不同固位方法修复游离端缺失的生物力学研究及临床分析

发布时间：2018-05-26 12:48

本文选题：种植义齿 + 附着体义齿　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:探讨不同固位方法修复游离端缺失基牙应力分布及临床应用的优缺点,旨在为临床游离端缺失修复方法的选择提供理论依据,提高临床游离端缺失修复质量。方法:针对单侧游离端缺失的患者,本文选取的原始CT为成年人下颌骨锥形束CT,通过Materialise Mimics 17.0软件完成三维模型初步重建,通过软件3-Matic STL 10.2和Geomagic Studio 2013完成三维有限元模型的细化,利用软件Hyper Works 14.0和ABAQUS 6.1.4进行有限元建模仿真处理。本文用上述软件分别建立了包含基牙、牙周膜、牙槽嵴和义齿部位的五种义齿修复方式(种植义齿、天然牙-种植义齿联合固定桥、套筒冠义齿、附着体义齿、可摘局部义齿)修复游离端缺失三维有限元仿真模型。在义齿之间、义齿与基牙之间面与面接触的部位采用接触单元,其他部位采用二阶四面体单元。应用三维有限元生物力学分析方法测定并比较分析垂直及斜向(颊向、舌向、远中向)加载在磨牙牙合面中心时不同固位结构义齿修复游离端缺失基牙应力分布及应力峰值。根据三维有限元分析结果指导临床游离端缺失患者的修复,对临床不同固位方法(种植义齿、套筒冠义齿、附着体义齿、可摘局部义齿)修复游离端缺失咀嚼效率、患者满意度进行比较。研究对象为来吉林大学中日联谊医院口腔科门诊因旧可摘局部义齿舒适度差、不美观或咀嚼效果不好要求重新制作义齿的患者。结果:1、基牙应力分布均匀性:单纯种植义齿优于套筒冠义齿优于附着体义齿优于可摘局部义齿优于种植义齿与天然牙联合固定桥。2、基牙应力峰值:套筒冠义齿(2.23MPa)附着体义齿(2.65MPa)可摘局部义齿(4.16MPa)种植义齿(41.54MPa)种植义齿与天然牙联合固定桥(50.05Mpa)3、最大应力集中部位:种植义齿种植体均集中在舌侧牙颈部;天然牙-种植义齿联合固定桥天然牙与种植体均集中在远中舌侧牙颈部;套筒冠义齿两个基牙均集中在远中牙颈部;附着体义齿近中基牙集中在远中牙颈部,远中基牙集中在远中颊侧牙颈部;可摘局部义齿近中基牙集中在远中牙颈部,远中基牙集中在远中颊侧牙颈部。4、基牙加载方向与应力的关系:所有固位方法中,垂直方向加载应力峰值小于斜向加载,且更均匀。5、套筒冠义齿、附着体义齿及可摘局部义齿均显示近中基牙应力峰值小于远中基牙且应力分布更均匀。6、咀嚼效率比较:种植义齿、附着体义齿、套筒冠义齿的咀嚼效率无显著差异,可摘局部义齿咀嚼效率最小且与其他种三种固位方法比较有显著差异。结论:1、当游离端缺失缺牙区牙槽骨密度较好的情况下,用单纯种植义齿修复临床效果优于其他固位修复方法。2、球帽式套筒冠义齿对基牙应力缓冲作用最好,更适于基牙牙周条件较差且不适宜或不耐受种植义齿患者的游离端缺失修复。3、按扣式附着体义齿也可较好的降低基牙所受应力,较适合基牙牙周较健康,且不适宜或不耐受种植义齿,或基牙解剖条件又不适宜做套筒冠义齿患者的游离端缺失修复。4、设计良好的可摘局部义齿修复游离端缺失也能获得较好的咀嚼效率,较适宜不能耐受或不愿接受其他类修复且对美观与舒适度要求不高或受经济条件所限不能选用其它类修复患者的游离端缺失修复。5、天然牙-种植义齿联合固定桥基牙应力峰值最大、分布不均匀且天然牙与种植义齿应力差异较大可能会影响修复远期效果,不建议临床采用此种类型的修复方法修复游离端缺失。
[Abstract]:Objective: To explore the advantages and disadvantages of different fixation methods to repair the stress distribution and clinical application of free terminal missing base teeth, and to provide a theoretical basis for the selection of clinical free end deletion methods and to improve the quality of clinical free end defect repair. Methods: the original CT was selected as the mandible cones for the patients with unilateral free end deletion. The shape beam CT was reconstructed by Materialise Mimics 17 software. The three-dimensional finite element model was refined by software 3-Matic STL 10.2 and Geomagic Studio 2013. The software Hyper Works 14 and ABAQUS 6.1.4 were used to simulate the finite element modeling. Five kinds of denture repair methods of alveolar ridge and denture (implant denture, natural tooth - implant denture joint fixed bridge, sleeve crown denture, attachment denture, removable partial denture) repair the three-dimensional finite element simulation model of free end deletion. Two order tetrahedral elements are used to determine the stress distribution and stress peak value of the free end missing base teeth with different fixed structure dentures when the vertical and oblique (cheek, tongue, and far middle direction) are loaded in the center of the molar occlusal surface. The results of three-dimensional finite element analysis guide the clinical free end according to the results of three-dimensional finite element analysis. The patients with different fixation methods (implant denture, sleeve crown denture, attachment denture, removable partial denture) were used to repair the free end missing chewing efficiency, and the patient satisfaction was compared. The object of the study was to come to the Department of Stomatology at the Department of Stomatology, China Japan Friendship Hospital, Jilin University because of the poor comfort, unpleasant or chewing effect of the old removable partial denture. Results: 1, the distribution uniformity of base teeth stress distribution: simple implant denture superior to the sleeve denture superior to the attachment denture superior to the removable partial denture is superior to the implant denture and the natural teeth combined fixed bridge.2, the peak value of the base tooth stress: 2.23MPa attachment denture (2.65MPa) removable partial denture (4 .16MPa) implant denture (41.54MPa) implant denture and natural teeth combined fixed bridge (50.05Mpa) 3, the maximum stress concentration parts: implant denture implants are concentrated in the lingual side of the tooth neck; natural tooth implant denture combined fixed bridge natural teeth and implants are concentrated in the distal lingual side of the tooth neck; sleeve crown denture two base teeth are concentrated in the distal middle tooth The proximal and middle teeth of the attachment denture concentrated in the neck of the distal middle teeth and the distal middle teeth concentrated in the far middle and buccal teeth neck; the removable partial denture was concentrated in the neck of the distal middle teeth. The distal middle teeth were concentrated in the far middle and buccal teeth neck.4, the relationship between the loading direction and the stress of the base teeth: the peak stress in the vertical direction was less than the oblique stress in all retention methods. Loading, and even more uniform.5, telescopic crown denture, attachment denture and removable partial denture all show that the peak stress peak of near medium teeth is less than that of far middle base teeth and the stress distribution is more uniform.6. The masticatory efficiency of the implant denture, the attachment denture and the sleeve crown denture has no significant difference, and the chewing efficiency of the removable partial denture is the smallest and the others. There are significant differences in the three kinds of retention methods. Conclusion: 1, when the density of alveolar bone in the free end missing tooth area is better, the clinical effect of simple implant denture is better than that of other fixation methods.2. The ball cap sleeve crown denture has the best cushioning effect on the base tooth stress, and is more suitable for the poor periodontal condition and unsuitable or intolerance of the base teeth. The free end deletion of the implant denture patients repair.3, the button attachment denture can also better reduce the stress of the base teeth. It is more suitable for the base tooth periodontium, not suitable for or intolerance of implant denture, or the basic tooth anatomy condition is not suitable for the free end deletion of the telescopic denture patients to repair the.4, and the good removable partial denture is designed. The free end deletion can also obtain better masticatory efficiency. It is better to tolerate or unwilling to accept other kind of repair and not to require high aesthetic and comfortable degree or the free end deletion repair of.5 which can not be used in other repair patients. The large difference of stress between the natural tooth and the implant denture may affect the long-term effect of the repair. It is not recommended that this type of repair method be used to repair the loss of free end.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6

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