中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (28): 6020-6029.doi: 10.12307/2025.480

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

下颌All-on-4种植固定义齿不同咬合接触应力分布的有限元分析

吴正敏1，李常旭1，崔艳玮1， 陈  溯2   

  1. 1首都医科大学附属北京友谊医院口腔科，北京市   100050；2首都医科大学口腔医学院特诊特需科，北京市   100050
  • 收稿日期:2024-05-11 接受日期:2024-08-14 出版日期:2025-10-08 发布日期:2024-12-07
  • 通讯作者: 陈溯，教授，主任医师，博士生导师，首都医科大学口腔医学院特诊特需科，北京市 100050
  • 作者简介:吴正敏，女，1988年生，山东省潍坊市人，汉族，硕士，主治医师，主要从事口腔种植修复和种植牙的咬合设计方面的研究。

Finite element analysis of stress distribution on mandibular All-on-4 implant fixed denture with different occlusion

Wu Zhengmin1, Li Changxu1, Cui Yanwei1, Chen Su2   

  1. 1Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; 2VIP Department, School of Stomatology, Capital Medical University, Beijing 100050, China
  • Received:2024-05-11 Accepted:2024-08-14 Online:2025-10-08 Published:2024-12-07
  • Contact: Chen Su, Professor, Chief physician, Doctoral supervisor, VIP Department, School of Stomatology, Capital Medical University, Beijing 100050, China
  • About author:Wu Zhengmin, MS, Attending physician, Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

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摘要：


文题释义：

三维有限元分析：是一种数值分析方法，被广泛运用于工程、物理及生物力学等领域中求解复杂问题，它可以在脱离实物的情况下对组织结构所受到的应力和位移趋势进行预测，也可以对不同参数进行优化设计，以满足特定目标和要求。 
All-on-4种植固定义齿：指单颌仅使用4颗种植体来支持一个由螺丝固定的全牙弓种植修复体，是一种高效、微创的半口或全口牙种植方案，可以为牙列缺失患者实现即刻修复。 


背景：All-on-4种植固定义齿的长期修复效果与生物力学问题密切相关，其中咬合设计影响修复体各部位的应力分布，然而，国内外目前有关All-on-4种植固定义齿的生物力学研究较少且无定论。

目的：分析不同咬合接触对下颌All-on-4种植固定义齿应力分布的影响。
方法：建立下颌All-on-4种植固定义齿的模型，通过改变加载力的大小、方向和加载部位，设置了10种加载工况，模拟正中咬合、侧方咬合和前伸咬合，通过在不同牙位上加载模拟不同的咬合接触类型，分析比较各组模型不同加载工况中模型各部分的应力分布和最大应力值。

结果与结论：①各组模型的应力分布云图基本相似，种植体应力主要集中在种植体颈部，周围骨组织的应力主要集中在种植体颈部周围，并且皮质骨的应力明显高于松质骨；基台的应力主要集中在基台与种植体和基台与上部修复体连接的部位，上部修复体中钛支架的应力主要集中在基台与钛支架连接部位，上部修复体中树脂面的应力主要集中在各加载点上；②模拟正中咬合中，末端悬臂不加载时种植体的最大Von-Mises应力值明显增大，说明下颌All-on-4种植固定义齿在正中咬合时末端悬臂区可有咬合接触；③模拟侧方咬合中，在模拟尖牙保护牙合工况中模型各部分的最大Von-Mises应力值明显增大；模拟平衡牙合工况中模型各部分的最大Von-Mises应力值较组牙功能牙合工况略低，说明下颌All-on-4种植固定修复在完成骨整合永久修复时，为了提高咀嚼效率，可选择组牙功能牙合，种植术后即刻修复时可选择平衡牙合；④模拟前伸咬合中，只在前牙区加载时模型各部分的最大Von-Mises应力值明显增大；模拟平衡牙合工况中，后牙区加载点在悬臂区和在悬壁区前方时模型各部分的最大Von-Mises应力值较小，说明下颌All-on-4种植固定修复义齿前伸运动的咬合接触可选择前伸平衡牙合。

https://orcid.org/0009-0005-9929-716X (吴正敏) 

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: 有限元分析, All-on-4, 咬合接触, 应力分布, 种植修复, 工程化口腔材料

Abstract: BACKGROUND: The long-term effect of All-on-4 implant fixed denture is closely related to biomechanics. Its occlusion design affects the stress distribution of every part of the restoration. However, there is limited and inconclusive biomechanical research on All-on-4 implant fixed denture both domestically and internationally so far. 
OBJECTIVE: To analyze the effect of different occlusal contacts on the stress distribution of mandibular All-on-4 implant fixed denture. 
METHODS: A model of mandibular All-on-4 implant fixed denture was established. By changing the loading force, direction, and position, 10 loading conditions were set up to simulate centric occlusion, laterotrusive occlusion, and protrusive occlusion. The stress distribution and maximum stress values of every part of the model in different loading conditions were analyzed and compared among each group of models by loading different tooth positions to simulate different occlusal contact types.
RESULTS AND CONCLUSION: (1) The stress distribution cloud diagrams of each group of models were basically similar. The stress of the implant was mainly concentrated at the implant neck. The stress of the surrounding bone tissue was mainly concentrated around the implant neck, and the stress of the cortical bone was significantly higher than that of the cancellous bone. The stress of the abutment was mainly concentrated at the connection between the abutment and the implant and the abutment and the upper restoration. The stress of the titanium bracket in the upper restoration was mainly concentrated at the connection between the abutment and the titanium bracket, and the stress of the resin surface in the upper restoration was mainly concentrated on each loading point. (2) In simulating centric occlusion, the maximum stress value of the implant significantly increased when the cantilever was not loaded. It indicates that the mandibular All-on-4 implant fixed denture can have occlusal contact in the distal cantilever during centric occlusion. (3) In simulating laterotrusive occlusion, the maximum stress values of every part of the model significantly increased when simulating canine-guided occlusion. The maximum stress value of the simulated laterotrusive balanced occlusion was slightly lower than that of the simulated group functional occlusion. It indicates that group functional occlusion can be selected in the permanent prosthesis after osseointegration and laterotrusive balanced occlusion can be selected in the provisional restoration of mandibular All-on-4 implant fixed denture. (4) In simulating protrusive occlusion, the maximum stress values of every part of the model significantly increase when only the front tooth is loaded. In simulating protrusive balanced occlusion, the maximum Von-Mises stress value is relatively small. It indicates that the protrusive occlusion of mandibular All-on-4 implant fixed denture can choose protrusive balanced occlusion.

Key words: finite element analysis, All-on-4, occlusal contact, stress distribution, implant restoration, engineered dental material

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