골-임플란트 접촉 양상에 따른 골 변형 연구: 유한요소법적 연구 = Effect of bone-implant contact pattern on bone strain distribution: finite element method study

국문 초록 (Abstract)

연구 목적: 기존 대부분의 유한요소 연구에서는 100%의 골-임플란트 접촉을 가정하여 왔으나 인간사체연구(human retrieval study)에서는 골-임플란트 부착비율이 20-80%라고 보고되었다. 본 연구에서는 비선형 삼차원 유한요소법을 이용하여 실제적인 골-임플란트 접촉을 재현하기 위해 무작위 골접촉 양상을 비교연구하고자 하였다. 연구 재료 및 방법: 컴퓨터단층촬영에서 얻은 영상을 근거로 하여 제작한 골모형에 두 가지 디자인의 임플란트(MK III Br${\aa}$nemark$^{(R)}$, Inplant$^{(R)})$를 상악제2소구치에 해당하는 위치에 식립한 모형을 만들었다. 골질은 골형 2로서 Lekholm과 Zarb의 분류를 따랐다. 각 임플란트 디자인마다 두 가지(40%, 70%)의골-임플란트 접촉비율을 가정하였다. 각디자인과 골접촉율마다 5개의 모형을 제작하여 총 40 개의 모형을 만들었다. 이골-임플란트 접촉을 무작위 섞기방식(random shuffle method)으로 하였고 피질골과 해면골을 다 포함하여 골유착을 시킨 군(wholly randomized osseointegration; W)과 피질골과 해면골을 분리하여 골접촉시키기 위해서 각 0.75 mm마다 무작위 골접촉을 시킨 군(segmentally randomized osseointegration; S)을 비교연구하였다. 결과: 골-임플란트 접촉율이나 임플란트 디자인에 상관없이 W군과 S군 간 maximum von Mises strain의 평균에 있어서 유의성 있는 차이가 없었다(P=.939). 골-임플란트 접촉율이40%보다70%가 von Mises strain이 유의하게 낮았다(P=.007). 골-임플란트 접촉율이 40%일때는 Inplant$^{(R)}$과 MK III Br${\aa}$nemark$^{(R)}$의 변형율 간에는 유의성 있는 차이가 없었으나(P=.116), 골-임플란트 접촉율이 70%일때 Inplant$^{(R)}$에서는 $4886{\pm}1034\;{\mu}m/m$, MK III Br${\aa}$nemark$^{(R)}$에서는 $7134{\pm}1232\;{\mu}m/m$로서 Inplant$^{(R)}$의 von Mises strain이MK III Br${\aa}$nemark$^{(R)}$의 것보다 유의하게 낮았다(P<.0001). 결론: 골-임플란트 접촉을 가정함에 있어서 무작위 섞기방식(random shuffle method)을 이용하여 임플란트 전체에 대해서나 피질골과 해면골을 분리하여 무작위 골-임플란트 접촉을 시키든 간에 통계적으로 유의한 차이가 없어서 표본의 크기에 상관없이 둘 다 유효한 방법이라 할 수 있었다.

다국어 초록 (Multilingual Abstract)

Purpose: To date most of finite element analysis assumed the presence of 100% contact between bone and implant, which is inconsistent with clinical reality. In human retrieval study bone-implant contact (BIC) ratio ranged from 20 to 80%. The objective of this study was to explore the influence of bone-implant contact pattern on bone of the interface using nonlinear 3-dimensional finite element analysis. Materials and methods: A computer tomography-based finite element models with two types of implant (Mark III Br${\aa}$nemark$^{(R)}$, Inplant$^{(R)}$) which placed in the maxillary 2nd premolar area were constructed. Two different degrees of bone-implant contact ratio (40, 70%) each implant design were simulated. 5 finite element models were constructed each bone-implant contact ratio and implant design, and sum of models was 40. The position of bone-implant contact was determined according to random shuffle method. Elements of bone-implant contact in group W (wholly randomized osseointegration) was randomly selected in terms of total implant length including cortical and cancellous bone, while ones in group S (segmentally randomized osseointegration) was randomly selected each 0.75 mm vertically and horizontally. Results: Maximum von Mises strain between group W and group S was not significantly different regardless of bone-implant contact ratio and implant design (P=.939). Peak von Mises strain of 40% BIC was significantly lower than one of 70% BIC (P=.007). There was no significant difference between Mark III Br${\aa}$nemark$^{(R)}$ and Inplant$^{(R)}$ in 40% BIC, while average of peak von Mises strain for Inplant$^{(R)}$ was significantly lower ($4886{\pm}1034\;{\mu}m/m$) compared with MK III Br${\aa}$nemark$^{(R)}$ ($7134{\pm}1232\;{\mu}m/m$) in BIC 70% (P<.0001). Conclusion: Assuming bone-implant contact in finite element method, whether the contact elements in bone were wholly randomly or segmentally randomly selected using random shuffle method, both methods could be effective to be no significant difference regardless of sample size.

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