动态载荷下牙半切与种植体联合修复的三维有限元分析
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摘要
背景:磨牙半切除术后传统的修复方式对基牙健康均存在不利影响,近年来,随着种植技术的发展,牙半切与种植体联合为下颌磨牙修复提供了新的思路。目的:对比动态载荷下牙半切与种植体联合修复、单种植体修复和双种植体修复下颌磨牙的生物力学差异。方法:分别建立牙半切与种植体联合修复、单种植体修复、双种植体修复下颌第一磨牙的三维有限元模型,对修复体施加一个周期0.875 s的动态载荷,分析种植体、天然牙根及其周围骨组织在咀嚼周期不同阶段的应力分布情况。结果与结论:(1)同一材料咀嚼周期不同阶段的应力对比:种植体、皮质骨和松质骨的应力变化,舌颊向加载>颊舌向加载>垂直向加载;天然牙根的应力变化,垂直向加载>颊舌向加载>舌颊向加载;(2)1个咀嚼周期末种植体、皮质骨、松质骨的应力对比:牙半切与种植体联合修复模型>双种植体修复模型>单种植体修复模型;(3)种植体与基台连接处安全系数较低,是发生疲劳破坏的危险区域;牙半切与种植体联合修复模型的种植体使用寿命远大于种植体再口腔内受到的咀嚼压力次数,不会发生疲劳断裂现象;(4)结果表明,牙半切与种植体联合修复遵循仿生学原理,对咬合力的调节有重要作用,从生物力学角度是一种安全可行的下颌磨牙修复方式。
BACKGROUND: The traditional treatment options after tooth hemisection are harmful to the abutment tooth. In recent years, with the development of oral implantology technique, combination of dental implant and residual tooth after hemisection provides a new way for mandibular molar restoration.OBJECTIVE: To compare the biomechanical properties of implant-residual tooth supported prosthesis, single implant and double implants in the mandibular molar restoration under dynamic loads.METHODS: Three-dimensional finite element models in which implant-residual tooth supported prosthesis, single implant and double implants were used to restore the mandibular first molar were established. A dynamic load of 0.875 s as a chewing cycle was applied on the restorations. Stress distributions of the implant, natural tooth and its surrounding bone tissues during the chewing cycle were analyzed. RESULTS AND CONCLUSION:(1) At different stages of one chewing cycle, the stresses of the implant, cortical bone and cancellous bone changed as follows: lingual-buccal loading > buccal-lingual loading > vertical loading; the stress of the natural tooth changed as follows: vertical loading > buccal-lingual loading > lingual-buccal loading.(2) At the end of the chewing cycle, the stress distribution of the implant, cortical bone and cancellous bone was ranked as follows: the implant-residual tooth model > double-implant model > single-implant model.(3) The safety factor at the implant-abutment junction was lowest, which was the most dangerous area of fatigue failure. The implant-residual tooth supported prosthesis had a service life enough to bear chewing pressures in the oral cavity, but not developing fatigue fracture. All these results suggest that dental implant combined with residual tooth after hemisection follows the principle of bionics and plays an important role in the regulation of occlusal force, which is an acceptable treatment from a biomechanical perspective.
BACKGROUND: The traditional treatment options after tooth hemisection are harmful to the abutment tooth. In recent years, with the development of oral implantology technique, combination of dental implant and residual tooth after hemisection provides a new way for mandibular molar restoration.OBJECTIVE: To compare the biomechanical properties of implant-residual tooth supported prosthesis, single implant and double implants in the mandibular molar restoration under dynamic loads.METHODS: Three-dimensional finite element models in which implant-residual tooth supported prosthesis, single implant and double implants were used to restore the mandibular first molar were established. A dynamic load of 0.875 s as a chewing cycle was applied on the restorations. Stress distributions of the implant, natural tooth and its surrounding bone tissues during the chewing cycle were analyzed. RESULTS AND CONCLUSION:(1) At different stages of one chewing cycle, the stresses of the implant, cortical bone and cancellous bone changed as follows: lingual-buccal loading > buccal-lingual loading > vertical loading; the stress of the natural tooth changed as follows: vertical loading > buccal-lingual loading > lingual-buccal loading.(2) At the end of the chewing cycle, the stress distribution of the implant, cortical bone and cancellous bone was ranked as follows: the implant-residual tooth model > double-implant model > single-implant model.(3) The safety factor at the implant-abutment junction was lowest, which was the most dangerous area of fatigue failure. The implant-residual tooth supported prosthesis had a service life enough to bear chewing pressures in the oral cavity, but not developing fatigue fracture. All these results suggest that dental implant combined with residual tooth after hemisection follows the principle of bionics and plays an important role in the regulation of occlusal force, which is an acceptable treatment from a biomechanical perspective.
