上颌窦内提升不植骨与植骨即刻负重的动态应力分析  

Dynamic stress analysis of maxillary sinus lifting without bone grafting and with immediate loading after bone grafting

作　　者：艾克丽亚•艾尼瓦尔 娜菲莎•吾普尔 白布加甫•叶力思 孜拉来•居来提 古丽再努•依布拉音 尼加提•吐尔逊 Akliya·Anwar;Nafisa·Gupur;Baibugafu·Yelisi;Zilalai·Gulaiti;Guzalnur·Emrayim;Nijat·Tursun(Department of Stomatology,Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830063,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第二附属医院口腔科,新疆维吾尔自治区乌鲁木齐市830063

出　　处：《中国组织工程研究》2025年第30期6416-6425,共10页Chinese Journal of Tissue Engineering Research

基　　金：新疆维吾尔自治区自然科学基金(2021D01C362),项目负责人:尼加提·吐尔逊。

摘　　要：背景:在口腔种植修复领域,上颌后牙区域常面临由多重因素交织导致的骨量萎缩问题,这一现象极大地提升了手术的复杂性。为了增进手术远期成功率,缓解患者承受的不适,同时追求手术流程的简化与时间的缩短,上颌窦内提升技术是无需额外植骨的即刻负重方法,已成为一种广泛应用的策略。针对不同剩余牙槽骨高度的个体情况,精准选择适宜的种植修复方案,对于确保种植体的长久稳定性和维持周围骨组织的健康水平而言,具有至关重要的决定性作用。目的:利用三维有限元法分析不同牙槽骨剩余骨高度条件下植骨或不植骨时,上颌磨牙即刻负重模拟口腔动态咬合过程对种植体、骨组织应力分布的影响。方法:获取1例需提升上颌窦区域行种植修复患者的锥形束CT数据,通过Mimics 21.0软件建立上颌骨模型。将颌骨模型导入Solidworks 2017软件后,分别构建上颌第一磨牙牙槽骨高度10 mm常规单冠修复体模型和牙槽骨高度7,5,3 mm植骨或不植骨单冠修复体模型。在ANSYS Workbench 17.0软件中模拟后牙动态咬合过程,分别在上颌第一磨牙功能尖颊舌斜面进行动态加载,分析不同牙槽骨高度植骨与否在即刻动态加载下周围骨组织的应力分布情况。结果与结论:①在不同牙槽骨高度组中,种植体于咬合周期各阶段均显示应力集中于颈缘骨组织;②对于植骨与不植骨各剩余牙槽骨高度的情况,种植体周边骨应力增长最大幅度均现于第三阶段(>0.150-0.260 s),在第四阶段(>0.260-0.300 s)等效应力均达峰值;牙槽骨高度3 mm时,不植骨组各咬合阶段等效应力峰值均较植骨组增大;牙槽骨高度5 mm时,不植骨组在第三、四阶段周围骨应力较大;牙槽骨高度7 mm时,植骨与否对应力分布不足以引起关注;③在不植骨情况下,随剩余牙槽骨高度减少,应力分布范围扩大,最大应力范围更为集中,特别是牙槽骨高度3 mmBACKGROUND:In the field of oral implant restorations,the maxillary posterior region is often confronted with bone atrophy caused by a combination of factors,a phenomenon that greatly increases the complexity of the procedure.To improve the long-term success rate of the surgery,alleviate the discomfort suffered by the patient,and at the same time pursue the simplification and shortening of the surgical process,the maxillary sinus lift technique,especially the immediate weight-bearing method without additional bone grafting,has become a widely adopted strategy.The precise selection of the appropriate implant restoration plan for each individual case with different residual alveolar bone heights is crucial and decisive for ensuring the long term stability of the implant and maintaining the healthy level of the surrounding bone tissue.OBJECTIVE:To analyze the influence of immediate loading of maxillary molars simulating dynamic occlusion on the stress distribution of implants and bone tissue under different residual alveolar bone height conditions with or without bone grafting using three-dimensional finite element method.METHODS:Cone-beam CT data of one patient who needed to elevate the maxillary sinus region for implant restoration were obtained,and the maxillary model was constructed by Mimics 21.0 software.After importing the maxillary model into Solidworks 2017 software,the maxillary first molar alveolar bone height of 10 mm conventional single crown restoration model was constructed 7,5,3 mm bone-implanted or non-bone-implanted single crown restoration model,respectively.The dynamic occlusion process of posterior teeth was simulated in ANSYS Workbench 17.0 software,and dynamic loading was carried out in the buccolingual bevel of the functional cusp of the maxillary first molar,respectively,to analyze the stress distribution of the surrounding bone tissues under the immediate dynamic loading of bone grafting with or without bone grafting at different alveolar bone heights.RESULTS AND CONCLUSION:(1)In the groups

关 键 词：牙槽骨高度 种植修复体 上颌窦内提升 动态载荷 咬合 应力 骨组织 植骨 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学] R783.4