臺灣博碩士論文加值系統

研究目的
探討下顎骨在”All-on-four”治療原則下，前牙區近心植體種植角度傾斜與否，以及植體未完全骨整合與百分之百骨整合後，對植體周圍骨組織生物力學效應的影響。

材料與方法
建立下顎骨、植體及贗復物的三維有限元素模型，其中一組依照”All-on-four”治療原則，另一組將兩側前牙區近心植體植入角度改成往近心傾斜。植體-骨介面則分為未完全骨整合與百分之百骨整合之條件。於左側第一大臼齒區施予斜向咬合力後，觀察植體周圍骨應力的變化，及未完全骨整合時植體的微移動量。

結果
無論是傾斜或非傾斜近心植體模型，在兩種不同的骨整合介面，皮質骨和海綿骨內所產生的等效應力和主應力的最大值皆出現在施力端遠心植體周圍。在同一種骨整合介面下，傾斜或非傾斜近心植體模型骨應力的分布相近，但傾斜近心植體模型植體周圍骨應力值較小，下降比率可多達66%。未完全骨整合時，應力會較平均分散於皮質骨和海綿骨以及各植體周圍；完全骨整合後，應力較集中於近受力端植體周圍的皮質骨。而未完全骨整合時各植體的微小移動量，在傾斜或非傾斜近心植體模型中皆相近。

結論
當下顎以”All-on-four”治療，將近心植體改成傾斜植入，在單側後牙咬合力之下，整體骨應力的分布及未完全骨整合時植體的初期穩定度與傳統非傾斜近心植體相似；而完全骨整合後的長期植體周圍骨應力比傳統非傾斜近心植體模型更低。

Purpose:
The aim of this study was to evaluate the biomechanical effect of peri-implant bone between non-tilted and tilted mesial implants for mandibular “All-on-four” treatment protocol. The difference of the biomechanical effect between the conditions of complete and imperfect osseointegration would be evaluated as well.

Materials and methods:
Three-dimensional FE models were consisted of mandibular bone, dental implants and superstructures with two different configurations: one model follow the “All-on-four” protocol, the other one changed the inserted angle of bilateral mesial implants with mesially tilted by 30 degrees. Imperfect and complete osseointegration were simulated and 250 N oblique occlusal loading was applied on the occlusal surface of left first molar. Stress of peri-implant bone and micromotion of implants were determined.

Results:
Under the same bone-to-implant interface, the distribution of peri-implant bone stress was similar in tilted and non-tilted models; however, the stress value of peri-implant bone was lower (up to 66%) in tilted model. Stress concentrated in cortical bone and implant near loading area when complete osseointegrated; however, under imperfect osseointegration, stress more evenly distributed in both cortical and cancellous bone and around each implant. The micromotion of implants were similar in both models under imperfect osseointegration.

Conclusions:
Changing the inserted angle of mesial implants in “All-on-four” protocol did not obviously alter the pattern of stress distribution and the primary stability of implants under imperfect osseointegration. However, the stress value of peri-implant bone was lower than non-tilted model after complete osseointegration.

目錄
目錄……………………………………………………………………I
圖目錄…………………………………………………………………V
表目錄………………………………………………………………VII
中文摘要………………………………………………………… VIII
英文摘要………………………………………………………………X

第一章 緒論 1
1.1 前言 1
1.2“All-on-four”治療方式的文獻回顧 2
1.2.1“All-on-four”的定義 2
1.2.2“All-on-four”的相關研究 2
1.2.3“All-on-four”的優缺點 4
1.3 傾斜植體的文獻回顧 6
1.4 桁架（Truss）的簡介 8
1.5 有限元素分析 9
1.6 研究目的 14


第二章 研究材料與方法 15
2.1 研究流程 15
2.2 三維幾何模型建立 15
2.2.1 下顎骨模型 15
2.2.2 植體與支柱體模型 16
2.2.3 橫桿模型 17
2.3 材料性質的設定 17
2.4 介面的設定 18
2.5 有限元素模型的建立 18
2.6 邊界條件的設定 19
2.7 施力條件的設定 20
2.7.1 力量大小 20
2.7.2 力量方向 20
2.8 收斂測試與驗證 21
2.9 分析目標 22



第三章 結果 23
3.1 收斂測試與驗證之結果 23
3.1.1 收斂測試結果 23
3.1.2 模型驗證結果 23
3.2 等效應力在下顎骨的分布情形 24
3.2.1 等效應力在皮質骨的分布情形 24
3.2.2 等效應力在海綿骨的分布情形 25
3.3 主應力在下顎骨的分布情形 26
3.3.1 主應力在皮質骨的分布情形 26
3.3.2 主應力在海綿骨的分布情形 27
3.4 未完全骨整合植體的微小移動（Micromotion） 28

第四章 討論 29
4.1 測量工具 29
4.2 有限元素模型的驗證 29
4.3 植體周圍骨應力的探討 30
4.3.1 近心植體角度對骨應力的影響 31
4.3.2 骨整合程度對骨應力的影響 32
4.4 植體微小移動的探討 33
4.5 本研究的限制與未來研究方向 34

第五章 結論 36
附圖 37
附表 60
參考文獻 65

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