引文
[1]陈虹,徒珂,欣田,等.牙半切除术联合固定修复保留患牙36例[J].实用医学杂志,2016,32(4):685-686.
[2]Sharma S,Sharma R,Ahad A,et al.Hemisection as a Conservative Management of Grossly Carious Permanent Mandibular First Molar.J Nat Sci Biol Med.2018;9(1):97-99.
[3]陈俊良,何芸,黄跃.种植体联合牙半切剩余牙体共同支持下颌磨牙的三维有限元分析[J].中国组织工程研究,2016,20(34):5027-5032.
[4]安倩.牙半切术的临床应用[J].口腔医学研究,2013,29(10):984-986.
[5]He Y,Hasan I,Keilig L,et al.Combined implant-residual tooth supported prosthesis after tooth hemisection:A finite element analysis.Ann Anat.2016;206:96-103.
[6]Heinemann F,Hasan I,Bourauel C,et al.Bone stability around dental implants:Treatment related factors.Ann Anat.2015;199(5):3-8.
[7]冯晓苏,吴桂萍,梁成文.超声骨刀与高速涡轮钻行下颌磨牙半切术临床效果观察[J].现代实用医学,2016,28(3):382-384.
[8]Sharma S,Tewari RK,Mishra SK,et al.Conservative management of grossly carious mandibular first molar with a hemisection approach:a case report.Gen Dent.2015;(4):19-21.
[9]Anitha S,Rao DS.Hemisection:A Treatment Option for an Endodontically treated Molar with Vertical Root Fracture.JContemp Dent Pract.2015;16(2):163-165.
[10]Babaji P,Sihag T,Chaurasia VR,et al.Hemisection:Aconservative management of periodontally involved molar tooth in a young patient.J Nat Sci Biol Med.2015;(1):253-255.
[11]吕佳,刘翠玲,蓝菁,等.动态载荷下种植体位置和直径对悬臂梁种植固定义齿应力影响的三维有限元研究[J].华西口腔医学杂志,2013,31(6):552-556.
[12]李晓宇,左雯鑫,朱啸,等.连续动态加载下单种植体周围骨组织应力的三维有限元分析[J].实用口腔医学杂志,2011,27(1):26-29.
[13]Kayabas O,Yuzbasoglu E,Erzincanl F.Static,dynamic and fatigue behaviors of dental implant using finite element method.Adv Eng Software.2006;37(10):649-658.
[14]张杨,王超,张晓南,等.动态载荷下不同骨质对天然牙-种植体联合修复应力分布的影响[J].华西口腔医学杂志,2015,33(3):286-290.
[15]Bouazza-Juanes K,Martínez-González A,PeiróG,et al.Effect of platform switching on the peri-implant bone:A finite element study.J Clin Exp Dent.2015;7(4):e483-488.
[16]Bouazza-Juanes K,Martínez-González A,PeiróG,et al.Effect of platform switching on the peri-implant bone:A finite element study.J Clin Exp Dent.2015;7(4):e483-488.
[17]高飞,张恩维,魏世成,等.种植体螺纹结构及接触面静力和疲劳分析[J].中国组织工程研究与临床康复,2010,14(30):5531-5534.
[18]赵吉奎.牙种植体系统的生物力学有限元分析[D].沈阳:东北大学2012.
[19]Davis SM,Plonka AB,Wang HL.Risks and benefits of connecting an implant and natural tooth.Implant Dent.2014;23(3):253-257.
[20]崇阳阳,丁超,王屹博,等.种植体联合牙半切术单冠修复下颌第一磨牙三维有限元分析[J].哈尔滨医科大学学报,2016,50(2):170-173.
[21]Anitua E,Tapia R,Luzuriaga F,et al.Influence of implant length,diameter,and geometry on stress distribution:a finite element analysis.Int J Periodontics Restorative Dent.2010;30(1):89-95.
