것이일반적이다. 28 흐름성이좋은실리콘인상재 (light body) 는단독으로제거하면변형될위험이높기때문에강도가높은실리콘인상재 (medium or heavy body) 를외측이나내측에서보강하여분리한후, 필요한부분의두께를측정하는방법으로사용되고있다. 비용과시간이비교적적게들고마스터모델이보존가능하므로반복적인측정이가능하다는장점이있지만, 미세한부분에서실리콘이찢어지거나변형될수있다는점과실리콘상에서지대치의마진과보철물의변연을구별하기어렵다는점이단점으로지적되고있다. 실리콘인상재의두께를측정하는방법은인상재를절단하여원하는부위만측정하는 2차원적인방법 과모형스캐너를통해인상재를전부스캔하여 3 차원적으로측정하는 3차원적인방법으로나눌수있다 실리콘인상재를절단하여 2차원적으로측정하는방법은앞서살펴본절단면측정법과마찬가지로절단부위가한정되어있기때문에여러곳에서측정이불가하다는한계가있다. 뿐만아니라절단하는각도에따라측정두께가달라질수있다는점을주의해야한다. Fig. 3은 2차원적인방법으로실리콘인상재를이용하여지대치의마진과보철물의변연을인상재의두께측정으로확인하는과정을보여준다. 모형스캐너를통한 3차원적인분석은전반적인내면간격의양상을확인할수있는장점이있지만, 변연간격을측정할때에는치아나보철물과같은주위구조물의형상이없기때문에측정지점을명확하게설정할수없다는단점이있다. 또한, 아직까지실리콘인상재의얇은부위를정확하게인식할정도로스캐너해상도가발전하지못해서실제와다른스캔이미지가오차로작용할수있는가능성도한계로지적되고있다. Fig. 4는모형스캐너를통해 3차원적으로인상재의두께를측정하여지대치의마진과보철물사이의변연을확인하는과정을보여준다. 2) 간접측정법 (1) 실리콘복제측정법 (Replica technique) 실리콘복제측정법은마스터모형과보철물사이에실리콘인상재를넣고균일하게시적시켜인상재가경화되면내면공간의모양이실리콘에그대로인기되는원리를이용한것이다 이방법은 1993년인레이적합도를알아보는실험에서처음으로사용된방법 15 에서발전하여점차보철물의적합도를알아보는가장대표적인방법으로발전해왔다. (2) 마이크로 CT 측정법 (Micro-CT) 마이크로 CT 측정법은방사선을이용한비파괴적인측정방법으로원하는부위에서 2차원또는 3차원영상을획득할수있다. 수많은단면영상을얻을수있기때문에원하는지점에서의수치를평가할수도있고, 단면영상을합쳐 3차원적으로재구성하면보철물의전체적인적합도결과도함께평가할수있다는장점이있다. 이방법의가장큰단점은방사선을이용하므로금속성인공물에대한장해음영 (artifact) 이나타난다는점이다. 따라서금속으로된보철물평가에는적용하기힘들다. 또한, 162 J Dent Rehabil Appl Sci 2016;32(3):158-68

2-D measurement of the thickness of the film with outer or inner coating using

6 Study on methodology for the assessment of internal and marginal adaptation on fixed dental prosthesis Fig D measurement of the thickness of the film with outer or inner coating using heavy body silicone. Fig D measurement of the thickness of the film using model scanner. J Dent Rehabil Appl Sci 2016;32(3):

Pyo SW, Lee JJ, Han JS, Lim YJ 똑같은방사선흡수계수를가진서로다른두물질이접촉해있을때이를분리해낼수없다는점도주의해야한다. 그리고시간과비용이비교적많이든다는점과광학현미경이나전자현미경이각각 300 nm, 0.25 nm 정도의나노단위분해능을가진것에비해마이크로 CT는 1.8 µm의분해능으로현미경보다조금덜선명한확대영상을제공한다는점도한계라고할수있다.

이방법은비파괴적인방법이며, 변연부위를연속적으로측정할수있기때문에기존의다른방법과달리보철물의전체적인절대변연간극을추정하는데유용하다. 하지만이방법은연속적인결과를바탕으로변연상태를간접적으로추론하는것일뿐, 해당부위의자세한영상을얻지못하므로측정시에생기는오류를수정할수없는단점이있다.

7 Pyo SW, Lee JJ, Han JS, Lim YJ 똑같은방사선흡수계수를가진서로다른두물질이접촉해있을때이를분리해낼수없다는점도주의해야한다. 그리고시간과비용이비교적많이든다는점과광학현미경이나전자현미경이각각 300 nm, 0.25 nm 정도의나노단위분해능을가진것에비해마이크로 CT는 1.8 µm의분해능으로현미경보다조금덜선명한확대영상을제공한다는점도한계라고할수있다 Fig. 5는마이크로 CT 측정을통하여보철물의적합도를평가하는모식도를나타내고있다. (3) 조면계측정법 (Profilometry) Fig. 6은조면계를이용하여보철물의변연오차를측정하는방법을보여준다. 조면계 (Profilometer) 는본래표 면의거칠기를측정하는장비로변연부오차가존재하는부위에서경계부가매끄럽게이어지지않고불규칙한표면을갖는특징을이용한것이다. 이방법은비파괴적인방법이며, 변연부위를연속적으로측정할수있기때문에기존의다른방법과달리보철물의전체적인절대변연간극을추정하는데유용하다. 하지만이방법은연속적인결과를바탕으로변연상태를간접적으로추론하는것일뿐, 해당부위의자세한영상을얻지못하므로측정시에생기는오류를수정할수없는단점이있다. 예를들어수직적으로과도한변연길이를갖는보철물이지대치와매끄럽게이행된다면, 이런경우에이장비는변연부오차가없는것으로간주하게되므로실험결과에오류가생길가능성이있다. 46,47 Fig. 5. The schematic of micro-ct measurement and CT image. Fig. 6. The schematic of measurement using profilometry. 164 J Dent Rehabil Appl Sci 2016;32(3):158-68

8 Study on methodology for the assessment of internal and marginal adaptation on fixed dental prosthesis 결론 보철물의적합도평가방법은여러가지기준에의해 분류할수있다. 보철물의제작방법 ( 기존의방식또는 디지털방식 ), 보철물의재료 ( 금속관또는전부도재관 등 ), 지대치의마진형태 (chamfer 또는 shoulder), 보철물 의완성도 ( 코핑단계또는완성단계 ), 보철물시적대상 ( 실제지대치또는마스터모형 ), 시멘트합착여부 ( 합착 전또는합착후 ), 보철물내면조정여부등많은기준에 따라구분이가능하다. 48 또한, Table 2 에서보는바와같 이 2013 년 Nawafleh 등은여러가지방법으로보철물의 적합도를평가한 183 개의논문을찾아서조사한결과, 직 접측정하는방법인변연부측정법과절단면측정법이총 70% 이상으로가장많았고, 간접적으로측정하는실리 콘복제측정법이 20% 를나타내어그다음으로자주사 용되었다고발표하였다. 49 이는역사가오래된방법일수 록많은빈도로사용된것으로추정되며, 시간과비용이 적게들어가는변연부측정법이가장선호된것으로판 단된다. 반면에최근새롭게개발된평가방법일수록발 표된연구논문이적은것은당연한결과라고할수있을 것이다. 본논문에서는보철물의적합도를평가하는방법으로 크게임상적평가법 (in vivo) 과실험실평가법 (in vitro) 으 로나누어비교해보았다. 임상적평가법에는탐침검사 법, 방사선사진검사법, 인상채득법이있고, 실험실평가 법은다시직접측정법과간접측정법으로분류하여직 접측정하는변연부측정법과절단면측정법, 간접측정 하는실리콘복제측정법과마이크로 CT 측정법, 그리고 조면계측정법이있으며, 각각의평가방법에대해본논 문에서자세히알아보았다. 본논문에서소개한다양한 Table 2. Analysis of marginal adaptation reported by various methods Methods Number of papers (%) Direct-view technique 87 (47.5%) Cross-sectioning technique 43 (23.5%) Replica technique 37 (20.2%) Profile projector 7 (3.8%) Digimatic micrometer 2 (1.2%) Micro-CT 3 (1.6%) Combination of two methods 4 (2.2%) Total 183 (100%) 적합도평가법을바탕으로하여시간이흐를수록기술 이발전하고있으며, 기존방법들이가지고있는단점들 을극복하고, 보다정확도가높은다양한새로운실험방 법들이계속개발되고추세이다. 그러므로이런다양한 적합도평가방법들의장, 단점을숙지하여알맞은디자 인으로실험을한다면보철물의적합도를더욱정밀하게 평가할수있을것으로기대된다. 또한, 이와같이현재 사용되고있는보철물의적합도에대한평가방법들을정 확히숙지하고이해하는것은보철물을환자에게식립하 기전에보다적확한형태의보철물제작을가능하게하 여환자에대한보철물식립의실패가발생하지않게하 는척도가될것으로생각한다. Acknowledgements 본연구는산업통상자원부의재원으로산업핵심기술 개발사업의지원에의하여이루어진것임 (No ). ORCID Se-Wook Pyo Jun-Jae Lee Jung-Suk Han Young-Jun Lim References 1. Hung SH, Hung KS, Eick JD, Chappell RP. Marginal fit of porcelain-fused-to-metal and two types of ceramic crown. J Prosthet Dent 1990;63: McLean JW, von Fraunhofer JA. The estimation of cement film thickness by an in vivo technique. Br Dent J 1971;131: Schwartz NL, Whitsett LD, Berry TG, Stewart JL. Unserviceable crowns and fixed partial dentures: life-span and causes for loss of serviceability. J Am Dent Assoc 1970;81: Grasso JE, Nalbandian J, Sanford C, Bailit H. Effect of restoration quality on periodontal health. J Prosthet Dent 1985;53: Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial denture failures: length of service and reasons for replacement. J Prosthet J Dent Rehabil Appl Sci 2016;32(3):

