牙槽突裂植骨前后上颌扩弓对上颌牙槽骨位移影响的三维有限元分析

doi:10.7518/hxkq.2022.04.013

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (4): 451-456.doi: 10.7518/hxkq.2022.04.013

牙槽突裂植骨前后上颌扩弓对上颌牙槽骨位移影响的三维有限元分析

袁玮¹(), 侯彦², 宋鹏², 张晓焕³, 黄威²()

^1.邯郸市口腔医院，邯郸 056000
^2.河北医科大学口腔医学院?口腔医院，河北省口腔医学重点实验室，河北省口腔疾病临床医学研究中心，石家庄 050017
^3.唐山市滦南县医院口腔科，唐山 063500

收稿日期:2021-11-10 修回日期:2022-06-16 出版日期:2022-07-25 发布日期:2022-07-27
通讯作者: 黄威 E-mail:417131721@qq.com;505060770@qq.com
作者简介:袁玮，主治医师，学士，E-mail：417131721@qq.com
基金资助:
河北省医学科学研究课题计划(20211075)

Comparative study on the effect of maxillary expansion on the displacement of maxillary alveolar bone before and after alveolar bone graft: a three-dimensional finite element analysis

Yuan Wei¹(), Hou Yan², Song Peng², Zhang Xiaohuan³, Huang Wei²()

^1.Handan Stomatological Hospital, Handan 056000, China
^2.School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Disease, Shijiazhuang 050017, China
^3.Dept. of Stomatology, Luannan County Hospital in Tangshan, Tangshan 063500, China

Received:2021-11-10 Revised:2022-06-16 Online:2022-07-25 Published:2022-07-27
Contact: Huang Wei E-mail:417131721@qq.com;505060770@qq.com
Supported by:
Medical Science Research Project in Hebei Province(20211075);Correspondence: Huang Wei, E-mail: 505060770@qq.com

摘要/Abstract

摘要：

目的　模拟比较牙槽突裂植骨前后上颌扩弓对上颌牙槽骨位移影响。方法　在已建立的植骨前上颌骨有限元模型上，采用ANSYS软件模拟牙槽突裂植骨，形成植骨后上颌骨模型。在2组模型上分别施加相同上颌扩弓力，观察比较牙槽骨区域三维方向位移形变情况。结果　三维方向位移量比较，植骨前扩弓组均显著大于植骨后扩弓组（P<0.05）。水平向位移：植骨前扩弓，由前向后牙槽骨区域位移量逐渐降低；植骨后扩弓，由前向后牙槽骨区域位移量逐渐升高；植骨前后扩弓健侧牙槽骨位移量均显著大于患侧（P<0.05）。垂直向位移：植骨前后扩弓，牙槽骨前内侧均向下移动，牙槽骨后外侧均向上移动。矢状向位移：植骨前扩弓，牙槽骨前内侧向前移动，后外侧向后移动，植骨后扩弓移动趋势相反。结论　单侧完全性唇腭裂患者植骨前扩弓三维方向移动均较植骨后明显，植骨前扩弓建议扩弓器适当向后移动，植骨后扩弓建议扩弓器适当向前移动并配合前牵引治疗，同时治疗中需警惕不对称扩弓及前牙开𬌗的发生。

关键词: 牙槽突裂植骨, 上颌扩弓, 牙槽骨三维方向位移, 有限元分析

Abstract:

Objective This paper aimed to simulate and compare the effect of maxillary expansion on the displacement of maxillary alveolar bone before and after alveolar bone graft. Methods On the established finite element model of the maxilla before bone grafting, ANSYS was used to simulate alveolar bone graft to form the model of maxilla after bone grafting. The same expansion force was applied to the two models, and the three-dimensional displacement of alveolar bone was observed and compared between them. Results Comparison of the three-dimensional displacement showed that expansion before bone grafting was significantly larger than that after bone grafting (P<0.05). For horizontal displacement, in the expansion group before bone grafting, the displacement was gradually decreased from anterior to posterior alveolar bone. In the expansion group after bone grafting, the displacement was gradually increased from anterior to posterior alveolar bone. Displacement of noncleft side alveolar bone was significantly larger than that of cleft side alveolar bone with maxillary expansion before and after alveolar bone graft (P<0.05). In terms of vertical displacement, the anteromedial alveolar bone moved downward and the posterolateral alveolar bone moved upward with maxillary expansion before and after alveolar bone graft. For sagittal displacement, the anteromedial alveolar bone moved forward and the posterolateral alveolar bone moved backward with maxillary expansion before alveolar bone graft. However, the movement trend was opposite with maxillary expansion after alveolar bone graft. Conclusion The three-dimensional movement with maxillary expansion before alveolar bone graft is more obvious than that after bone grafting for patients with unilateral complete cleft lip and palate. Expander should be moved backward properly with maxillary expansion before alveolar bone graft and moved forward properly and cooperated with maxillary protraction with maxillary expansion after alveolar bone graft. Meanwhile, precaution must be taken in terms of asymmetric expansion and anterior open bite in operation.