[22]郭莹,唐亮,潘燕环.动态载荷下单端桥基牙牙周膜应力的三维有限元分析[J].中华口腔医学杂志,2009,44(9):553-557.
[23]He Y,Hasan I,Chen J,et al.The influence of residual root number and bone density on combined implant-residual tooth supported prosthesis after tooth hemisection:A finite element study.Ann Anat.2016;208:103-108.
[24]Naveen YG,Patel JR,Parikh P,et al.Alternatives for restoration of a hemisected mandibular molar.BMJ Case Rep.2014;30(7):75.
[25]卢熹,杨瑛.下颌骨-牙种植体有限元建模与瞬态分析[J].东南大学学报,2010,40(4):722-725.
[26]丁存善,王荃,徐小红.磨牙半切除术后与邻牙联冠修复的临床疗效[J].口腔医学,2015,35(5):386-388.
[27]李景辉,陈光宇,张方明.种植体联合牙半切术单冠修复下颌磨牙的疗效观察[J].北京口腔医学,2012,20(6):334-337.
[28]Rittel D,Shemtov-Yona K,Lapovok R.Random spectrum fatigue performance of severely plastically deformed titanium for implant dentistry applications.J Mech Behav Biomed Mater.2018;83:94-101.
[29]Stefanini M,Felice P,Mazzotti C,et al.Esthetic evaluation and patient-centered outcomes in single-tooth implant rehabilitation in the esthetic area.Periodontol 2000.2018;77(1):150-164.
[30]王姝,李琼金,武龙.有限元法在口腔种植领域的研究进展[J].中华老年口腔医学杂志,2018,17(2):125-128.
[31]潘勇.口腔种植牙生物力学研究进展[J].全科口腔医学电子杂志,2018,5(1):12-13.
[32]Al-Jewair TS,Swiderski B.Orthodontic Canine Substitution for the Management of Missing Maxillary Lateral Incisors May Have Superior Periodontal and Esthetic Outcomes Compared to an Implant-or Tooth-Supported Prosthesis.J Evid Based Dent Pract 2018;18(2):153-156.
[33]Soliman TA,Tamam RA,Yousief SA,et al.El-Anwar.Assessment of stress distribution around implant fixture with three different crown materials.Tanta Dental J.2015;12:249.
[34]Jeong HS,Sung SJ,Moon YS,et al.Factors influencing the axes of anterior teeth during SWA en masse sliding retraction with orthodonticmini-implant anchorage:a finite element study.Korean J Orthod.2006;36:339-348.
[35]都吉秀,叶平,吴润发,等.双根单冠种植修复下颌第一磨牙的三维有限元分析[J].中国口腔种植学杂志,2008,13(1):1-5.
[36]De Paula GA,Silva GC,Vilaca EL,et al.Biomechanical Behavior of Tooth-Implant Supported Prostheses With Different Implant Connections:A Nonlinear Finite Element Analysis.Implant Dent.2018.doi:10.1097/ID.0000000000000737.[Epub ahead of print]
[37]Rasouli-Ghahroudi AA,Geramy A,Yaghobee S,et al.Evaluation of Platform Switching on Crestal Bone Stress in Tapered and Cylindrical Implants:A Finite Element Analysis.JInt Acad Periodontol.2015;17(1):2-13.
[38]陶江丰,陈宁,顾卫平,等.不同直径和数目种植体支持修复下颌第一磨牙的有限元分析[J].口腔医学,2009,29(10):522-524.
[39]李晓宇,左雯鑫,朱啸,等.连续动态加载下单种植体周围骨组织应力的三维有限元分析[J].实用口腔医学杂志,2011,27(1):26-28.
[40]Clelland NL,Ismail YH,Zaki HS,et al.Three-dimensional finite element stress analysis in and around the Screw-Vent implant.Int J Oral Maxillofac Implants.1991;6(4):391-398.
[41]韩雪莲,刘宗伟,李岩涛.种植牙即刻负重的生物力学的三维有限元分析[J].华西口腔医学杂志,2011,29(2):121-124.
[42]武常亮,周延民,龚学庆.单、双种植体修复下颌第一磨牙载荷状态下种植体周围组织应变及受力的实验研究[J].现代口腔医学杂志,2006,20(4):388-390.
[43]Gehrke SA,Pérez-Albacete Martínez C,Piattelli A,et al.The influence of three different apical implant designs at stability and osseointegration process:experimental study in rabbits.Clin Oral Implants Res.2017;28(3):355-361.
