切牙颈部穿髓型缺损唇、舌面入路的有限元分析

上海口腔医学 ›› 2013, Vol. 22 ›› Issue (4): 374-377.

切牙颈部穿髓型缺损唇、舌面入路的有限元分析

苏凡，赵莹，苏勤

(口腔疾病研究国家重点实验室，四川大学华西口腔医学院，四川成都 610041)

出版日期:2013-08-10 发布日期:2013-08-10
通讯作者: 苏勤，Fax：028-85582167，E-mail：susan_sq@hotmail.com
作者简介:苏凡(1987-)，女，硕士，E-mail：levelsufan@163.com
基金资助:
国家临床重点专科建设项目；四川省科技厅科技支撑计划项目(2010SZ0118)

Three-dimensional finite element analysis of the upper cervical-defected incisor with labial access or lingual access

SU Fan, ZHAO Ying, SU Qin

State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University. Chengdu 610041, Sichuan Province, China

Online:2013-08-10 Published:2013-08-10
Supported by:
Supported by National Key Clinical Discipline Construction Plan and Science and Technology Supporting Program from the Bureau of Science and Technology of Sichuan Province (2010SZ0118).

摘要/Abstract

摘要： 目的：应用三维有限元法比较颈部穿髓型缺损的切牙，在唇侧和舌侧不同开髓入路下的牙体受力情况，探讨唇侧入路在抗折力方面是否具有优势。方法：进行锥形束CT(cone-beam CT,CBCT)扫描，采用Mimics、Catia、Ansys软件建立上切牙模型，分别用唇、舌侧2种入路及直接树脂充填、纤维桩树脂修复、纤维桩全瓷冠修复3种不同修复方式，对其施加载荷，比较缺损部位及髓腔根管表面应力分布和最大von Mises值，采用Ansys10.0有限元分析软件对数据进行统计学分析。结果：在实验条件下，直接树脂修复时，唇、舌侧入路无明显区别；纤维桩复合树脂修复时，唇侧入路可以转移牙体应力集中部位，降低缺损处牙体折断几率而增加根折几率；桩冠修复可有效分散缺损处的应力集中，从而降低牙体从缺损处折断的几率。结论：对于颈部穿髓型缺损的切牙，直接树脂充填时，唇、舌侧入路均可采用；纤维桩树脂修复和桩冠修复时，分散了牙体应力的集中，而唇侧入路较舌侧入路更为明显。

关键词: 三维有限元, 切牙, 颈部缺损, 开髓入路

Abstract: PURPOSE: To evaluate the stress distribution of the cervical-defected incisor with labial or lingual endodontic access with finite element analysis (FEA), and to explore the advantage of resistance in labial endodontic access. METHODS: 3-D finite element models of upper cervical-defected incisor were established using cone-beam CT (CBCT), Mimics Catia, and Ansys software. The subjects were categorized according to the two endodontic accesses and three restorative ways, which were composite resin, glass fiber-reinforced composite resin and glass fiber-reinforced post-crown. All the models were loaded.The von Mises stress values and distribution were recorded and analyzed with Ansys 10.0 software. RESULTS: In this study, direct composite resin restoration showed no significant difference between the labial and lingual access. In glass fiber-reinforced composite resin, labial access could transfer the stress concentration area. It could reduce the incidence of fracture of the cervical lesion but increase the incidence of root fracture. Post-crown restoration could obviously reduce the incidence of fracture of the cervical lesion. CONCLUSIONS: When the cervical-defected incisor is restored with composite resin, labial and lingual accesses can be considered. Labial access with glass fiber-reinforced composite resin or post-crown restoration is a good choice.

Key words: Finite element analysis, Incisor, Cervical lesion, Endodontic access

中图分类号:

R781

苏凡, 赵莹, 苏勤. 切牙颈部穿髓型缺损唇、舌面入路的有限元分析[J]. 上海口腔医学, 2013, 22(4): 374-377.

SU Fan, ZHAO Ying, SU Qin. Three-dimensional finite element analysis of the upper cervical-defected incisor with labial access or lingual access[J]. Shanghai Journal of Stomatology, 2013, 22(4): 374-377.

参考文献

[1] Madjar D, Kusner W, Shifman A. The labial endodontic access: a rational treatment approach in anterior teeth[J]. J Prosthet Dent, 1989, 61(3): 317-320.
[2] Mack RB, Halterman CW. Labial pulpectomy access followed by esthetic composite resin restoration for nonvital maxillary deciduous incisors[J]. J Am Dent Assoc, 1980, 100(3): 374-377.
[3] 洪水清, 黄璟. Z350 纳米树脂美容修复前牙的疗效分析[J]. 临床医学工程, 2011, 18(3): 381-382.
[4] Zillich RM, Jerome JK. Endodontic access to maxillary lateral incisors[J]. Oral Surg Oral Med Oral Pathol, 1981, 52(4): 443-445.
[5] Laturno SA, Zillich RM. Straight-line endodontic access to anterior teeth[J]. Oral Surg Oral Med Oral Pathol, 1985, 59(4): 418-419.
[6] 陈勤超, 孙淑芬, 张颖丽. 不同开髓方向对探查下颌切牙双根管的影响[J]. 中华老年口腔医学杂志, 2009, 7(4): 215-217.
[7] 皮昕. 口腔解剖生理学[M]. 第6版. 北京: 人民卫生出版社, 2007: 41.
[8] 朱静, 李国强, 汪黎明, 等. 下颌第一前磨牙不同角度楔状缺损的三维有限元应力分析[J]. 上海生物医学工程, 2007, 28(4): 225-228.
[9] 林瑾, 胡晓阳, 邓旭亮, 等. 上颌中切牙不同厚度瓷贴面应力分布的三维有限元分析[J]. 现代口腔医学杂志, 2006, 20(1): 31-32.
[10] Poiate IA, Vasconcellos AB, Mori M, et al. 2D and 3D finite element analysis of central incisor generated by computerized tomography[J]. Comput Methods Programs Biomed, 2011, 104(2): 292-299.
[11] Poiate IA, Vasconcellos AB, Andueza A, et al. Three dimensional finite element analyses of oral structures by computerized tomography[J]. J Biosci Bioeng, 2008, 106(6): 606-609.
[12] Mannan G, Smallwood ER, Gulabivala K. Effect of access cavity location and design on degree and distribution of instrumented root canal surface in maxillary anterior teeth[J]. Int Endod J, 2001, 34(3): 176-183.
[13] Mauger MJ, Waite RM, Alexander JB, et al. Ideal endodontic access in mandibular incisors[J]. J Endod, 1999, 25(3): 206-207.
[14] Logani A, Singh A, Singla M, et al. Labial access opening in mandibular anterior teeth—an alternative approach to success[J]. Quintessence Int, 2009, 40(7): 597-602.
[15] 杰恩斯, 史力, 刘鹏, 等. 纤维桩核修复3种上切牙牙冠缺损类型的有限元应力对比[J]. 中国组织工程研究与临床康复, 2009, 13(17): 3251-3255.
[16] Dejak B, Mlotkowski A. Finite element analysis of strength and adhesion of cast posts compared to glass fiber-reinforced composite resin posts in anterior teeth[J]. J Prosthet Dent, 2011, 105(2): 115-126.