贴面式瓷嵌体修复上颌第一前磨牙穿髓型非龋性颈部缺损的三维有限元应力分析

doi:10.7518/hxkq.2023.2023123

摘要/Abstract

摘要：

目的探讨2种陶瓷材料贴面式嵌体及纤维桩修复上颌第一前磨牙穿髓型非龋性颈部缺损的应力分布规律，以期为临床选择微创、有效的修复方法提供思考。方法选择符合标准的右上第一前磨牙锥形束CT数据，建立健康对照（HC）组、缺损对照（DC）组，根据2种贴面式嵌体材料［IPS e.max CAD（LD）、Lava Ultimate（LU）］以及不同的纤维桩位置［无纤维桩（NP）、颊侧根管纤维桩（B）、腭侧根管纤维桩（P）、颊腭侧根管纤维桩（BP）］，建立8个实验模型（LD_NP、LD_B、LD_P、LD_BP、LU_NP、LU_B、LU_P、LU_BP）组，模拟轴向和侧向载荷，采用有限元软件分析各结构最大主应力峰值，采用颊尖位移量分析颊尖顶位移变化量。在各实验组中：缺损尖端牙体应力峰值与DC组进行变化量分析；颊尖位移量、釉质应力峰值、牙本质应力峰值与HC组进行变化量分析，变化量百分数相差小于5%认为是无差异的。结果 LD组与LU组均可有效减小缺损尖端牙体的应力峰值，且LD组降幅更为显著。关于贴面式嵌体及树脂粘接剂应力，LD组高于LU组，并且呈现同一材料不同实验组之间应力峰值相近。此外，双根管纤维桩组可显著减小颊尖位移量。结论贴面式瓷嵌体可在穿髓非龋性颈部缺损的修复中进行应用，且与Lava Ultimate相比，IPS e.max CAD可更好保护尖端牙体组织，此外推测联合颊腭双根管纤维桩修复时可减小整体变形量及修复体脱粘接事件的发生。

关键词: 贴面式瓷嵌体, 纤维桩, 应力分析, 颊尖位移量

Abstract:

Objective This study aimed to explore the stress distribution of surface-mounted inlays with two ceramic materials and different strategies for fiber post-restoration on pulp-penetrating non-carious cervical lesion in a maxillary first premolar to provide minimally invasive and reasonable restorative methods. Methods The cone beam computed tomography data of the standard right upper first premolar were selected. Healthy control (HC) and defective control (DC) finite element models were established. Then, eight experimental models were established according to two different ceramic materials (IPS e.max CAD [LD] and Lava Ultimate [LU]) and different locations of fiber post (without fiber post [NP], fiber post in buccal root canal [B], fiber post in palatal root canal [P], fiber post in both root canals [BP]), namely, LD_NP, LD_B, LD_P, LD_BP, LU_NP, LU_B, LU_P, and LU_BP. Axial load F1 and lateral load F2 were applied. Maximum principal stress and displacement of the buccal tip were investigated using finite element analysis software. Then, the percentage change of the following indicators in each experimental group was analyzed: stress of defective tip with group DC, stress of enamel and dentine, and displacement of buccal tips with group HC. It was considered similar when the percentage change was less than 5%. Results LD and LU groups could effectively reduce the stress of the defective tip, but the decreasing amplitude in the former was greater than that of the latter. For the stress of surface-mounted inlays and resin adhesive layer, LD groups were higher than LU groups, and no significant difference in stress peak was found among different experimental groups in the same material. In addition, fiber posts in double root canals could significantly reduce buccal tip displacement. Conclusion For pulp-penetrating non-carious cervical lesions, the restorative strategy of surface-mounted inlays could be applied. Compared with Lava Ultimate, IPS e.max CAD could better protect the defective tip tooth. Furthermore, fiber posts in double root canals could decrease overall deformation and increase the retention of surface-mounted inlays.

Key words: surface-mounted inlay, fiber post, stress analysis, displacement of buccal tip

中图分类号:

R 783.3

马典, 钱捷. 贴面式瓷嵌体修复上颌第一前磨牙穿髓型非龋性颈部缺损的三维有限元应力分析[J]. 华西口腔医学杂志, 2023, 41(5): 541-553.

Ma Dian, Qian Jie.. Three-dimensional finite element stress analysis of surface-mounted inlays in repairing pulp-penetrating non-carious cervical lesion of maxillary first premolar[J]. West China Journal of Stomatology, 2023, 41(5): 541-553.

