中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (3): 411-418.doi: 10.12307/2023.877

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

两种方案设计下支架材料对无牙上颌种植固定修复影响的有限元分析

陈圆圆 ，王  为，赵  璐，安尼卡尔·安尼瓦尔，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:2022-11-28 接受日期:2023-01-10 出版日期:2024-01-28 发布日期:2023-07-10
  • 通讯作者: 尼加提·吐尔逊，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:陈圆圆，女，1995年生，湖北省宜昌市人，汉族，新疆医科大学在读硕士，主要从事口腔种植修复学研究。
  • 基金资助:
    新疆维吾尔自治区自然科学基金项目(2016D01c192)，课题名称：维药买朱尼对种植体周围炎龈沟液中IL-β1以及骨界面改建影响的实验研究，项目负责人：尼加提·吐尔逊

Finite element analysis of the influence of scaffold materials on the fixed restoration of edentulous maxillary implants under two designs

Chen Yuanyuan, Wang Wei, Zhao Lu, Annikaer·Aniwaer, Nijati·Turson   

  1. Department of Stomatology, Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, Xinjiang Uygur Autonomous Region, China
  • Received:2022-11-28 Accepted:2023-01-10 Online:2024-01-28 Published:2023-07-10
  • Contact: Nijati·Turson, Chief physician, Associate professor, Department of Stomatology, Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, Xinjiang Uygur Autonomous Region, China
  • About author:Chen Yuanyuan, 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)

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摘要：


文题释义：

All-on-4：由MALÓ等所提出的一个关于解决上下颌牙列缺失问题的无牙颌种植修复理念，通过使用4个种植体就可进行无牙颌的全牙列修复，即2颗前牙种植体垂直植入于侧切牙区，另2颗后牙种植体分别向远中斜向植入于双侧上颌窦前壁或双侧颏孔前，不但避免了额外的植骨手术，还避开了重要的解剖结构并缩减了临床缺牙时间，近年来已获得广泛应用。
上部支架结构：是无牙颌固定种植修复系统中的重要支撑部分，当承受咬合负载时的应力经由上部支架结构传递至种植体及周围的骨组织，继而影响着种植体的长期存留率。同时，其支架材料不仅需具有优良的力学性能、良好的生物相容性和自然协调的美学修复效果，还需有利于分散应力和保护种植体-骨结合，从而达到修复治疗长期稳定的目的。


背景：在上颌无牙颌种植体支持式固定修复治疗中，上部支架结构材料的选择及不同远端种植体植入方式的设计密切影响着全口种植修复体的长期稳定性。

目的：采用三维有限元方法，综合研究3种材料的上部支架及2种固定种植设计方案对上颌种植固定修复生物力学的影响。
方法：根据1名健康成人正常颌的锥形束CT资料，采用 Mimics软件分离上颌骨及上颌牙列三维实体模型，利用Geomagic Studio软件结合具体的模型参数构建无牙上颌全牙弓种植固定义齿的三维有限元模型。依据上颌后牙区远中种植体植入方式设计的不同，建立两种方案模型：方案1，按照临床常规应用的“All-on-4”设计，即2个种植体垂直植入上颌骨的双侧侧切牙区，另2个种植体则倾斜30°植入到双侧第二前磨牙区；方案2，即2个种植体垂直植入上颌骨的侧切牙区，后牙区采用2个短植体垂直植入双侧第二前磨牙区；在两种方案设计中使用3种材料(钛、氧化锆及聚醚醚酮)分别对上部支架结构进行赋值，得到6个模型，随后对比分析在斜向加载力方向下种植体、周围骨组织及上部支架结构的生物力学效果。

结果与结论：①无论采用何种材料的上部支架，在两种无牙颌种植固定修复方案设计下，每个模型的最大应力峰值均分布于后侧种植体周围的颈部区域和皮质骨处；②与方案2中采用短种植体垂直植入的替代设计相比，方案1在上颌骨上显示出更为理想的应力分布；③由聚醚醚酮材料构建的支架模型，向上颌骨接近载荷区的种植体和周围骨组织传递了更高的应力，其次是钛、氧化锆；对于支架本身，聚醚醚酮上部支架内部应力峰值均明显小于氧化锆和钛支架；在3种上部支架材料中，选用氧化锆支架更有利于分散种植体及骨组织的应力分布；④结果提示，两种无牙颌种植固定修复设计方案都可以应用于临床实践，但从生物力学角度上考虑，方案1设计中的种植体、周围骨组织及上部支架的应力分散较为理性，更有利于无牙颌患者固定种植修复的远期预后；上部支架材料对种植体-骨界面的应力分布有着一定的影响。

https://orcid.org/0000-0001-8678-1351(陈圆圆)

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: 上颌无牙颌, 无牙颌固定种植修复, All-on-4, 倾斜种植, 短植体, 支架材料, 静态载荷, 三维有限元分析

Abstract: BACKGROUND: In the treatment of edentulous maxillary implants supported fixed repair, the selection of upper scaffold structure materials and the design of different distal implant implantation methods have a close influence on the long-term stability of the whole mouth implant repair.
OBJECTIVE: To comprehensively explore the influence of three different materials of upper scaffold and two implant fixation designs on the biomechanics of the fixed maxillary implant repair based on the three-dimensional finite element method. 
METHODS: Based on the conical beam CT data of a healthy adult with normal jaws, the Mimics software was used to separate the maxillary and maxillary dentin three-dimensional solid models, and the Geomagic Studio software was used to construct the three-dimensional finite element model of denture with denture implant and fixed maxillary arch combined with specific model parameters. According to the different designs of distal implants in the maxillary posterior region, two scheme models were established. Scheme 1 (Design 1) was designed in accordance with the “All-on-4” design used in clinical practice. Two implants were vertically implanted in the bilateral incisor region of the maxilla, and the other two implants were implanted in the bilateral second premolar region at a 30° angle. In scheme 2 (Design 2), two implants were vertically implanted in the lateral incisor region of the maxilla, and two short implants were vertically implanted in the posterior region of the maxilla in the bilateral second premolar region. Three materials (titanium, zirconia and polyether ether ketone) were used to assign values to the upper scaffold structure in the two designs, and six different models were obtained. The biomechanical effects of the implant, surrounding bone tissue and the upper scaffold structure were compared and analyzed in the oblique loading direction.
RESULTS AND CONCLUSION: (1) The maximum stress peaks of all models were distributed in the neck region around the posterior implant and the cortical bone under the two edentulous implant fixed restoration schemes, regardless of the material of the upper scaffold. (2) Compared with the alternative design of Design 2, which adopted vertical implantation of short implants, Design 1 showed a more ideal stress distribution on the maxilla. (3) The scaffold model constructed by polyether ether ketone material transferred higher stress to the implant and surrounding bone tissue close to the loading zone of the upper jaw bone, followed by titanium and zirconia. As for the support itself, the peak stress of the upper scaffold of polyether ether ketone was significantly lower than that of the zirconia and titanium scaffolds. Zirconia scaffolds were used among the three upper scaffolds to disperse the stress distribution of implant and bone tissue. (4) The results suggest that both designs can be applied to clinical practice. However, from the perspective of biomechanics, the stress distribution of the implant, surrounding bone tissue and upper scaffold in Design 1 is more rational, which is more conducive to the long-term prognosis of fixed implant repair in patients with edentulous jaws. The upper scaffold material has a certain influence on the stress distribution of the implant-bone interface. 

Key words: toothless jaw, fixed implant repair of edentulous jaw, All-on-4, tilted implantation, short implant, support material, static load, three-dimensional finite element analysis

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