CN107496040A - 纤维桩用于制备穿髓型隐裂磨牙修复体的应用 - Google Patents
纤维桩用于制备穿髓型隐裂磨牙修复体的应用 Download PDFInfo
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Abstract
本发明公开了一种纤维桩用于制备穿髓型隐裂磨牙修复体的应用,所述穿髓型隐裂磨牙的隐裂纹位于牙冠面沿发育沟近远中向并且平行于牙长轴,纤维桩位于距牙冠面3.0‑3.5mm处并且垂直于隐裂纹方向水平放置。纤维桩直径为1.3‑1.5mm,纤维桩长度与髓腔长度相同。本发明的修复体,在树脂修复体中加入纤维桩可以改善上颌第一前磨牙近远中向穿髓型隐裂牙裂纹尖端的应力集中,能有效阻止全冠下裂纹的进一步扩展。
Description
技术领域
本发明属于牙体修复技术领域,具体涉及一种纤维桩用于制备穿髓型隐裂磨牙修复体的应用。
背景技术
穿髓型隐裂磨牙是指裂纹已经到达髓腔而尚未发生冠根折的隐裂磨牙,属于隐裂牙的晚期。常出现激发痛、咬合痛、自发痛等牙髓炎症状或根尖周炎症状。隐裂磨牙的预后与其裂纹深度相关,一般认为裂纹深度越深,隐裂磨牙的预后越差。隐裂磨牙的裂纹方向并不规则,可呈近远中方向、颊舌向、斜向;或涉及两个及以上方向,约81.1%的隐裂磨牙为近、远中向的裂纹。隐裂牙的病因较为复杂,一般认为是由多种因素共同作用的结果,包括牙体自身发育形态、咬合创伤、牙体组织修复治疗、未治疗的深龋、不正常磨耗、牙髓治疗等危险因素。
临床上针对穿髓型隐裂磨牙常用的治疗方案是:调牙合、预防性冠保护、完善的根管治疗+全冠修复。目前,全冠修复是穿髓型隐裂磨牙根管治疗后公认的最佳修复方式。然而,有文献报道即使进行了全冠修复,穿髓型隐裂磨牙的预后也不容乐观。有资料显示穿髓型隐裂磨牙根管治疗后全冠修复一年成功率为95.2%、三年成功率仅为68.91%。失败原因多为全冠下的裂纹进一步扩展、感染物质进入裂缝,从而引起疼痛、牙龈肿胀甚至牙齿劈裂。因此,仅进行全冠修复并不能完全阻止穿髓型隐裂磨牙裂纹的进一步扩展,还需要对其修复方式进行改进,以减少患牙裂纹处所受的应力,而纤维桩与树脂结合垂直裂纹铺设,通过连接断端,可阻止或延缓裂纹进一步扩展。目前尚无人将纤维桩的连接作用应用于穿髓型隐裂牙的治疗。
发明内容
针对现有技术中存在的不足,本发明提出一种纤维桩用于制备穿髓型隐裂磨牙修复体的应用,可改变裂纹处的应力分布、阻止或延缓裂纹进一步扩展。
为实现上述目标,本发明采用如下技术方案:
本发明提供一种纤维桩用于制备穿髓型隐裂磨牙修复体的应用。
上述穿髓型隐裂磨牙的隐裂纹位于牙冠牙合面沿发育沟近远中向并且平行于牙长轴,纤维桩位于距牙冠牙合面3mm-3.5mm处并且垂直于隐裂纹方向。
尤其是:隐裂纹的深度为穿髓处至釉牙骨质界根方1mm,纤维桩直径为1.3mm-1.5mm,纤维桩长度与髓腔长度相同。
穿髓型隐裂磨牙修复体的制备方法,包括如下步骤:
步骤一、对穿髓型隐裂磨牙的牙模型充填根管至根管口下0.5mm-1mm,采用玻璃离子封闭根管口;
步骤二、复合树脂充填窝洞至距离牙冠牙合面约4mm处,垂直于隐裂纹方向水平放置纤维桩,纤维桩距合面3mm-3.5mm,光固化;