[44]Valente ML,de Castro DT,Shimano AC,et al.Analysis of the influence of implant shape on primary stability using the correlation of multiple methods.Clin Oral Investig.2015;19(8):1861-1866.
[2]Sharma S,Sharma R,Ahad A,et al.Hemisection as a Conservative Management of Grossly Carious Permanent Mandibular First Molar.J Nat Sci Biol Med.2018;9(1):97-99.
[3]陈俊良,何芸,黄跃.种植体联合牙半切剩余牙体共同支持下颌磨牙的三维有限元分析[J].中国组织工程研究,2016,20(34):5027-5032.
[4]安倩.牙半切术的临床应用[J].口腔医学研究,2013,29(10):984-986.
[5]He Y,Hasan I,Keilig L,et al.Combined implant-residual tooth supported prosthesis after tooth hemisection:A finite element analysis.Ann Anat.2016;206:96-103.
[6]Heinemann F,Hasan I,Bourauel C,et al.Bone stability around dental implants:Treatment related factors.Ann Anat.2015;199(5):3-8.
[7]冯晓苏,吴桂萍,梁成文.超声骨刀与高速涡轮钻行下颌磨牙半切术临床效果观察[J].现代实用医学,2016,28(3):382-384.
[8]Sharma S,Tewari RK,Mishra SK,et al.Conservative management of grossly carious mandibular first molar with a hemisection approach:a case report.Gen Dent.2015;(4):19-21.
[9]Anitha S,Rao DS.Hemisection:A Treatment Option for an Endodontically treated Molar with Vertical Root Fracture.JContemp Dent Pract.2015;16(2):163-165.
[10]Babaji P,Sihag T,Chaurasia VR,et al.Hemisection:Aconservative management of periodontally involved molar tooth in a young patient.J Nat Sci Biol Med.2015;(1):253-255.
[11]吕佳,刘翠玲,蓝菁,等.动态载荷下种植体位置和直径对悬臂梁种植固定义齿应力影响的三维有限元研究[J].华西口腔医学杂志,2013,31(6):552-556.
[12]李晓宇,左雯鑫,朱啸,等.连续动态加载下单种植体周围骨组织应力的三维有限元分析[J].实用口腔医学杂志,2011,27(1):26-29.
[13]Kayabas O,Yuzbasoglu E,Erzincanl F.Static,dynamic and fatigue behaviors of dental implant using finite element method.Adv Eng Software.2006;37(10):649-658.
[14]张杨,王超,张晓南,等.动态载荷下不同骨质对天然牙-种植体联合修复应力分布的影响[J].华西口腔医学杂志,2015,33(3):286-290.
[15]Bouazza-Juanes K,Martínez-González A,PeiróG,et al.Effect of platform switching on the peri-implant bone:A finite element study.J Clin Exp Dent.2015;7(4):e483-488.
[16]Bouazza-Juanes K,Martínez-González A,PeiróG,et al.Effect of platform switching on the peri-implant bone:A finite element study.J Clin Exp Dent.2015;7(4):e483-488.
[17]高飞,张恩维,魏世成,等.种植体螺纹结构及接触面静力和疲劳分析[J].中国组织工程研究与临床康复,2010,14(30):5531-5534.
[18]赵吉奎.牙种植体系统的生物力学有限元分析[D].沈阳:东北大学2012.
[19]Davis SM,Plonka AB,Wang HL.Risks and benefits of connecting an implant and natural tooth.Implant Dent.2014;23(3):253-257.
[20]崇阳阳,丁超,王屹博,等.种植体联合牙半切术单冠修复下颌第一磨牙三维有限元分析[J].哈尔滨医科大学学报,2016,50(2):170-173.
[21]Anitua E,Tapia R,Luzuriaga F,et al.Influence of implant length,diameter,and geometry on stress distribution:a finite element analysis.Int J Periodontics Restorative Dent.2010;30(1):89-95.
[22]郭莹,唐亮,潘燕环.动态载荷下单端桥基牙牙周膜应力的三维有限元分析[J].中华口腔医学杂志,2009,44(9):553-557.
[23]He Y,Hasan I,Chen J,et al.The influence of residual root number and bone density on combined implant-residual tooth supported prosthesis after tooth hemisection:A finite element study.Ann Anat.2016;208:103-108.
