上颌窦内提升术最佳二期修复时间的有限元分析  

Finite element analysis of the optimal time for second-stage maxillary sinus floor lift

作　　者：徐大鹏 景捷[2] 马璐[2] 曲爱丽[1] Xu Dapeng;Jing Jie;Ma Lu;Qu Aili(School of Mechanical Engineering,Ningxia University,Yinchuan 750000,Ningxia Hui Autonomous Region,China;Ningxia Medical University Dental Hospital,Yinchuan 750000,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏大学机械工程学院,宁夏回族自治区银川市750000 [2]宁夏医科大学口腔医院,宁夏回族自治区银川市750000

出　　处：《中国组织工程研究》2024年第11期1647-1652,共6页Chinese Journal of Tissue Engineering Research

基　　金：宁夏重点研发项目(2021BEB04009),项目负责人:曲爱丽;宁夏自然科学基金(2020AACO3357),项目负责人:景捷。

摘　　要：背景:牙缺失区由于缺乏功能性加载产生的力学刺激,导致牙槽骨萎缩、骨质丢失,致使牙种植体不能有效埋入。因此种植修复时就需要植入骨粉,弥补牙槽骨高度不足对种植体稳定度的影响。目的:借助有限元分析法从生物力学角度得出种植体二期修复的最佳时间点,为临床缩短种植疗程选择正确二期修复时间点提供了生物力学基础。方法:采集1名女性健康志愿者颅面骨拍摄的锥形束CT,建立正常上颌骨模型、16缺失采用常规种植术(模型B)和16缺失采用上颌窦内提升术(模型A)后的上颌骨三维有限元模型。模型A在黏膜与上颌窦底之间以羟基磷灰石骨粉填充,模型B和正常上颌骨模型无需植骨。设置植骨愈合时间为术后的3-9个月,于术后3-5个月施加200 N的力在邻牙上,6-9个月直接施加在种植体上,模拟二期修复对种植体施加载荷。借助种植体及周围的软硬组织对3种模型进行生物力学分析。结果与结论:①种植体直接加载时,模型A上的应力在103 MPa左右、模型B上的应力在95 MPa左右。植骨后会增加种植体的应力值,而不做植骨则能降低种植体和整个系统的应力。随着骨粉强度的增加,牙槽骨上的应力值随之降低。②当愈合时间到术后6-9个月,在种植体或相应的第1磨牙牙位加载时,正常模型中的应力值最小,模型B次之,模型A最大;植入种植体后的上颌骨的应力大于正常上颌骨。③模型整体松质骨应力水平,在6-9个月模型A的松质骨应力略呈下降趋势,模型B应力水平显著低于正常下颌骨模型。④结论:利用原有的牙槽骨进行修复能提高种植体存活率;植骨后在获得足够的牙槽骨高度的情况下,可在6个月后考虑二期修复。临床应用时可根据患者的骨质、生活习惯、年龄等因素综合判定后,在此基础上适当调整二期修复时间。BACKGROUND:Due to the lack of mechanical stimulation generated by functional loading,alveolar bone atrophy and bone loss in the missing area prevents the effective embedding of dental implants.Therefore,it is necessary to implant bone meal during implantation to compensate for the lack of alveolar bone height on the stability of the implant.OBJECTIVE:To derive the optimal time point for second-stage restorations from a biomechanical perspective by means of finite element analysis,thereby providing a biomechanical basis for selecting the correct time point for second-stage restoration to shorten the clinical course of dental implantation.METHODS:Three-dimensional finite element models of the maxilla were developed for normal,16-deficient with conventional implant surgery(model B)and 16-deficient with internal maxillary sinus lift(model A).Model A was filled with hydroxyapatite bone powder between the mucosa and the maxillary sinus floor,and Model B and the normal maxillary bone model did not require bone grafting.The healing time of bone grafting was set at 3-9 months postoperatively,and a force of 200 N was applied to the adjacent teeth at 3-5 months postoperatively,and directly to the implant at 6-9 months,simulating the load applied to the implant in the second stage of restoration.Biomechanical analysis of the three models was performed with the aid of the implants and the surrounding hard and soft tissues.RESULTS AND CONCLUSION:The stress on Model A and Model B was around 103 MPa and 95 MPa respectively when the force was directly loaded onto the implant.Bone grafting increased the stress values on the implant,while not doing bone grafting reduced the stress on the implant and the whole system.As the strength of the bone powder increased,the stress values on the alveolar bone decreased.When the healing time was up to 6-9 months postoperatively,the stress values were ranked as follows:normal model<Model B<Model A,when the force was loaded in the implant or the corresponding first molar sites.The stress on the

关 键 词：有限元 二期修复 内提升术 生物力学 种植体 牙槽骨 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R496