All-on-4与穿颧种植在不同皮质骨厚度中的生物力学研究  

A biomechanical study of All-on-4 and zygomatic implants in different cortical bone thickness

作　　者：王璨 顾卫平[1] 朱琳 陈岗[1] WANG Can;GU Weiping;ZHU Lin;CHEN Gang(Department of General Dentistry,The Affiliated Stomatological Hospital of Nanjing Medical University,Jiangsu Province Key Laboratory of Oral Diseases,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine,Nanjing 210029,China)

机构地区：[1]南京医科大学附属口腔医院综合科,江苏省口腔疾病研究重点实验室,江苏省口腔转化医学工程研究中心,江苏南京210029

出　　处：《口腔医学》2021年第8期685-691,共7页Stomatology

基　　金：江苏高校优势学科建设工程(2018-87);南京市卫生科技发展专项资金(YKK20246)。

摘　　要：目的利用有限元分析法,比较在不同皮质骨厚度下后牙区垂直骨量严重不足的上颌无牙颌中All-on-4与穿颧种植中种植体、皮质骨的应力值与钛支架的变形量的差异,为临床种植方案的设计提供参考依据。方法选取一无牙颌上颌骨锥形束CT数据并建立4个不同皮质骨厚度的模型,模型中还包括了种植体、基台、钛支架,在双侧后牙区施加200 N垂直压力,计算出种植体、皮质骨的应力值及钛支架的变形量并进行统计分析。结果随着皮质骨厚度的增加,All-on-4组与穿颧种植组中种植体、皮质骨应力值及钛支架变形量逐渐减小,在All-on-4组中,当皮质骨厚度由0.5 mm增加到1.5 mm时,各数据降低明显,当皮质骨厚度由1.5 mm增加到2.0 mm时各数据变化较小,并且,当皮质骨厚度为1.5 mm时,等效应力和变形量均达到一个较低的水平。在穿颧种植组中,随着皮质骨厚度的改变总体数据变化均较小,穿颧种植组的种植体、皮质骨应力值及钛支架变形量均小于All-on-4组,且2号位点植体、皮质骨及钛支架变形量之间的差异有统计学意义(P<0.05)。结论对于后牙区垂直骨量严重不足的上颌无牙颌,皮质骨厚度的增加有利于减小种植修复的应力分布和钛支架的变形;当皮质骨厚度较小时(<1.5 mm),穿颧种植的种植方案是更为合适的选择;当皮质骨厚度较厚时(≥1.5 mm),虽然穿颧种植组中的数据表现较All-on-4组好,但All-on-4组中各数据已明显降低,此时,也可以考虑选择All-on-4进行修复。Objective To compare the stress of implant and cortical bone and the deformation of titanium framework using different designs of All-on-4 and zygomatic implants with various thickness of cortical bone,via finite element analysis in the maxillary edentulous with severe insufficient vertical bone in the posterior region and to provide reference for clinical implant scheme.Methods CBCT data of a maxillary edentulous were selected to establish four different cortical bone thickness models.The model also included implant,abutment and titanium framework.The stress of the implant and cortical bone and the deformation of the titanium framework were calculated with a vertical load of 200 N exerted bilaterally in the posterior region.Results With the increase of cortical bone thickness,the stress of implant and cortical bone and the deformation of the titanium framework gradually decreased.In the All-on-4 model,when the thickness of cortical bone increased from 0.5 mm to 1.5 mm,the stress and the deformation decreased significantly;when the thickness of cortical bone increased from 1.5 mm to 2.0 mm,the decrease tended to level off.Both of the stress and the deformation had reached a very low level at 1.5 mm cortical thickness point.However,in zygomatic implant model,slight change was shown with various cortical bone thickness.The stress of implant and cortical bone and the deformation of titanium framework in the zygomatic implant model were smaller than those in the All-on-4 model,and there was a statistical difference in the stress of implant and cortical bone and the deformation of titanium framework at the site of lateral incisor(P<0.05).Conclusion For maxillary edentulous with insufficient vertical bone in the posterior region,the increase in the thickness of cortical bone is beneficial to reduce the stress of implant and cortical bone and deformation of titanium framework.The zygomatic implant is a more suitable design in thin cortical bones(<1.5 mm).If the cortical bone is thick(≥1.5 mm),though the zygomatic impl

关 键 词：上颌无牙颌 种植固定义齿 有限元分析 All-on-4 穿颧种植 

分 类 号：R783.4[医药卫生—口腔医学]