載荷骨量對微型種植體穩(wěn)定性影響的生物力學(xué)分析
發(fā)布時(shí)間：2018-08-08 14:11
【摘要】：目的： 正畸治療成功的前提是有足夠的支抗，支抗不足是限制正畸學(xué)發(fā)展的重要因素。牙弓嚴(yán)重前突、露齦笑、磨牙伸長及推磨牙向后等臨床疑難病例常因支抗不足，影響治療結(jié)果。支抗是抵抗不希望發(fā)生移動(dòng)的牙移動(dòng)的能力，傳統(tǒng)的加強(qiáng)支抗的方法如橫腭桿、Nance弓、頜間牽引、口外弓等存在穩(wěn)定性、舒適性、方便性和患者合作性等方面的問題。而微型種植體支抗體積小，植入部位靈活、操作方法簡單且可以提供有效的骨性支抗，植入后能夠進(jìn)行即刻加載，在正畸臨床上得到廣泛應(yīng)用。 然而目前微植體支抗的成功率仍明顯低于修復(fù)種植體，國內(nèi)外學(xué)者從微型種植體的材料、形態(tài)尺寸，操作方法、加力時(shí)機(jī)及大小等多方面做研究，取得了寶貴的成果，確定了一些影響微植體穩(wěn)定性的因素和提高初期穩(wěn)定性的方法。只有具有高水平的初期穩(wěn)定性，才能使微植體作為臨時(shí)支抗應(yīng)用于臨床。微植體剛剛植入后，其初期穩(wěn)定性僅由微植體與周圍骨組織的機(jī)械嵌合作用決定。而當(dāng)對微植體進(jìn)行即刻加載時(shí)，其穩(wěn)定性不僅與機(jī)械嵌合力有關(guān)，還和微植體周圍承受載荷的骨量有密切關(guān)系。為了確定在上下頜骨不同位置植入時(shí)，載荷骨量和植入角度對微植體即刻加載時(shí)的穩(wěn)定性的影響，本研究采用體外實(shí)驗(yàn)法，將微型種植體按到骨邊緣的不同距離植入家豬髂骨骨塊上，通過生物力學(xué)方法分析不同載荷骨量對正畸微型種植體初期穩(wěn)定性的影響。 方法： 1制作骨塊模型 選擇新鮮家豬髂骨作為骨塊模型，先沿髂骨長軸在兩側(cè)各切去一薄層骨組織，以暴露出髂骨外表面的皮質(zhì)骨，用游標(biāo)卡尺測量各髂骨四周的皮質(zhì)骨厚度，從中選擇12塊厚度介于1.3-1.5mm的髂骨。用22號的解剖刀剔除髂骨表面的軟組織和軟骨，用線鋸將12個(gè)髂骨切割成約長11cm，寬9cm的骨塊，然后將骨塊嵌入到盛有自凝樹脂的模型盒中以固定骨塊，自凝樹脂在冷的生理鹽水下固化以避免聚合過程中散熱對骨塊的損傷。隨后將固定好的骨塊模型放入4°C的10㳠福爾馬林緩沖液中進(jìn)行保存。 2植入微型種植體 2.1在骨塊上標(biāo)記微植體植入位點(diǎn) 完全去除骨塊表面的軟組織后，在骨塊模型上描點(diǎn)八個(gè)點(diǎn)以確定微植體的植入位置，在距離骨塊邊緣3mm、4mm、5mm和6mm處分別標(biāo)記兩點(diǎn)，相鄰兩點(diǎn)的間距是10mm。到骨邊緣相同距離的兩點(diǎn)中左側(cè)的點(diǎn)為垂直植入，右側(cè)的為牙合向45°植入（微型種植體向一側(cè)骨邊緣傾斜45°植入）。 2.2在標(biāo)記點(diǎn)處制作預(yù)備洞 將手機(jī)的轉(zhuǎn)速設(shè)定為1100rpm，在預(yù)備過程中用冷的生理鹽水進(jìn)行降溫。到骨邊緣相同距離的兩點(diǎn)中左側(cè)的點(diǎn)為向一側(cè)骨邊緣傾斜45°植入，右側(cè)的為垂直植入。預(yù)備洞的深度固定于7mm，其中預(yù)備鉆的直徑為1.2mm。 2.3擰入微型種植體 將微植體按預(yù)備洞方向順時(shí)針植入，最后換用扭矩儀再進(jìn)一步擰入至扭矩值為10Ncm。每一個(gè)骨塊模型上有8顆微植體。 3生物力學(xué)測試 使用微機(jī)控制電子萬能試驗(yàn)機(jī)進(jìn)行拉出力試驗(yàn)。將微植體/骨塊模型牢固地夾在萬能試驗(yàn)機(jī)底座上，微植體頸部通過不銹鋼絲與上夾頭相連。拉出實(shí)驗(yàn)時(shí)拉力應(yīng)平行于骨面且與骨邊緣垂直。加載拉力由電腦監(jiān)控，施力夾板以0.05mm/s的恒定速度向上移動(dòng)。具體數(shù)據(jù)以力-位移曲線的形式在電腦顯示。當(dāng)曲線呈現(xiàn)急劇下滑趨勢時(shí)，停止施力，施力橫梁停止移動(dòng)。記錄下所有微植體的（Fmax），即使微植體喪失支抗能力所需的最大拉力。 