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新型个体化下颌骨种植体修复严重萎缩牙槽嵴的有限元评估

Finite Element Assessment of a Novel Patient-Specific Mandibular Implant for Severely Atrophic Ridge.

机构信息

Department of Maxillofacial Surgery School of Dentistry Tehran University of Medical Sciences, Tehran, Iran.

School of Mechanical Engineering College of Engineering University of Tehran, Tehran, Iran.

出版信息

Biomed Res Int. 2024 Aug 29;2024:9735427. doi: 10.1155/2024/9735427. eCollection 2024.

DOI:10.1155/2024/9735427
PMID:39238768
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11377113/
Abstract

Dental reconstruction for patients diagnosed with severe mandibular bone atrophy using common dental implants is a challenging process. In such cases, surgeons may encounter challenges such as insufficient available bone, soft tissue, damage to the inferior alveolar nerve, and even the risk of bone fracture. In this study, a new design concept of mandibular patient-specific implants for severely atrophic ridges followed by finite element evaluation was presented to investigate the mechanical functionality of the concept. The implant is comprised of two modular parts including an inferior border cover and a horseshoe-shaped structure. This horseshoe segment fits into the cover and is then screwed to it using two screws on each side. A 1 mm deflection was applied to a reference point located between the two anterior posts to extract the resulting Von Mises stress distribution in each part and the reaction force on the reference point which corresponds to the chewing force that the patient must apply to deform the horseshoe. This 1 mm gap is a design consideration and critical distance that horseshoe contacts the gingiva and disturbs the alveolar nerve. The results revealed that load was transmitted from the horseshoe to the cover, and there were no stress contours on the body of the mandible. However, stress concentration was observed in screw locations in the mandible, the amount of which was decreased by increasing the number of used screws. In horseshoe, stress concentration values were around 350 MPa, and the measured reaction force on the reference point was just under 200 N. The finite element analysis results showed that this concept would be functional as the minimum load would be transmitted to the mandibular ridge, and since the patients diagnosed with atrophic ridge are not able to apply load to an amount near 200 N, the horseshoe would not contact the gingiva. Also, it is concluded that increasing the number of bone screw fixations would decrease the risk of long-term screw loosening.

摘要

对于诊断为严重下颌骨萎缩的患者,使用普通牙种植体进行牙齿重建是一个具有挑战性的过程。在这种情况下,外科医生可能会遇到诸如可用骨量不足、软组织问题、下牙槽神经损伤,甚至骨折风险等问题。在这项研究中,提出了一种新的下颌骨患者特异性种植体设计概念,用于严重萎缩牙槽嵴,并通过有限元评估来研究该概念的机械功能。该种植体由两个模块组成,包括下颌骨下缘覆盖体和马蹄形结构。马蹄形部分嵌入覆盖体中,然后用两侧的两颗螺丝将其拧到覆盖体上。在位于两个前柱之间的参考点上施加 1 毫米的挠度,以提取每个部分的 Von Mises 应力分布和参考点上的反作用力,该反作用力对应于患者必须施加的咀嚼力,以使马蹄形发生变形。这个 1 毫米的间隙是设计考虑因素和关键距离,马蹄形接触牙龈并干扰牙槽神经。结果表明,载荷从马蹄形传递到覆盖体,下颌骨体没有应力轮廓。然而,在下颌骨的螺丝位置观察到了应力集中,增加使用的螺丝数量可以减少这种集中。在马蹄形中,应力集中值约为 350 MPa,参考点上测量的反作用力略低于 200 N。有限元分析结果表明,该概念将具有功能性,因为最小载荷将传递到下颌骨嵴,并且由于诊断为萎缩嵴的患者无法施加接近 200 N 的载荷,所以马蹄形不会接触到牙龈。此外,还得出结论,增加骨螺丝固定的数量可以降低长期螺丝松动的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3629/11377113/4a0c69125b50/BMRI2024-9735427.009.jpg
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