- 學位論文
外接式及內接式牙科植體之不同水平偏移程度平台轉換對於嵴骨區應力改變之影響:利用應變規分析
Effects of Different Horizontal Offset Platform Switching on the Crestal Bone Stress in Dental Implants with External and Internal Connections: A Strain Gauge Analysis
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摘要
實驗目的: 植體周圍骨質應力會影響植體早期或晚期齒槽嵴骨的吸收狀況，進而影響植體的癒後。本研究的目的是利用電阻式應變規的技術來評估（1）在三種力量：正中垂直力量、側方垂直力量、水平力量的施力下，外接式與內接式植體的補綴物有無平台轉換在相對於嵴骨區域的位置其應變量之比較（2）在相對於嵴骨區域的位置應變量是否隨著水平偏移愈大而減少。 實驗方法: 選用外、內六角各2種不同平台尺寸的BIOMET 3i植體（OSSEOTITE® Parallel Walled Implants, BIOMET 3i, Palm Beach Gardens, USA），直徑分別為5.0㎜、6.0㎜，長度均為13mm，共4支植體，分別將植體包埋在寬高長分別為20x22x70 mm 的環氧樹脂塊之中，露出至植體平台下1mm的部分。四組電阻應變計(EA-00-031CE-350)分別黏貼於植體平台周圍的近心，舌側、遠心及頰側的樹脂表面，之後選用數位齒雕系統製作客製化支台齒，尺寸10＊10＊11.5㎜鈦金屬長方體。分別施以3組不同方向力量：（1）正中垂直靜力（2）偏舌側垂直靜力：距離支柱牙舌側邊緣1mm施力（3）水平靜力：距離支柱牙冠側邊緣1mm，由頰側往舌側施力，每組力量分三種不同程度施與，分別是(10N;30N；50N),每種力量每次施以五秒鐘，每組力量共施予10次。從應變規上面得到的資料加以記錄及分析。 實驗結果: 1.於正中垂直施力下，有無平台轉換設計對於植體周圍應變量變化並無規律性影響。2.於舌側垂直施力下，不論植體尺寸或組別屬於內接式或外接式，有平台轉換設計的支柱牙，植體周圍應變量會較小。且有趨勢當水平偏移程度愈大，植體周圍測得之應變量會愈小。當力量愈大時，平台轉換造成的應變量差異會更明顯，也愈容易有統計學上的差異。3.於水平施力下，不論植體尺寸或組別屬於內接式或外接式，有平台轉換設計支柱牙其植體周圍應變量會有較小的趨勢。當水平偏移程度愈大，植體周圍測得之應變量會有愈小的趨勢；當施予力量愈大時，此種趨勢會變得更明顯，愈容易有統計學上的差異。4.於舌側垂直施力和水平施力下，各組別應變減少百分比（％）顯示出外接式植體平台轉換造成植體周圍應變減少百分比（％）較內接式植體有較大的趨勢。 結論:實驗結果顯示在非軸向力量時，不論植體尺寸或組別屬於內六角或外六角，有平台轉換設計的植體周圍應變量會有較小的趨勢。且有當platform switching的水平平台程度愈大，植體周圍測得之應變量會愈小的趨勢。當力量愈大時，這些趨勢會更明顯，也愈容易有統計學上的差異。此外，應變減少百分比（％）顯示出外接式植體平台轉換造成植體周圍應變減少百分比（％）較內接式植體大的趨勢。
並列摘要
Objectives: The stress around implants has been considered to affect the prognosis of implant therapy. The purpose of this study was to evaluate the effects of platform switching on the peri-implant bone strain in dental implants with external and internal connections, with strain gauge technique, under three different loads: the central vertical load, the lingual vertical load, the horizontal load. The other purpose was to evaluate whether increasing the degree of horizontal offset resulted in decreasing the peri-implant bone strain. Methods: Four types of implant：external hex connection and internal hex connection platform implant（OSSEOTITE® Parallel Walled Implants, BIOMET 3i, Palm Beach Gardens,USA）, length 13㎜ with different diameter 5.0 ㎜, 6.0 ㎜, were embedded in a 20 x 22 x 70 mm (width x height x length) epoxy resin block. Four strain gauges (EA-00-031CE-350) were bonded on resin surface adjacent to the buccal, mesial , lingual , and distal side of the implant platform. A CAD-CAM 10 x 10 x 11.5 ㎜ (width x length x height) tetragonal column customized abutments was fabricated. Three types of load were applied (vertical loads at two locations:the central vertical load, the lingual vertical load, and a horizontal load) with three different intensities (10N, 30 N and 50N). Each load was repeated 10 times and the data from the strain gauge were recorded and analyzed. Results: 1. Under the central vertical load, the platform switching design did not change peri-implant bone strain tendancy significantly. 2. Under the lingual vertical load, there was a tendency that the platform switching design decreased peri-implant bone strain. The greater amount of horizontal shifting, the smaller the peri-implant bone strain. When the applied load was larger, the tendency of reduced bone strain became more statistically significant. 3. Under the horizontal load, the trend was similar to that under lingual vertical load. 4. There was a difference between external hex connection and internal hex connection groups. Under the off-axis load, the reduction percentage of peri-implant bone strain in platform switching group of the internal hex connection group was not as large as that of the external hex connection. Conclusions: The data suggested that under off-axis load, there was a trend that the platform switching design decreased peri-implant bone strain in both external and internal connection groups. The greater amount of horizontal shifting, the smaller the peri-implant bone strain. When the applied load was larger, the tendency become more statistically significant. However, the reduction percentage in peri-implant bone strain in platform switching group of the internal hex connection group was not as large as that of the external hex connection under the off-axis force application.
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