4皮質(zhì)骨厚度測量 生物力學(xué)測試完成后，用線鋸小心地將骨塊模型沿每顆微植體周圍切開，切割成八個(gè)方形的小骨塊，每個(gè)骨塊上含有一顆微型種植體，利用游標(biāo)卡尺測量每個(gè)小骨塊四周的皮質(zhì)骨的厚度（CBT），結(jié)果取平均值。 結(jié)果： 1微植體/骨模型形態(tài)改變情況 在進(jìn)行拉力實(shí)驗(yàn)過程中有一顆種植體被折斷，有兩顆發(fā)生輕微彎曲變形，有兩顆被拉出骨塊，其它微型種植體在拉力試驗(yàn)完成后仍留在骨塊中，僅發(fā)生輕微的移動(dòng)或傾斜。 2不同載荷骨量時(shí)種植體生物力學(xué)性能的比較： 2.1當(dāng)種植體垂直于骨面植入時(shí)，隨著到骨邊緣距離的增加，拉力峰值不斷增大（P0.05）。 2.2當(dāng)種植體傾斜45°植入時(shí)，隨著到骨邊緣距離的增加，拉力峰值不斷增大（P0.05）。 3不同植入角度時(shí)種植體的生物力學(xué)性能比較： 3.1種植體距離骨邊緣3mm-5mm時(shí)，垂直植入組的拉出力峰值均小于45°植入組（P0.05）。 3.2種植體距離骨邊緣6mm時(shí)，垂直植入組的拉出力峰值與傾斜45°植入組無顯著性差別（P=0.052）。 4種植體不同組皮質(zhì)骨厚度比較： 4.1種植體垂直植入組及傾斜植入組皮質(zhì)骨厚度均無顯著差異(P0.05)。 結(jié)論： 1.載荷骨量影響微型種植體/骨的生物力學(xué)性能。一定范圍內(nèi)，隨著微型種植體到牙槽嵴頂距離的增加（即增加載荷骨量），可以提高微型種植體的生物力學(xué)性能，增加其穩(wěn)定性。在臨床上應(yīng)用微植體時(shí)，應(yīng)在其它條件允許的情況下，適當(dāng)增加微植體到牙槽嵴頂?shù)木嚯x，增大載荷骨量，以提高其支抗能力。 2.植入角度影響微型種植體/骨的生物力學(xué)性能。微型種植體承受垂直于骨邊緣的載荷時(shí)，傾斜植入較垂直植入更有利于微型種植體的穩(wěn)定。在臨床應(yīng)用微植體時(shí)，應(yīng)盡量根據(jù)需要加載的方向選擇力矩較小的角度植入微植體，，尤其當(dāng)載荷骨量較小時(shí)應(yīng)盡量避免植入角度與載荷方向垂直。
[Abstract]:Objective:
The precondition for the success of orthodontic treatment is that there is sufficient anchorage, and the lack of support is an important factor restricting the development of orthodontics. The severe anterior process of the dental arch, the gingival smile, the elongation of the molar and the backwards of the grinding teeth are often caused by the insufficiency of the anchorage, which affects the ability to resist the movement of the teeth that do not want to move. The methods such as the transverse palate, the Nance bow, the intermaxillary traction, the extraoral bow and so on exist the problems of stability, comfort, convenience and patient cooperation. However, the microimplant support is small, the implant site is flexible, the operation method is simple and can provide effective bone anchorage, and the implant can be loaded immediately after implantation, and it is widely used in orthodontic clinic. General application.
