本文選題：冠外彈性附著體 + 分裂基托��； 參考：《第三軍醫(yī)大學(xué)》2016年碩士論文

【摘要】：游離端缺失是臨床上常見的牙列缺損類型,由于缺損位于牙列末端,缺少遠端基牙,且受上頜竇、下頜神經(jīng)管等解剖結(jié)構(gòu)限制,可摘局部義齒(RPD)仍然是目前臨床最常選用的一種修復(fù)方式。常規(guī)RPD修復(fù)游離端缺失后,遠中鞍基功能狀態(tài)中常常下沉,從而對基牙產(chǎn)生較大的非軸向扭力,這是造成RPD基牙和牙周組織損傷并最終導(dǎo)致修復(fù)失敗的主要原因。研究表明,彈性附著體義齒具有應(yīng)力緩沖作用,可以減小對支持組織的損傷。分裂基托則通過應(yīng)力中斷的的機制,將基牙受到的非軸向力轉(zhuǎn)變?yōu)檩S向力,利于支持組織的健康。為此,本研究結(jié)合冠外彈性附著體(ERA)和分裂基托設(shè)計了單側(cè)游離端缺失的應(yīng)力中斷式修復(fù)方式,在此基礎(chǔ)上,構(gòu)建三維數(shù)字模型,通過三維有限元法(3D FEM)研究義齒在不同功能載荷下的應(yīng)力分布情況,從生物力學(xué)的角度探討其應(yīng)力分布規(guī)律,探索應(yīng)力中斷式附著體義齒修復(fù)遠中游離端缺失的可行性,為臨床應(yīng)用提供研究基礎(chǔ)。方法:1、制取個別正常牙合志愿者的下頜模型,磨除46、47和48并平整牙槽嵴以模擬右側(cè)下頜游離端缺失,設(shè)計并制作了應(yīng)力中斷式附著體義齒。2、選擇同一志愿者進行下頜骨和牙列的數(shù)據(jù)采集,在逆向工程軟件中建立三維實體模型和網(wǎng)格劃分,構(gòu)建分裂基托ERA附著體義齒和普通ERA附著體義齒的三維有限元模型。3、分別對兩組附著體的三維有限元模型施加軸向載荷,比較基牙、牙周組織、游離端牙槽嵴最大von Mises應(yīng)力值及其應(yīng)力分布。4、分別對兩組修復(fù)體的三維有限元模型施加非軸向(頰舌向、近遠中向)載荷,比較基牙、牙周組織、游離端牙槽嵴的最大von Mises應(yīng)力值及其應(yīng)力分布。結(jié)果:1、完成附著體義齒修復(fù)下頜單側(cè)游離端缺失的應(yīng)力中斷式設(shè)計,并制作了應(yīng)力中斷式附著體義齒。2、建立了兩組ERA附著體義齒修復(fù)單側(cè)游離端缺失的三維有限元模型。普通組得到473376個節(jié)點和238800個單元,分裂基托組共得到447567個節(jié)點和233576個單元,并進行了有效的初步運算。3、普通組和分裂基托組在軸向載荷時應(yīng)力分布規(guī)律一致,末端基牙應(yīng)力主要分布在遠中頸部,最大von Mises應(yīng)力值分別為40.236MPa和12.056MPa,分裂基托組較普通組降低了233%;分裂基托組基牙牙周膜應(yīng)力小于普通組;缺牙區(qū)牙槽嵴近中應(yīng)力稍高,牙槽骨應(yīng)力略高于普通組,分裂基托組總體分布更均勻,。4、頰舌向載荷時兩組ERA附著體應(yīng)力分布規(guī)律一致,末端基牙在遠中頸部應(yīng)力集中,普通組和分裂基托組最大von Mises應(yīng)力值分別為53.568MPa和39.255MPa,分裂基托組明顯較小;基牙牙周組織應(yīng)力主要分布在頸部,缺牙區(qū)牙槽嵴應(yīng)力分布在近中,分裂基托組應(yīng)力均低于普通組。近遠中向載荷時兩組應(yīng)力分布規(guī)律有所不同,普通組末端基牙遠舌側(cè)為應(yīng)力集中區(qū),最大von Mises應(yīng)力值為21.323MPa,分裂基托組基牙應(yīng)力集中區(qū)位于近舌側(cè)頸部,最大von Mises應(yīng)力值為17.926MPa;基牙牙周膜應(yīng)力主要分布于遠中,分裂基托組應(yīng)力分布均勻程度高于普通組;基牙頸部牙槽骨和缺牙區(qū)近中牙槽骨為應(yīng)力主要分布區(qū),分裂基托組應(yīng)力低于普通組。5、分裂基托ERA附著體基牙和牙周組織非軸向載荷時的應(yīng)力明顯高于軸向載荷時,其中頰舌向時最大,垂直向最小。結(jié)論:1、根據(jù)單側(cè)游離端缺失應(yīng)力中斷式附著體修復(fù)的設(shè)計,成功建立了其三維有限元模型。較一般建模法提高了模型的幾何相似性和力學(xué)相似性,通過初步驗證分析保證了計算的準(zhǔn)確性。2、與普通ERA附著體比較,軸向載荷時分裂基托ERA附著體充分達到應(yīng)力中斷的效應(yīng),基牙在得到保護的同時可以承擔(dān)較多的牙合力;更多的牙合力轉(zhuǎn)移至缺牙區(qū)牙槽嵴,減輕基牙了的負擔(dān);整體上促進了基牙和缺牙區(qū)牙槽嵴平衡和分散牙合力的作用。3、與普通ERA附著體比較,分裂基托ERA附著體在非軸向載荷時通過應(yīng)力中斷機制,達到對基牙和牙周組織一定程度的保護作用,支持組織支撐作用的加強提高了義齒的穩(wěn)定性,其中頰舌向力對支持組織的影響最大。4、分裂基托ERA附著體義齒通過應(yīng)力中斷機制比普通ERA附著體降低了基牙所受扭側(cè)向扭力,利于維護支持組織的健康,為游離端缺失的臨床修復(fù)提供了較好的修復(fù)策略。
[Abstract]:Free end deletion is a common clinical dentition defect type. Due to the defect located at the end of the dentition, the lack of distal base teeth, and the anatomical structure of the maxillary sinus and the mandibular nerve canal, the removable partial denture (RPD) is still the most commonly used repair method at present. After the normal RPD repair, the free end of the free end is in the function state of the far middle saddle base. This is the main cause of the failure of the RPD base teeth and the periodontal tissue damage. The study shows that the elastic attachment denture has a stress buffer and can reduce the damage to the supporting tissue. The change of the non axial force to the axial force is beneficial to support the health of the tissue. Therefore, this study combines the ERA and the split base to the design of the stress interruption repair mode of the unilateral free end loss. On this basis, a three-dimensional digital model is constructed and the three dimensional finite element method (3D FEM) is used to study the denture under different functional loads. The stress distribution of the stress distribution is discussed from the biomechanical point of view, and the feasibility of the repair of the distal and distal end deletion of the stress interruption attachment denture is explored. Methods: 1, the mandibular model of the volunteers in a few normal occlusion is made, and the 46,47 and the 48 and flat alveolar ridge are removed to simulate the right mandible. Free end deletion, the stress interruption attachment denture.2 was designed and made, and the data collection of the mandible and tooth column was selected by the same volunteers. Three dimensional solid model and grid division were set up in the reverse engineering software, and the three-dimensional finite element model of the ERA attachment denture and the common ERA attachment denture was constructed, which were two groups respectively. The three-dimensional finite element model of the attachment applied the axial load to compare the maximum von Mises stress value of the base teeth, the periodontal tissue, the free end alveolar ridge and the stress distribution.4, and applied the non axial (cheek tongue, near far middle) load to the three-dimensional finite element model of the two groups, compared with the largest von Mises of the base teeth, the periodontium and the free end of the alveolar ridge. Stress distribution and stress distribution. Results: 1, the stress interruption design of the attachment denture to repair the unilateral free end of the mandible was completed, and the stress interruption attachment denture.2 was made, and a three-dimensional finite element model of two groups of ERA attachment dentures was established for the unilateral free end deletion. 