套筒冠式下颌种植覆盖义齿的三维有限元分析
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摘要
目的：通过观察缓冲型与非缓冲型套筒冠固位的下颌种植覆盖义齿在各种载荷条件下及不同数量种植体支持时，对种植体及其周围支持组织、基托下组织的应力分布和覆盖义齿动度的影响，为临床修复设计提供理论依据。
方法：利用螺旋CT扫描、数字化影像数据采集、三维重建技术及有限元软件进行无牙下颌、种植体及覆盖义齿的三维有限元模型的构建，分别建立由两种植体及四种植体支持的，采用缓冲型、非缓冲型套筒冠固位的种植覆盖义齿的三维有限元模型。在实验一中设计了前牙、后牙集中加载及垂直、斜向集中加载的载荷条件，以观察比较缓冲型、非缓冲型模型在不同加载部位及不同加载方向下的生物力学性能差异；实验二中根据正中(牙合)时的咬合情况设计多个后牙同时加载的分布载荷条件，以观察比较缓冲型、非缓冲型模型在不同数目的种植体支持时的生物力学性能差异。记录模型在各种载荷条件下的应力分布情况及义齿的动度改变。
结果：通过观察缓冲型和非缓冲型模型在各种载荷条件下的应力分布情况，发现在种植体颈部及其周围骨皮质上有应力集中的趋势。对于不同的加载部位，后牙加载较前牙加载更利于降低种植体、种植体周围支持组织上的应力峰值及义齿的动度；而对于不同的加载方向，垂直载荷较斜向载荷更利于减少应力峰值及动度。缓冲型套筒冠模型较非缓冲型更有利于降低种植体一骨界面上的应力峰值，四种植体支持式模型较两种植体支持式模型更利于减少牙槽嵴上的压力，同时减少义齿动度。
结论：
1．不同加载方向、部位对覆盖义齿及其支持组织中的应力分布有一定影响。
2．在套筒冠的内、外冠间设置缓冲间隙有利于种植体周围骨组织的保护。
3．增加种植体数目有利于剩余牙槽嵴组织的保存，同时有助于保持义齿稳定。
Objective: To analyze the effects of clearence fit in the telescopic crowns to stress distribution and denture mobility of mandibular implant supported overdentures under different kinds of loads when different numbers of implants were used.
Methods: By means of spiral computed tomographic(SCT), three-dimentional image reconstruction and three-dimentional finite element methods to study the stress distribution of the supporting tissues of implant overdentures when rigid and non-rigid telescope copings and different numbers of implants were applied in various loading conditions.
Results: The most exstreme stresses of implant and implant-bone interface are located around the implant neck. Load location and direction can influence the stress distribution and denture stability. The mesially placed load and oblique load can increase the stress value in the implant and the implant-bone interface.While, the stress in alveolar bone and denture displacement decreased when the number of implant increased.
Conclusions:The study showed when the load direction is oblique or placed mesially, it could be more harmful. The study also suggested that the non-rigid telescopic copings could be advantageous for implant-supported overdentures with regard to optimizing stress in peri-implant tissue, while the increase of implant number can minimize denture movement.
方法：利用螺旋CT扫描、数字化影像数据采集、三维重建技术及有限元软件进行无牙下颌、种植体及覆盖义齿的三维有限元模型的构建，分别建立由两种植体及四种植体支持的，采用缓冲型、非缓冲型套筒冠固位的种植覆盖义齿的三维有限元模型。在实验一中设计了前牙、后牙集中加载及垂直、斜向集中加载的载荷条件，以观察比较缓冲型、非缓冲型模型在不同加载部位及不同加载方向下的生物力学性能差异；实验二中根据正中(牙合)时的咬合情况设计多个后牙同时加载的分布载荷条件，以观察比较缓冲型、非缓冲型模型在不同数目的种植体支持时的生物力学性能差异。记录模型在各种载荷条件下的应力分布情况及义齿的动度改变。
结果：通过观察缓冲型和非缓冲型模型在各种载荷条件下的应力分布情况，发现在种植体颈部及其周围骨皮质上有应力集中的趋势。对于不同的加载部位，后牙加载较前牙加载更利于降低种植体、种植体周围支持组织上的应力峰值及义齿的动度；而对于不同的加载方向，垂直载荷较斜向载荷更利于减少应力峰值及动度。缓冲型套筒冠模型较非缓冲型更有利于降低种植体一骨界面上的应力峰值，四种植体支持式模型较两种植体支持式模型更利于减少牙槽嵴上的压力，同时减少义齿动度。
结论：
1．不同加载方向、部位对覆盖义齿及其支持组织中的应力分布有一定影响。
2．在套筒冠的内、外冠间设置缓冲间隙有利于种植体周围骨组织的保护。
3．增加种植体数目有利于剩余牙槽嵴组织的保存，同时有助于保持义齿稳定。
Objective: To analyze the effects of clearence fit in the telescopic crowns to stress distribution and denture mobility of mandibular implant supported overdentures under different kinds of loads when different numbers of implants were used.