步骤三、使用复合树脂充填窝洞至合面,光固化;
步骤四、全冠修复。
本发明的纤维桩包括玻璃纤维桩。
相较于现有技术,本发明的技术效果如下:
本发明的修复体,在树脂修复体中加入纤维桩可以改善上颌第一前磨牙近远中向穿髓型隐裂牙裂纹尖端的应力集中,能有效阻止全冠下裂纹的进一步扩展。
附图说明
图1为本发明模拟隐裂牙示意图。
图2为纤维桩髓腔内垂直于裂纹方向水平铺设加树脂充填修复隐裂牙示意图(颊舌剖面,近中面观)。
图3为隐裂牙根管治疗后树脂充填加全冠修复的示意图。
图4为270N颊向45°加载下各组模型的牙本质应力云图。
图中各标号的含义为:
1-纤维桩,2-Z350树脂,3-隐裂纹,4-牙胶尖,5-玻璃离子。
以下结合附图对本发明作进一步的说明。
具体实施方式
下面结合附图和具体实施方式对本发明进行详细说明,不能认定本发明的具体实施只局限于这些说明。对于本发明所属技术领域的普通技术人员来说,在不脱离本发明构思的前提下,还可以做出若干简单推演或替换,都应当视为属于本发明的保护范围。
本发明牙模型隐裂纹3的获取方法为:在正常牙模型牙冠牙合面沿发育沟近远中向构建一平行于牙长轴的裂纹平面:隐裂纹3长度为牙冠近远中径;隐裂纹3宽度为0.10mm;隐裂纹3深度深达釉牙骨质界根方1.00mm,如图1所示。
本发明牙模型的定义材料见下表1:
表1
本发明一种穿髓型隐裂磨牙纤维桩修复体的制备方法,包括如下步骤:
步骤一、模拟常规根管治疗:穿髓型隐裂牙上橡皮障,开髓,5.25%次氯酸钠冲洗,探查根管口,10#、15#K锉初步预备根管,根管长度测量仪测长,采用机用Waveone系统预备根管至F2,拍测长片确定工作长度。清理消毒根管,干燥,使用热牙胶垂直加压法牙胶尖4充填根管至根管口下1mm,玻璃离子5封闭根管口。拍X光片确定根充恰填。
步骤二、见图2,在距离面3.5mm处制备垂直于裂纹方向的凹槽(宽2.00mm,深3.50mm)。酸蚀窝洞,涂布全酸蚀粘结剂(Vrey-Best,USA),垂直裂纹方向水平放置一个直径为1.50mm的纤维桩1、长度与髓腔长度一致、涂布了全酸蚀粘结剂并光照过的纤维桩,结合树脂光固化(这样可以在纤维桩上方留出2.00mm树脂修复体的空间),最后使用Z350树脂2完成牙冠部充填。
最近进行穿髓型隐裂牙全冠修复,全冠制作规则为常规方法:牙合面厚度2.00mm;肩台1.00mm;聚合度6°;冠边缘位于釉牙骨质界冠方1.00mm。见图3。
按照上述的制备方法,采用如下实验思路,设置如下实施例及对比例:
对比例1:正常牙
对比例2:隐裂牙
对比例3:树脂充填
对比例4:树脂充填+全瓷冠
实施例1:纤维桩髓腔内垂直于裂纹方向水平铺设+树脂充填
实施例2:纤维桩髓腔内垂直于裂纹方向水平铺设+树脂充填+全瓷冠
对上述各模型进行三维有限元分析:
三维有限元的分析方法参照发明人前期研究:“建立上颌前磨牙穿髓型楔状缺损三维有限元模型”,李迎楼,蒋月桂等,第九次全国牙体牙髓病学学术会议论文汇编。采用ANSYS软件对各组模型加载不同大小(135N和270N)和颊向45°作用于颊尖三角嵴中部的载荷,加载方式为静态加载。计算不同载荷下各组模型的牙本质最大等效应力值和裂纹处等效应力峰值,并生成牙本质应力云图,分析对比各组修复方式对穿髓型隐裂牙应力分布及应力大小的影响,牙本质应力云图反映牙本质内的综合应力分布情况;牙本质最大等效应力值反映牙本质内应力的最大值,该值越大越易折裂;裂纹处等效应力峰值反映裂纹处应力的最大值,该值越大裂纹越易扩展。
