下顎全口無牙患者施行 All-on-4 人工植牙周邊骨質應力分析

Bone Stress Analysis in "All-on-Four" Implantation for Completely Edentulous Mandibles

顧紹彤(Shau-Tung Ku)

指導教授 ： 黃漢邦 ； 黃恆立

國立臺灣大學/工學院/機械工程學研究所/碩士(2016年)

https://doi.org/10.6342/NTU201601444

摘要

這項研究的目的在於針對在不同萎縮程度下顎骨下，使用?All-on-four”植牙手術方式，在不同鬆質骨骼強度、植體種類、後方質體植入角度及不同植體長度，承受咀嚼力時周遭骨質的受力。
　　?All-on-four”是一種植牙手術方式，藉由植入四根植體於兩頦孔之間，用以支撐及固定全口無牙患者之假牙。然而，因應不同手術環境需考量多種植牙時可能面臨的變數。本研究藉由CT掃描，建立兩種三維下顎全口無牙的下顎骨模型，一種代表輕微下顎骨萎縮，另一種則是中度下顎骨萎縮。每一種萎縮骨骼分別都有兩種不同強度的鬆質骨。如此設計，是為了能夠模擬不同生理及病理狀況的病人骨骼。此外，就植體選擇方面，本研究選擇NobelActive及NobelSpeedy兩種植體，並使用長、中、短三種植體長度。在植體放置分面，前側植體垂直植入下顎骨，而後側植體則有傾斜30度以及垂直兩種植入方式。咀嚼力受力則分別使用55 N、65 N及150 N，分別代表側門牙、犬齒及第二大臼齒咀嚼時所施加的力量。當變數設定完成，便能模擬出靜力下周遭骨質的受力。
　　根據有限元素分析在四根植體支撐下所得到的受力的大小以及分布，我們將得到在環境下受力表現最佳的植體，並給予臨床醫師使用植體種類、長度及傾斜角度的建議，能夠減緩病患在治療療程中有骨質劣化和吸收等問題。

關鍵字

All-on-four ； 萎縮下顎骨 ； 有限元素分析 ； 牙科植體

並列摘要

The aim of this thesis is to evaluate the von Mises stress in the peri-implant bone of an “All-on-four” implant supported prosthesis through finite element analysis using different types of bone, implant types, posterior implant angle and implant lengths under three kinds of mastication force.
　　“All-on-four” is a kind of implant protocol that inserts four implants between the mental foramina in placing a fixed prosthesis on an edentulous mandible. However, different treatment alternatives with various implant designs and surrounding conditions were performed in an edentulous mandible. Two 3D models of a human edentulous mandible were generated by CT scanner, one representing slight atrophy and the other representing moderate atrophy. Each mandibular bone has two bone types showing different biomechanical features, based on various patients physiological and pathological conditions. Two types of implant: NobelActive and NobelSpeedy with three different lengths (long/medium/short) were used. The two anterior implants were inserted in a parallel manner and the two distal implants were placed axially or tilted 30 degrees in each model. Three loading conditions (55 N / lateral incisor, 65 N / canine and 150 N / left second molar) were considered, and von Mises stress values in the peri-implant bone were determined.
　　Based on information and the stress distribution from finite element analysis of prosthesis supported by four implants, we are able to offer clinical dentists and patients suggestions regarding which kind of implant protocol may be more favorable under differing patients’ conditions, so as to avoid potential bone resorption, which may then facilitate bone deterioration during the treatment.

並列關鍵字

All-on-four ； atrophic mandible ； finite element analysis ； dental implant

參考文獻

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