本文選題：上頜骨缺損 + 有限元分析��； 參考：《中國人民解放軍醫(yī)學(xué)院》2014年碩士論文

【摘要】：研究背景：單側(cè)上頜骨缺損為上頜骨缺損的常見類型，常見于腫瘤切除術(shù)后、外傷等。單側(cè)上頜骨缺損由于一側(cè)牙列缺失，贗復(fù)體修復(fù)幾乎全靠健側(cè)基牙提供固位和支持，如果設(shè)計不當(dāng)會對基牙及剩余牙槽骨造成損傷。如何優(yōu)化贗復(fù)體設(shè)計是上頜骨缺損贗復(fù)體修復(fù)研究的重點。有學(xué)者利用種植技術(shù)，如顴骨種植體，改善贗復(fù)體的固位，但種植體存在創(chuàng)傷大、費用高、對患者全身狀況要求高、不適合需行放射治療患者等問題。也有國內(nèi)外學(xué)者利用附著體改善贗復(fù)體固位，但利用前牙烤瓷聯(lián)冠附著體固位的相關(guān)力學(xué)分析，未見相關(guān)的研究報道。目的：建立單側(cè)上頜骨缺損及前牙附著體固位贗復(fù)體三維有限元模型，為附著體固位贗復(fù)體生物力學(xué)研究奠定基礎(chǔ)。利用模擬正中咬合及側(cè)向咬合的加載方法，將前牙附著體固位贗復(fù)體的基牙及義齒受力情況與傳統(tǒng)卡環(huán)固位贗復(fù)體做對比，確定既有利于最大限度的保存牙體組織又能夠提供足夠固位、支持力的附著體烤瓷聯(lián)冠基牙數(shù)目，為臨床設(shè)計與義齒制作提供理論依據(jù)。 方法：本研究包含四部分： 1、基于螺旋CT數(shù)據(jù)建立單側(cè)上頜骨缺損及贗復(fù)體三維實體模型，選擇牙列完整、咬合關(guān)系正常的健康志愿者一名，GE Light Speed32排螺旋CT行頸部以上掃描。Mimics10.01軟件讀取圖像數(shù)據(jù)，三維重建。使用軟件切割法建立單側(cè)上頜骨缺損三維實體模型。用切割下的一側(cè)上頜骨修改形成贗復(fù)體初步模型。 2、建立正常顱骨三維有限元模型，模擬正中咬合力學(xué)加載。通過分析頜骨應(yīng)力分布驗證有效性。利用ANSA軟件對贗復(fù)體初步模型進行修改，形成傳統(tǒng)卡環(huán)固位的中空阻塞器贗復(fù)體三維有限元模型，與單側(cè)上頜骨缺損模型裝配后進行垂直加載及側(cè)向加載，利用ABAQUS軟件計算得出應(yīng)力大小及分布情況。 3、建立單側(cè)上頜骨缺損前牙附著體固位贗復(fù)體有限元模型。首先利用CATIAV5軟件建立SG迷你滑行型附著體三維模型，利用ANSA軟件將附著體模型與贗復(fù)體模型進行裝配、修改后形成附著體固位的贗復(fù)體模型。利用Mimics10.01軟件進行布爾運算對單側(cè)上頜骨缺損模型中切牙、側(cè)切牙、尖牙及第一前磨牙進行烤瓷基牙的預(yù)備，Ansa軟件中做局部精細調(diào)整。最終形成含有附著體烤瓷聯(lián)冠的單側(cè)上頜骨缺損三維有限元模型。 4、對不同烤瓷聯(lián)冠基牙數(shù)的附著體固位贗復(fù)體模型進行垂直加載及側(cè)向加載，得出各部位應(yīng)力大小及分布情況，，并與傳統(tǒng)卡環(huán)固位贗復(fù)體模型進行比較分析。 結(jié)果：1.建立了單側(cè)上頜骨缺損頜骨三維有限元模型。具有良好的生物力學(xué)相似性。 2.建立了傳統(tǒng)卡環(huán)固位的傳統(tǒng)中空阻塞器贗復(fù)體及前牙附著體固位贗復(fù)體三維有限元模型，網(wǎng)格劃分后分別有92331、87957個網(wǎng)格單元。 3.經(jīng)過兩種阻塞器模型的垂直加載和側(cè)向加載后的應(yīng)力分析，使用附著體固位贗復(fù)體后，模型整體應(yīng)力最大值明顯減小，健側(cè)基牙的受力均勻，除與附著體相連的中切牙及側(cè)切牙受力增加外，其他基牙的受力沒有明顯增加。綜合組織保存、基牙、牙槽骨受力等因素，三基牙聯(lián)冠模型效果最好。 結(jié)論：應(yīng)用螺旋CT掃描數(shù)據(jù)結(jié)合Mimics10.01、ANSA逆向工程軟件和ABAQUS有限元分析軟件建立單側(cè)上頜骨缺損模型。此方法建�？旖�、模型精確度高。 就本實驗結(jié)果分析，前牙附著體固位贗復(fù)體與傳統(tǒng)卡環(huán)固位贗復(fù)體相比，有利于基牙應(yīng)力平均分布，避免局部應(yīng)力過高，增加義齒固位及穩(wěn)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.

【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R782

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