However, the success rate of microimplant anchorage is still lower than that of the repair implants at present. Scholars at home and abroad have obtained valuable results from the materials, shape, size, operation method, loading opportunity and size of microimplants, and have determined some factors affecting the stability of microplants and methods to improve the initial stability. With a high level of initial stability, microplants can be used as temporary anchorage for clinical use. After the implant is just implanted, the initial stability is determined only by the mechanical chimerism of the microexplants and the surrounding bone tissue. When the microimplant is loaded immediately, the stability is not only related to the mechanical interlocking force, but also to the micro implant. In order to determine the effect of load bone mass and implantation angle on the stability of the microimplant when the implant is implanted in different positions of the maxilla and mandible, in this study, the experimental method was used to implant the microimplants at the different distances of the bone to the bone of the iliac bone of the pig, and the different biomechanical methods were used to analyze the differences. Effect of bone loading on the initial stability of orthodontic Mini implants.
Method:
1 making bone block model
The iliac bone of fresh domestic pig was selected as a bone block, and a thin layer of bone tissue was cut along the iliac long axis to expose the cortical bone on the outer surface of the iliac bone. The thickness of the cortical bone around the iliac bone was measured with a vernier caliper. 12 iliac bones with a thickness of 1.3-1.5mm were selected from it. The soft tissue and soft tissue of the iliac bone surface were removed with the anatomic knife No. 22. Bone, using a wire saw to cut 12 iliac bones into a long 11cm, wide 9cm bone block, and then insert a bone block into a model box with a self condensing resin to fix the bone. The self condensing resin is solidified under cold physiological saline to avoid the damage to the bone during the polymerization. Then the fixed bone block model is put into the 10? Formalin buffer of the 4 degree C. Keep it in it.
2 implant microimplant
2.1 labeling the implant site on the bone block
After completely removing the soft tissue on the surface of the bone, eight points were traced to determine the position of the implant on the bone block model. The two points were marked at 3mm, 4mm, 5mm, and 6mm at the edge of the bone block. The distance between the two points was perpendicular to the left point of the two points with the same distance from the bone to the edge of the bone, and the right one was implanted into the 45 degree (miniaturized). The implant sloped 45 degrees to one side of the bone.
2.2 make a preparation hole at the mark point
The rotational speed of the cell phone is set to 1100rpm, and the cold physiological saline is used to cool down during the preparation process. The left point on the left side of the two points with the same distance to the bone edge is 45 degrees to one side of the bone edge, and the right one is implanted vertically. The depth of the preparation hole is fixed to 7mm, and the diameter of the reserve drill is 1.2mm.
2.3 unscrewed microimplants
The micro-implants were clockwise implanted in the direction of the prepared cavity, and then further screwed in with a torque meter until the torque value was 10Ncm. There were eight micro-implants on each bone block model.
3 biomechanical test
The micro-computer controlled electronic universal testing machine is used to carry out the pulling force test. The microimplant / bone block model is firmly clamped on the base of the universal testing machine. The neck of the micro implant is connected with the upper clamp with stainless steel wire. The tensile force should be parallel to the bone surface and perpendicular to the edge of the bone. The loading force is monitored by the computer and the force splint is constant in 0.05mm/s. Velocity moves upwards. The concrete data is displayed in the form of a force displacement curve in the form of a force displacement curve. When the curve presents a sharp downward trend, the force stops and the force beam stops moving. Record all the microplants (Fmax), even if the microimplant loses its maximum support.
4 cortical bone thickness measurement
After the biomechanics test was completed, the bone block was cut carefully around each microimplant with a wire saw and cut into eight square small bone blocks, each of which contains a micro implant. The thickness of the cortical bone around each small bone (CBT) was measured with a vernier caliper. The results were averaged.
