远中邻|牙合|腭面缺损的上颌第一磨牙纤维桩-树脂核修复的有限元分析
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上海交通大学医学院附属第九人民医院口腔修复科

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Finite element analysis of FRC post-resin core restored maxillary first molar with disto-occluso-palatal defect
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    摘要:

    目的:探究根管治疗后的远中邻牙合腭面(disto-occluso-palatal,DOP)缺损的上颌第一磨牙的纤维桩-树脂核修复策略。 方法:建立了8种不同的纤维桩-树脂核修复策略修复后的上颌第一磨牙有限元模型。多根桩在髓腔内存在重叠部分,将较细的桩在重叠部分下方1 mm处水平截断作为辅桩,较粗的桩保留原长作为主桩。分别进行两种力学加载:与牙体长轴平行的总大小为800 N的垂直力和与牙体长轴呈45°角的总大小为225 N的侧向力。通过有限元分析(finite element analysis,FEA)计算牙体组织和纤维桩内的等效应力及桩-树脂水门汀、树脂水门汀-根管壁界面上的切应力。 结果:在相同载荷下,不同组间在牙体组织外表面的应力分布形式相似,垂直加载时应力集中于根干的腭侧面,侧向加载时应力集中于根干的近中颊侧面。置入纤维桩的根管中1/3处内表面最大应力值上升,而根管颈1/3处内表面最大应力值下降。垂直载荷和侧向载荷下所受应力最大的桩分别是腭桩和近颊桩。垂直载荷下,在同一根管内主桩较辅桩在桩-树脂水门汀界面上的切应力大,侧向载荷下,近中颊桩的桩-树脂水门汀界面切应力最大。垂直载荷下腭根内放置纤维桩时树脂水门汀-根管壁界面上的最大切应力值高于其他组,侧向载荷下近颊根放置纤维桩时界面上的最大切应力值高于其他组。 结论:FEA结果表明,对于DOP缺损的上颌第一磨牙,纤维桩修复能有效地将牙合力向根方传导,改善剩余牙体组织中的应力分布,在腭根内置入单根纤维桩进行纤维桩-树脂核-全瓷冠修复可能是其最佳修复策略。

    Abstract:

    Objectives. To explore which and how many root canal(s) should be inserted fiber-reinforced composite (FRC) post(s) in for an endodontically-treated maxillary first molar with a disto-occluso-palatal (DOP) defect. Methods. Eight different models of the maxillary first molar were established. In the multi-post groups, the thinner post was horizontally trimmed 1 mm below the intersection point as the assistant post, and the thicker one was named the main post. Two types of forces were applied: one is a vertical force of 800 N parallel to the long axis of the tooth and the another one is a lateral force of 225 N directed at 45° to the long axis of the tooth. The equivalent stresses on the external surfaces of the tooth tissue, the internal surfaces of the root canals and in the posts, as well as the maximal shear stresses on the post-cement interface and the cement-dentin interface were calculated with finite element analysis (FEA). Results. All the models showed similar distribution patterns of equivalent stress on the external surfaces of the tooth tissue under the same loading. The maximal equivalent stress values were found on the palatal (P) side of the root trunk under vertical loading, and on the mesiobuccal (MB) side of the root trunk under lateral loading. On the internal surfaces of root canals, the maximal equivalent stress value increased at the middle third of the post-placed canal, and decreased at the cervical third of the canal. Under vertical loading, P posts showed the highest equivalent stress values, while MB posts showed the highest equivalent stress values under lateral loading. Under vertical loading, the main post encountered larger shear stress than the assistant one on the post-cement interface in the same canal. Under lateral loading, the post-cement interface in the MB canal showed the highest shear stress values. The highest shear stress values appeared on the cement-canal interface with a P post under vertical loading, and with a MB post under lateral loading. Conclusion. The FEA results indicated that the restoration with FRC post could conduct the occlusal force towards apical area, so as to improve the stress distribution in the residual tooth tissue for a maxillary first molar with DOP defect. One post in the P canal may be the best strategy of FRC restoration for such a tooth.

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  • 收稿日期:2021-11-23
  • 最后修改日期:2021-12-26
  • 录用日期:2022-01-04
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