图/表 21

表 1

图 1

表 2

图 2

图 3

图 4

图 5

图 6

图 7

图 8

图 9

表 3

图 10

图 11

表 4

表 5

图 12

图 13

表 6

图 14

图 15

参考文献 34

1	Aw TC, Lepe X, Johnson GH, et al. Characteristics of noncarious cervical lesions: a clinical investigation[J]. J Am Dent Assoc, 2002, 133(6): 725-733.
2	Shafiei F, Memarpour M, Karimi F. Fracture resistance of cuspal coverage of endodontically treated maxillary premolars with combined composite-amalgam compared to other techniques[J]. Oper Dent, 2011, 36(4): 439-447.
3	曹婷婷, 葛春慧, 张红艳. 上颌第一前磨牙非龋性牙颈部病变的缺损形态、修复材料及咬合方式对应力的影响[J]. 口腔疾病防治, 2019, 27(8): 515-521.
	Cao TT, Ge CH, Zhang HY. Influence of the shape, materials and occlusal mode of the maxillary first premolars on stress in noncarious cervical lesions[J]. J Prev Treat Stomatol Dis, 2019, 27(8): 515-521.
4	Canali GD, Ignácio SA, Rached RN, et al. One-year cli-nical evaluation of bulk-fill flowable vs. regular nanofilled composite in non-carious cervical lesions[J]. Clin Oral Investig, 2019, 23(2): 889-897.
5	Pereira FA, Zeola LF, de Almeida Milito G, et al. Restorative material and loading type influence on the biomechanical behavior of wedge shaped cervical lesions[J]. Clin Oral Investig, 2016, 20(3): 433-441.
6	Caneppele TMF, Meirelles LCF, Rocha RS, et al. A 2-year clinical evaluation of direct and semi-direct resin composite restorations in non-carious cervical lesions: a randomized clinical study[J]. Clin Oral Investig, 2020, 24(3): 1321-1331.
7	Fei X, Wang Z, Zhong W, et al. Fracture resistance and stress distribution of repairing endodontically treated maxillary first premolars with severe non-carious cervical lesions[J]. Dent Mater J, 2018, 37(5): 789-797.
8	Schmitz JH, Beani M. Effect of different cement types on monolithic lithium disilicate complete crowns with feather-edge preparation design in the posterior region[J]. J Prosthet Dent, 2016, 115(6): 678-683.
9	李飞鸣, 阎旭. 贴面式树脂和瓷嵌体修复楔状缺损的研究[C]//中华口腔医学会老年口腔医学专业委员会. 2021年中华口腔医学会老年口腔医学专业委员会第十六次全国老年口腔医学学术年会论文汇编. [出版者不详], 2021: 83.
	Li FM, Yan X. The evaluation of faced-resin or ceramic inlay on tooth wedge-shaped defect prosthesis[C]//Professional Committee of Geriatric Dentisty of the Chinese Stomatological Association. Thesis Collection of the 16th National Academic Annual Meeting of Geriatric Dentistry of the Professional Committee of Geriatric Dentisty of the Chinese Stomatological Association in 2021. [s.n.], 2021: 83.
10	嵇潇雷, 张瑞, 刘玉, 等. 牙体楔状缺损修复中贴面式瓷嵌体的应用[J]. 口腔医学, 2016, 36(2): 129-131.
	Ji XL, Zhang R, Liu Y, et al. Application study of faced-ceramic inlay on tooth wedge-shaped defect prosthesis[J]. Stomatology, 2016, 36(2): 129-131.
11	Chen Y, Chen D, Ding H, et al. Fatigue behavior of endodontically treated maxillary premolars with MOD defects under different minimally invasive restorations[J]. Clin Oral Investig, 2022, 26(1): 197-206.
12	Sulaiman E, Alarami N, Wong YI, et al. The effect of fiber post location on fracture resistance of endodontically treated maxillary premolars[J]. Dent Med Probl, 2018, 55(3): 275-279.
13	莫思溯, 鲍炜, 沈晴昳. 纤维桩修复上颌前磨牙穿髓型楔状缺损三维有限元模型的建立[J]. 中国组织工程研究, 2018, 22(2): 183-188.
	Mo SS, Bao W, Shen QY. Construction of a three-dimensional finite element model of pulp-exposed maxillary premolar with wedge-shaped defect restored by fiber post[J]. Chin J Tis Eng Res, 2018, 22(2): 183-188.
14	薛盛豪, 王宇轩, 许桐楷, 等. 异色牙瓷贴面修复的遮色效果[J]. 北京大学学报(医学版), 2020, 52(5): 943-947.
	Xue SH, Wang YX, Xu TK, et al. Study of masking ability of laminate veneers for discolored teeth[J]. J Peking Univ Heal Sci, 2020, 52(5): 943-947.
15	Wendler M, Belli R, Petschelt A, et al. Chairside CAD/CAM materials. Part 2: flexural strength testing[J]. Dent Mater, 2017, 33(1): 99-109.
