All-on-Four和上颌窦提升技术对不同骨质上颌骨应力分布影响的三维有限元分析

摘要/Abstract

摘要： 目的：利用三维有限元分析，比较上颌后牙区骨量不足无牙颌患者在不同骨质条件下，分别采用All-on-Four、上颌窦提升技术时种植体、皮质骨的应力值及钛支架变形量的差异。方法：选取1例牙列缺失上颌骨锥形束CT数据，建立D2、D3、D4三类骨质的实体化模型，在每种骨质下设计两种种植方案，根据有无悬臂于双侧后牙区分别施加200?N垂直载荷，共计12个模型，计算出种植体、皮质骨的von Mises应力值及钛支架的变形量，并进行统计学分析。结果：有悬臂时种植体和皮质骨的von Mises应力值及钛支架变形量显著大于无悬臂时的各项值（P＜0.05）；上颌窦提升组的种植体、皮质骨von Mises应力值及钛支架变形量均小于All-on-Four组（P＜0.05）；当骨质类型为D4时，模型中种植体、皮质骨的von Mises应力值及钛支架变形量最大，随着骨质密度的增加，种植体、皮质骨的von Mises应力值及钛支架变形量逐渐减小。结论：上颌窦提升种植设计显示出更优的生物力学行为，适合各类骨质的种植修复。当骨质类型为D2时，可考虑选择All-on-Four技术，应减少或避免悬臂；当骨质类型为D4时，All-on-Four技术应谨慎使用。

关键词: 种植修复, 上颌无牙颌, All-on-Four, 上颌窦提升术, 骨质量, 有限元分析

Abstract: Objective：To compare the difference of implant and cortical bone stress value and the deformation value of titanium frame, in the design of All-on-Four and maxillary sinus floor augmentation with varies bone qualities, using finite element analysis in maxillary edentulous with insufficient bone mass in posterior tooth area. Methods:The CBCT data of a maxillary edentulous was selected to establish the solid models of D2, D3 and D4 bone quality. Two implant schemes were designed under each kind of bone quality, and a total of 12 models were applied 200 N vertical load on both posterior teeth with or without cantilever. Then, the von Mises stress values of implants and cortical bones and the deformation of titanium frame were calculated and statistically analyzed. Results:The von Mises stress of implant and cortical bone and the deformation of titanium frame with cantilever were significantly higher than those without cantilever, and the difference was statistically significant (P＜0.05). The von Mises stress of implant and cortical bone and the deformation of titanium frame in maxillary sinus floor augmentation group were lower than those in All-on-Four group, and the difference was statistically significant (P＜0.05). When the bone type was D4, the von Mises stress value of implant and cortical bone and the deformation of titanium frame were the largest. With the increase of bone quality, the von Mises stress value of implant and cortical bone and the deformation of titanium frame decreased gradually. Conclusions:The maxillary sinus floor augmentation showed more favorable biomechanical behavior than All-on-Four, which was suitable for all kinds of bone qualities. The increase of bone quality was beneficial to the overall stress distribution. When the bone type was D2, we could consider choosing All-on-Four for repair, but the cantilever should be reduced oravoided. When the bone type was D4, the All-on-Four technique should be used cautiously.

Key words: implant restoration, maxillary edentulous jaws, All-on-Four, maxillary sinus floor augmentation, bone quality, finite elements analysis

朱琳顾卫平王璨. All-on-Four和上颌窦提升技术对不同骨质上颌骨应力分布影响的三维有限元分析[J]. 口腔生物医学, 2021, 12(3): 170-175.

