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研究生：	林鼎勝 Lin, Ting-Sheng
論文名稱：	後牙區樹脂黏合牙橋設計參數之生物力學評估 Biomechanical Evaluation of Design Parameters of Posterior Resin-bonded Prosthesis
指導教授：	張志涵 Chang, Chih-Han
學位類別：	博士 Doctor
系所名稱：	工學院 - 醫學工程研究所 Institute of Biomedical Engineering
論文出版年：	2004
畢業學年度：	92
語文別：	英文
論文頁數：	70
中文關鍵詞：	生物力學、有限元素法、電腦輔助工程、介面應力、樹脂黏合牙橋
外文關鍵詞：	Resin-bonded prosthesis, Finite element method, Interfacial stress, Dental biomechanics
相關次數：	點閱：160 下載：3
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　　在臨床上對於後牙區缺牙的病患常使用樹脂黏合牙橋來恢復其功能，使用此種治療方式不但可以將鄰近支台齒之修形量減至最低，避免傷害正常牙齒之牙本質，同時更兼具經濟美觀之優點，避免缺牙區受到更進一步的傷害。但由於樹脂黏合牙橋在力學行為的複雜性，因而使得其使用壽命不能達到預期，總結其原因不外乎牙橋/牙齒界面結合強度與牙橋結構之設計參數等原因。因此本研究將利用電腦輔助分析的研究方法，探討評估牙橋結構設計參數對樹脂黏合牙橋之生物力學的影響。在進行分析之前，本研究亦設計體外實驗做為電腦輔助分析結果之印證，從中亦可獲得部分生物力學資訊。待證明模型之可靠性後，方才進行進一步之參數探討。本研究首先針對牙周膜韌帶與與咬合力量之影響進行探討，所得之結果再提供改變不同生物力學上之設計參數，以進行互相交叉比較，希望能夠釐清牙橋結構設計參數對樹脂黏合牙橋整體生物力學之影響，進一步提供臨床牙醫師科學量化之準則以供參考。

　　由體外實驗的結果可知，比較所有實驗量測與數值模擬所得之應變值，模擬所得之應變值大部分都落在一個標準差的範圍內，足可證明本研究中所建立之樹脂黏合牙橋三維網格模型之正確性。由本研究結果顯示，若在模型中忽略牙周膜韌帶，則將造成過份低估介面應力之情形；而所採用之七種咬合力量中，水平側向力之影響皆較垂直力量要來的明顯；而在此七種咬合力量中，垂直與水平側向力分別施加在小臼齒時會造成極高之介面應力。在牙橋設計參數方面，雖然改變固位器(retainer)之尺寸會改變介面應力之分佈情形，由分析結果顯示固位器高度(retainer height)所扮演的角色最為重要，其次則是固位器厚度(retainer thickness)，同時並建議臨床應用時高度應可能延伸，同時厚度應至少要有0.8mm可能有較佳之預後；溝靠座(occlusal rest seats)在使用時最好必須製作；相對而言，溝槽(grooves)的設計則必須視病人之咬合情況而定，配合咬合調整以獲得最佳之預後。

　　According to its design concept, a resin-bonded prosthesis, compared with the conventional fixed partial denture, is a weak and unstable structure. Therefore, a resin-bonded prosthesis induces a higher failure rate, especially in the posterior region. Recently, adhesion agents have been profoundly improved. However, the design guidelines of resin-bonded prosthesis have seldom been evaluated especially in the biomechanical aspect. The objective of this study was to investigate the biomechanical effects of the design parameters on posterior resin-bonded prostheses using finite element (FE) method. A solid model of a posterior mandibular resin-bonded prosthesis, which employed the second molar and second premolar as the abutment teeth, was constructed. After meshing, all nodes on the distal and proximal surface of alveolar bone were fixed as the boundary condition. Parallel experiment of five samples, which used fresh extracted teeth as abutments, were performed to validate the accuracy and reliability of the FE model before parametric analyze. Measured strains on specific locations were compared with numerical results. After validation, biological and mechanical factors were evaluated via the FE models. For biological factors, firstly, the effect of periodontal ligament was investigated. Secondly, seven independent occlusal loadings of 200N were applied respectively at various sites to identify the loading effect based on the stress level at the interface between the retainer and abutment teeth. For the mechanical factors, geometric design parameters of the resin-bonded prosthesis, were investigated according to the result of biological factors.

