本文關鍵詞：不同程度萎縮的上頜后牙區(qū)種植修復的生物力學研究　出處：《山東大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 三維有限元 種植體 萎縮 上頜竇提升術 生物力學

【摘要】：口腔種植技術因其良好的舒適度、美觀的效果、及較高的成功率等優(yōu)勢,已成為牙缺失患者的首選治療方案。然而隨著牙槽骨的進行性吸收,上頜后牙區(qū)垂直骨高度不斷降低,在行種植修復時常出現(xiàn)垂直骨高度不足的情況。特別是一些缺失牙時間較長的患者,多合并存在骨質(zhì)疏松的問題,為上頜后牙區(qū)種植修復增加了更大的難度。因此,上頜后牙區(qū)的種植體難以獲得較為滿意的初期穩(wěn)定性,其失敗率也較其他區(qū)域要高。如今上頜竇提升術不斷發(fā)展和完善,已有效地解決了上頜后牙區(qū)骨量不足的難題,極大程度地擴展了種植修復的適應證。對于上頜后牙缺失并伴有明顯牙槽嵴高度不足的患者,在準備種植體植入之前常需行上頜竇底提升并放置植骨材料。這一方法現(xiàn)已得到廣泛的認可,但在植骨材料的選擇上仍存在一定的爭議。自體骨由于自身良好的骨傳導性,骨生成性及骨誘導性,故被認為是最佳的移植骨材料。但自體骨移植存在著一些顯而易見的缺陷,如開辟第二術區(qū),取骨區(qū)的組織創(chuàng)傷以及有限的供區(qū)骨量等,使自體骨的應用受到了巨大的限制。隨著組織工程學的發(fā)展,新興的人工合成骨材料不斷涌現(xiàn)出來,使口腔種植技術獲得了長足的進步。良好的人工骨材料應具有促進細胞定植,利于骨生成的支架結(jié)構(gòu)等特性,但目前的人工移植材料尚無法完全達到這些要求。近年來,不使用植入物的上頜竇提升術正逐漸獲得臨床醫(yī)師的認可,且不斷有成功案例的報道。有學者認為,使用移植物增加了術后感染的風險,為避免上頜竇提升術的創(chuàng)傷及術后的并發(fā)癥,殘余骨量尚可的患者建議使用短種植體,而臨床實踐表明,短種植體同樣能取得滿意的療效。綜上所述,在不同程度萎縮的上頜后牙區(qū)行種植修復時,對于種植體的選擇及上頜竇提升術的應用方面,仍需進一步的研究和探討。本研究主要運用三維有限元技術,對種植體-骨界面周圍的應力分布情況評估,從生物力學角度進行分析,實驗內(nèi)容分為如下兩部分。盡管有限元分析尚不足以對頜骨應力進行定量分析,但定性研究的結(jié)果仍對臨床實踐具有一定的參考價值。1.上頜骨骨質(zhì)對種植體穩(wěn)定性影響的三維有限元分析目的：本實驗主要評估上頜竇提升術后,由不同骨質(zhì)量所引起的生物力學效應,并根據(jù)實際骨質(zhì)情況選擇最佳的種植體及其植入方式。材料與方法：建立一牙槽嵴剩余高度為8m的簡化上頜骨后牙區(qū)模型,頜骨質(zhì)量分為3類(D2,D3,D4)。合面加載150N的斜向合力,評估種植體周圍的應力分布情況。結(jié)果：使用高強度移植物的上頜竇提升組的應力分布情況最為理想；在D2和D3類骨質(zhì)情況下,短種植體也能取得較為理想的應力分布效應；隨著骨質(zhì)量的下降,種植體周圍的應力水平也隨之上升。結(jié)論：骨頜骨骨質(zhì)條件應納入種植體植入術前檢查項目：當周圍骨質(zhì)條件尚可時,標準種植體與短種植體均能取得良好的穩(wěn)定效果,當骨質(zhì)條件較差時,推薦行上頜竇提升術及標準種植體植入。2.上頜后牙區(qū)剩余骨量對種植體穩(wěn)定性影響的三維有限元分析目的：本實驗主要研究在不同程度萎縮的上頜后牙區(qū),是否放置植入物的上頜竇提升術對種植體穩(wěn)定性的影響。材料與方法：建立4組不同牙槽嵴高度(10mm,7mm,5mm,3mm)的上頜后牙區(qū)模型,頜骨骨質(zhì)量分為D3和D4兩類,將l0mm的標準種植體與頜骨模型整合。斜向加載150N的合力,評估種植體周圍的應力分布情況。結(jié)果：使用植入物的上頜竇提升術對應力分布有一定的改善作用,并且高強度組的效果更為明顯；在D3類骨質(zhì)組中,當牙槽嵴高度為5mm和7mm時,無植入物的上頜竇提升術后的種植體周圍應力水平尚可。結(jié)論：在萎縮的上頜后牙區(qū)行種植體植入術時,疏松的骨質(zhì)是一個不利因素,但可通過上頜竇提升術得到一定程度的改善。在臨床實踐中,上頜竇提升術方法的選擇應根據(jù)患者剩余骨質(zhì)及骨量的情況而定。
[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.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R783.6

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