473376 nodes and 238800 units were obtained in the ordinary group. A total of 447567 nodes and 233576 units were obtained in the crack base group, and the effective initial operation.3 was carried out. The stress distribution of the common group and the split base group was the same in the axial load. The stress of the terminal base tooth was mainly distributed in the far middle and the neck, the maximum von Mises stress was 40.236MPa and 12.056MPa respectively, and the split base group decreased by 2 compared with the ordinary group. 33%, the stress of the periodontal membrane of the split base group was less than that of the common group; the stress in the alveolar ridge was slightly higher, the stress of the alveolar bone was slightly higher than that of the common group, and the overall distribution of the split base group was more uniform. The stress distribution of the two groups of attachments in the.4 and the buccal tongue was the same, the end base teeth were concentrated in the far middle and neck regions, and the most common group and the split base group were the most important. The stress values of the large von Mises were 53.568MPa and 39.255MPa, and the split base group was significantly smaller. The stress in the periodontal tissue was mainly distributed in the neck, and the stress distribution in the alveolar ridge was in the near middle. The stress of the split base group was lower than that of the common group. The stress distribution in the two groups was different in the near far middle direction, and the distal lingual side of the end of the common group was the distal lingual side. In the stress concentration area, the maximum von Mises stress value is 21.323MPa. The stress concentration area of the base teeth in the division base group is located near the lingual side neck and the maximum von Mises stress value is 17.926MPa. The stress of the periodontal ligament is mainly distributed in the far middle, the distribution of the stress distribution in the division base group is higher than that of the common group; the alveolar bone in the base tooth and the proximal alveolar bone in the tooth area of the teeth of the abutment neck are of the middle alveolar bone. In the main stress distribution area, the stress of the split base group is lower than that of the common group.5. The stress of the base teeth of the split base ERA attachments and the non axial load of the periodontal tissue is obviously higher than that of the axial load, of which the buccal tongue is the largest and the smallest. Conclusion: 1, the third is the design of the single side free end deletion stress interruption attachment. The geometric similarity and mechanical similarity of the model are improved compared with the general modeling method. The accuracy of the calculation is guaranteed by preliminary verification and analysis.2. Compared with the common ERA attachment, the effect of the splitting of the base ERA attachments is fully achieved when the axial load is loaded, and the base teeth can bear more teeth while they are protected. Combined force, more joint force transfer to the alveolar ridge in the odontist area, lighten the burdens of the base teeth; promote the role of the alveolar ridge balance and the dispersion of the dental joint force in the basic teeth and the odontist area as a whole.3, and compare with the common ERA attachment, the split base ERA attachment through the stress interruption mechanism in the non axial load, to a certain degree to the base teeth and periodontal tissue. The stability of the denture is enhanced by the strengthening of the supporting role of the tissue, in which the influence of the buccal tongue force on the support tissue is most.4. The split base ERA attachment denture reduces the torsion lateral torsion of the base teeth through the stress interruption mechanism than the ordinary ERA attachment, and is beneficial to the maintenance of the health of the supporting tissue and the absence of the free end. Bed repair provides a better repair strategy.

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R783.6

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