強化鈦基合金及奧氏體不銹鋼之生物與生物力學特性以用於植體之立即承載

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題名:	強化鈦基合金及奧氏體不銹鋼之生物與生物力學特性以用於植體之立即承載 Enhance the Biological and Biomechanical Properties of Titanium Based Alloys and Austenitic Stainless Steels for Implant Immediate Loading
作者:	郭繼勳 Paul Chi-Hsiun Kuo
貢獻者:	李婉若歐耿良
關鍵詞:	鈦基植體;奧氏不銹鋼;立即承載 Titanium implant;Austenitic stainless steels;Immediate loading
日期:	2012-05-30
上傳時間:	2018-11-05 14:50:17 (UTC+8)
摘要:	在過去二十年，口腔顎顏面破壞性手術之後，例如：顎顏面腫瘤切除、頭頸部外傷、甚至取代失去的牙齒，嘗試著立即使用植體重建方式，去修復病人的美觀及咀嚼功能，經由多年的臨床追蹤報告，此種立即植牙儼然成為一種成功的例行術式。這種顎顏面手術後立即植牙並負載贋復物之重建方式，稱之為立即承載 (immediate loading)。換句話說，在破壞性手術之後，所植入的植體與其上贋復物一併即時提供病人生物機械性與生物性的穩定功效，立即功能的優點在於減少病人生理上的不健全、減少治療時間、並獲得有效的美觀效果。然而，在先期研究中，對植體及其上贋復物的十年追蹤報告顯示出植體贋復物之長期成功率決定於植體之表面處理，另一方面立即承載的成敗關鍵則取決於植體上贋復物之材料與設計。立即承載之缺點以及承載後遺症 (postloading complications) 經由長期的追蹤評估可歸納出，植體的起始穩定度是立即承載之成功關鍵，而良好的骨頭質與量、以及植體表面的優良性，便成為得到植體高起始穩定度的先決條件。次之，我們尚須考慮植體贋復物提供功能時之條件，例如植體所承受之咬合壓力、或不預期之不良咬合力量(如磨牙等)，這些可能超越植體本身或植體與骨頭介面所能承受之生物力學極限，造成植體本身的斷裂、或齒槽骨的流失或吸收。爾今，顎顏面手術的治療趨勢呈現兩大主軸，包含植體立即承載及縮短骨癒合時間，進而達到植體贋復物之生物性與機械性穩定度之終極目標。那第一個必須面臨之問題，便是如何縮短骨癒合時間，對此最重要之因素為達成齒槽骨與鈦基合金介面之完全骨整合。在此研究中，我們提出使用經表面功能化之鈦基合金以促進完全骨整合。對於立即承載而言，最主要之課題為如何增強植體及其贋復物兩者之生物性及機械性之性質，同時我們開展出第二個研究：使用電漿表面氮化之奧氏不鏽鋼以增強植體及其上贋復物之功效，以改善立即承載之長期成功率。在我們的第一個研究中，可結論出增進鈦基合金表面的奈米結構及生物機械性質，能增進完全骨整合並達成植體的高成功率，縮短骨癒合時間。在第二個研究中，顯示出電漿表面氮化可增強植體上贋復物之材料特性、生物機械性、及生物表現，可避免植體種植後之承載後遺症，以達到立即承載之功效。 During the past two decades, the trend of maxillofacial surgery was trying to restore the aesthetic and masticatory function following destructive surgery by using implant-retained reconstruction. For example: after maxillofacial tumour resection, head and neck injury or even replacing missing teeth, the implant-retained reconstruction has been a successful routine procedure for most cases. This simultaneous surgery combined healing process with aesthetic and masticatory function is called immediate function. That means after destructive surgery, the inserted implant and implant-retained prosthesis together provide both the mechanical and biology stability for the patient. The advantages of immediate function are reduction in morbidity and treatment time with optimal aesthetic result. However, several disadvantages and postloading complications have been reported after long-term clinical evaluation. The initial implant stability is critical for immediate loading and the prerequisites for high initial stability are good bone quality and quantity and / or fixture with excellent performance. Only if the implant fixture surface has excellent performance for bone osseointegration then the implant initial stability and immediate loading can be reached. All the careful consideration must be given to the final functional aspects of the restoration, such as assessing the forces which will be placed on the implant. Implant loading from chewing and parafunction (abnormal grinding or clenching habits) can exceed the biomechanic tolerance of the implant bone interface and/or the titanium material itself, causing failure. This can be failure of the implant itself (fracture) or bone loss, a "melting" or resorption of the surrounding bone. If the trend of maxillofacial treatment, including immediate function and reduced healing time, the first problem need to be resolve is how to reach the simultaneously of implant and implant-retained prosthesis initial biological and mechanical stability. For reducing healing time, the key factor is completely bone-titanium interface osseointegration. In our present research, we propose the hypothesis using surface functionalization of titanium based alloys to improve completely osseointegration. For the immediate function, the major issue is how to enhanced implant and implant-retained prosthesis biological and mechanical properties. That’s the reason why we propose the second hypothesis using austenitic stainless steels treated with plasma nitriding for long term implant and implant-retained prosthesis cumulative survival rate. In our previous studies (Paul Chi-Hsiun Kuo et al. 2005), a retrospective evaluation of implant-retained reconstruction in edentulous mandible after a ten-year follow-up, revealed the long term implant cumulative survival rate depend on implant surface treatment and immediate function long term success rate counted on implant-retained prosthesis material and design. The completely osseointegration between bone-implant interface is the most important factor to affect the implant success rate. Our first study concluded that improved the surface functionalization of the nanostructure and biomechanical properties of binary titanium-niobium alloys can induce the completely osseointegration for higher implant success rate. The second study revealed that increased the biomechanical and biological properties of material that used in implant-prostheses design may prevent the post-loading complications after implant insertion.
描述:	博士指導教授-李婉若共同指導教授-歐耿良委員-張雍敏委員-劉沖明委員-陳順隆
資料類型:	thesis
顯示於類別:	[醫學科學研究所] 博碩士論文

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