髁突在咬合载荷作用下的应力效应
摘要
颞下颌关节(Temporomandibular joint,TMJ)是人体中唯一保持较强终身改建能力的关节，改建活动与其所承受的咬合负荷密切相关，在咀嚼等生理活动中，咬合力传导至TMJ，因此TMJ所承受负荷对其正常的生理功能和一些疾病的形成及转归具有重要的作用。借助现有的先进的研究咬合特征的检测手段和广泛应用于生物力学研究中的有限元分析方法，对咬合与TMJ的生物力学关系进行研究，并且通过改变咬合接触情况来观察TMJ应力分布变化的特点和规律，以探索咬合面形态变化所造成的合力方向及大小的变化，对TMJ载荷的影响，以期对颞下颌关节的改建原因作一初步探索。
首先，应用T—scanⅡ咬合测定分析系统来分析调合前后TMD患者咬合情况的变化；其次采用CT图像与牙面形态三维扫描相结合的建模方法，建立包括关节盘、下颌骨和上下牙列的三维有限元模型；然后设计了以下三个类型的工况，工况一：对前后牙不同牙位进行垂直加载。由于牙合面形态的引导作用，该垂直载荷将被合面各牙尖斜面分解为多个方向的分力，并通过下颌骨传导至颞下颌关节；工况二：改变下颌第二磨牙的加载位置，分别加载于其合面远中及颊面，由于模型设计为加载方向与咬合接触部位的加载平面相垂直，因此本工况实际上模拟了第一磨牙缺失，第二磨牙近中倾斜的临床咬合紊乱表现，以及锁合表现，其咬合的结果是加载负荷被咬合面结构引导为垂直于接触部位的异常方向的咬合力。工况三：选择第二前磨牙扭转30°，进行咬合接触部位加载，其意义类同于工况二，但模拟的是临床上常见的牙齿扭转错合畸形。通过对上述三种工况下髁状突应力变化的分析，得出以下结果：
1、通过咬合调改治疗，改变咬合接触特征，使咬合接触分布更加广泛，接触更加密切，其对于颞下颌关节紊乱病具有明确的疗效。
2、采用本文所描述的实验方法，成功建立了包括上下颌牙列及双侧髁状
第四军医大学硕士学位论文
突在内的下颌骨三维有限元模型，为今后模拟临床多种咬合载荷探讨额下颌关
节应力特点创造了条件，并奠定了良好的实验基础。
3、运用上述三维有限元模型，对调合治疗的机理进行了初步探索。结果
表明：由于咬合加载的部位、方向和位置不同，在双侧踝状突上可产生不同的
应力效应，其变化包括应力性质（拉或压应力）变化，应力强度（以压强形式
表示）变化，以及应力分布特点变化等方面。这种应力特性的变化说明了咬合
可以通过其外形对垂直载荷的引导效应，改变载荷的方向，影响躲状突的应力
环境。
因此，通过本项目的研究得到以下结论：
1、颤下颌关节生物力学环境与咬合力密切相关，而咬合面形态特点对咬合力
的传导具有重要的引导作用，这种引导作用对颜下颌关节内的应力环境也
可产生重要的影响。
2、牙列中咬合加载的前后部位不同，对双侧额下颌关节也会产生不同的应力
效果。
3、改善或重建咬合面形态，是口腔医学临床上进行许多治疗的重要内容，通
过合理治疗合面形态，将对改善额下领关节的应力环境，促进其正常改建，
具有重要的意义。
Temporomandibular joint (TMJ) is the only joint that keeps relatively active reconstruction ability for all one's life. The load on TMJ is very important for its physiological function and the development of some diseases. Occlusal force is the most direct origin of that load. So investigation on the occlusion's characteristic must be done by using modern occlusal measures and FEM.Then changing contact areas,we can find out the sreess's abnormal distribution.
?T-scan II system is used to analysis occlusal conditions before and after occlusal adjustment. ?Constitute FEM model containing mandibulan disc and all teeth by CT and three-dimensions scan. ?According to tooth's different position in the arc,FEM models are applied with upright load; load position changing; rotate second premolar, in this three conditions we investigate the stress distribution of the condyle.
The results indicated as the following.
1. T梥can n system is suitable for determine the occlusion's accurate positons. In the case of TMD patients, after occlusal adjustment bilateral occlusion get much more balanced.
2.A FEM model containing mandibulan disc and all teethis is formed .When the model loaded with different patterns of stress by altering teeth location, TMJ stress transformation can be infered and relationship between occlusion and TMJ maybe revealed.
3.Adapt or reconstruct the shape of teeth contact area is very important in oral clinic therapy. By adjusting occlusal shape appropriately,the TMJ stress will
-3-
occur corresponding changes,and this will be helpful to TMJ physiological function transformation.
首先，应用T—scanⅡ咬合测定分析系统来分析调合前后TMD患者咬合情况的变化；其次采用CT图像与牙面形态三维扫描相结合的建模方法，建立包括关节盘、下颌骨和上下牙列的三维有限元模型；然后设计了以下三个类型的工况，工况一：对前后牙不同牙位进行垂直加载。由于牙合面形态的引导作用，该垂直载荷将被合面各牙尖斜面分解为多个方向的分力，并通过下颌骨传导至颞下颌关节；工况二：改变下颌第二磨牙的加载位置，分别加载于其合面远中及颊面，由于模型设计为加载方向与咬合接触部位的加载平面相垂直，因此本工况实际上模拟了第一磨牙缺失，第二磨牙近中倾斜的临床咬合紊乱表现，以及锁合表现，其咬合的结果是加载负荷被咬合面结构引导为垂直于接触部位的异常方向的咬合力。工况三：选择第二前磨牙扭转30°，进行咬合接触部位加载，其意义类同于工况二，但模拟的是临床上常见的牙齿扭转错合畸形。通过对上述三种工况下髁状突应力变化的分析，得出以下结果：
1、通过咬合调改治疗，改变咬合接触特征，使咬合接触分布更加广泛，接触更加密切，其对于颞下颌关节紊乱病具有明确的疗效。
2、采用本文所描述的实验方法，成功建立了包括上下颌牙列及双侧髁状
第四军医大学硕士学位论文
突在内的下颌骨三维有限元模型，为今后模拟临床多种咬合载荷探讨额下颌关
节应力特点创造了条件，并奠定了良好的实验基础。
3、运用上述三维有限元模型，对调合治疗的机理进行了初步探索。结果
表明：由于咬合加载的部位、方向和位置不同，在双侧踝状突上可产生不同的
应力效应，其变化包括应力性质（拉或压应力）变化，应力强度（以压强形式
表示）变化，以及应力分布特点变化等方面。这种应力特性的变化说明了咬合
可以通过其外形对垂直载荷的引导效应，改变载荷的方向，影响躲状突的应力
环境。
因此，通过本项目的研究得到以下结论：
1、颤下颌关节生物力学环境与咬合力密切相关，而咬合面形态特点对咬合力
的传导具有重要的引导作用，这种引导作用对颜下颌关节内的应力环境也
可产生重要的影响。
2、牙列中咬合加载的前后部位不同，对双侧额下颌关节也会产生不同的应力
效果。
3、改善或重建咬合面形态，是口腔医学临床上进行许多治疗的重要内容，通
过合理治疗合面形态，将对改善额下领关节的应力环境，促进其正常改建，
具有重要的意义。
Temporomandibular joint (TMJ) is the only joint that keeps relatively active reconstruction ability for all one's life. The load on TMJ is very important for its physiological function and the development of some diseases. Occlusal force is the most direct origin of that load. So investigation on the occlusion's characteristic must be done by using modern occlusal measures and FEM.Then changing contact areas,we can find out the sreess's abnormal distribution.
?T-scan II system is used to analysis occlusal conditions before and after occlusal adjustment. ?Constitute FEM model containing mandibulan disc and all teeth by CT and three-dimensions scan. ?According to tooth's different position in the arc,FEM models are applied with upright load; load position changing; rotate second premolar, in this three conditions we investigate the stress distribution of the condyle.
The results indicated as the following.
1. T梥can n system is suitable for determine the occlusion's accurate positons. In the case of TMD patients, after occlusal adjustment bilateral occlusion get much more balanced.
2.A FEM model containing mandibulan disc and all teethis is formed .When the model loaded with different patterns of stress by altering teeth location, TMJ stress transformation can be infered and relationship between occlusion and TMJ maybe revealed.
3.Adapt or reconstruct the shape of teeth contact area is very important in oral clinic therapy. By adjusting occlusal shape appropriately,the TMJ stress will
-3-
occur corresponding changes,and this will be helpful to TMJ physiological function transformation.
引文
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