Key words: alveolar bone graft, maxillary expansion, three dimensional displacement of alveolar bone, finite e-lement analysis

中图分类号:

R 782.2

袁玮, 侯彦, 宋鹏, 张晓焕, 黄威. 牙槽突裂植骨前后上颌扩弓对上颌牙槽骨位移影响的三维有限元分析[J]. 华西口腔医学杂志, 2022, 40(4): 451-456.

Yuan Wei, Hou Yan, Song Peng, Zhang Xiaohuan, Huang Wei. Comparative study on the effect of maxillary expansion on the displacement of maxillary alveolar bone before and after alveolar bone graft: a three-dimensional finite element analysis[J]. West China Journal of Stomatology, 2022, 40(4): 451-456.

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参考文献 14

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标记点	未植骨组		植骨组
标记点	患侧	健侧	患侧	健侧
1	0.068 309	0.076 846	0.000 272	0.002 043
2	0.064 039	0.068 307	0.002 124	0.003 432
3	0.055 501	0.055 499	0.002 587	0.003 895
4	0.046 962	0.051 230	0.003 050	0.004 358
5	0.038 424	0.038 422	0.003 281	0.004 821
6	0.029 886	0.034 153	0.003 629	0.004 936

标记点	未植骨组		植骨组
标记点	患侧	健侧	患侧	健侧
1	0.024 147	0.018 667	0.001 469	0.000 193
2	0.020 515	0.010 525	0.001 005	0.000 695
3	0.015 973	0.004 168	0.000 851	0.001 004
4	0.009 617	0.003 259	0.000 745	0.001 158
5	0.002 351	0.004 914	0.000 338	0.001 313
6	0.002 204	0.006 730	0.000 330	0.001 467

标记点	未植骨组		植骨组
标记点	患侧	健侧	患侧	健侧
1	0.007 229	0.002 453	0.001 728	0.001 075
2	0.004 808	0.005 974	0.001 075	0.000 666
3	0.003 708	0.006 854	0.000 314	0.001 101
4	0.001 067	0.006 414	0.000 102	0.001 435
5	0.000 533	0.006 194	0.000 333	0.001 319
6	0.001 226	0.006 020	0.000 166	0.001 310

比较内容	t值	P值
X轴方向：未植骨组患侧与植骨组患侧	7.370	<0.01
X轴方向：未植骨组健侧与植骨组健侧	6.980	<0.01
X轴方向：未植骨组健、患侧	2.710	<0.05
X轴方向：植骨组健、患侧	17.988	<0.01
Y轴方向：未植骨组患侧与植骨组患侧	3.232	<0.05
Y轴方向：未植骨组健侧与植骨组健侧	2.789	<0.05
Y轴方向：未植骨组健、患侧	-1.637	>0.05
Y轴方向：植骨组健、患侧	0.501	>0.05
Z轴方向：未植骨组患侧与植骨组患侧	2.956	<0.05
Z轴方向：未植骨组健侧与植骨组健侧	7.005	<0.01
Z轴方向：未植骨组健、患侧	1.581	>0.05
Z轴方向：植骨组健、患侧	1.539	>0.05

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牙槽突裂植骨前后上颌扩弓对上颌牙槽骨位移影响的三维有限元分析

Comparative study on the effect of maxillary expansion on the displacement of maxillary alveolar bone before and after alveolar bone graft: a three-dimensional finite element analysis

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