不同程度萎缩的上颌后牙区种植修复的生物力学研究

发布时间：2018-01-04 09:31

本文关键词：不同程度萎缩的上颌后牙区种植修复的生物力学研究　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：口腔种植技术因其良好的舒适度、美观的效果、及较高的成功率等优势,已成为牙缺失患者的首选治疗方案。然而随着牙槽骨的进行性吸收,上颌后牙区垂直骨高度不断降低,在行种植修复时常出现垂直骨高度不足的情况。特别是一些缺失牙时间较长的患者,多合并存在骨质疏松的问题,为上颌后牙区种植修复增加了更大的难度。因此,上颌后牙区的种植体难以获得较为满意的初期稳定性,其失败率也较其他区域要高。如今上颌窦提升术不断发展和完善,已有效地解决了上颌后牙区骨量不足的难题,极大程度地扩展了种植修复的适应证。对于上颌后牙缺失并伴有明显牙槽嵴高度不足的患者,在准备种植体植入之前常需行上颌窦底提升并放置植骨材料。这一方法现已得到广泛的认可,但在植骨材料的选择上仍存在一定的争议。自体骨由于自身良好的骨传导性,骨生成性及骨诱导性,故被认为是最佳的移植骨材料。但自体骨移植存在着一些显而易见的缺陷,如开辟第二术区,取骨区的组织创伤以及有限的供区骨量等,使自体骨的应用受到了巨大的限制。随着组织工程学的发展,新兴的人工合成骨材料不断涌现出来,使口腔种植技术获得了长足的进步。良好的人工骨材料应具有促进细胞定植,利于骨生成的支架结构等特性,但目前的人工移植材料尚无法完全达到这些要求。近年来,不使用植入物的上颌窦提升术正逐渐获得临床医师的认可,且不断有成功案例的报道。有学者认为,使用移植物增加了术后感染的风险,为避免上颌窦提升术的创伤及术后的并发症,残余骨量尚可的患者建议使用短种植体,而临床实践表明,短种植体同样能取得满意的疗效。综上所述,在不同程度萎缩的上颌后牙区行种植修复时,对于种植体的选择及上颌窦提升术的应用方面,仍需进一步的研究和探讨。本研究主要运用三维有限元技术,对种植体-骨界面周围的应力分布情况评估,从生物力学角度进行分析,实验内容分为如下两部分。尽管有限元分析尚不足以对颌骨应力进行定量分析,但定性研究的结果仍对临床实践具有一定的参考价值。1.上颌骨骨质对种植体稳定性影响的三维有限元分析目的：本实验主要评估上颌窦提升术后,由不同骨质量所引起的生物力学效应,并根据实际骨质情况选择最佳的种植体及其植入方式。材料与方法：建立一牙槽嵴剩余高度为8m的简化上颌骨后牙区模型,颌骨质量分为3类(D2,D3,D4)。合面加载150N的斜向合力,评估种植体周围的应力分布情况。结果：使用高强度移植物的上颌窦提升组的应力分布情况最为理想；在D2和D3类骨质情况下,短种植体也能取得较为理想的应力分布效应；随着骨质量的下降,种植体周围的应力水平也随之上升。结论：骨颌骨骨质条件应纳入种植体植入术前检查项目：当周围骨质条件尚可时,标准种植体与短种植体均能取得良好的稳定效果,当骨质条件较差时,推荐行上颌窦提升术及标准种植体植入。2.上颌后牙区剩余骨量对种植体稳定性影响的三维有限元分析目的：本实验主要研究在不同程度萎缩的上颌后牙区,是否放置植入物的上颌窦提升术对种植体稳定性的影响。材料与方法：建立4组不同牙槽嵴高度(10mm,7mm,5mm,3mm)的上颌后牙区模型,颌骨骨质量分为D3和D4两类,将l0mm的标准种植体与颌骨模型整合。斜向加载150N的合力,评估种植体周围的应力分布情况。结果：使用植入物的上颌窦提升术对应力分布有一定的改善作用,并且高强度组的效果更为明显；在D3类骨质组中,当牙槽嵴高度为5mm和7mm时,无植入物的上颌窦提升术后的种植体周围应力水平尚可。结论：在萎缩的上颌后牙区行种植体植入术时,疏松的骨质是一个不利因素,但可通过上颌窦提升术得到一定程度的改善。在临床实践中,上颌窦提升术方法的选择应根据患者剩余骨质及骨量的情况而定。
[Abstract]:Oral implant technology because of its good comfort, beautiful appearance, and high success rate and other advantages, the preferred treatment for edentulous patients has become. However with the alveolar bone absorption in maxillary posterior region vertical bone height decreases, at the implant often lack vertical bone height especially. Some missing teeth longer in patients with osteoporosis, existing problems, for the cultivation of maxillary posterior region increased to repair more difficult. Therefore, the implant in maxillary posterior region is difficult to obtain satisfactory initial stability, the failure rate is higher than other regions. Now the maxillary sinus augmentation with continuous development and have perfect, can effectively solve the problem of the bone deficiency in the posterior maxilla, greatly expanded the implant. The indications for the lack of posterior teeth loss and was associated with the height of alveolar crest Patients before implants often need maxillary sinus floor elevation and bone grafting material has been placed. This method has been widely recognized, but there are still some controversy in the selection of materials of bone graft. Autogenous bone due to its good bone conduction, bone formation and bone induction, it is considered is the best grafting materials. But autogenous bone graft has some defects such as the opening of the second obviously, the operation area, the area of bone tissue trauma and limited donor bone, the application of autologous bone has been greatly limited. With the development of tissue engineering, a new artificial bone material emerge that has made the considerable progress that the oral implant technology. Good artificial bone material should be conducive to promoting cell colonization, bone formation support structure and other characteristics, but the current artificial graft is still not fully meet these For. In recent years, without the use of implants in maxillary sinus