16	Belli R, Wendler M, de Ligny D, et al. Chairside CAD/CAM materials. Part 1: measurement of elastic constants and microstructural characterization[J]. Dent Mater, 2017, 33(1): 84-98.
17	Huang XQ, Hong NR, Zou LY, et al. Estimation of stress distribution and risk of failure for maxillary premolar restored by occlusal veneer with different CAD/CAM materials and preparation designs[J]. Clin Oral Investig, 2020, 24(9): 3157-3167.
18	Soares PV, Machado AC, Zeola LF, et al. Loading and composite restoration assessment of various non-carious cervical lesions morphologies—3D finite element analysis[J]. Aust Dent J, 2015, 60(3): 309-316.
19	Meng Q, Zhang Y, Chi D, et al. Resistance fracture of minimally prepared endocrowns made by three types of restorative materials: a 3D finite element analysis[J]. J Mater Sci Mater Med, 2021, 32(11): 137.
20	Dejak B, Młotkowski A, Langot C. Three-dimensional finite element analysis of molars with thin-walled prosthetic crowns made of various materials[J]. Dent Mater, 2012, 28(4): 433-441.
21	Perdigão J, Gomes G, Augusto V. The effect of dowel space on the bond strengths of fiber posts[J]. J Prosthodont, 2007, 16(3): 154-164.
22	Soares CJ, Castro CG, Neiva NA, et al. Effect of gamma irradiation on ultimate tensile strength of enamel and dentin[J]. J Dent Res, 2010, 89(2): 159-164.
23	Giannini M, Soares CJ, de Carvalho RM. Ultimate tensile strength of tooth structures[J]. Dent Mater, 2004, 20(4): 322-329.
24	李珊珊, 褚福行, 莫宏兵. 牙本质暴露量对瓷贴面剪切粘接强度的影响[J]. 口腔疾病防治, 2019, 27(2): 90-94.
	Li SS, Chu FH, Mo HB. Effect of dentin exposure on the shear bond strength of cast porcelain veneers[J]. J Prev Treat Stomatol Dis, 2019, 27(2): 90-94.
25	Singer L, Fouda A, Bourauel C. Biomimetic approaches and materials in restorative and regenerative dentistry: review article[J]. BMC Oral Health, 2023, 23(1): 105.
26	王静, 殷金萍, 孙亚丽, 等. 静态载荷下不同材料修复下颌第二前磨牙非龋性颈部缺损的有限元分析[J]. 郑州大学学报(医学版), 2022, 57(1): 68-72.
	Wang J, Yin JP, Sun YL, et al. Estimation of biomechanical behavior of different materials in non-carious cervical defect model of mandibular second premolars resto-red: a 3D finite analysis[J]. J Zhengzhou Univ Med Sci, 2022, 57(1): 68-72.
27	Dal Piva AMO, Tribst JPM, Borges ALS, et al. CAD-FEA modeling and analysis of different full crown mo-nolithic restorations[J]. Dent Mater, 2018, 34(9): 1342-1350.
28	宁未来. 水门汀厚度及弹性模量对种植牙冠粘接层应力影响的二维有限元研究[D]. 合肥: 安徽医科大学, 2015.
	Ning WL. The effect of cement thickness and elasticity modulus on the stress distribution at cement layer of the implant crown using 2D finite element approaches[D]. Hefei: Anhui Medical Unixersity, 2015.
29	Belli R, Geinzer E, Muschweck A, et al. Mechanical fatigue degradation of ceramics versus resin composites for dental restorations[J]. Dent Mater, 2014, 30(4): 424-432.
30	El-Damanhoury HM, Elsahn NA, Sheela S, et al. Adhesive luting to hybrid ceramic and resin composite CAD/CAM blocks: Er: Laser versus chemical etching and micro-abrasion pretreatment[J]. J Prosthodont Res, 2021, 65(2): 225-234.
31	吴悦梅, 张富强, 宋宁, 等. 石英纤维根管桩复合材料的力学性能研究[J]. 上海口腔医学, 2006, 15(3): 304-307.
	Wu YM, Zhang FQ, Song N, et al. Study on the mecha-nical properties of quartz fiber-reinforced composite for canal post[J]. Shanghai J Stomatol, 2006, 15(3): 304-307.
32	Skupien JA, Sarkis-Onofre R, Cenci MS, et al. A systematic review of factors associated with the retention of glass fiber posts[J]. Braz Oral Res, 2015, 29: S1806-83242015000100401.
33	Juloski J, Radovic I, Goracci C, et al. Ferrule effect: a li-terature review[J]. J Endod, 2012, 38(1): 11-19.
34	赵凌, 杨丽媛, 刘翠玲, 等. 不同修复方法对深型楔状缺损牙应力分布影响的三维有限元分析[J]. 华西口腔医学杂志, 2017, 35(1): 77-81.
	Zhao L, Yang LY, Liu CL, et al. Three-dimensional finite element analyses of the deep wedge-shaped defective premolars restored with different methods[J]. West China J Stomatol, 2017, 35(1): 77-81.

