中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (30): 4824-4829.doi: 10.12307/2023.833

• 组织工程口腔材料 tissue-engineered oral materials • 上一篇    下一篇

超短种植体不同修复方式的三维有限元分析

热依拉·库尔班，霞黑达·依拉尔江，陈  欣，孜拉来·居来提，白布加甫·叶力思，尼加提·吐尔逊   

  1. 新疆医科大学第二附属医院口腔科，新疆维吾尔自治区乌鲁木齐市  830063
  • 收稿日期:2022-08-30 接受日期:2022-11-30 出版日期:2023-10-28 发布日期:2023-04-03
  • 通讯作者: 尼加提·吐尔逊，硕士，主任医师，副教授，新疆医科大学第二附属医院口腔科，新疆维吾尔自治区乌鲁木齐市 830063
  • 作者简介:热依拉·库尔班，女，1994年生，新疆维吾尔自治区乌鲁木齐市人，新疆医科大学在读硕士，主要从事口腔种植修复相关技术研究。
  • 基金资助:
    新疆维吾尔自治区自然科学基金项目(2016D01C192)，项目负责人：尼加提·吐尔逊

Three-dimensional finite element analysis of different restorative methods for ultrashort implants

Reyila·Kuerban, Xiaheida·Yilaerjiang, Chen Xin, Zilala·Julaiti, Baibujiafu·Yellisi, Nijati·Turson   

  1. Department of Stomatology, Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, Xinjiang Uygur Autonomous Region, China
  • Received:2022-08-30 Accepted:2022-11-30 Online:2023-10-28 Published:2023-04-03
  • Contact: Nijati·Turson, Master, Chief physician, Associate professor, Department of Stomatology, Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, Xinjiang Uygur Autonomous Region, China
  • About author:Reyila·Kuerban, Master candidate, Department of Stomatology, Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, Xinjiang Uygur Autonomous Region, China
  • Supported by:
    Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2016D01C192 (to NT)

PDF

44

摘要：


文题释义：

种植体上部结构：种植义齿主要分为种植体、固位螺丝、修复基台、上部结构(上部修复体)4部分。上部结构是恢复咀嚼、美观功能的部分，它与天然牙形态相似，可分为单冠、联冠、固定桥。
范式等效应力：是将压应力、拉应力、剪应力的不同分量用数学方法综合起来产生的一个单独的量，这个标量常用于表示某种材料承受的总体应力情况，可以在口腔生物力学中以此作为实验分析的应力指标。

背景：在超短种植体修复过程中，不同的修复方式与不同方向的咬合受力等因素影响着种植体内部结构及植体-骨界面处应力的分布，其决定着种植体存留时间及周围骨质水平的稳定性。
目的：分析超短种植体植入牙槽骨严重吸收(距下颌神经距离不足)的第一、二磨牙区后，不同修复方式对种植体及周围骨组织应力的影响。
方法：从新疆医科大学第二附属医院口腔科选取一名患者的锥形束CT影像资料，该患者下颌第一、二磨牙区需行种植修复，并且满足颌骨骨质分类中的Ⅱ类骨质，种植体选用超短种植体2枚(Φ5 mm×5 mm)。依据锥形束CT影像资料，建立下颌骨三维模型，随后构建下第一、二磨牙区种植体联冠修复体模型或2颗单冠修复体模型，在第一、二磨牙区施加垂直于牙体长轴与牙体长轴呈45°斜向的力(作用点分别位于牙合面窝沟与颊侧牙合1/2面上，第一、二磨牙的作用点上各施加150 N)。应用有限元软件分析种植体内部各个结构与骨组织的应力分布。