[24]Naveen YG,Patel JR,Parikh P,et al.Alternatives for restoration of a hemisected mandibular molar.BMJ Case Rep.2014;30(7):75.
[25]卢熹,杨瑛.下颌骨-牙种植体有限元建模与瞬态分析[J].东南大学学报,2010,40(4):722-725.
[26]丁存善,王荃,徐小红.磨牙半切除术后与邻牙联冠修复的临床疗效[J].口腔医学,2015,35(5):386-388.
[27]李景辉,陈光宇,张方明.种植体联合牙半切术单冠修复下颌磨牙的疗效观察[J].北京口腔医学,2012,20(6):334-337.
[28]Rittel D,Shemtov-Yona K,Lapovok R.Random spectrum fatigue performance of severely plastically deformed titanium for implant dentistry applications.J Mech Behav Biomed Mater.2018;83:94-101.
[29]Stefanini M,Felice P,Mazzotti C,et al.Esthetic evaluation and patient-centered outcomes in single-tooth implant rehabilitation in the esthetic area.Periodontol 2000.2018;77(1):150-164.
[30]王姝,李琼金,武龙.有限元法在口腔种植领域的研究进展[J].中华老年口腔医学杂志,2018,17(2):125-128.
[31]潘勇.口腔种植牙生物力学研究进展[J].全科口腔医学电子杂志,2018,5(1):12-13.
[32]Al-Jewair TS,Swiderski B.Orthodontic Canine Substitution for the Management of Missing Maxillary Lateral Incisors May Have Superior Periodontal and Esthetic Outcomes Compared to an Implant-or Tooth-Supported Prosthesis.J Evid Based Dent Pract 2018;18(2):153-156.
[33]Soliman TA,Tamam RA,Yousief SA,et al.El-Anwar.Assessment of stress distribution around implant fixture with three different crown materials.Tanta Dental J.2015;12:249.
[34]Jeong HS,Sung SJ,Moon YS,et al.Factors influencing the axes of anterior teeth during SWA en masse sliding retraction with orthodonticmini-implant anchorage:a finite element study.Korean J Orthod.2006;36:339-348.
[35]都吉秀,叶平,吴润发,等.双根单冠种植修复下颌第一磨牙的三维有限元分析[J].中国口腔种植学杂志,2008,13(1):1-5.
[36]De Paula GA,Silva GC,Vilaca EL,et al.Biomechanical Behavior of Tooth-Implant Supported Prostheses With Different Implant Connections:A Nonlinear Finite Element Analysis.Implant Dent.2018.doi:10.1097/ID.0000000000000737.[Epub ahead of print]
[37]Rasouli-Ghahroudi AA,Geramy A,Yaghobee S,et al.Evaluation of Platform Switching on Crestal Bone Stress in Tapered and Cylindrical Implants:A Finite Element Analysis.JInt Acad Periodontol.2015;17(1):2-13.
[38]陶江丰,陈宁,顾卫平,等.不同直径和数目种植体支持修复下颌第一磨牙的有限元分析[J].口腔医学,2009,29(10):522-524.
[39]李晓宇,左雯鑫,朱啸,等.连续动态加载下单种植体周围骨组织应力的三维有限元分析[J].实用口腔医学杂志,2011,27(1):26-28.
[40]Clelland NL,Ismail YH,Zaki HS,et al.Three-dimensional finite element stress analysis in and around the Screw-Vent implant.Int J Oral Maxillofac Implants.1991;6(4):391-398.
[41]韩雪莲,刘宗伟,李岩涛.种植牙即刻负重的生物力学的三维有限元分析[J].华西口腔医学杂志,2011,29(2):121-124.
[42]武常亮,周延民,龚学庆.单、双种植体修复下颌第一磨牙载荷状态下种植体周围组织应变及受力的实验研究[J].现代口腔医学杂志,2006,20(4):388-390.
[43]Gehrke SA,Pérez-Albacete Martínez C,Piattelli A,et al.The influence of three different apical implant designs at stability and osseointegration process:experimental study in rabbits.Clin Oral Implants Res.2017;28(3):355-361.
[44]Valente ML,de Castro DT,Shimano AC,et al.Analysis of the influence of implant shape on primary stability using the correlation of multiple methods.Clin Oral Investig.2015;19(8):1861-1866.