不同修复方式下上颌第一前磨牙穿髓型楔状缺损牙体和修复体的生物力学分析  

Biomechanical analysis of maxillary first premolars with different restoration methods for transmedullary wedge-shaped defects

作　　者：田国兵[1] 温鹏霞 赵彬[1] 武峰[1] TIAN Guobing;WEN Pengxia;ZHAO Bin;WU Feng(Department of Prosthodontics,Shanxi Medical University Stomatological Hospital,Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials,Taiyuan 030001,China)

机构地区：[1]山西医科大学口腔医院修复科口腔疾病防治与新材料山西省重点实验室,太原030001

出　　处：《山东医药》2022年第26期30-35,共6页Shandong Medical Journal

基　　金：山西省卫生健康委员会科研课题项目(2019105)。

摘　　要：目的利用有限元方法分析不同修复方式的各型楔状缺损上颌第一前磨牙剩余牙体和修复体内部的应力大小及分布情况。方法选择成年女性志愿者1例,牙齿形态及功能均正常。采用锥形束CT对志愿者上下颌骨区域进行整体扫描,使用MimicsMedical 19.0软件提取右侧上颌第一前磨牙及右侧上颌前磨牙区牙槽骨数据进行三维重建,使用GeomagicWrap17.0软件进行三维模型的细化和精修,使用Simensnx12.0软件制作仿生牙周组织,构建右侧上颌第一前磨牙及右侧上颌前磨牙区牙槽骨模型。将重构的牙体各部件的实体模型导入NS软件中,对牙冠和根管进行形态修整以模拟根管治疗。将建立好的模型进行分割,建立不同程度穿髓型楔状缺损的上颌第一前磨牙三维有限元模型,根据楔状缺损程度分为三组,A组:楔状缺损宽度大于1/3近远中径,未到达邻颊轴角;B组:楔状缺损宽度跨过邻颊轴角但未及1/2近远中邻面壁;C组:楔状缺损宽度越过1/2近远中邻面壁。将各组再按照不同修复方式进行分组,空白对照组:无缺损的上颌第一前磨牙;A1组:未行修复组;A2组:纤维桩+复合树脂直接充填修复;A3组:纤维桩+桩核树脂+氧化锆全瓷冠修复(保留悬突);A4组:纤维桩+桩核树脂+氧化锆全瓷冠修复(去除悬突);B1组:未行修复组;B2组:纤维桩+桩核树脂+氧化锆全瓷冠修复(保留悬突);B3组:纤维桩+桩核树脂+氧化锆全瓷冠修复(去除悬突);B4组:金属桩核+氧化锆全瓷冠修复;C1组:未行修复组;C2组:纤维桩+桩核树脂+氧化锆全瓷冠修复(保留悬突);C3组:纤维桩+桩核树脂+氧化锆全瓷冠修复(去除悬突);C4组:金属桩核加全冠修复。分别施加垂直和侧两种静态载荷,记录分析各工况牙体和修复体内部的等效应力和最大主应力以及应力分布情况,记录牙体和修复体的等效应力峰值和最大主应力峰值并进行对比分析。结果①在牙合力加载下,AObjective To analyze the stress magnitude and distribution in the remaining teeth and restorations of vari⁃ous types of wedge-shaped defects of maxillary first premolars with different restoration methods by the finite element meth⁃od.Methods One adult female volunteer was selected.The tooth shape and function were normal.Cone beam CT was used to scan the maxilla and mandible of volunteer.Mimics medical 19.0 software was used to extract the data of the right maxillary first premolar and the alveolar bone in the right maxillary premolar area for three-dimensional reconstruction,and Geomagic wrap17.0 software was used to refine the three-dimensional model.Simens nx12.0 software was used to make bi⁃onic periodontal tissue and construct the alveolar bone models of the right maxillary first premolar and the right maxillary pre⁃molar area.The solid model of each part of the reconstructed tooth was imported into NS software,and the crown and root ca⁃nal were shaped to simulate root canal treatment.The first part was to establish a three-dimensional finite element model of the maxillary first premolar with different degrees of penetrating wedge-shaped defect.According to the degree of the wedge-shaped defect,it was divided into three groups:group A:the width of the wedge-shaped defect was greater than 1/3 of the mesial and distal diameter,and the angle of the adjacent buccal axis was not reached;group B:the width of the wedge-shaped defect spanned the adjacent buccal axial angle but did not reach 1/2 of the mesial and distal adjacent walls;group C:the width of the wedge-shaped defect exceeded 1/2 of the mesial and distal proximal face walls.According to different repair methods,they were divided into the blank control group(maxillary first premolars without defect),A1 group(no res⁃toration group),A2 group(fiber post+composite resin direct filling restoration),A3 group[fiber post+post-core resin+zirconia all-ceramic crown restoration(overhang preserved)],A4 group[fiber post+post and core resin+zirconia all-ce�

关 键 词：口腔修复 牙体楔状缺损 生物力学 

分 类 号：R783.3[医药卫生—口腔医学]