Methods: By means of spiral computed tomographic(SCT), three-dimentional image reconstruction and three-dimentional finite element methods to study the stress distribution of the supporting tissues of implant overdentures when rigid and non-rigid telescope copings and different numbers of implants were applied in various loading conditions.
Results: The most exstreme stresses of implant and implant-bone interface are located around the implant neck. Load location and direction can influence the stress distribution and denture stability. The mesially placed load and oblique load can increase the stress value in the implant and the implant-bone interface.While, the stress in alveolar bone and denture displacement decreased when the number of implant increased.
Conclusions:The study showed when the load direction is oblique or placed mesially, it could be more harmful. The study also suggested that the non-rigid telescopic copings could be advantageous for implant-supported overdentures with regard to optimizing stress in peri-implant tissue, while the increase of implant number can minimize denture movement.
引文
1. Merickse-Stern R.Clinical evaluation of overdenture restorations supported by osseointegrated titanium implants:A retrospective study. Int J Oral Maxillofac Implants. 1990;18(3):447-52.
2. Doundoulakis JH, Eckert SE, Lindquist CC, Jeffcoat MK. The implant-supported overdenture as an alternative to the complete mandibular denture. J Am Dent Assoc. 2003 Nov; 134(11): 1455-8.
3. Watson P. Longevity expectations of prosthodontic treatments for dentate and edentulous patients. Int J Prosthodont. 2003;16 Suppl:66-8; discussion 68-70.
4. Isler M, Behneke N, Behneke A, d'Hoedt B. Residual ridge resorption in the edentulous maxilla in patients with implant-supported mandibular overdentures: an 8-year retrospective study. Int J Prosthodont. 2003 May-Jun;16(3):295-300.
5. Rangert B, Krogh PH, Langer B, Van Roekel N. Bending overload and implant fracture: a retrospective clinical analysis. Int J Oral Maxillofac Implants. 1995 May-Jun;10(3): 326-34.
6. Isidor F. Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys. Clin Oral Implants Res. 1996 Jun;7(2):143-52.
7. Sposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (Ⅰ). Success criteria and epidemiology. Eur J Oral Sci. 1998 Feb; 106(1):527-51.
8. O'Mahony A, Bowles Q, Woolsey G, Robinson SJ, Spencer P. Stress distribution in the single-unit osseointegrated dental implant: finite element analyses of axial and off-axial loading. Implant Dent. 2000;9(3):207-18.
9. Mericske-Stern R, Piotti M, Sirtes G. 3-D in vivo force measurements on mandibular implants supporting overdentures. A comparative study. Clin Oral Implants Res. 1996 Dec;7(4):387-96.
10. Bergendal T, Engquist B. Implant-supported overdentures: a longitudinal prospective study. Int J Oral Maxillofac Implants. 1998 Mar-Apr;13(2):253-62.
11. Duyck J, Van Oosterwyck H, Vander Sloten J, De Cooman M, Puers R, Naert I. In vivo forces on oral implants supporting a mandibular overdenture: the influence of attachment system. Clin Oral Investig. 1999 Dec;3(4):201-7.
12. Von Wowem N, Gotfredsen K.Implant-supported overdentures, a prevention of bone loss in edentulous mandibles? A 5-year follow-up study. Clin Oral Implants Res. 2001 Feb;12(1):19-25.
13. Heckmann SM, Winter W, Meyer M, Weber HP, Wichmann MG. Overdenture attachment selection and the loading of implant and denture-bearing area. Part 2: A methodical study using five types of attachment.. Clin Oral Implants Res. 2001 Dec;12(6):640-7.
14．张富强主编．圆锥型套筒冠义齿[M]第一版，上海科学技术文献出版社．2002
15. Geng JP, Tan KB, Liu GR. Application of finite element analysis in implant dentistry: a review of the literature. J Prosthet Dent. 2001 Jun;85(6):585-98.
16. Chun HJ, Cheong SY, Han JH, Heo SJ, Chung JP, Rhyu IC, Choi YC, Baik HK, Ku Y, Kim MH. Evaluation of design parameters of osseointegrated dental implants using finite element analysis. J Oral Rehabil. 2002 Jun;29(6):565-74.
17. Akca K, Cehreli MC, Iplikcioglu H. A comparison of three-dimensional finite element stress analysis with in vitro strain gauge measurements on dental implants, Int J Prosthodont. 2002 Mar-Apr;15(2):115-21.
18. DeTolla DH, Andreana S, Patra A, Buhite R, Comella B. Role of the finite element model in dental implants. J Oral Implantol. 2000;26(2):77-81.
19. Van Oossterwyck H, Duyck J, Vander Sloten J, Van der Perre G, Jansen J, Wevers M, Naert I. Use of microfocus computerized tomography as a new technique for characterizing bone tissue around oral implants. J Oral Implantol. 2000;26(1):5-12.
20. Stegaroiu R, Kusakari H, Nishiyama S, Miyakawa O. Influence of prosthesis material on stress distribution in bone and implant: a 3-dimensional finite element analysis. Int J Oral Maxillofac Implants. 1998 Nov-Dec;13(6):781-90.
21. Holmgren EP, Seckinger RJ, Kilgren LM, Mante F. Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional
comparative study examining the effects of implant diameter, implant shape, and load direction. J Oral Implantol. 1998;24(2):80-8.
22. Pierrisnard L, Hure G, Barquins M, Chappard D. Two dental implants designed for immediate loading: a finite element analysis. Int J Oral Maxillofac Implants. 2002 May-Jun; 17(3):353-62.
23. Meijer HJA, Kuiper JH, Starmans FJM, et al. Stress distribution around dental implants: influence of superstructure, lenth of implants and height of mandible. J Prothet Dent, 1992,18:116-21.
24．魏红，巢永烈，韩晓莉。全下颌改良卡式与传统卡式种植覆盖义齿受载的比较性研究。口腔医学纵横杂志，1999，15(1)：13-16
25. Meijer HJ,Starmans FJ,Steen WH,Bosman F.A Three-Dimensional Finite Element Study on Two Versus Four Implants in an Edentulous Mandible. Int J Oral Maxillofac Implants. 1994;7:271-279
26. Rieger MR, Adams WK, Kinzel GL. Finite Element Analysis of Bone- adapted and Bonebonded Endosseous Implants. J Prosthet Dent,1 989,62:43 6～ 43 9.
27. Clelland NL, Ismail YH, Zaki HS, Pipko D. Three-dimensional finite element stress analysis in and around the Screw-Vent implant. Int J Oral Maxillofac Implants. 1991 Winter;6(4):391-8.
28. Iplikcioglu H, Akca K, Cehreli MC, Sahin S. Comparison of non-linear finite element stress analysis with in vitro strain gauge measurements on a Morse taper implant. Int J Oral Maxillofac Implants. 2003 Mar-Apr;18(2):258-65.
29. Akagawa Y, Sato Y, Teixeira ER, Shindoi N, Wadamoto M. A mimic osseointegrated implant model for three-dimensional finite element analysis. J Oral Rehabil. 2003 Jan;30(1):41-5.
30. Iplikcioglu H, Akca K.Comparative evaluation of the effect of diameter, length and number of implants supporting three-unit fixed partial prostheses on stress distribution in the bone. J Dent. 2002 Jan;30(1):41-6.
31. Meijer HJ, Starmans FJ, Steen WH, Bosman F. Loading conditions of endosseous
implants in an edentulous human mandible: a three-dimensional, finite-element study. J Oral Rehabil. 1996 Nov;23(11):757-63.
32. Holmes DC, Loftus JT. Influence of bone quality on stress distribution for endosseous implants. J Oral Implantol. 1997;23(3): 104-11.
33. Ishigaki S, Nakano T, Yamada S, Nakamura T, Takashima F. Biomechanical stress in bone surrounding an implant under simulated chewing. Clin Oral Implants Res. 2003 Feb;14(1):97-102.
34. Hansson S. Implant-abutment interface: biomechanical study of flat top versus conical. Clin Implant Dent Relat Res. 2000;2(1):33-41.
35. Wenz HJ, Lehmarm KM. A telescopic crown concept for the restoration of the partially edentulous arch: the Marburg double crown system. Int J Prosthodont. 1998 Nov-Dec; 11(6):541-50.
36. Lindstrom H, Preiskel H. The implant-supported telescopic prosthesis: a biomechanical analysis. Int J Oral Maxillofac Implants. 2001 Jan-Feb;16(1):34-42.