augmentation is gaining recognition and to clinicians, successful case reports. Some scholars believe that the risk of infection with the graft increased after operation, in order to avoid the maxillary sinus augmentation with trauma and postoperative complications, residual bone can be patient to suggest the use of short implants, and clinical practice shows that the short implant can obtain satisfactory curative effect. To sum up, in the maxillary posterior region for implant different degrees of atrophy, for the application of implant selection and maxillary sinus lifting face, still need further research and discussion. This research mainly uses the three-dimensional finite the element technique, the stress distribution around the evaluation of the implant bone interface, carries on the analysis from the view of biomechanics, the experimental contents are divided into two parts as follows. Although the finite element analysis is not sufficient for jaw stress Quantitative analysis, three-dimensional finite element analysis to qualitative research results but still in clinical practice has certain reference value on the influence of.1. on the stability of jaw bone implant: this experiment evaluates the maxillary sinus augmentation, biomechanical effect caused by different bone quality, and the best choice of implant and implant way according to the actual bone. Materials and methods: the establishment of a residual alveolar ridge height of maxillary posterior region 8m model simplified, bone quality is divided into 3 types (D2, D3, D4). The oblique force surface load 150N, evaluate the effects of stress distribution around the body. Results: the use of high strength graft the maxillary sinus lifting group should be the most ideal stress distribution in D2 and D3; bone case, short implant can achieve ideal stress distribution effect; bone quality decreased with the water stress around the implant Ping also increased. Conclusion: bone jaw bone implant conditions should be included in the preoperative examination items: when the bone around the fair condition, standard implant and short implant can achieve good and stable effect, when the bone condition is bad, the 3D finite element analysis to recommend the maxillary sinus augmentation and standard planting.2. implant in maxillary posterior region residual bone effect on implant stability: this experiment mainly studied in different degree of atrophy of the posterior maxilla, whether the implant placement of maxillary sinus lifting operation on implant stability. Materials and methods: 4 groups of different height of alveolar crest (10mm, 7mm, 5mm, 3mm) the model of the maxillary posterior region, bone quality is divided into D3 and D4 two, the standard of planting l0mm body and jaw model integration. To load the 150N cable force, the evaluation of peri implant stress distribution. Results: Implants for maxillary sinus lifting have certain effect of stress distribution, and high intensity group effect is more obvious; in type D3 bone group, when the height of alveolar crest was 5mm and 7mm, no implant maxillary sinus lifting implant after operation. Conclusion: the stress level is growing implantation in atrophic maxillary posterior region for osteoporosis, bone is a disadvantage, but through the maxillary sinus augmentation is improved to a certain extent. In clinical practice, maxillary sinus augmentation methods should be selected according to the residual bone and bone mass in patients with the situation.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.6

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