本文選題：種植義齒 + 附著體義齒�。� 參考：《吉林大學》2017年碩士論文

【摘要】：目的:探討不同固位方法修復游離端缺失基牙應力分布及臨床應用的優(yōu)缺點,旨在為臨床游離端缺失修復方法的選擇提供理論依據(jù),提高臨床游離端缺失修復質量。方法:針對單側游離端缺失的患者,本文選取的原始CT為成年人下頜骨錐形束CT,通過Materialise Mimics 17.0軟件完成三維模型初步重建,通過軟件3-Matic STL 10.2和Geomagic Studio 2013完成三維有限元模型的細化,利用軟件Hyper Works 14.0和ABAQUS 6.1.4進行有限元建模仿真處理。本文用上述軟件分別建立了包含基牙、牙周膜、牙槽嵴和義齒部位的五種義齒修復方式(種植義齒、天然牙-種植義齒聯(lián)合固定橋、套筒冠義齒、附著體義齒、可摘局部義齒)修復游離端缺失三維有限元仿真模型。在義齒之間、義齒與基牙之間面與面接觸的部位采用接觸單元,其他部位采用二階四面體單元。應用三維有限元生物力學分析方法測定并比較分析垂直及斜向(頰向、舌向、遠中向)加載在磨牙牙合面中心時不同固位結構義齒修復游離端缺失基牙應力分布及應力峰值。根據(jù)三維有限元分析結果指導臨床游離端缺失患者的修復,對臨床不同固位方法(種植義齒、套筒冠義齒、附著體義齒、可摘局部義齒)修復游離端缺失咀嚼效率、患者滿意度進行比較。研究對象為來吉林大學中日聯(lián)誼醫(yī)院口腔科門診因舊可摘局部義齒舒適度差、不美觀或咀嚼效果不好要求重新制作義齒的患者。結果:1、基牙應力分布均勻性:單純種植義齒優(yōu)于套筒冠義齒優(yōu)于附著體義齒優(yōu)于可摘局部義齒優(yōu)于種植義齒與天然牙聯(lián)合固定橋。2、基牙應力峰值:套筒冠義齒(2.23MPa)附著體義齒(2.65MPa)可摘局部義齒(4.16MPa)種植義齒(41.54MPa)種植義齒與天然牙聯(lián)合固定橋(50.05Mpa)3、最大應力集中部位:種植義齒種植體均集中在舌側牙頸部;天然牙-種植義齒聯(lián)合固定橋天然牙與種植體均集中在遠中舌側牙頸部;套筒冠義齒兩個基牙均集中在遠中牙頸部;附著體義齒近中基牙集中在遠中牙頸部,遠中基牙集中在遠中頰側牙頸部;可摘局部義齒近中基牙集中在遠中牙頸部,遠中基牙集中在遠中頰側牙頸部。4、基牙加載方向與應力的關系:所有固位方法中,垂直方向加載應力峰值小于斜向加載,且更均勻。5、套筒冠義齒、附著體義齒及可摘局部義齒均顯示近中基牙應力峰值小于遠中基牙且應力分布更均勻。6、咀嚼效率比較:種植義齒、附著體義齒、套筒冠義齒的咀嚼效率無顯著差異,可摘局部義齒咀嚼效率最小且與其他種三種固位方法比較有顯著差異。結論:1、當游離端缺失缺牙區(qū)牙槽骨密度較好的情況下,用單純種植義齒修復臨床效果優(yōu)于其他固位修復方法。2、球帽式套筒冠義齒對基牙應力緩沖作用最好,更適于基牙牙周條件較差且不適宜或不耐受種植義齒患者的游離端缺失修復。3、按扣式附著體義齒也可較好的降低基牙所受應力,較適合基牙牙周較健康,且不適宜或不耐受種植義齒,或基牙解剖條件又不適宜做套筒冠義齒患者的游離端缺失修復。4、設計良好的可摘局部義齒修復游離端缺失也能獲得較好的咀嚼效率,較適宜不能耐受或不愿接受其他類修復且對美觀與舒適度要求不高或受經濟條件所限不能選用其它類修復患者的游離端缺失修復。5、天然牙-種植義齒聯(lián)合固定橋基牙應力峰值最大、分布不均勻且天然牙與種植義齒應力差異較大可能會影響修復遠期效果,不建議臨床采用此種類型的修復方法修復游離端缺失。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R783.6

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