Result:
Morphological changes of 1 micro implant / bone model
During the tension test, one of the implants was broken, two were slightly curved, two were pulled out of the bone, and the other micro implants remained in the bone after the tension test was completed, only slightly moving or inclined.
2 Comparison of biomechanical properties of implants with different bone loads.
2.1 When the implant is perpendicular to the bone surface, the peak value of tensile force increases with the increase of the distance to the bone edge (P0.05).
2.2 when the implant tilted at 45 degrees, the peak value of tension increased with the increase of the distance to the edge of the bone (P0.05).
3 biomechanical properties of implants at different implant angles:
3.1 the peak value of pullout force in the vertical implant group was less than that in the 45 degree implant group (P0.05) when the implant was 3mm-5mm away from the bone edge.
3.2 there was no significant difference in the pullout peak between the vertical implant group and the 45 degree implant group (6mm) when the implant was at the edge of the bone edge (P=0.052).
The thickness of cortical bone in different groups of 4 implants was compared.
4.1 there was no significant difference in cortical bone thickness between vertical implant group and inclined implant group (P0.05).
Conclusion:
The biomechanical properties of microimplants / bones are affected by 1. load bone. Within a certain range, the increase in the distance between the microimplants and the crest of the alveolar ridge (that is, increasing the load of the bone) can increase the biomechanical properties of the micro implant and increase its stability. The distance between the micro implant and the alveolar ridge will increase the load bone mass to enhance the anchorage ability.
The 2. implantation angle affects the biomechanical properties of the micro implant / bone. When the micro implant bears the load perpendicular to the edge of the bone, the tilt implantation is more conducive to the stability of the micro implant. In the clinical application of microimplant, the microimplant should be implanted in a small angle, especially when the load is required, especially when the load is loaded. When the bone mass is small, the angle of implantation should be avoided as far as the load is concerned.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.5
本文編號：2172040
[Abstract]:Objective:
The precondition for the success of orthodontic treatment is that there is sufficient anchorage, and the lack of support is an important factor restricting the development of orthodontics. The severe anterior process of the dental arch, the gingival smile, the elongation of the molar and the backwards of the grinding teeth are often caused by the insufficiency of the anchorage, which affects the ability to resist the movement of the teeth that do not want to move. The methods such as the transverse palate, the Nance bow, the intermaxillary traction, the extraoral bow and so on exist the problems of stability, comfort, convenience and patient cooperation. However, the microimplant support is small, the implant site is flexible, the operation method is simple and can provide effective bone anchorage, and the implant can be loaded immediately after implantation, and it is widely used in orthodontic clinic. General application.
However, the success rate of microimplant anchorage is still lower than that of the repair implants at present. Scholars at home and abroad have obtained valuable results from the materials, shape, size, operation method, loading opportunity and size of microimplants, and have determined some factors affecting the stability of microplants and methods to improve the initial stability. With a high level of initial stability, microplants can be used as temporary anchorage for clinical use. After the implant is just implanted, the initial stability is determined only by the mechanical chimerism of the microexplants and the surrounding bone tissue. When the microimplant is loaded immediately, the stability is not only related to the mechanical interlocking force, but also to the micro implant. In order to determine the effect of load bone mass and implantation angle on the stability of the microimplant when the implant is implanted in different positions of the maxilla and mandible, in this study, the experimental method was used to implant the microimplants at the different distances of the bone to the bone of the iliac bone of the pig, and the different biomechanical methods were used to analyze the differences. Effect of bone loading on the initial stability of orthodontic Mini implants.
Method:
1 making bone block model
The iliac bone of fresh domestic pig was selected as a bone block, and a thin layer of bone tissue was cut along the iliac long axis to expose the cortical bone on the outer surface of the iliac bone. The thickness of the cortical bone around the iliac bone was measured with a vernier caliper. 12 iliac bones with a thickness of 1.3-1.5mm were selected from it. The soft tissue and soft tissue of the iliac bone surface were removed with the anatomic knife No. 22. Bone, using a wire saw to cut 12 iliac bones into a long 11cm, wide 9cm bone block, and then insert a bone block into a model box with a self condensing resin to fix the bone. The self condensing resin is solidified under cold physiological saline to avoid the damage to the bone during the polymerization. Then the fixed bone block model is put into the 10? Formalin buffer of the 4 degree C. Keep it in it.