37. Weischer T, Mohr C. Implant-supported mandibular telescopic prostheses in oral cancer patients: an up to 9-year retrospective study. Int J Prosthodont. 2001 Jul-Aug;14(4): 329-34.
38. Porter JA Jr, Petropoulos VC, Brunski JB. Comparison of load distribution for implant overdenture attachments. Int J Oral Maxillofac Implants. 2002 Sep-Oct;17(5):651-62.
39. Papavasiliou G, Kamposiora P, Bayne SC, Felton DA. 3D-FEA of osseointegration percentages and patterns on implant-bone interfacial stresses. J Dent. 1997 Nov;25(6):485-91.
40. Lindquist LW, Rockier B, Carlsson GE. Bone resorption around fixtures in edentulous patients treated with mandibular fixed tissue-integrated prostheses. J Prosthet Dent. 1988 Jan;59(1):59-63.
41. White SN, Caputo AA, Anderkvist T. Effect of cantilever length on stress transfer by implant-supported prostheses. J Prosthet Dent. 1994 May;71(5):493-9.
42. Atwood DA. Reduction of residual ridges in the partially edentulous patient. Dent Clin
North Am. 1973 Oct;17(4):747-54.
43. Zitzmann NU, Marinello CP. A review of clinical and technical considerations for fixed and removable implant prostheses in the edentulous mandible. Int J Prosthodont. 2002 Jan-Feb;15(1):65-72. Review.
44. Weischer T, Schettler D,Mohr C. Implant-supported telescopic restorations in maxillofacial prosthetics. Int J Prosthodont. 1997 May-Jun;10(3):287-92.
45．朱希涛，主编。口腔修复学。第2版。北京：人民卫生出版社，1990．149．
46. Menicucci G, Mossolov A, Mozzati M, et al. Tooth-implant connection: some biomechanical aspects based on finite element analyses. Clin Oral Impl Res, 2002, 13:334-341.
47. Batenburg RH, Raghoebar GM,Van Oort RP,Boering G.Mandibular overdentures supported by two or four endosteal implants.a prospective,comparative study. Int J Oral Maxillofac Surg 1998;27(4):435-9.
48. Barbier L, Schepers E. Adaptive bone remodeling around oral implants under axial and nonaxial loading conditions in the dog mandible. Int J Oral Maxillofac Implants. 1997 Mar-Apr; 12(2):215-23.
49. Sadowsky SJ. Mandibular implant-retained overdentures: a literature review. J Prosthet Dent, 2001, 86(5):468-73.
50. Sadowsky SJ, Caputo AA. Effect of anchorage systems and extension base contact on load transfer with mandibular implant-retained overdentures. J Prosthet Dent. 2000, 84(3):327-34.
2. Doundoulakis JH, Eckert SE, Lindquist CC, Jeffcoat MK. The implant-supported overdenture as an alternative to the complete mandibular denture. J Am Dent Assoc. 2003 Nov; 134(11): 1455-8.
3. Watson P. Longevity expectations of prosthodontic treatments for dentate and edentulous patients. Int J Prosthodont. 2003;16 Suppl:66-8; discussion 68-70.
4. Isler M, Behneke N, Behneke A, d'Hoedt B. Residual ridge resorption in the edentulous maxilla in patients with implant-supported mandibular overdentures: an 8-year retrospective study. Int J Prosthodont. 2003 May-Jun;16(3):295-300.
5. Rangert B, Krogh PH, Langer B, Van Roekel N. Bending overload and implant fracture: a retrospective clinical analysis. Int J Oral Maxillofac Implants. 1995 May-Jun;10(3): 326-34.
6. Isidor F. Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys. Clin Oral Implants Res. 1996 Jun;7(2):143-52.
7. Sposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (Ⅰ). Success criteria and epidemiology. Eur J Oral Sci. 1998 Feb; 106(1):527-51.
8. O'Mahony A, Bowles Q, Woolsey G, Robinson SJ, Spencer P. Stress distribution in the single-unit osseointegrated dental implant: finite element analyses of axial and off-axial loading. Implant Dent. 2000;9(3):207-18.
9. Mericske-Stern R, Piotti M, Sirtes G. 3-D in vivo force measurements on mandibular implants supporting overdentures. A comparative study. Clin Oral Implants Res. 1996 Dec;7(4):387-96.
10. Bergendal T, Engquist B. Implant-supported overdentures: a longitudinal prospective study. Int J Oral Maxillofac Implants. 1998 Mar-Apr;13(2):253-62.
