单侧上颌骨缺损前牙附着体固位赝复体三维有限元研究

发布时间：2018-04-24 17:28

本文选题：上颌骨缺损 + 有限元分析　；参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：研究背景：单侧上颌骨缺损为上颌骨缺损的常见类型，常见于肿瘤切除术后、外伤等。单侧上颌骨缺损由于一侧牙列缺失，赝复体修复几乎全靠健侧基牙提供固位和支持，如果设计不当会对基牙及剩余牙槽骨造成损伤。如何优化赝复体设计是上颌骨缺损赝复体修复研究的重点。有学者利用种植技术，如颧骨种植体，改善赝复体的固位，但种植体存在创伤大、费用高、对患者全身状况要求高、不适合需行放射治疗患者等问题。也有国内外学者利用附着体改善赝复体固位，但利用前牙烤瓷联冠附着体固位的相关力学分析，未见相关的研究报道。目的：建立单侧上颌骨缺损及前牙附着体固位赝复体三维有限元模型，为附着体固位赝复体生物力学研究奠定基础。利用模拟正中咬合及侧向咬合的加载方法，将前牙附着体固位赝复体的基牙及义齿受力情况与传统卡环固位赝复体做对比，确定既有利于最大限度的保存牙体组织又能够提供足够固位、支持力的附着体烤瓷联冠基牙数目，为临床设计与义齿制作提供理论依据。方法：本研究包含四部分： 1、基于螺旋CT数据建立单侧上颌骨缺损及赝复体三维实体模型，选择牙列完整、咬合关系正常的健康志愿者一名，GE Light Speed32排螺旋CT行颈部以上扫描。Mimics10.01软件读取图像数据，三维重建。使用软件切割法建立单侧上颌骨缺损三维实体模型。用切割下的一侧上颌骨修改形成赝复体初步模型。 2、建立正常颅骨三维有限元模型，模拟正中咬合力学加载。通过分析颌骨应力分布验证有效性。利用ANSA软件对赝复体初步模型进行修改，形成传统卡环固位的中空阻塞器赝复体三维有限元模型，与单侧上颌骨缺损模型装配后进行垂直加载及侧向加载，利用ABAQUS软件计算得出应力大小及分布情况。 3、建立单侧上颌骨缺损前牙附着体固位赝复体有限元模型。首先利用CATIAV5软件建立SG迷你滑行型附着体三维模型，利用ANSA软件将附着体模型与赝复体模型进行装配、修改后形成附着体固位的赝复体模型。利用Mimics10.01软件进行布尔运算对单侧上颌骨缺损模型中切牙、侧切牙、尖牙及第一前磨牙进行烤瓷基牙的预备，Ansa软件中做局部精细调整。最终形成含有附着体烤瓷联冠的单侧上颌骨缺损三维有限元模型。 4、对不同烤瓷联冠基牙数的附着体固位赝复体模型进行垂直加载及侧向加载，得出各部位应力大小及分布情况，，并与传统卡环固位赝复体模型进行比较分析。结果：1.建立了单侧上颌骨缺损颌骨三维有限元模型。具有良好的生物力学相似性。 2.建立了传统卡环固位的传统中空阻塞器赝复体及前牙附着体固位赝复体三维有限元模型，网格划分后分别有92331、87957个网格单元。 3.经过两种阻塞器模型的垂直加载和侧向加载后的应力分析，使用附着体固位赝复体后，模型整体应力最大值明显减小，健侧基牙的受力均匀，除与附着体相连的中切牙及侧切牙受力增加外，其他基牙的受力没有明显增加。综合组织保存、基牙、牙槽骨受力等因素，三基牙联冠模型效果最好。结论：应用螺旋CT扫描数据结合Mimics10.01、ANSA逆向工程软件和ABAQUS有限元分析软件建立单侧上颌骨缺损模型。此方法建模快捷、模型精确度高。就本实验结果分析，前牙附着体固位赝复体与传统卡环固位赝复体相比，有利于基牙应力平均分布，避免局部应力过高，增加义齿固位及稳定。
[Abstract]:Background: unilateral maxillary defect is a common type of maxillary defect. It is common in tumor resection and trauma. Unilateral maxillary defect due to unilateral deletion of unilateral dentition, prosthesis prosthesis is almost completely repositioned and supported by the abutment base teeth. If the design is inappropriate, the abutment and the remaining alveolar bone are damaged. How to optimize the prosthesis The design is the focus of the prosthesis of maxillary defect prosthesis. Some scholars have used planting techniques, such as zygomatic implant, to improve the retention of the prostheses, but the implant has a large trauma, high cost, high requirement for the patient's general condition, and is not suitable for patients with radiation therapy. However, the related mechanical analysis of the fixation of the attachment of the anterior dental porcelain fused to crown has not been reported. Objective: to establish a three-dimensional finite element model of the unilateral maxillary defect and the prosthetic prosthesis of the anterior attachment, and lay the foundation for the biomechanical study of the attachment prosthesis. The force situation of the base teeth and denture of the anterior attachment prosthesis is compared with that of the traditional clasp fixation prosthesis. It can provide a theoretical basis for clinical design and denture making, to determine the number of denture base teeth with sufficient retention and support.
Methods: This study consists of four parts:
1, based on the spiral CT data to establish the unilateral maxillary defect and the three-dimensional solid model of the prosthesis, select a healthy volunteer with complete dentition and normal occlusion. The GE Light Speed32 spiral CT scan the.Mimics10.01 software to read the image data above the neck and reconstruct the three-dimensional reconstruction of the unilateral maxillary defect by software cutting. The primary model of the prosthesis was modified by cutting the maxillary side.
