중간 지대치가 존재하는 고정성 국소의치에서 보철물 설계 및 치조골 상태가 응력분포에 미치는 영향
Effect of prosthetic designs and alveolar bone conditions on stress distribution in fixed partial dentures with pier abutments
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연구목적: 하악 제 1 소구치 및 제 1 대구치가 결손 되어 중간 지대치를 갖는 5 본 고정성 국소의치에서 비고정형 어태치먼트의 설계 유무 및 지대치의 지지골 상태에 따른 변위 및 응력분포의 차이를2 차원 유한요소분석을 통해 비교하여 보고자 하였다. 연구 재료 및 방법: 5 본 고정성 국소의치는 일체형과 분할형으로 구분하였으며, 분할형에는 제 2 소구치와 제 1 대구치 사이에 비고정형 어태치먼트를 설계하였다. 지지골은 모두 정상인 경우와 세 개 지대치중 한 개의 지대치에서 임상적 치관 대 치근 비율이 6 : 4 정도까지 골 흡수가 일어난 세 가지 경우를 가정하여 총 네 가지의 지지골 상태를 설정하였다. 제1 소구치와 제1 대구치 가공치 중앙에 각각 150 N의 수직 분산하중과, 제1 대구치 가공치 중앙에 300 N의 수직 집중하중을 가하였다. 결과: 일체형과 분할형 고정성 국소의치 모두에서 하중 시 하방 변위를 보였다. 분할형 고정성 국소의치에서 일체형보다 전방 지대치 지지골에서의 응력은 감소하였으나 중간 및 후방 지대치 지지골에서의 응력은 증가하였다. 지대치의 치조골 흡수가 있는 경우 해당 지대치의 지지골에 국소적인 응력 증가가 나타났다. 결론: 중간 지대치를 갖는 고정성 국소의치를 설계할 경우 유지 장치의 유지 능력과 지대치의 지주 상태 그리고 어태치먼트의 사용에 대한 주의 깊은 고찰이 필요하겠다.
Abstract
Statement of problem: Pier abutments act as a Class I fulcrum lever system when the teeth are incorporated in a fixed partial denture with rigid connectors. Therefore non-rigid connector incorporated into the fixed partial denture might reduce the stresses created by the leverage. Purpose: The purpose of this study was to evaluate, by means of finite element method, the effects of non-rigid connectors and supporting alveolar bone level on stress distribution for fixed partial dentures with pier abutments. Material and methods: A 2-dimensional finite element model simulating a 5-unit metal ceramic fixed partial denture with a pier abutment with rigid or non-rigid designs, the connector was located at the distal region of the second premolar, was developed. In the model, the lower canine, second premolar, and second molar served as abutments. Four types of alveolar bone condition were employed. One was normal bone condition and others were supporting bone reduced 20% height at one abutment. Two different loading conditions, each 150 N on 1st premolar and 1st molar and 300N on 1st molar, were used. Results: Two types of FPD were displaced apically. The amount of displacement decreased in an almost linear slope away from the loaded point. Non-rigid design tended to cause the higher stresses in supporting bone of premolar and molar abutments and the lower stresses in that of canine than rigid design. Alveolar bone loss increased the stresses in supporting bone of corresponding abutment. Conclusion: Careful evaluation of the retentive capacity of retainers and the periodontal condition of abutments may be required for the prosthetic design of fixed partial denture with a pier abutment.
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