组别	修复方式
HC	健康对照组
DC	缺损对照组
LD_NP	根管治疗+无纤维桩+LD贴面式嵌体
LU_NP	根管治疗+无纤维桩+LU贴面式嵌体
LD_B	根管治疗+颊侧根管纤维桩+LD贴面式嵌体
LU_B	根管治疗+颊侧根管纤维桩+LU贴面式嵌体
LD_P	根管治疗+腭侧根管纤维桩+LD贴面式嵌体
LU_P	根管治疗+腭侧根管纤维桩+LU贴面式嵌体
LD_BP	根管治疗+颊腭侧根管纤维桩+LD贴面式嵌体
LU_BP	根管治疗+颊腭侧根管纤维桩+LU贴面式嵌体

材料	弹性模量/MPa	泊松比
釉质	84 100	0.31
牙本质	18 600	0.31
牙髓	2	0.45
牙周膜	68.9	0.45
皮质骨	13 700	0.30
松质骨	1 370	0.30
树脂	10 000	0.24
纤维桩	18 000	0.30
树脂粘接剂	8 300	0.35
Lava Ultimate	12 700	0.45
IPS e.max CAD	102 700	0.215

组别	F1载荷下的应力峰值/MPa	较DC组的变化量	F2载荷下的应力峰值/MPa	较DC组的变化量
DC	9.248	-	156.690	-
LD_NP	4.665	-49.56%	19.198	-87.75%
LD_B	3.481	-62.36%	19.054	-87.84%
LD_P	4.617	-50.07%	19.095	-87.81%
LD_BP	4.757	-48.55%	18.703	-88.06%
LU_NP	4.019	-56.54%	36.446	-76.74%
LU_B	3.669	-60.32%	35.860	-77.11%
LU_P	3.959	-57.19%	36.491	-76.71%
LU_BP	4.023	-56.49%	35.992	-77.03%

组别	F1载荷下的颊尖位移量/μm	较HC组变化量	F2载荷下的颊尖位移量/μm	较HC组变化量
HC	6.723	-	34.658	-
DC	7.188	-	39.130	-
LD_NP	6.756	0.49%	34.319	-0.97%
LD_B	6.750	0.40%	34.284	-1.07%
LD_P	6.737	0.20%	34.217	-1.27%
LD_BP	4.780	-28.90%	31.779	-8.30%
LU_NP	7.008	4.23%	35.524	2.49%
LU_B	6.982	3.85%	34.945	0.82%
LU_P	6.902	2.66%	34.873	0.62%
LU_BP	4.982	-25.89%	32.449	-6.37%

组别	F1载荷下的应力峰值/MPa	较HC组的变化量	F2载荷下的应力峰值/MPa	较HC组的变化量
HC	43.854	-	52.713	-
DC	44.685	-	156.690	-
LD_NP	43.701	-0.34%	55.759	5.77%
LD_B	43.761	-0.21%	55.253	4.81%
LD_P	41.768	-4.75%	50.327	-4.52%
LD_BP	41.820	-4.63%	50.292	-4.59%
LU_NP	43.660	-0.44%	55.570	5.41%
LU_B	43.725	-0.29%	55.061	4.45%
LU_P	41.728	-4.84%	50.136	-4.88%
LU_BP	41.796	-4.69%	50.092	-4.97%