2, a three-dimensional finite element model of the normal skull was established to simulate the mechanical loading of the median occlusal force. By analyzing the validity of the stress distribution of the jaw, the ANSA software was used to modify the preliminary model of the prosthetic prosthesis to form a three-dimensional finite element model of the hollow block prosthesis with a traditional clasp fixation and a vertical addition to the unilateral maxillary defect model. Load and lateral loading are used to calculate stress magnitude and distribution by ABAQUS software.
3, a finite element model of the prosthetic prosthesis of the anterior attachment of the unilateral maxillary defect was established. First, the three-dimensional model of the SG Mini slid type attachment was established by CATIAV5 software, and the attachment model was assembled with the prosthesis model by ANSA software, and the prosthesis model was formed after the modification. The Mimics10.01 software was used to carry out the Boolean operation. The incisors, lateral incisors, canines and first premolar were prepared for the basic teeth in the unilateral maxillary defect model. The local fine adjustment was made in the Ansa software. Finally, a three-dimensional finite element model of unilateral maxillary defect containing the attachment of porcelain fused to porcelain was formed.
4, the vertical loading and lateral loading of the attachment prosthesis model of different porcelain fused to crown base teeth were carried out, and the stress size and distribution of various parts were obtained, and compared with the traditional clasp prosthesis model.
Results: 1.. A three-dimensional finite element model of unilateral maxillary defect was established. It has good biomechanical similarity.
2. the three-dimensional finite element model of the traditional hollow block prosthesis and the prosthetic prosthesis of the anterior attachment is established, and 9233187957 grid units are divided after the mesh is divided.
3. after the vertical loading and the stress analysis after the lateral loading of the two blocker models, the maximum overall stress of the model decreased obviously with the attachment prosthesis. The force of the abutment teeth on the healthy side was uniform, and the force of the incisors and the lateral incisors except the attachment to the attachments did not increase obviously. For the abutment and alveolar bone, the triad combined crown model has the best effect.
Conclusion: the model of unilateral maxillary defect is established by using spiral CT scanning data combined with Mimics10.01, ANSA reverse engineering software and ABAQUS finite element analysis software. This method is quick and accurate.
Compared with the traditional clasp prosthesis, the anterior attachment prosthesis is beneficial to the average stress distribution of the base teeth, to avoid excessive local stress and to increase the retention and stability of the denture.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782

【参考文献】