结果表明:1)当统一加载条件(大小、方向和加载部位)时,各组模型的牙本质应力分布有以下规律:隐裂牙(对比例2)较正常牙(对比例1)有明显的裂纹尖端应力集中;充填后的隐裂牙(对比例3、实施例1)较未充填的隐裂牙(对比例2)均可明显改善裂纹尖端的应力集中,使应力分布更接近正常牙;全冠修复组(对比例4、实施例2)较充填修复组(对比例3、实施例1)可进一步改善裂纹尖端的应力集中情况、总体上减少牙本质内的应力集中区的范围。各模型的牙本质应力集中区范围大致呈现出实施例2﹤对比例4﹤实施例1﹤对比例3的规律,但充填组和全冠组组内差异并不明显。以270N颊向45°加载下的牙本质应力云图为例,见图4,全冠组较充填组可明显改善裂纹尖端的应力集中情况、总体上降低牙本质内的应力值。
修复方式对牙本质最大等效应力值的影响:
在载荷大小及加载方向相同的条件下,分别对各修复模型的牙本质最大等效应力值进行比较,表2是各组牙本质最大等效应力值的统计描述表。结果表明:1、隐裂牙模型均需要进行修复治疗;2、进行全冠修复的组别(对比例4、实施组2)的牙本质最大等效应力值均小于不进行全冠修复的组别(对比例3、实施组1);3、全冠组中,加入纤维桩组别(实施例2)的牙本质最大等效应力值最低,效果最佳。
表2各组牙本质最大等效应力值
修复方式对裂纹处等效应力峰值的影响:
在载荷大小及加载方向相同的条件下,分别对各修复模型的裂纹处等效应力峰值进行比较,表3是各组裂纹处等效应力峰值的统计描述表。结果表明:1、修复组裂纹处等效应力峰值明显小于未修复组;2、全冠修复的组别(对比例4、实施组2)的裂纹处等效应力峰值明显小于不进行全冠修复的组别(对比例3、实施组1);3、全冠修复组中,加入纤维桩组别(实施例2)的裂纹处等效应力峰值最低,效果最佳。
表3各组裂纹处等效应力峰值统计描述表
Claims (5)
1.纤维桩用于制备穿髓型隐裂磨牙修复体的应用。
2.如权利要求1所述应用,其特征在于,穿髓型隐裂磨牙的隐裂纹位于牙冠面沿发育沟近远中向并且平行于牙长轴,纤维桩位于距牙冠面3mm-3.5mm处并且垂直于隐裂纹方向。
3.如权利要求2所述应用,其特征在于,隐裂纹的深度为穿髓处至釉牙骨质界根方1mm,隐裂纹宽度为0.01mm-0.1mm,纤维桩直径为1.3mm-1.5mm,纤维桩长度与髓腔长度相同。
4.如权利要求2所述应用,其特征在于,穿髓型隐裂磨牙修复体的制备方法,包括如下步骤:
步骤一、对穿髓型隐裂磨牙的牙模型充填根管至根管口下0.5mm-1.0mm,采用玻璃离子封闭根管口;
步骤二、复合树脂充填窝洞至距离牙冠面4mm处,垂直于隐裂纹方向铺设纤维桩,纤维桩距面3mm-3.5mm,光固化;
步骤三、使用复合树脂充填窝洞至合面,光固化;
步骤四、全冠修复。
5.如权利要求4所述应用,其特征在于,纤维桩包括玻璃纤维桩。
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