本文選題：無牙頜 + All-on-4　； 參考：《第四軍醫(yī)大學》2014年碩士論文

【摘要】：無牙頜是口腔修復臨床中的常見病，對患者的外貌、發(fā)音、咀嚼功能和社交等產(chǎn)生很大影響。全口義齒修復是傳統(tǒng)的無牙頜修復治療方法，但由于缺少固位基牙，以及牙槽骨的吸收和軟組織的萎縮變薄，使得全口義齒的固位和穩(wěn)定性較差，咀嚼效率不高，常出現(xiàn)黏膜壓痛潰瘍，修復效果令人不盡滿意。隨著口腔種植技術的發(fā)展，種植體的應用大大提高了全口義齒的固位和穩(wěn)定，提升了無牙頜患者咀嚼效率以及使用舒適度。但是，對于部分牙槽嵴嚴重萎縮的無牙頜患者，種植修復經(jīng)常面臨骨量不足的問題。對此，為減少手術并發(fā)癥，有學者提出了All-on-4種植修復方案。此方案是指在無牙頜中采用4顆種植體，包括2顆直式前牙種植體和2顆傾斜后牙種植體，支撐一個固定的全口無牙頜修復體。該方案可通過應用傾斜后牙種植體，來避開上頜竇或下牙槽神經(jīng)等相關解剖結(jié)構(gòu)，并減少遠中游離距和增大種植體與骨的接觸面積。在All-on-4中，如何選擇合適的后牙種植體傾斜角度、上部修復體懸臂梁長度以及后牙種植體長度等參數(shù)，以減小種植體周圍骨組織的應力，增加種植體和義齒的長期存留率，是一個需要研究和探討的問題。 研究目的：采用三維有限元法，分析All-on-4遠中種植體不同傾斜角度及懸臂梁長度、遠中種植體不同長度、上部結(jié)構(gòu)不同加載方式對種植體周圍骨組織應力的影響，為臨床提供生物力學參考。 研究方法：CT掃描獲得無牙頜下頜骨的三維數(shù)據(jù)，采用Mimcs、Geomagic和Unigraphics軟件對圖像進行相應處理后得到無牙頜下頜骨的三維實體模型。在HyperMesh軟件中對模型進行四面體網(wǎng)格劃分，建立無牙頜下頜骨的三維有限元模型。 分別建立遠中種植體傾斜0°、15°、30°和45°時，所對應懸臂梁長度分別為19.5mm、17.2mm、13.3mm和9.8mm的All-on-4種植修復有限元模型，賦予模型中各部分的材料屬性，設定模型的邊界約束，150N垂直靜載荷施于上部結(jié)構(gòu)右側(cè)懸臂梁末端，觀察種植體周圍骨組織的等效應力峰值和應力分布。 建立遠中種植體傾斜均為45°懸臂梁長9.8mm，而遠中種植體長度分別為13mm、15mm、17mm和19mm的All-on-4種植修復有限元模型。設定材料屬性和邊界約束，150N垂直靜載荷施于上部結(jié)構(gòu)右側(cè)懸臂梁末端，觀察種植體周圍骨組織的等效應力峰值和應力分布。 分別在遠中種植體傾斜0°、懸臂梁長19.5mm和傾斜45°、懸臂梁長9.8mm的兩組All-on-4種植修復有限元模型中，對上部結(jié)構(gòu)施以單側(cè)游離端、單側(cè)非游離端、前牙區(qū)、雙側(cè)游離端、雙側(cè)非游離端、雙側(cè)游離端及前牙區(qū)、雙側(cè)非游離端及前牙區(qū)加載，每個加載點大小均為150N垂直靜載荷，觀察種植體周圍骨組織的等效應力峰值和應力分布。 研究結(jié)果： 1.建立了下頜骨體高25mm、寬8mm、頦孔間距離53mm、頦孔區(qū)管嵴距約8mm、皮質(zhì)骨在各個方向的厚度均為2mm的無牙頜下頜骨三維有限元模型。 2.在對All-on-4遠中種植體傾斜角度和懸臂梁長度對周圍骨組織應力影響的研究中，增大遠中種植體傾斜角度的同時，不斷減小懸臂梁長度，種植體周圍骨組織的應力均減小。 3.在對All-on-4遠中種植體長度對周圍骨組織應力影響的研究中，增加遠中傾斜種植體的長度，種植體周圍皮質(zhì)骨和松質(zhì)骨的應力均減小，但沒有傾斜角度及懸臂梁長度共同應用時，對種植體周圍骨組織應力的影響大。 4.在不同加載方式對All-on-4種植體周圍骨組織應力影響的研究中，單側(cè)游離端、單側(cè)非游離端、前牙區(qū)、雙側(cè)游離端、雙側(cè)游離端及前牙區(qū)加載時，遠中種植體傾斜45°、懸臂梁長9.8mm的模型中，其種植體周圍骨組織的應力低于傾斜0°、懸臂梁長19.5mm的模型；而雙側(cè)非游離端、雙側(cè)非游離端及前牙區(qū)加載時，傾斜45°模型中種植體周圍骨組織的應力略高于傾斜0°模型；表明在上部結(jié)構(gòu)游離端加載時，遠中種植體傾斜角度大懸臂梁短的All-on-4種植設計能降低周圍骨組織的應力。 5.由應力分布圖可以看出，無論在上部結(jié)構(gòu)的何種部位進行加載，種植體周圍皮質(zhì)骨和松質(zhì)骨的等效應力都主要集中在種植體頸部。 結(jié)論：以上實驗結(jié)果表明，在All-on-4中，懸臂梁長度對種植體周圍骨組織應力的影響大于傾斜角度對種植體周圍骨組織應力的影響；遠中傾斜種植體長度的增加可以減少種植體周圍骨組織的應力，但沒有傾斜角度及懸臂梁長度共同應用時，，對種植體周圍骨組織應力的影響大；在上部修復體游離端加載時，遠中傾斜種植體較遠中垂直種植體能顯著減小骨界面應力。
[Abstract]:Odonless jaw is a common disease in the clinic of oral repair. It has a great influence on the appearance, pronunciation, masticatory function and sociality of the patients. Complete denture repair is a traditional method for the treatment of edentulous jaws. However, the lack of retainable base teeth, the absorption of alveolar bone and the thinning of the soft tissue, make the retention and stability of the complete denture poor. With the development of dental implant technology, the application of implant greatly improves the retention and stability of complete denture, improves the masticatory efficiency and the use of the maxillary crest patients. In order to reduce the complications of surgery, a All-on-4 implant repair scheme is proposed to reduce surgical complications. This scheme refers to the use of 4 implants in the edentulous jaws, including 2 straight anterior teeth implants and 2 tilted posterior dental implants to support a fixed full oral edentulous prosthesis. The scheme can be used for application. Incline implant to avoid the anatomic structures such as the maxillary sinus or the inferior alveolar nerve, and reduce the distance between the distal and the implant and the contact area of the bone. In All-on-4, how to choose the appropriate angle of the posterior implant, the length of the cantilever beam of the upper prosthesis and the length of the posterior dental implants, in order to reduce the surrounding of the implant. The stress of bone tissue increases the long-term retention rate of implant and denture, which is a problem that needs to be studied and discussed.
Objective: to provide a biomechanical reference for clinical application of three-dimensional finite element method (3D finite element method) for the analysis of the stress of bone tissue around the implant by the different angles and length of the cantilever beam of the All-on-4 and the different length of the implant and the different loading ways of the superstructure.
Research methods: the 3D data of mandible of edentulous jaw were obtained by CT scanning. The 3D solid model of edentulous mandible was obtained by using Mimcs, Geomagic and Unigraphics software to obtain the three-dimensional solid model of the mandible of the edentulous jaw. In the HyperMesh software, the tetrahedral mesh was divided and the three-dimensional finite element model of the mandible of the edentulous jaw was established.
