自然牙併合植體支持贋復體於三單元牙橋之臨床結果及生物力學分析：整合分析與有限元素分析

Clinical outcomes and biomechanical analysis of three-unit dental bridge combined with tooth-implant supported prosthesis: A meta-analysis and a finite element analysis

黃彥彰(Yen-Chang Huang)

指導教授 ： 燕敏

中山醫學大學/口腔醫學院/口腔科學研究所/博士(2022年)

https://doi.org/10.6834/csmu202200078

摘要

目的：結合自然牙與植體的三單元牙橋為部分缺牙的患者提供了擴展治療計畫的可能性。本研究的目的首先對文獻中之臨床試驗進行系統性回顧及整合分析，以評估與植體支持贋復體(Implant supported prosthesis，ISP)相比之自然牙併合植體支持贋復體(Tooth-implant supported prosthesis，TISP)三單元陶瓷熔付金屬(Porcelain-fused-to-metal，PFM)其重建結果與併發症。其次，牙橋連接器和植體支臺的設計可能會影響 TISP 整個系統在咬合負載後的應力分佈。因此，本研究的另一個目的是研究負載後不同連接器和不同植體支臺於TISP系統中的應力分佈。材料和方法：第一項研究先於PubMed、Embase和Cochrane數據庫中搜索了2021年2月之前發表的文章。隨後以整合分析使用隨機效應模型來計算總體效應大小。該研究在PROSPERO註冊(編號：CRD 42021232606）。另一項研究設計則建構六個用於有限元素分析(Finite element analysis，FEA)的TISP模型。R1、R2和R3分別代表牙齒和通過剛性連接器連接的一件式、兩件式和三件式植體支臺系統，而 NR1、NR2和NR3則是相應的通過以非剛性連接器連接之植體支臺系統。在各個模型咬合面以300N垂直咬合施力均佈負載於牙冠的6個咬合點上。結果：在本研究的整合分析中，包括 2004年至 2015年間發表的七篇文章，樣本量從10到250名患者不等。TISP組和ISP組的贋復體失敗率、植體失敗率、贋復體併發症發生率、植體併發症發生率和植體邊緣骨水平變化於統計學上無顯著差異。在TISP組中，自然牙的失敗率在0% 到 4.3%之間，與自然牙相關的生物併發症報告則在0%到26.9%之間。有限元素分析之最大平均應力分佈，R1和NR1出現在植體本體上，其他四個模型則出現在植體支臺上。另一方面，無論植體支臺系統如何，剛性連接器產生的最大von Mises 應力皆大於植體周圍皮質骨中相應的非剛性連接器。此外，三件式植體支臺系統的von Mises應力皆低於皮質骨中的一件式和兩件式之植體支臺系統。結論：三單元短跨距TISP是後牙缺失患者潛在可靠的治療選擇。此外，通過在TISP中加入非剛性連接器和三件式支臺裝置設計，不僅可分散植體的咬合負荷，同時應力也可以逐漸引入到相對堅固的植體支臺內。

關鍵字

自然牙併合植體 ； 贋復體故障率 ； 植體失敗率 ； 整合分析 ； 有限元素分析 ； 應力分佈

並列摘要

Background/purpose: The three-unit bridge that combines a natural tooth and an implant provides extended treatment possibilities for partially edentulous patients. The purpose of this study was to conduct a systematic review and meta-analysis of clinical trials to evaluate three-unit porcelain-fused-to-metal (PFM) tooth-implant supported prosthesis (TISP) compared with implant supported prosthesis (ISP) reconstruction outcomes and complications. The design of the connectors and implant abutments could affect the stress distribution of the TISP entire system after loading. Therefore, another purpose of this study was to investigate the stress distribution of the TISP in different connectors and different implant abutments after loading. Materials and methods: One of the study the PubMed, Embase, and Cochrane library databases were searched for articles published before February 2021. The meta-analysis used a random-effects model to calculate overall effect size. The study was registered with PROSPERO (number: CRD 42021232606). Another study design was divided into six TISP models for finite element analysis (FEA). R1, R2 and R3 represented the tooth and the one-piece, two-piece and three-piece abutment implant system connected by a rigid connector, respectively, while NR1, NR2 and NR3 were the corresponding tooth-abutment implant systems connected by a non-rigid connector. The 300N vertical occlusal force was evenly distributed on the 6 occlusal points. Results: In meta-analysis of this study seven articles published between 2004 and 2015, with sample sizes ranging from 10 to 250 patients were included. No significant difference in the prosthesis failure rate, implant failure rate, prosthesis technical complication rate, implant technical complication rate, and marginal bone level change was observed between the TISP group and the ISP group. In TISP group, natural tooth failure rate was reported to range from 0% to 4.3%, biological complication related to the natural tooth was reported to range from 0% to 26.9%, and no trial reported natural tooth intrusion. As a result of FEA, regarding the maximum average stress distribution, R1 and NR1 appeared on the implant fixture, and the other four models were on the implant abutment. On the other hand, regardless of the abutment implant system, the maximum von Mises stress generated by the rigid connector was greater than the corresponding non-rigid connector in the cortical bone around implant. In addition, the three-piece abutment implant system had lower von Mises stress than the one-piece and two-piece implant systems in the cortical bone. Conclusion: The three-unit short-span TISP is a potentially reliable treatment option for patients with missing posterior teeth. In addition, by adding a flexible non-rigid connector and three-piece abutment device design to TISP, the occlusal load of the implant was dispersed, and the stress could be gradually introduced into the relatively strong implant abutment.

並列關鍵字

Tooth-implant supported prosthesis ； Prosthesis failure rate ； Implant failure rate ； Meta-analysis ； Finite element analysis ； Stress distribution

參考文獻

1. Uhac I, Kovac Z, Vukovojac S, Zuvić-Butorac M, Grzić R, Delić Z. The effect of occlusal relationships on the occurrence of sounds in the temporomandibular joint. Coll Antropol 2002;26:285-92.

2. Kaplan P. Drifting, tipping, supraeruption, and segmental alveolar bone growth.

J Prosthet Dent 1985;54:280-3.

3. Pal TK. Fundamentals and history of implant dentistry. Journal of ICDRO 2015;7:6-12.

4. Johns RB, Jemt T, Heath MR et al. A multicenter study of overdentures supported by Brånemark implants. Int J Oral Maxillofac Implants 1992;7:513–522.