　　The percentage errors between the measured and simulated data were all within 15% (within one standard deviation), which supported the reliability of the established FE resin-bonded prosthesis model. The simulated results showed that periodontal ligament was an essential component in evaluation of resin-bonded prosthesis and should be included in the FE model to prevent from underestimating the interfacial stress on resin-bonded prosthesis. For the loading modes, lateral occlusal forces increased the retainer/abutment interfacial stresses more significantly than axial occlusal forces. The retainer/abutment interfacial stresses increased more obviously when occlusal force was applied on the premolar than on the molar. For the geometric design, the most important design parameter was retainer height. The secondary parameter was retainer thickness. Sufficient retainer height and thickness could effectively reduce the interfacial stresses. According to the assumptions of this study, the retainer height should cover as much as possible and the retainer thickness was suggested to be greater than 0.8mm for long-term survival of resin-bonded prosthesis. Occlusal rest seat was essential in framework design and grooves should be included in accompany with occlusion adjustment.

CONTENTS

CHINESE ABSTRACT…………………………………………………………….Ⅰ
ENGLISH ABSTRACT…………………………………………………………….Ⅱ
誌謝…………………………………………………………………………………Ⅳ
CONTENTS…………………………………………………………………………Ⅴ
LIST OF FIGURES…...………………………………………………...…………..Ⅶ
LIST OF TABLES…………………………….…………………….………………XI
CHAPTER
1.	INTRODUCTION…………………………………………………..………1
1.1	Problems and background…………………………………….…………1
1.2	Background of resin-bonded prosthesis…………………………………4
1.2.1  Development of resin-bonded prosthesis………………………..4
1.2.2  Designs of posterior resin-bonded prosthesis….…………………5
1.3	Literatures review of resin-bonded prosthesis………………………...….7
1.3.1	Clinical follow-up of resin-bonded prosthesis…………………...7
1.3.2	Numerical studies………………………………………………...8
1.4	General hypothesis and objectives…………………………………….11
2.	MATERIALS AND METHODS…………………………..……….……..12
2.1	Finite element models of posterior resin-bonded prosthesis………..…..12
2.1.1	Sample fabrication for finite element model……………..……..12
2.1.2	Mesh model generation…………………………………………12
2.1.3	Definition of interfacial stress…………………………………18
2.2	Mechanical Testing of posterior resin-bonded prosthesis………………20
2.2.1	Specimen preparation……………………………………….…..20
2.2.2	Testing machine……………………………………………...….20
2.2.3	Testing procedures…………………………………...………….21
2.3 Parametric analysis of posterior resin-bonded prosthesis.……...…..…..23
3.	RESULTS……………………………………..……...…………………….29
3.1	Validation of finite element model………………………….…………29
3.2	Parametric analysis of posterior resin-bonded prosthesis………………30
3.2.1	Biological factors…………………………………………….....30
3.2.2	Mechanical factors……………………………………………...35
3.2.3	Prediction of failure mechanism………………………………43
4.	DISCUSSION…………….…………………..……...…………………….45
4.1	Validation of finite element model……………………………………...45
4.2	Parametric Studies of Resin-bonded Prosthesis……………………...…46
4.2.1	Stress index selection………………..………………………….46
4.2.2	Effect of biological effect……………………………………….46
4.2.3	Effect of mechanical factor……………………………………..48
4.2.4	Possible failure mechanism……………………………………..56
4.3	Assumptions and limitations…………………………………….…...…57
5.	CONCLUSIONS AND FUTURE WORKS…………..………………….59
5.1	Conclusions……………………………………………………..….…...59
5.2	Future works…………………………………………………………….60