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11 Review Article 고정성보철물의내면및변연적합도를평가하는방법에대한고찰 표세욱, 이준재, 한중석, 임영준 * 서울대학교치의학대학원치과보철학교실 본논문은기존에선행되었던연구들을바탕으로고정성보철물의내면및변연적합도를평가하는여러가지방법에관하여정리하였으며, 각방법에대한장, 단점에대해언급하였다. 보철물의적합도를평가하는방법은크게임상적평가법과실험실평가법으로분류할수있다. 임상적평가법에는탐침검사법, 방사선사진검사법, 인상채득법이있으며, 실험실평가법에는현미경을이용하는변연부측정법, 절단면측정법, 실리콘복제측정법, 그리고마이크로 CT나조면계를사용하여측정하는방법등이있다. 최근스캐닝기법이발전하면서내면및변연적합도를 3차원적으로평가하는것이가능해졌으며, 앞으로측정법및분석법의개발에따라보철물의적합도평가가더욱간편해지고효과적으로변화할것이라생각된다. ( 구강회복응용과학지 2016;32(3):158-68) 주요어 : 변연적합도 ; 내면적합도 ; 보철물시적평가 ; 적합도평가법 * 교신저자 : 임영준 (03080) 서울시종로구대학로 101 연건동서울대학교치의학대학원치과보철학교실 Tel: Fax: limdds@snu.ac.kr 접수일 : 2016 년 8 월 29 일 수정일 : 2016 년 9 월 9 일 채택일 : 2016 년 9 월 19 일 168

Holst 등 7 은 triple-scan 방식을이용하여보철물의적합도를평가하는방법을소개하였다. 이방법은첫째, 지대치의주모형을스캔하고둘째, 보철물의내면을스캔한후마지막으로임상적으로보철물이지대치상에적절히위치된상태를스캔한다. 이데이터를 surface match algorith

Holst 등 7 은 triple-scan 방식을이용하여보철물의적합도를평가하는방법을소개하였다. 이방법은첫째, 지대치의주모형을스캔하고둘째, 보철물의내면을스캔한후마지막으로임상적으로보철물이지대치상에적절히위치된상태를스캔한다. 이데이터를 surface match algorith ORIGINAL ARTICLE https://doi.org/10.4047/jkap.2017.55.4.372 신미선 1 이장훈 2 * 1 호서대학교벤처대학원융합공학과, 2 호서대학교건축토목환경공학부 Marginal and internal fit of all ceramic crown using the replica technique and the triple-scan