套筒冠修复下颌前牙缺失的有限元应力分析
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摘要
牙周病是造成牙列缺损的主要原因之一,牙周病缺牙的特点是缺牙两侧的余留牙也有不同程度的牙周疾患。牙周病缺牙修复后,基牙及余留牙的牙周维护和治疗对于牙周病的控制和修复体的使用寿命是至关重要的。牙周病造成牙列缺损的类型主要为下颌前牙的缺失。对于牙周病造成的下颌个别前牙缺失,目前临床采用的较多的是常规固定烤瓷桥修复方式,但是该修复方式由于其自身特点的限制,不利于基牙及邻牙牙周的检查与维护。而采用套筒冠作为固位体的烤瓷桥修复下颌缺失前牙,则不仅能兼顾固定义齿美观,舒适,咀嚼效率高的特点,还有利于基牙的牙周维护。套筒冠作为固位体在活动义齿修复方面有关学者已进行了大量的研究,但对于采用套筒冠烤瓷桥修复下颌前牙缺失,其基牙的牙周组织应力与常规固定桥相比有何异同目前国内外文献尚无相关报道。因此,本论文通过建立三维有限元模型,对套筒冠烤瓷桥以及常规固定烤瓷桥修复下颌前牙缺失的基牙牙周组织应力进行了比较分析,探讨采用套筒冠烤瓷桥修复下颌前牙缺失时基牙的受力特点,为临床针对该类患者修复方式的选择提供理论依据。
目的:本研究模拟下颌前牙缺失,分别建立采用常规固定烤瓷桥修复及套筒冠烤瓷桥修复的三维有限元模型,并对所建立的三维有限元模型进行生物力学研究和分析比较,探讨采用套筒冠烤瓷桥修复下颌前牙缺失时基牙的受力特点,为临床工作中采用套筒冠烤瓷桥修复牙周病导致的下颌前牙缺失提供生物力学依据。
方法:本研究采用螺旋CT对正常牙颌志愿者进行扫描,在工作站上进行选择后获取BMP格式的CT图像;将所得图像输入专业医学影像重建软件,进行牙颌组织及修复体外型的三维重建;再通过专业逆向工程软件对重建的三维模型进行实体化。在有限元软件中分别建立采用常规固定烤瓷桥修复及三种类型套筒冠烤瓷桥修复的三维有限元模型,并通过删减牙槽骨及牙周膜高度来模拟牙槽骨Ⅰ度吸收的情况。对所建立的三维有限元模型进行生物力学分析;比较同等载荷下套筒冠烤瓷桥与常规固定烤瓷桥基牙牙周组织的应力值;对基牙牙槽骨正常和吸收时,基牙牙周组织的应力进行分析比较。
结果:
1.分别建立了下颌前牙缺失的常规固定烤瓷桥及三种类型套筒冠烤瓷桥修复的三维有限元模型,即a内、外冠之间无磨擦的非缓冲型套筒冠烤瓷桥;b内、外冠之间有磨擦的非缓冲型套筒冠烤瓷桥及c缓冲型套筒冠烤瓷桥修复,并在此基础上分别建立了牙槽骨Ⅰ度吸收时的三维有限元模型。加载测试后,应力分布与生理状况下的受力分布情况基本一致。所建模型是有效的。
2.在垂直加载时,套筒冠烤瓷桥修复模型基牙牙周组织应力值较常规固定烤瓷桥修复模型基牙牙周组织应力值小。
3.在垂直加载时,缓冲型套筒冠烤瓷桥修复方式的基牙牙周组织应力值最小;内、外冠之间有磨擦的非缓冲型套筒冠模型基牙牙周组织应力较内、外冠之间无磨擦的非缓冲型套筒冠模型基牙牙周组织应力小。
4.牙槽骨吸收后,基牙牙周组织应力增大,但不同修复方式增大幅度不同,常规固定烤瓷桥修复模型的基牙牙周组织应力值的增加幅度大于其他套筒冠烤瓷桥修复模型。
结论:
1.建立套筒冠修复体的三维有限元模型时,不同的设计类型对基牙的受力影响是不同的,应尽量模拟临床的实际情况。本研究中套筒冠内、外冠之间有、无磨擦关系会影响基牙牙周组织应力结果,内、外冠之间有磨擦关系比没有磨擦关系,基牙牙周组织应力值小。因此,在对套筒冠修复体及其支持组织进行有限元生物力学研究时,在内、外冠之间建立磨擦关系是必要的,也是可行的。
2.针对牙周病导致下颌前牙缺失病例,套筒冠烤瓷桥修复方式,无论是基牙牙周维护的便捷性,还是从生物力学角度,保护基牙牙周组织方面,都优于常规固定烤瓷桥修复方式。本研究为套筒冠烤瓷桥在临床的应用推广奠定了理论基础。
Periodontal disease is one of chiefly reasons of dentition defect. The left teeth with periodontal disease characterize the defect. After restoration, periodontal maintenance and therapy of abutments and left teeth is vital to controlling periodontal disease and longevity of service of restorations. Periodontal disease always causes mandibular incisors and canines defect. Fixed PFM bridge is usually used to restore mandibular incisor defect, but this way is not convenient to clean and check the abutments and adjacent teeth. An another way-PFM bridge fixed by telescopic crowns retainers-can change this. There are plenty of studies about telescope denture as an removable denture. But, compared with fixed denture, how the stress analysis of periodontal tissues is is not clear. This research is to compare the stress analysis of periodontal tissues of different restorations, and give a theoretical support of application of PFM bridge fixed by telescopic crowns retainers.