REFERENCES…………………………………………………………...…………61




LIST OF FIGURES

FIGURES
1-1 Missing first molar resulted in tipping, drifting and super-eruption………………2
1-2 Conventional fixed partial dentures. (a) Structural components; (b) Complete assembly of fixed partial denture.…………………………………….….……………2
1-3 Concept of resin-bonded prosthesis. (a) Edentulous region (anterior region); (b) Placement of resin-bonded prosthesis; (c) Appearance after resin-bonded fixed partial denture were bonded (metal retainers were hidden in lingual aspect); (d) Resin-bonded prosthesis applied in posterior region(Resin-based sample)………...…3
1-4 Perforated resin-bonded prosthesis...........................................……………..…….6
1-5 Appearance of etched surface……………………………………………………..6
1-6 Retention features on metal framework (proximal grooves were not shown)…….6
1-7 Finite element model of anterior all ceramic resin-bonded prosthesis (from Popeich et al., 1996)………………………………………………….…………….10
2-1 Flowchart of this study…………………………………………………………...14
2-2 Procedures of sample fabrication for finite element model……………………15
2-3 Intervals of sections of resin-bonded prosthesis……………….……………..….16
2-4 Self-developed image processing system (a) Cross-section contour was obtained from scanned images; (b) Keypoints were generated with equal length and translated into finite element package…………………………………………………………...16
2-5 The normal vector of the node C was defined by averaging the normal vectors of the eight triangle planes around node C…………………………………………...…19
2-6 The procedures of specimen preparation……………………………………….21
2-7 Complete arrangement of experiment…………………………………………....21
2-8 (a) Specimen was clamped on fixation apparatus; (b) Overview of fixation apparatus……………………………………………………………………………...22
2-9 Overview of custom-made testing machine……………………………………...22
2-10 The three-dimensional resin-bonded prosthesis FE model (PDL, alveolar bone were not shown). The arrows indicated the loading sites and directions of seven occlusal loadings………………………...…………….……..………………………24
2-11 Design parameters of posterior resin-bonded prosthesis in contrast to realistic sample (a) Proximal and distal grooves; (b) Occlusal rest seats on both abutment teeth. (Right: Realistic replica of resin-bonded prosthesis; Left: Sketch of retention features.)……………………………………………………………………………...26
2-12 Definition of retainer wraparound angles (started from proximal end)………...26
3-1 (a) Finite element mesh model of resin-bonded prosthesis (Left: complete model including PDL and alveolar bone; Right: abutment teeth and prosthesis extracted from entire model). (b) Mesh model to validate with experimental results (The material properties of alveolar bone and PDL were changed to resin)…………………..……28
3-2 Strain pattern of the four guages. (Buccal side: tensile strain; lingual side: compressive strain)…………………………………………………….……………..29
3-3 Maximum interfacial stresses in premolar between intact and simplified model with various retainer thickness under horizontal force………………………….....31
3-4 Maximum interfacial stresses in premolar between intact and simplified model with various retainer thickness under vertical force…………………………………31
3-5 Maximum interfacial stresses in molar between intact and simplified model with various retainer thickness under horizontal force…………………………………….32
3-6 Maximum interfacial stresses in molar between intact and simplified model with various retainer thickness under vertical force…………………………………….....32
3-7 Distal view of the interfacial (a) normal and (b) shear stresses distribution of the premolar under horizontal loading. The metal bridgework was removed to expose the interfacial stress distribution on abutment (premolar). Only the surface attached to the retainer was plotted…………………………………………………………………..33
3-8 Distal view of the interfacial (a) normal and (b) shear stresses distribution of the premolar under vertical loading. The metal bridgework was removed to expose the interfacial stress distribution on abutment (premolar). Only the surface attached to the retainer was plotted…………………………………………………………………..33
3-9 Maximum interfacial normal and shear stresses in both abutment teeth under seven loading types……………………………………………………………….….34
3-10 The maximum interfacial normal and shear stresses in both abutments under loading types 1, 2 and 3 conditions; (a) the premolar normal stresses; (b) the molar normal stresses; (c) the premolar shear stresses; (d) the molar shear stresses……….37
