上海交通大学学报(医学版)

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种植体支持的覆盖可摘义齿修复下颌KennedyⅠ类缺损及其支持组织的应力分析

张硕 1,范锐 2﹡,郑元俐 3   

  1. 1. 北京大学口腔医院第三门诊部综合一科,北京 100091;2. 上海市普陀区中心医院口腔科,上海 200062;3. 上海交通大学医学院附属第九人民医院口腔特需科,上海 200011
  • 出版日期:2017-04-28 发布日期:2017-05-04
  • 通讯作者: 郑元俐,电子信箱:zhengyuanli@yahoo.com。
  • 作者简介:张硕(1987—),女,住院医师,硕士生;电子信箱:772877356@qq.com。范锐(1976—),男,主治医师,学士;电子信箱:fanrui1015@163.com。*并列第一作者。

Stress analysis of the supporting tissues for mandibular Kennedy Class Ⅰ defect repaired with removable partial dentures supported by implants

ZHANG Shuo1, FAN Rui2 * , ZHENG Yuan-li3   

  1. 1. General Department, 3rd Dental Center, Peking University Hospital of Stomatology, Beijing 100091, China; 2. Department of Stomatology, Shanghai Putuo District Central Hospital, Shanghai 200062, China; 3. Special Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2017-04-28 Published:2017-05-04

摘要:

目的 ·应用三维光弹性应力分析法,比较不同直径种植体支持的覆盖RPI型可摘局部义齿与常规RPI型可摘局部义齿在垂直载荷下基牙、缺牙区牙槽骨及种植体周围的应力分布情况。方法 ·选取标准下颌模型,制备形成下颌Kennedy Ⅰ类牙列缺损。在双侧第一磨牙区分别植入不同直径(4.1 mm和3.3 mm)的Straumann系统软组织水平种植体各2枚。将种植钉及环氧树脂牙倒置于下颌硅橡胶阴模中,制作环氧树脂光弹模型,并将RN愈合基台旋入种植体内。将含有模拟2 mm厚的牙槽黏膜及下颌传统RPI型可摘局部义齿置于环氧树脂模型上(分别为含种植体和不含种植体),正中咬合状态下对模型垂直加载 1 kg力。应力冻结后,切取相应牙位的模型切片,观测应力条纹图样,以单位厚度的条纹级数值计算应力大小。结果 ·常规RPI型可摘局部义齿远中基牙的最大应力值主要集中在根尖区,其缺牙区牙槽骨中最大应力集中在第一磨牙区,且集中在牙槽骨舌侧。种植体支持的覆盖RPI型可摘局部义齿远中基牙最大受力值小于常规RPI型可摘局部义齿远中基牙的最大受力,同时其缺牙区牙槽骨(不含种植体部分)最大受力与基牙及其支持组织的受力接近,且最大受力值小于常规RPI型。种植体周围应力最大,且种植体尖周应力值大于颈部应力值。同时,随着种植体直径变小,其种植体周围最大应力值相对变大。结论 ·与常规RPI型可摘局部义齿比较,种植体支持的覆盖
RPI型可摘局部义齿的稳定性增加,支持组织的受力更趋均衡,对基牙及其缺牙区支持组织的健康有利。

关键词: 种植体支持, 可摘局部义齿, 光弹法

Abstract:

Objective · To compare the stress distribution at abutments, edentulous ridge, and peri-implant tissue under the vertical load between the RPI-type removable partial denture supported by implants with different diameter and the conventional RPI-type removable partial denture using a three-dimensional photoelastic method. Methods · The mandibular Kennedy I type denture defect models were fabricated according to the standard mandibular model. Four Straumann system soft tissue level implants with different diameters (two 4.1 mm implants and two 3.3 mm implants) were implanted into the bilateral first molar areas. Planting nails and epoxy resin teeth were inversely put into the mandibular silicone rubber molds to fabricate the epoxy resin photoelastic models and the regular neck (RN) healing abutments were screwed into the implants. A simulated alveolar mucosa with thickness of 2mm and a conventional RPI-type removable partial denture were placed on the epoxy resin models with or without implants. Then a force of 1 kg was vertically applied by a bite force loading device which fixed the model and denture in the centric occlusion. After the stress was frozen, model slices at different areas were cut and the stress fringes were observed. The stress was calculated according to the fringe value of per unit thickness. Results · For the conventional RPI-type removable partial denture, the maximum stress of distal abutment was mainly concentrated on the apical regions and the maximum stress of edentulous ridge was concentrated on the first molar area, particular on the lingual side of alveolar bone. For the implant-supported RPI-type removable partial denture, the maximum stress of distal abutment was lower than that of the conventional RPI-type removable partial denture, and the maximum stress of edentulous ridge (without the implants) was similar to that of abutment and supporting tissues and was lower than that of the conventional RPI-type removable partial denture. The stress around the implant was the largest and the peri-apical stress of implant was greater than the neck stress of implant. Meanwhile, the maximum stress around the implant was increased with the decrease of implant diameter. Conclusion · Compared to the conventional RPI-type removable partial denture, removable partial dentures supported by implants are more stable with a more balanced stress distribution in supporting tissues, thus benefit the health of abutments and supporting tissues.

Key words:  implant-supported, removable partial denture, photoelastic method