参考文献 39

[1]	Buser D, Sennerby L, Bruyn HD. Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions [J] Periodontology 2000. 2017, 73(1):7-21.
[2]	Ramos CB, Tomas A, Ann W. Bone Quality and Quantity and Dental Implant Failure: A Systematic Review and Meta-analysis. [J] The International journal of prosthodontics. 2017, 30(3):219-237.
[3]	Farhad V, Gitanjali P-S. Complications associated with implant-retained removable prostheses. [J] Dental clinics of North America. 2015, 59(1):215-26.
[4]	A-W RI, Wafaa I, S ISM, et al. Prognosis of dental implants in patients with low bone density: A systematic review and meta-analysis. [J] The Journal of prosthetic dentistry. 2018，120(5):668-677.
[5]	Raghoebar G M, Onclin P, Boven G C, et al. Long-term effectiveness of maxillary sinus floor augmentation: A systematic review and meta-analysis[J]. Journal of clinical periodontology,2019,4621(SI):307-318
[6]	Aghaloo T L, Misch C, Lin G, et al. Bone Augmentation of the Edentulous Maxilla for Implant Placement: A Systematic Review[J]. International journal of oral & maxillofacial implants.2016,31S：S19-S30
[7]	David S-P, Regino Z-A, María P-D, et al. The all-on-four treatment concept: Systematic review. [J] Journal of clinical and experimental dentistry. 2017, 9（3）:e474–e488.
[8]	Ragucci GM, Elnayef B, Amo FS-Ld, et al. Influence of exposing dental implants into the sinus cavity on survival and complications rate: a systematic review. [J] Springer Berlin Heidelberg. 2019, 5(1):6.
[9]	汤春波.无牙颌种植固定修复术后并发症的反思与总结[J].口腔医学,2019,39(05):385-389.
[10]	Lisiak-Myszke M, Marciniak D, Bieliński M, et al. Application of Finite Element Analysis in Oral and Maxillofacial Surgery—A Literature Review [J] Materials. 2020, 13(14):3063.
[11]	Lekholm U, Zarb GA. Patient selection and preparation. Tissue integrated prostheses: osseointegration in clinical dentistry [M].Chicago: Quintessence Publishing Company, 1985: 199-209.
[12]	许月丹, 金鑫阳, 赵维家, 等. 种植义齿的咬合设计 [J] 口腔医学. 2020, 40（12）:1124-1128.
[13]	Kumari A, Malhotra P, Phogat S, et al. A finite element analysis to study the stress distribution on distal implants in an all-on-four situation in atrophic maxilla as affected by the tilt of the implants and varying cantilever lengths. [J] J Indian Prosthodont Soc. 2020,20(4):409-416.
[14]	Gallucci G O, Avrampou M, Taylor J C, et al. Maxillary Implant-Supported Fixed Prosthesis: A Survey of Reviews and Key Variables for Treatment Planning[J]. International journal of oral & maxillofacial implants.2016,31S:S192-S197.
[15]	Almeida EO, Rocha EP, Freitas Júnior AC, et al. Tilted and short implants supporting fixed prosthesis in an atrophic maxilla: a 3D-FEA biomechanical evaluation. [J] Clinical Implant Dentistry and Related Research. 2015,17 Suppl 1:e332-e342.
[16]	Durkan R, Oyar P, Deste G. Maxillary and mandibular all-on-four implant designs: A review [J] Nigerian Journal of Clinical Practice. 2019, 22(8):1033-1040.
[17]	Taylor TD.Prosthodontic complications associated with implant therapy[J]. Oral Maxillofac Surg Clin North Am. 1991,3:979-992.
[18]	Liu X, Pang F, Li Y, et al. Effects of Different Positions and Angles of Implants in Maxillary Edentulous Jaw on Surrounding Bone Stress under Dynamic Loading: A Three-Dimensional Finite Element Analysis [J] Computational and Mathematical Methods in Medicine. 2019, 2019:8074096
[19]	Kaleli N, Sarac D, Külünk S, et al. Effect of different restorative crown and customized abutment materials on stress distribution in single implants and peripheral bone: A three-dimensional finite element analysis study [J] The Journal of Prosthetic Dentistry. 2018, 119(3):437-445.