3-11 The maximum interfacial normal and shear stresses in both abutments under loading types 4, 5, 6 and 7 conditions; (a) the premolar normal stresses; (b) the molar normal stresses; (c) the premolar shear stresses; (d) the molar shear stresses……….38
3-12 The maximum interfacial (a) normal and (b) shear stresses with different retainer height under vertical forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar)………………………...…………………..……39
3-13 The maximum interfacial (a) normal and (b) shear stresses with different retainer height under lateral forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar)………………………………………………….39
3-14 The maximum interfacial (a) normal and (b) shear stresses with different wraparound angles under vertical forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar; D: degree)………………………………....40
3-15 The maximum interfacial (a) normal and (b) shear stresses with different wraparound angles under lateral forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar; D: degree)…………………………………40
3-16 The maximum interfacial (a) normal and (b) shear stresses with and without rests under vertical forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar)……………………………………………………………….…41
3-17 The maximum interfacial (a) normal and (b) shear stresses with and without rests under lateral forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar)……………………………………………………………….....41
3-18 The maximum interfacial (a) normal and (b) shear stresses with and without grooves under vertical forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar)………………………………………………….42
3-19 The maximum interfacial (a) normal and (b) shear stresses with and without grooves under lateral forces. Three retainer thickness (0.6, 0.8 and 1.0mm) was considered (P: premolar; M: molar)………………………………………………….42
3-20 Prediction of possible crack propagation. (a) Maximum interfacial normal and (b) shear stress were adopted as predictor. (Arrow illustrated the direction of interface debonding)……………………………………...…………………………………….43
3-21 Interfacial normal stress distribution following with progressive interface debonding…………………………………………………………………………….44
3-21 Interfacial shear stress distribution following with progressive interface debonding…………………………………………………………………………….44 4-1 Section view of the distribution of von Mises strain in periodontal ligament under vertical force applied on the pontic. Relative large strains were observed in premolar side. (Abutment teeth and metal framework were removed)…………...……………47 
4-2 Deformation of entire resin-bonded prosthesis under loading type 1. (The displacement was magnified by 50 times)…………...………………………………47
4-3 The plots of averaged maximum interfacial stresses in premolar with respect to the variables of the design parameters of retainer……………………………………53
4-4 The plots of averaged maximum interfacial stresses in molar with respect to the variables of the design parameters of retainer………………………………………..54
4-5 Normalized interfacial (a) normal and (b) shear stresses results of the interaction between three design parameters of retainer dimension in second premolar………...55

4-6 Normalized interfacial (a) normal and (b) shear stresses results of the interaction between three design parameters of retainer dimension in second molar……………55


















LIST OF TABLES

TABLES
1-1 Most common resin-bonded prosthesis complications……………………………9
1-2 Clinical performance of resin-bonded prosthesis……………………………….....9
2-1 Material properties were assigned to dental tissues, alveolar bone (cortex and cancellous), bridgework and resin……………………………………………………17
2-2 The detail loading sites of seven occlusal forces……………………….………..23
3-1 Comparison between numerical and experimental strain data.………………..…29
3-2 Maximum normal and shear stresses in abutment teeth under seven loading types (retainer dimension was 1.0mm (T) × 4.5mm (H) × 180° (W) and the other retention features were not included)…………………...……………………...………………34
4-1 Maximum interfacial stresses and the volume of removed enamel were computed for different retainer dimensions in premolar under loading type 4…………………51
4-2 Maximum interfacial stresses and the volume of removed enamel were computed for different retainer dimensions in molar under loading type 4……………………..52



                                    

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