结果与结论：①施加垂直载荷时，采用单冠修复时，牙冠的应力集中均位于冠的内侧壁与基台连接处，各组件应力峰值集中于中央螺丝上；采用联冠修复时，牙冠的应力峰值集中于联冠连接体靠近龈缘处，各部件应力峰值集中于联冠上；单冠修复各部件的应力峰值均高于联冠修复，骨组织应力峰值也明显大于联冠修复；②施加斜向载荷时，采用单冠修复时，牙冠的应力集中区位于冠的内侧壁与基台连接处，各组件应力峰值集中于中央螺丝上；采用联冠修复时，牙冠的应力峰值集中于联冠连接体靠近龈缘处，冠、中央螺丝、基台、超短种植体的应力分布较集中；单冠修复体及各部件应力峰值明显小于联冠修复，行联冠修复时中央螺丝、超短种植体、基台的应力峰值较大；③采用单冠修复时，施加两种载荷后的应力分布大小无明显差异；采用联冠修复时，施加两种载荷后，种植修复体的应力主要分布在联冠中间的连接体上，其中施加垂直载荷时各组件的应力峰值小且均匀；④如仅考虑超短种植体骨应力分布时，两种修复方式均可选择；如考虑超短种植体长期的存留率，为避免机械并发症可以选用单冠修复方式。

https://orcid.org/0000-0002-5804-0721(热依拉·库尔班)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: 口腔种植, 超短种植体, 骨量不足, 单冠修复, 联冠修复, 应力, 生物力学, 三维有限元

Abstract: BACKGROUND: During the restoration of ultrashort implants, different restorative methods and occlusal forces in different directions affect the internal structure of the implant and the distribution of stresses at the implant-bone interface, which determine the longevity of the implant and the stability of the surrounding bone level.
OBJECTIVE: To analyze the effects of different restorative methods on the implant and surrounding bone tissue after implantation of ultrashort implants in the first and second molar areas with severe alveolar bone resorption (insufficient distance from the mandibular nerve).  
METHODS: Cone beam CT images of a patient with implant restoration in the first and second mandibular molar areas were selected from Department of Stomatology, Second Affiliated Hospital of Xinjiang Medical University. This patient met the Class II bone quality classification of the jaw. Two Φ5 mm×5 mm ultra-short implants were used. Based on cone beam CT imaging data, a three-dimensional model of the mandible was established. A joint-crown restoration model or two single-crown restoration models for the implants in the lower first and second molar areas were established. A force perpendicular to the long axis of the dentition with the long axis of the dentition was applied in the first and second molar areas at 45° obliquely (the points of action were located on the fossa of the dentition and buccal occlusal half surface, respectively) with a loading force of 150 N on the points of the first and second molars respectively. The stress distribution in the internal structures and bone tissues of the implant was analyzed using finite element software. 
RESULTS AND CONCLUSION: (1) When the vertical load was applied, using single-crown restoration, the stress of the crown was concentrated at the connection between the inner wall of the crown and the abutment, and the peak stress of each component was concentrated on the central screw. When using the joint-crown restoration, the peak stress of the crown was concentrated near the gingival margin of the joint-crown connector, and the peak stress of each component was concentrated on the joint crown. The peak stress of each component of single-crown restoration was higher than that of joint-crown restoration, and the peak stress of bone tissue was also significantly higher than that of joint-crown restoration. (2) When the oblique load was applied, using single-crown restoration, the stress concentration area of the crown was located at the connection between the inner wall of the crown and the abutment, and the peak stress of each component was concentrated on the central screw. When using the joint-crown restoration, the peak stress of the crown was concentrated near the gingival margin of the joint-crown connector, and the stress distribution of the crown, central screw, abutment, and ultrashort implant was relatively concentrated. The peak stress of a single-crown prosthesis and its components was significantly lower than that of the joint-crown prosthesis, and the peak stress of the central screw, ultrashort implant and abutment was larger when the joint-crown prosthesis was performed. (3) There was no significant difference in stress distribution between the two kinds of loads when the single-crown restoration was used. When using the joint-crown restoration, the stress of the implant prosthesis was mainly distributed on the connector in the middle of the joint crown after applying two kinds of loads, and the peak stress of each component was small and uniform when applying the vertical load. (4) If only the bone stress distribution of the ultrashort implant is considered, two different repair methods can be selected. If the long-term retention rate of the ultrashort implant is considered, the single-crown restoration can be selected to avoid mechanical complications.

Key words: oral implant, ultrashort implant, bone insufficiency, single-crown restoration, joint-crown restoration, stress, biomechanics, three-dimensional finite element

中图分类号: