楔状缺损修复后牙颈部的应力分析
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摘要
牙体楔状缺损是牙齿唇、颊面牙颈部釉质与骨质交界处的牙体硬组织发生慢性消耗所致的缺损。它是临床上一种比较常见的非龋性损害,其缺损由两个平面相交而成,表面坚硬光滑,边缘整齐,一般均为牙组织本色,有时可有程度不等的着色。好发生于前磨牙,尤其是第一前磨牙,随年龄增长,楔状缺损趋势愈大、愈严重。临床上治疗楔状缺损的方法有脱敏和充填两种,充填方法效果最好并且广泛应用,治疗洞型属BlackV类洞。目前,对于楔状缺损的治疗,在洞形预备方式存在很多争议。本研究采用三维有限元的方法,分析了楔状缺损经不同固位方式修复后对
牙齿产生应力的影响,为今后的临床修复提供实验依据。目的:应用三维有限元法研究倒凹固位形、箱型固位形、复合体点状洞固位形三种不同固位方法修复楔状缺损后,牙颈部硬组织的应力分布,为临床楔状缺损牙的修复治疗,提供生物力学依据。
方法:通过螺旋CT扫描技术,借助于Mimics,Geomagic Studio等软件分别建立上颌第一前磨牙楔状缺损的三维有限元模型。将CT图象输入到photoshop软件进行增加清晰度和对比度的处理,应用Mimics软件行成初步的三维图象,导入Unigraphics NX 6.0三维有限元软件分别建立上颌第一前磨牙楔状缺损、倒凹固位形修复楔状缺损牙、箱型固位形修复楔状缺损牙、复合体点状洞修复楔状缺损牙的三维有限元模型,模拟咬合的垂直加载方式,对比分析不同固位方式充填对楔状缺损牙整体的影响。
结果:(1)建立了准确、直观、符合生物力学研究的上颌第一前磨牙三维有限元模型,总共含有节点数92,078个,单元数为53,834个。
(2)倒凹固位形修复楔状缺损、箱型固位形修复楔状缺损、复合体点状洞修复楔状缺损后,牙颈部硬组织最大主应力分别为5.0113MPa、5.0240MPa、4.7747MPa;最小主应力分别0.99187MPa、0.99396MPa、0.94488MPa。
结论:(1)本研究建立了上颌第一前磨牙楔状缺损及三种不同修复方式治疗充填的三维有限元模型共四个,模型具有高精确度、可比性和生物相似性,为后期的应力分析提供了切实的基础。
(2)三种固位方式充填治疗的楔状缺损,对牙体组织的应力水平有一定的影响。以箱型固位形修复的楔状缺损牙等效应力最大,倒凹固位形修复的次之,复合点状洞型修复楔状缺损牙等效应力最小。三种修复方法均比未充填治疗的楔状缺损牙等效应力小。在垂直载荷下,各模型缺损区域的应力分布趋势均为自牙体外表面向髓腔侧递增。以上三种固位方法修复楔状缺损中,复合体点状洞效果最好。
Wedge-shaped defect is an abrasion that caused by long-term abrasion in tooth cervical.It often is wedge shape.It is well-known to be prevalent in oral.Its defect by two planes intersect and become,the surface is hard and smooth, edge tidy,Normally,the tooth isecru,sometimes can have degree differs shading.Often occurs on premolar, especially the first premolar,Along with the age,the greater the wedge-shaped defect trend and more serious.Clinically,there are two kinds of treatment wedge-shaped defect methods, desensitization and filling ,Filling is the best therapy way and being used commonly.At present,the issue is still discuss as to the cavity form of wedge-shaped defect preparation during the treatment process therapy.In this study,we analyzed the influence of wedge-shaped defect retention form of restoration on stress distribution in tooth using three-dimensional finite element method and the consequence would provide useful data for clinical treatment.
Objective:Three-dimensional finite element method applied research in different ways of wedge-shaped teeth defect filling equivalent stress and displacement, wedge-shaped teeth defect for the clinical treatment of repair, provide biomechanical evidence.