Objective: Establish 3-D finite element models of mandibular incisor defect restored by PFM bridge fixed by telescopic crowns retainers and fixed bridge with different periodontal conditions. Analyze and compare the stress of abutments’periodontal tissues, give a theoretical support of application of PFM bridge fixed by telescopic crowns retainers.
Methods: Scan a normal man’s lower mandibular field by helical CT, choose proper CT images and get them into BMP format. Input the images of BMP format into medical images reconstruction software to obtain a 3-D figure of the model, use RE software to get the material object. Use finite software to establish 3-D finite element model of mandibular incisor defect restored by fixed denture and three types of PFM bridge fixed by telescopic crowns. Imitate ClassⅠalveolar bone loss by decreasing height of alveolar bone and periodontal membrane. Analyze stress distribution of the model with and without periodontal diseases, compare and analyze stress value of abutments’periodontal tissues of PFM bridge fixed by telescopic crowns retainers and fixed bridge.
Results:
1. Establish 3-D finite element model of mandibular incisor defect restored by fixed denture and three types of PFM bridge fixed by telescopic crowns, which are a. non-buffer-telescopic crowns retainers without friction between first crown and coping crown, b. non-buffer-telescopic crowns retainers with friction between first crown and coping crown, c. buffer-telescopic crowns retainers, and works with ClassⅠalveolar bone loss. The models past stress tests, matched the stress distribution of actual situation and proved effective.
2. Under vertical stresses, stress value of abutments’periodontal tissues restored by PFM bridge fixed by telescopic crowns retainers is lower than the one restored by fixed PFM bridge.
3. Under vertical stresses, stress value of abutments’periodontal tissues restored by PFM bridge fixed by buffer-telescopic crowns retainers is the lowest, the stress of non-buffer-telescopic crowns retainers with friction between first crown and coping crown is lower than the one without friction between first crown and coping crown.
4. When ClassⅠalveolar bone defect, the abutments’stress become higher, but the increase is different between different restoration methods. The increase of fixed denture model is a little bigger than the telescopic crowns models.
Conclusion:
1. When establishing 3-D finite element model of telescopic crowns, different types of connection between first crown and coping crown cause different stress value. It is important and feasible to create friction connection between first crown and coping crown, because it does affect the stress value of abutments’periodontal tissues.
2. To restore mandibular incisor defect caused by periodontal disease, it is better to use telescopic crowns retainers than fixed bridge, in both convenience of periodontal care and protection of periodontal tissues. This research gives a theoretical support of application of PFM bridge fixed by telescopic crowns retainers.
目的:本研究模拟下颌前牙缺失,分别建立采用常规固定烤瓷桥修复及套筒冠烤瓷桥修复的三维有限元模型,并对所建立的三维有限元模型进行生物力学研究和分析比较,探讨采用套筒冠烤瓷桥修复下颌前牙缺失时基牙的受力特点,为临床工作中采用套筒冠烤瓷桥修复牙周病导致的下颌前牙缺失提供生物力学依据。
方法:本研究采用螺旋CT对正常牙颌志愿者进行扫描,在工作站上进行选择后获取BMP格式的CT图像;将所得图像输入专业医学影像重建软件,进行牙颌组织及修复体外型的三维重建;再通过专业逆向工程软件对重建的三维模型进行实体化。在有限元软件中分别建立采用常规固定烤瓷桥修复及三种类型套筒冠烤瓷桥修复的三维有限元模型,并通过删减牙槽骨及牙周膜高度来模拟牙槽骨Ⅰ度吸收的情况。对所建立的三维有限元模型进行生物力学分析;比较同等载荷下套筒冠烤瓷桥与常规固定烤瓷桥基牙牙周组织的应力值;对基牙牙槽骨正常和吸收时,基牙牙周组织的应力进行分析比较。
结果:
1.分别建立了下颌前牙缺失的常规固定烤瓷桥及三种类型套筒冠烤瓷桥修复的三维有限元模型,即a内、外冠之间无磨擦的非缓冲型套筒冠烤瓷桥;b内、外冠之间有磨擦的非缓冲型套筒冠烤瓷桥及c缓冲型套筒冠烤瓷桥修复,并在此基础上分别建立了牙槽骨Ⅰ度吸收时的三维有限元模型。加载测试后,应力分布与生理状况下的受力分布情况基本一致。所建模型是有效的。
2.在垂直加载时,套筒冠烤瓷桥修复模型基牙牙周组织应力值较常规固定烤瓷桥修复模型基牙牙周组织应力值小。
3.在垂直加载时,缓冲型套筒冠烤瓷桥修复方式的基牙牙周组织应力值最小;内、外冠之间有磨擦的非缓冲型套筒冠模型基牙牙周组织应力较内、外冠之间无磨擦的非缓冲型套筒冠模型基牙牙周组织应力小。
4.牙槽骨吸收后,基牙牙周组织应力增大,但不同修复方式增大幅度不同,常规固定烤瓷桥修复模型的基牙牙周组织应力值的增加幅度大于其他套筒冠烤瓷桥修复模型。
结论:
1.建立套筒冠修复体的三维有限元模型时,不同的设计类型对基牙的受力影响是不同的,应尽量模拟临床的实际情况。本研究中套筒冠内、外冠之间有、无磨擦关系会影响基牙牙周组织应力结果,内、外冠之间有磨擦关系比没有磨擦关系,基牙牙周组织应力值小。因此,在对套筒冠修复体及其支持组织进行有限元生物力学研究时,在内、外冠之间建立磨擦关系是必要的,也是可行的。
2.针对牙周病导致下颌前牙缺失病例,套筒冠烤瓷桥修复方式,无论是基牙牙周维护的便捷性,还是从生物力学角度,保护基牙牙周组织方面,都优于常规固定烤瓷桥修复方式。本研究为套筒冠烤瓷桥在临床的应用推广奠定了理论基础。