2 implant microimplant
2.1 labeling the implant site on the bone block
After completely removing the soft tissue on the surface of the bone, eight points were traced to determine the position of the implant on the bone block model. The two points were marked at 3mm, 4mm, 5mm, and 6mm at the edge of the bone block. The distance between the two points was perpendicular to the left point of the two points with the same distance from the bone to the edge of the bone, and the right one was implanted into the 45 degree (miniaturized). The implant sloped 45 degrees to one side of the bone.
2.2 make a preparation hole at the mark point
The rotational speed of the cell phone is set to 1100rpm, and the cold physiological saline is used to cool down during the preparation process. The left point on the left side of the two points with the same distance to the bone edge is 45 degrees to one side of the bone edge, and the right one is implanted vertically. The depth of the preparation hole is fixed to 7mm, and the diameter of the reserve drill is 1.2mm.
2.3 unscrewed microimplants
The micro-implants were clockwise implanted in the direction of the prepared cavity, and then further screwed in with a torque meter until the torque value was 10Ncm. There were eight micro-implants on each bone block model.
3 biomechanical test
The micro-computer controlled electronic universal testing machine is used to carry out the pulling force test. The microimplant / bone block model is firmly clamped on the base of the universal testing machine. The neck of the micro implant is connected with the upper clamp with stainless steel wire. The tensile force should be parallel to the bone surface and perpendicular to the edge of the bone. The loading force is monitored by the computer and the force splint is constant in 0.05mm/s. Velocity moves upwards. The concrete data is displayed in the form of a force displacement curve in the form of a force displacement curve. When the curve presents a sharp downward trend, the force stops and the force beam stops moving. Record all the microplants (Fmax), even if the microimplant loses its maximum support.
4 cortical bone thickness measurement
After the biomechanics test was completed, the bone block was cut carefully around each microimplant with a wire saw and cut into eight square small bone blocks, each of which contains a micro implant. The thickness of the cortical bone around each small bone (CBT) was measured with a vernier caliper. The results were averaged.
Result:
Morphological changes of 1 micro implant / bone model
During the tension test, one of the implants was broken, two were slightly curved, two were pulled out of the bone, and the other micro implants remained in the bone after the tension test was completed, only slightly moving or inclined.
2 Comparison of biomechanical properties of implants with different bone loads.
2.1 When the implant is perpendicular to the bone surface, the peak value of tensile force increases with the increase of the distance to the bone edge (P0.05).
2.2 when the implant tilted at 45 degrees, the peak value of tension increased with the increase of the distance to the edge of the bone (P0.05).
3 biomechanical properties of implants at different implant angles:
3.1 the peak value of pullout force in the vertical implant group was less than that in the 45 degree implant group (P0.05) when the implant was 3mm-5mm away from the bone edge.
3.2 there was no significant difference in the pullout peak between the vertical implant group and the 45 degree implant group (6mm) when the implant was at the edge of the bone edge (P=0.052).
The thickness of cortical bone in different groups of 4 implants was compared.
4.1 there was no significant difference in cortical bone thickness between vertical implant group and inclined implant group (P0.05).
Conclusion:
The biomechanical properties of microimplants / bones are affected by 1. load bone. Within a certain range, the increase in the distance between the microimplants and the crest of the alveolar ridge (that is, increasing the load of the bone) can increase the biomechanical properties of the micro implant and increase its stability. The distance between the micro implant and the alveolar ridge will increase the load bone mass to enhance the anchorage ability.
The 2. implantation angle affects the biomechanical properties of the micro implant / bone. When the micro implant bears the load perpendicular to the edge of the bone, the tilt implantation is more conducive to the stability of the micro implant. In the clinical application of microimplant, the microimplant should be implanted in a small angle, especially when the load is required, especially when the load is loaded. When the bone mass is small, the angle of implantation should be avoided as far as the load is concerned.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.5
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