Simulation of multi-stage nonlinear bone remodeling induced by fixed partial dentures of different configurations: a comparative clinical and numerical study
Simulation of multi-stage nonlinear bone remodeling induced by fixed partial dentures of different configurations: a comparative clinical and numerical study
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DOI：
10.1007/s10237-016-0826-x
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发表时间：
2017-04
影响因子：
3.5
通讯作者：
Z. Liao;N. Yoda;Junning Chen;Keke Zheng;K. Sasaki;M. Swain;Qing Li
中科院分区：
文献类型：
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作者：
Z. Liao;N. Yoda;Junning Chen;Keke Zheng;K. Sasaki;M. Swain;Qing Li
本文旨在通过对种植体治疗的四年临床随访，以多阶段的方式整合骨的动态特性，开发一种临床验证的骨重塑算法。采用多阶段重构规则探讨固定局部义齿的形态效应。使用压电力传感器测量最大自主咬合时的三维实时咬合负荷，并将其纳入基于计算机层析成像的有限元下颌模型。基于模拟生成虚拟x线图像，并使用线性回归与临床数据进行统计相关。应变能密度驱动的重塑参数在考虑的时间框架内进行调节。通过线性回归（lowandR）发现，具有单一一组恒定重塑参数的线性单阶段骨重塑算法与临床数据拟合较差，而时间相关的多阶段算法则能更好地模拟临床结果的重塑过程（highandR）。三种植体支撑和远端悬臂式FPDs呈现明显且连续的骨对抗，主要邻近颈椎和根尖区域。桥式和中悬臂式FPDs显示骨吸收或部分区域未见骨形成。建议骨重塑参数随时间变化，以便更好地将骨重塑模拟与临床随访联系起来。FPD支架的位置在机械生物学功能和骨重塑中起着关键作用。选择悬臂式FPD时应谨慎，因为有骨吸收超载的风险。
This paper aimed to develop a clinically validated bone remodeling algorithm by integrating bone’s dynamic properties in a multi-stage fashion based on a four-year clinical follow-up of implant treatment. The configurational effects of fixed partial dentures (FPDs) were explored using a multi-stage remodeling rule. Three-dimensional real-time occlusal loads during maximum voluntary clenching were measured with a piezoelectric force transducer and were incorporated into a computerized tomography-based finite element mandibular model. Virtual X-ray images were generated based on simulation and statistically correlated with clinical data using linear regressions. The strain energy density-driven remodeling parameters were regulated over the time frame considered. A linear single-stage bone remodeling algorithm, with a single set of constant remodeling parameters, was found to poorly fit with clinical data through linear regression (lowandR), whereas a time-dependent multi-stage algorithm better simulated the remodeling process (highandR) against the clinical results. The three-implant-supported and distally cantilevered FPDs presented noticeable and continuous bone apposition, mainly adjacent to the cervical and apical regions. The bridged and mesially cantilevered FPDs showed bone resorption or no visible bone formation in some areas. Time-dependent variation of bone remodeling parameters is recommended to better correlate remodeling simulation with clinical follow-up. The position of FPD pontics plays a critical role in mechanobiological functionality and bone remodeling. Caution should be exercised when selecting the cantilever FPD due to the risk of overloading bone resorption.