Periodontal disease is one of chiefly reasons of dentition defect. The left teeth with periodontal disease characterize the defect. After restoration, periodontal maintenance and therapy of abutments and left teeth is vital to controlling periodontal disease and longevity of service of restorations. Periodontal disease always causes mandibular incisors and canines defect. Fixed PFM bridge is usually used to restore mandibular incisor defect, but this way is not convenient to clean and check the abutments and adjacent teeth. An another way-PFM bridge fixed by telescopic crowns retainers-can change this. There are plenty of studies about telescope denture as an removable denture. But, compared with fixed denture, how the stress analysis of periodontal tissues is is not clear. This research is to compare the stress analysis of periodontal tissues of different restorations, and give a theoretical support of application of PFM bridge fixed by telescopic crowns retainers.
Objective: Establish 3-D finite element models of mandibular incisor defect restored by PFM bridge fixed by telescopic crowns retainers and fixed bridge with different periodontal conditions. Analyze and compare the stress of abutments’periodontal tissues, give a theoretical support of application of PFM bridge fixed by telescopic crowns retainers.
Methods: Scan a normal man’s lower mandibular field by helical CT, choose proper CT images and get them into BMP format. Input the images of BMP format into medical images reconstruction software to obtain a 3-D figure of the model, use RE software to get the material object. Use finite software to establish 3-D finite element model of mandibular incisor defect restored by fixed denture and three types of PFM bridge fixed by telescopic crowns. Imitate ClassⅠalveolar bone loss by decreasing height of alveolar bone and periodontal membrane. Analyze stress distribution of the model with and without periodontal diseases, compare and analyze stress value of abutments’periodontal tissues of PFM bridge fixed by telescopic crowns retainers and fixed bridge.
Results:
1. Establish 3-D finite element model of mandibular incisor defect restored by fixed denture and three types of PFM bridge fixed by telescopic crowns, which are a. non-buffer-telescopic crowns retainers without friction between first crown and coping crown, b. non-buffer-telescopic crowns retainers with friction between first crown and coping crown, c. buffer-telescopic crowns retainers, and works with ClassⅠalveolar bone loss. The models past stress tests, matched the stress distribution of actual situation and proved effective.
2. Under vertical stresses, stress value of abutments’periodontal tissues restored by PFM bridge fixed by telescopic crowns retainers is lower than the one restored by fixed PFM bridge.
3. Under vertical stresses, stress value of abutments’periodontal tissues restored by PFM bridge fixed by buffer-telescopic crowns retainers is the lowest, the stress of non-buffer-telescopic crowns retainers with friction between first crown and coping crown is lower than the one without friction between first crown and coping crown.
4. When ClassⅠalveolar bone defect, the abutments’stress become higher, but the increase is different between different restoration methods. The increase of fixed denture model is a little bigger than the telescopic crowns models.
Conclusion:
1. When establishing 3-D finite element model of telescopic crowns, different types of connection between first crown and coping crown cause different stress value. It is important and feasible to create friction connection between first crown and coping crown, because it does affect the stress value of abutments’periodontal tissues.
2. To restore mandibular incisor defect caused by periodontal disease, it is better to use telescopic crowns retainers than fixed bridge, in both convenience of periodontal care and protection of periodontal tissues. This research gives a theoretical support of application of PFM bridge fixed by telescopic crowns retainers.
引文
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66. Oh W, Gotzen N, Anusavice KJ. Influence of connector design on fracture probability of ceramic fixed-partial dentures. J Dent Res, 2002, 81(9):623-627
67. Yang HS, Lang LA, Felton DA. Finite element stress analysis on the effect of splinting in fixed partial dentures. J Prosthet Dent, 1999, 81(6):721-727
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