The cantilever beam length of the distal implants is 0, 15, 30 and 45 degrees respectively. The length of the cantilever beam is 19.5mm, 17.2mm, 13.3mm and 9.8mm, respectively. The finite element model is used to fix the material properties of each part of the model. The boundary constraints of the model are set, and the vertical static load of 150N is applied to the end of the right cantilever beam of the superstructure, and the implant is observed. The equivalent stress peak and stress distribution of the surrounding bone tissue.
The long and middle implants were all inclined to 45 degree cantilever beam long 9.8mm, and the length of the distal implants was 13mm, 15mm, 17mm and 19mm for the finite element model. The material properties and boundary constraints were set. The vertical static load of 150N was applied to the end of the right cantilever beam of the superstructure. The equivalent stress peak of the bone tissue around the implant was observed and the corresponding stress was observed. Force distribution.
In the finite element model of two groups of All-on-4 implant repair of the distal implants with 0 degrees, cantilever beam long 19.5mm and 45 degrees, and long 9.8mm cantilever beam, the superstructure was loaded with unilateral free end, unilateral non free end, anterior tooth area, bilateral free end, bilateral free end, bilateral free end and anterior tooth area, bilateral non free end and anterior tooth area. The size of each loading point was 150N vertical static load, and the equivalent stress peak value and stress distribution of bone tissue around the implant were observed.
The results of the study:
1. the three-dimensional finite element model of mandibular mandible was established with high 25mm of mandible body, wide 8mm, 53mm between the mental foramen and the distance of the crest of the mental hole area about 8mm, and the thickness of the cortical bone in all directions was 2mm.
2. in the study of the influence of the incline angle of the All-on-4 and the length of the cantilever beam on the stress of the surrounding bone tissue, the stress of the bone tissue around the implant is reduced while the angle of the distal implants is increased and the length of the cantilever beam is continuously reduced.
3. in the study of the effect of the length of All-on-4 on the stress of the surrounding bone tissue, the stress of the cortical bone and the cancellous bone around the implant was reduced, but the stress of the bone tissue around the implant was greatly influenced without the joint application of the inclination angle and the length of the cantilever beam.
4. in the study of the effect of different loading methods on the stress of bone tissue around All-on-4 implant, the stress of the bone tissue around the implant was lower than 0 degrees in the model of the long 9.8mm in the cantilever beam when the unilateral free end, the anterior tooth area, the bilateral free end, the bilateral free end and the anterior tooth area were loaded. The stress of the bone tissue around the implant in the 45 degree tilt 45 degree model is slightly higher than that of the tilted 0 degree model when the bilateral non free end, bilateral non free end and front tooth area are loaded. It shows that the short All-on-4 planting design of the long middle implant inclined angle large cantilever beam can reduce the surrounding bone tissue when the free end of the superstructure is loaded. Power.
5. from the stress distribution map, it can be seen that the equivalent stress of cortical bone and cancellous bone around the implant is mainly concentrated in the neck of the implant no matter what part of the superstructure is loaded.
Conclusion: the experimental results show that in All-on-4, the effect of the length of the cantilever beam on the stress of the bone tissue around the implant is greater than that of the inclined angle on the stress of the bone tissue around the implant. The increase of the length of the long and middle inclined implants can reduce the stress of the bone tissue around the implant, but there is no inclination angle and the length of the cantilever beam. When used, the stress of the bone tissue around the implant is greatly influenced. When the free end of the upper prosthesis is loaded, the far middle vertical implant can significantly reduce the stress of the bone interface.

【學位授予單位】：第四軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R783.6

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