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研究生： 蔡依寧
Tsai, Yi-Ling
論文名稱： 植體固位式覆蓋義齒之生物力學評估:有限元素分析
Biomechanical Evaluation of Implant-Retained Overdenture: Finite Element Analysis
指導教授： 張志涵
Chang, Chih-Han
共同指導教授: 劉保興
Liu, Pao-Hsin
學位類別： 碩士
Master
系所名稱： 工學院 - 生物醫學工程學系
Department of BioMedical Engineering
論文出版年： 2013
畢業學年度： 101
語文別： 英文
論文頁數： 83
中文關鍵詞： 植體固位式覆蓋義齒 、有限元素分析 、植體數量 、植體分布 、皮質骨厚度
外文關鍵詞： Implant-retained overdenture, Finite element analysis, Implant number, Implant distribution, Cortical thickness
相關次數： 點閱：128  下載：7 
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    • 全口無牙為台灣老年患者常見的口腔疾病之一，其治療方式主要分為兩種形式:傳統假牙以及覆蓋義齒，然而植體式覆蓋義齒是現今最常用的技術，例如植體固位式覆蓋義齒，但是對於其植體數量，植體分布以及皮質骨厚度在生物力學上的影響尚未釐清。此外，兩根植體固位式覆蓋義齒廣泛使用於無牙患者並且主要植入於前牙區域。然而為何選用數量較少的植體且植入於前牙區的原因需要作進一步的探討。本研究的目的為使用有限元素分析探討具有完整解剖結構的植體固位式覆蓋義齒在不同的植體數量、植體分布以及皮質骨厚度參數下生物力學之影響。
    三維有限元素模型包括上顎、食團、覆蓋義齒、黏膜、附連體、植體以及下顎骨(皮質骨及海綿骨)，並搭配三種植體分布、三種植體數量(2根、3根及4根)和三種皮質骨厚度組合成19組模型，以探討各參數對於植體固位式覆蓋義齒之生物力學影響，並進一步探討植體固位式覆蓋義齒之應力、應變及穩定度與植體及覆蓋義齒斷裂之關聯性。
    研究結果顯示在植入兩根植體固位式覆蓋義齒於前牙區時，在各元件上有較低的應力值並提供較佳的穩定度，而在多根植體固位式覆蓋義齒時植體植入越往後牙區，降低應力的效果更為顯著；在覆蓋義齒、附連體以及植體上之最大等效應力植均未達到材料之降伏應力，反之，在植體周圍骨頭上之最大應變皆超過文獻所示之標準值(4000 microstrain)可能導致骨頭吸收。然而，在本研究中皮質骨厚度所造成的影響較無植體分布來得顯著。
    本研究中對於植體數量之生物力學行為可明顯看出兩根植體固位式覆蓋義齒較多根植體固位式覆蓋義齒佳，這也表示臨床上使用兩根植體固位式覆蓋義齒確實可以獲得較好的成功率。

    Overdenture combing with dental implant is the most common technique nowadays, such as implant-retained overdenture, but the influences of biomechanics in parameters of implant number, implant distribution, and cortical thickness are unclear. Moreover, two-implant-retained overdenture, which was mainly inserted at anterior region of dentition was widely used in edentulous patient. The reasons why less implants were chosen and where the implants were inserted at the anterior area should be further investigated. The purpose of this study is to investigate biomechanical effects of parameters in implant number, implant distribution and cortical thickness using complete anatomical structure of the implant-retained overdenture model by three-dimensional finite element (FE) analysis.
    FE model, which was consisted of maxilla, food, overdenture, mucosa, attachments, implants and mandible, was constructed combining with three types of implant distributions, implant numbers (insertion of two, three, and four implants), and cortical bone thicknesses, total 19 models for investigating. The FE models of this study were used to investigate biomechanical effect of implant-retained overdenture comparing with three major parameters (such as implant number, implant distribution and cortical thickness). The relationship between mechanical index of FE models, such as stress, strain and stability, and fracture of implant-retained overdenture were further investigated.
    The results showed that the type of two-implant insertion at the anterior dentation could provide a lower stress magnitude and better stability for all components of implant-retained overdenture model, moreover, the type of multiple implants retained overdenture was also demonstrated the tendency of more and more stress reduction of the overdenture components while the implant placements more shifted to posterior region of the dentition. Periimplant bones of the FE models were significantly evidenced the bone resorption effects due to 4000 micro strain exceeding, but on the contrary the stress magnitudes of the overdenture, attachments, and implants were too less to induce the failure. In addition, the effects of cortical thickness to implants retained overdenture were less important than implant distribution in this study.
    Obviously the biomechanical benefit in the type of two implants retained overdenture was better than the type of multiple implants retained overdenture. This evidence is consistent with clinical outcomes which indicate the two implants retained overdenture reconstruction can provide a better success rate.

    中文摘要 I Abstract III 致謝 V Contents VII List of Tables X List of Figures XI Chapter 1 Introduction 1 Background and Prevalence of Edentulism 1 1.1 Classification of Jawbone 2 1.2 Treatment of Edentulism 6 1.2.1 Conventional denture 6 1.2.2 Implant Overdenture 8 1.3 Differences between Implant-Retained and Implant-Supported Overdenture 10 1.3.1 Implant-supported overdenture 11 1.3.2 Implant-retained overdenture 11 1.3.3 Definition and Classification of Attachments 12 1.4 Literature Review 15 1.4.1 Clinical Review 15 1.4.2 Finite Element Analysis 16 1.4.3 Mechanical Adaptation in Bone 17 1.4.4 Experimental Study 18 1.5 Motivation and Objective 20 Chapter 2 Materials and Methods 22 2.1 Research Procedures 22 2.2 Reconstruction of Three-Dimensional Finite Element Model 24 2.2.1 Reconstruction of Maxillary and Mandible Bone 24 2.2.2 Reconstruction of Overdenture 28 2.2.3 Integrated Model of Implant-Retained Overdenture 29 2.3 Element Type and Material Properties 31 2.4 Interface Connection, Loading and Boundary Condition 33 2.4.1 Definition of Interface Connection 33 2.4.2 Loading Condition 33 2.4.3 Boundary Condition 35 2.5 Model Parameters of Implant Number, Distribution and Cortical Thickness 36 Chapter 3 Results 38 3.1 Effect of Implant Number and Distribution 38 3.1.1 The Implant Distribution Based on Inserted 22 Position 38 3.1.2 The Implant Distribution Based on Inserted 44 Position 40 3.1.3 The Implant Distribution Based on Inserted 66 Position 45 66 vs. 606 vs. 6226 vs. 6446 45 3.2 Stability 52 3.2.1 Thin Cortical Thickness (1 mm) 52 3.2.2 Thick Cortical Thickness (3 mm) 56 3.3 Difference in Anterior and Posterior Implant Placement 59 3.4 Failure 62 3.4.1 Bone Resorption 62 3.4.2 Damage 64 3.5 The convergent test 66 Chapter 4 Discussion 68 4.1 Biomechanical Effects of Implant Retained Overdenture 68 4.1.1 Implant Number and Distribution 68 4.1.2 Effect of Implant Placement between Anterior and Posterior Region 70 4.1.3 Stability 71 4.1.4 Failure 74 4.1.5 Damage 75 4.2 Overview 76 4.3 Limitation 77 Chapter 5 Conclusion 78 References 80

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