Methods:Through the spiral CT scan technology, using Ansys software such as Mimics to construct a three-dimensional finite-element model of the maxillary first premolar molar. Spiral CT scanning was used to obtain the morphological pictures of the maxillary first premolar molar.Photoshop ware used to improve the definition and contrast of the pictures which was saved as BMP.Mimics software was used to form the primary three-dimensional finite element models.And import the three-dimensional finite element models in MSC.MARC software to establish models of the tooth.Maxillary molar respectively established before the first wedge-shaped defect, concave of wedge-shaped teeth defect repair, box of wedge-shaped teeth defect repair, complex pointlike hole wedge-shaped teeth defect repair the three-dimensional finite element model, the simulation of two loading method occlusion, comparison and analysis of different ways of retention wedge-shaped teeth defect filling the overall effect.
Results:(1)Established a direct,complete three-dimensional finite element model of the maxillary first premolar molar.The model was fit for biomechanics analysis.(2)Different ways of treatment of filling defect, wedge-shaped teeth body tissue to stress level has certain effect. With a box of wedge-shaped teeth defect repair the maximum equivalent stress retention, concave shape of repair, composite pointlike hole type wedge-shaped teeth defect repair equivalent stress. Three methods are not filling treatment than wedge-shaped teeth defect equivalent stress.In the restored models, the maximum stresses of pour concave, box, the plaque-forming hole technique restorations were 5.0113Mpa, 5.0240Mpa, and 4.7747 Mpa;the minimum stresses were 0.99187MPa、0.99396MPa、0.94488MPa.
Conclusion:(1)This research established four three-dimensional finite element models of a maxillary first premolar with wedge-shaped defect restored by different techniques respectively.The model established by this way was of high accuracy,similarity and comparability.
(2)After the wedge-shaped with filling defect in the way of closely related.Different ways of treatment retention filling wedge-shaped defect,there are some influence on stress level of teeth organization.With box retention form wedge-shaped teeth defect repair the maximum equivalent stress,Pour concave retention form repair take second place. Composite plaque-forming hole type wedge-shaped teeth defect repair equivalent stress is the smallest.Equivalent stress of three repair methods are all smaller than an unfilled treatment wedge-shaped teeth defect.In vertical load,the stress distribution trends of each model defect area are since teeth in vitro surface to the medullary cavity side increase.The restored effect of the plaque-forming hole technigue is the best among the three techniques.
牙齿产生应力的影响,为今后的临床修复提供实验依据。目的:应用三维有限元法研究倒凹固位形、箱型固位形、复合体点状洞固位形三种不同固位方法修复楔状缺损后,牙颈部硬组织的应力分布,为临床楔状缺损牙的修复治疗,提供生物力学依据。
方法:通过螺旋CT扫描技术,借助于Mimics,Geomagic Studio等软件分别建立上颌第一前磨牙楔状缺损的三维有限元模型。将CT图象输入到photoshop软件进行增加清晰度和对比度的处理,应用Mimics软件行成初步的三维图象,导入Unigraphics NX 6.0三维有限元软件分别建立上颌第一前磨牙楔状缺损、倒凹固位形修复楔状缺损牙、箱型固位形修复楔状缺损牙、复合体点状洞修复楔状缺损牙的三维有限元模型,模拟咬合的垂直加载方式,对比分析不同固位方式充填对楔状缺损牙整体的影响。
结果:(1)建立了准确、直观、符合生物力学研究的上颌第一前磨牙三维有限元模型,总共含有节点数92,078个,单元数为53,834个。
(2)倒凹固位形修复楔状缺损、箱型固位形修复楔状缺损、复合体点状洞修复楔状缺损后,牙颈部硬组织最大主应力分别为5.0113MPa、5.0240MPa、4.7747MPa;最小主应力分别0.99187MPa、0.99396MPa、0.94488MPa。
结论:(1)本研究建立了上颌第一前磨牙楔状缺损及三种不同修复方式治疗充填的三维有限元模型共四个,模型具有高精确度、可比性和生物相似性,为后期的应力分析提供了切实的基础。
(2)三种固位方式充填治疗的楔状缺损,对牙体组织的应力水平有一定的影响。以箱型固位形修复的楔状缺损牙等效应力最大,倒凹固位形修复的次之,复合点状洞型修复楔状缺损牙等效应力最小。三种修复方法均比未充填治疗的楔状缺损牙等效应力小。在垂直载荷下,各模型缺损区域的应力分布趋势均为自牙体外表面向髓腔侧递增。以上三种固位方法修复楔状缺损中,复合体点状洞效果最好。
Wedge-shaped defect is an abrasion that caused by long-term abrasion in tooth cervical.It often is wedge shape.It is well-known to be prevalent in oral.Its defect by two planes intersect and become,the surface is hard and smooth, edge tidy,Normally,the tooth isecru,sometimes can have degree differs shading.Often occurs on premolar, especially the first premolar,Along with the age,the greater the wedge-shaped defect trend and more serious.Clinically,there are two kinds of treatment wedge-shaped defect methods, desensitization and filling ,Filling is the best therapy way and being used commonly.At present,the issue is still discuss as to the cavity form of wedge-shaped defect preparation during the treatment process therapy.In this study,we analyzed the influence of wedge-shaped defect retention form of restoration on stress distribution in tooth using three-dimensional finite element method and the consequence would provide useful data for clinical treatment.
