中国实用口腔科杂志

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种植体根尖部与上颌窦底皮质骨的关系对上颌后牙区种植影响的三维有限元分析

薛燕青毓天昊郑添予韩童童阎旭   

  1. 中国医科大学口腔医学院·附属口腔医院干诊科,辽宁  沈阳  110002
  • 出版日期:2018-01-15 发布日期:2018-02-01
  • 基金资助:

    辽宁省自然科学基金(2015020465)

  • Online:2018-01-15 Published:2018-02-01

摘要:

目的    利用三维有限元分析方法评估种植体根尖部与上颌窦底皮质骨的关系对上颌后牙区种植的生物力学影响。方法    应用计算机辅助设计(computer assisted design,CAD)软件建立标准种植体及上颌后牙区三维有限元模型(M1 ~ M6),皮质骨厚度均为1 mm,依据牙槽骨高度不同(10 ~ 14 mm),种植体根尖部与上颌窦底皮质骨的关系如下。M1:种植体根尖部穿通上颌窦底皮质骨(窦底皮质骨的上表面与种植体根尖部位于同一平面);M2:种植体根尖部进入窦底皮质骨厚度的一半;M3:种植体根尖部恰好接触窦底皮质骨的下表面;M4 ~ M6:种植体根尖部分别距离窦底皮质骨的下表面1、2、3 mm。采用129 N斜向加载,分别置于即刻负载与常规负载条件下,计算其应力分布、最大von Mises应力、种植体的最大位移和共振频率。结果    除M1即刻负载外,最大von Mises应力均集中于种植体颈部周围的牙槽嵴顶皮质骨表面。无论即刻负载或常规负载下,种植体根尖部进入或穿通窦底皮质骨时,牙槽嵴顶皮质骨的最大von Mises应力降低,窦底皮质骨的最大von Mises应力增加,种植体的轴向共振频率显著增加,颊舌向共振频率显著降低。即刻负载条件下,当种植体进入或穿通窦底皮质骨时,其最大位移尤其是根尖部的最大位移小于其他情况下的最大位移。常规负载条件下,种植体颈部与根尖部的最大位移几乎不受种植体根尖部位置的影响。结论    种植体根尖部与上颌窦底皮质骨的相对位置关系对种植体周围组织的应力分布、种植体的最大位移以及共振频率均有一定影响。种植体根尖部进入或穿通上颌窦底皮质骨有利于改善应力分布,减少种植体根尖部的位移,增加种植体的稳定性,尤其在即刻负载下作用显著。

关键词: 牙种植体, 上颌窦, 有限元分析, 应力分布, 共振频率分析, 皮质骨

Abstract:

Objective    To evaluate the biomechanical influence of the relationship between implant tip and sinus ?oor cortical bone on posterior maxilla implantation by means of 3-dimensional(3-D)finite element(FE)analysis. Methods        Six 3-D FE models (M1 to M6) of standard implants and posterior maxillary region were constructed using CAD software. The thickness of both crestal cortical bone and sinus floor cortical bone were 1mm;according to different heights of the alveolar bone,the relationship between implant tip and sinus floor cortical bone was as follows. M1:the implant tip just broke through sinus cortical bone(the upper surface of sinus cortical bone and the apical surface of the implant were at the same level);M2:the implant tip broke through half the thickness of sinus ?oor cortical bone;M3:the implant tip just made contact with the lower surface of sinus ?oor cortical bone;for the remaining models,the implant tips were 1mm,2mm and 3mm apart from sinus floor,respectively. An inclined force of 129N was applied under immediate loading and conventional loading. The maximum von Mises stress,stress distribution,implant displacement and resonance frequencies were calculated using CAD software. Results    Except the M1 under immediate loading,the maximum von Mises stress of all models were concentrated on the surface of the crestal cortical bone around the implant neck. When the implant tip broke into or through sinus floor cortical bone,the maximum von Mises stress of crestal cortical bone reduced while that of sinus cortical bone increased,and the occlusional resonance frequencies of implants increased significantly while horizontal frequencies decreased,whether under immediate loading or conventional loading. Under immediate laoding,the maximum displacement of implant,especially the maximum displacement of the implant tip,was lower than the other models when the implant tip broke into or through the sinus cortical bone. However,the maximum displacements of both implant neck and tip were  hardly affected by the association between implant tip or sinus floor cortical bone under conventional loading. Conclusion    The association between implant tip and sinus floor cortical bone has effects both on stress distribution of the bone tissues around implant and on the maximum displacement and resonance frequencies of implants. Making the implant tip break into or through the sinus floor cortical bone(bi-cortical anchorage)is beneficial to improve the stress distribution and reduce the maximum displacement of implant,increasing the stability of the implant,especially under immediate loading.

Key words: dental implants, maxillary sinus, finite element analysis, stress distribution, resonance frequency analysis, cortical bone