[20]	Li T, Yang X, Zhang D, et al. Analysis of the biomechanical feasibility of a wide implant in moderately atrophic maxillary sinus region with finite element method [J] Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2012, 114(2):e1-8.
[21]	Chang S-H, Lin C-L, Hsue S-S, et al. Biomechanical analysis of the effects of implant diameter and bone quality in short implants placed in the atrophic posterior maxilla [J] Medical Engineering and Physics. 2012, 34(2):153-60.
[22]	蒋煜彬, 顾卫平, 陈岗, 等. 紧咬型磨牙对后牙游离端种植体周围骨组织应力分布的有限元研究 [J] 口腔医学. 2019, 39（05）:409-413.
[23]	AL-zabib T, 王佐林. 上颌窦底提升不同高度对种植义齿受力影响的三维有限元分析 [J]. 口腔颌面外科杂志. 2012, 22（03）:192-196.
[24]	Giovanni F, Simone T, Dario V, et al. Three-dimensional finite element analysis of different implant configurations for a mandibular fixed prosthesis. [J] The International journal of oral & maxillofacial implants. 2011, 26(4):752-9.
[25]	施斌,吴涛.种植修复体机械并发症的原因、预防及处理[J].口腔疾病防治,2018,26(07):415-421.
[26]	Emami E, Michaud PL, Sallaleh I, et al. Implant-assisted complete prostheses.[J] Periodontology 2000. 2014, 66(1), 119–131.
[27]	Marco Cicciù. Bioengineering Methods of Analysis and Medical Devices: A Current Trends and State of the Art[J]. Materials,2020,13(3):797.
[28]	Gabriele C, Luca F, V AA, et al. Application of bioengineering devices for stress evaluation in dentistry: the last 10 years FEM parametric analysis of outcomes and current trends. [J] Minerva stomatologica. 2020, 69(1):55-62.
[29]	Paulo M, Bo R, Miguel N. "All-on-Four" immediate-function concept with Br?nemark System implants for completely edentulous mandibles: a retrospective clinical study. [J] Clinical implant dentistry and related research. 2003, 5 Suppl 1:2-9.
[30]	满毅,袁珊珊,赵磊,等.上颌窦提升术的历史、现状和发展[J].国际口腔医学杂志,2014,41(06):621-627
[31]	Tatum H Jr. Maxillary and sinus implant reconstructions. [J] Dental clinics of North America. 1986,30(2):207-229.
[32]	Summers R B. A new concept in maxillary implant surgery: the osteotome technique.[J]. Compendium (Newtown, Pa.),1994,15(2):152-162.
[33]	JiHyun K, YoungJun L, Bongju K, et al. How Do Parameters of Implant Primary Stability Correspond with CT-Evaluated Bone Quality in the Posterior Maxilla? A Correlation Analysis [J] Materials. 2021, 14(2):270.
[34]	Drago C, Howell K. Concepts for designing and fabricating metal implant frameworks for hybrid implant prostheses[J]. J Prosthodont. 2012;21(5):413-424.
[35]	Mustafa Y, Beyza K, Nihat L, et al. Three-Dimensional Finite Element Analysis of the Effect of Endosteal Implants with Different Macro Designs on Stress Distribution in Different Bone Qualities. [J] The International journal of oral & maxillofacial implants. 2019, 34(3):e43–e50.
[36]	Staden RCV, Guan H, Loo YC. Application of the finite element method in dental implant research [J] Computer Methods in Biomechanics and Biomedical Engineering. 2006, 9(4):257-70.
[37]	Saber FS, Ghasemi S, Koodaryan R, et al. The Comparison of Stress Distribution with Different Implant Numbers and Inclination Angles In All-on-four and Conventional Methods in Maxilla: A Finite Element Analysis [J] Journal of Dental Research, Dental Clinics, Dental Prospects. 2015, 9(4):246-53.
[38]	JunYu S, ShuJiao Q, YingXin G, et al. Long‐term outcomes of osteotome sinus floor elevation without grafting in severely atrophic maxilla: A 10‐year prospective study [J] Journal of Clinical Periodontology. 2020, 47(12):1528-1535.
[39]	Debora Armellini,J. Anthony von Fraunhofer. The shortened dental arch: A review of the literature[J]. The Journal of Prosthetic Dentistry,2004,92(6) :531-535.