Objective:Three-dimensional finite element method applied research in different ways of wedge-shaped teeth defect filling equivalent stress and displacement, wedge-shaped teeth defect for the clinical treatment of repair, provide biomechanical evidence.
Methods:Through the spiral CT scan technology, using Ansys software such as Mimics to construct a three-dimensional finite-element model of the maxillary first premolar molar. Spiral CT scanning was used to obtain the morphological pictures of the maxillary first premolar molar.Photoshop ware used to improve the definition and contrast of the pictures which was saved as BMP.Mimics software was used to form the primary three-dimensional finite element models.And import the three-dimensional finite element models in MSC.MARC software to establish models of the tooth.Maxillary molar respectively established before the first wedge-shaped defect, concave of wedge-shaped teeth defect repair, box of wedge-shaped teeth defect repair, complex pointlike hole wedge-shaped teeth defect repair the three-dimensional finite element model, the simulation of two loading method occlusion, comparison and analysis of different ways of retention wedge-shaped teeth defect filling the overall effect.
Results:(1)Established a direct,complete three-dimensional finite element model of the maxillary first premolar molar.The model was fit for biomechanics analysis.(2)Different ways of treatment of filling defect, wedge-shaped teeth body tissue to stress level has certain effect. With a box of wedge-shaped teeth defect repair the maximum equivalent stress retention, concave shape of repair, composite pointlike hole type wedge-shaped teeth defect repair equivalent stress. Three methods are not filling treatment than wedge-shaped teeth defect equivalent stress.In the restored models, the maximum stresses of pour concave, box, the plaque-forming hole technique restorations were 5.0113Mpa, 5.0240Mpa, and 4.7747 Mpa;the minimum stresses were 0.99187MPa、0.99396MPa、0.94488MPa.
Conclusion:(1)This research established four three-dimensional finite element models of a maxillary first premolar with wedge-shaped defect restored by different techniques respectively.The model established by this way was of high accuracy,similarity and comparability.
(2)After the wedge-shaped with filling defect in the way of closely related.Different ways of treatment retention filling wedge-shaped defect,there are some influence on stress level of teeth organization.With box retention form wedge-shaped teeth defect repair the maximum equivalent stress,Pour concave retention form repair take second place. Composite plaque-forming hole type wedge-shaped teeth defect repair equivalent stress is the smallest.Equivalent stress of three repair methods are all smaller than an unfilled treatment wedge-shaped teeth defect.In vertical load,the stress distribution trends of each model defect area are since teeth in vitro surface to the medullary cavity side increase.The restored effect of the plaque-forming hole technigue is the best among the three techniques.
引文
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2、郭玲,不同邻面高度的Ⅱ类洞型三维有限元应力分析[D]。中国医科大学,2003,9。
3、陈莉莉. 40岁以上牙楔状缺损发病率调查分析[J].上海医科大学学报, 2000, 27(4): 311。
4、Ali DA,Brown RS,Rodriguez LO,et al.Dental erosion caused by silent gastroesophageal reflux disease [J].J Am Dent Assoc,2002,133(6): 734-737.
5、Lee WC, Eakle WS. Stress- induced cervical lesions: review of advances in the past 10years[J]. J Prosthet Dent, 2006, 75 (5): 487- 494。
6、刘佼佼,刘荣森,王晨,老年人牙齿楔状缺损危险因素的Logistic回归分析[J],中华老年口腔医学杂志,2008 ,6 (2):65-68。
7、金艳,于晓霞.楔状缺损深度与牙合面磨损指数的Spearman等级相关分析[J].现代口腔医学杂志, 2002, 16(6): 532- 533。
8、刘洪臣.老年口腔医学[M].北京:人民军医出版社, 2002: 28。
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