11. Duyck J, Van Oosterwyck H, Vander Sloten J, De Cooman M, Puers R, Naert I. In vivo forces on oral implants supporting a mandibular overdenture: the influence of attachment system. Clin Oral Investig. 1999 Dec;3(4):201-7.
12. Von Wowem N, Gotfredsen K.Implant-supported overdentures, a prevention of bone loss in edentulous mandibles? A 5-year follow-up study. Clin Oral Implants Res. 2001 Feb;12(1):19-25.
13. Heckmann SM, Winter W, Meyer M, Weber HP, Wichmann MG. Overdenture attachment selection and the loading of implant and denture-bearing area. Part 2: A methodical study using five types of attachment.. Clin Oral Implants Res. 2001 Dec;12(6):640-7.
14．张富强主编．圆锥型套筒冠义齿[M]第一版，上海科学技术文献出版社．2002
15. Geng JP, Tan KB, Liu GR. Application of finite element analysis in implant dentistry: a review of the literature. J Prosthet Dent. 2001 Jun;85(6):585-98.
16. Chun HJ, Cheong SY, Han JH, Heo SJ, Chung JP, Rhyu IC, Choi YC, Baik HK, Ku Y, Kim MH. Evaluation of design parameters of osseointegrated dental implants using finite element analysis. J Oral Rehabil. 2002 Jun;29(6):565-74.
17. Akca K, Cehreli MC, Iplikcioglu H. A comparison of three-dimensional finite element stress analysis with in vitro strain gauge measurements on dental implants, Int J Prosthodont. 2002 Mar-Apr;15(2):115-21.
18. DeTolla DH, Andreana S, Patra A, Buhite R, Comella B. Role of the finite element model in dental implants. J Oral Implantol. 2000;26(2):77-81.
19. Van Oossterwyck H, Duyck J, Vander Sloten J, Van der Perre G, Jansen J, Wevers M, Naert I. Use of microfocus computerized tomography as a new technique for characterizing bone tissue around oral implants. J Oral Implantol. 2000;26(1):5-12.
20. Stegaroiu R, Kusakari H, Nishiyama S, Miyakawa O. Influence of prosthesis material on stress distribution in bone and implant: a 3-dimensional finite element analysis. Int J Oral Maxillofac Implants. 1998 Nov-Dec;13(6):781-90.
21. Holmgren EP, Seckinger RJ, Kilgren LM, Mante F. Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional
comparative study examining the effects of implant diameter, implant shape, and load direction. J Oral Implantol. 1998;24(2):80-8.
22. Pierrisnard L, Hure G, Barquins M, Chappard D. Two dental implants designed for immediate loading: a finite element analysis. Int J Oral Maxillofac Implants. 2002 May-Jun; 17(3):353-62.
23. Meijer HJA, Kuiper JH, Starmans FJM, et al. Stress distribution around dental implants: influence of superstructure, lenth of implants and height of mandible. J Prothet Dent, 1992,18:116-21.
24．魏红，巢永烈，韩晓莉。全下颌改良卡式与传统卡式种植覆盖义齿受载的比较性研究。口腔医学纵横杂志，1999，15(1)：13-16
25. Meijer HJ,Starmans FJ,Steen WH,Bosman F.A Three-Dimensional Finite Element Study on Two Versus Four Implants in an Edentulous Mandible. Int J Oral Maxillofac Implants. 1994;7:271-279
26. Rieger MR, Adams WK, Kinzel GL. Finite Element Analysis of Bone- adapted and Bonebonded Endosseous Implants. J Prosthet Dent,1 989,62:43 6～ 43 9.
27. Clelland NL, Ismail YH, Zaki HS, Pipko D. Three-dimensional finite element stress analysis in and around the Screw-Vent implant. Int J Oral Maxillofac Implants. 1991 Winter;6(4):391-8.
28. Iplikcioglu H, Akca K, Cehreli MC, Sahin S. Comparison of non-linear finite element stress analysis with in vitro strain gauge measurements on a Morse taper implant. Int J Oral Maxillofac Implants. 2003 Mar-Apr;18(2):258-65.
29. Akagawa Y, Sato Y, Teixeira ER, Shindoi N, Wadamoto M. A mimic osseointegrated implant model for three-dimensional finite element analysis. J Oral Rehabil. 2003 Jan;30(1):41-5.
30. Iplikcioglu H, Akca K.Comparative evaluation of the effect of diameter, length and number of implants supporting three-unit fixed partial prostheses on stress distribution in the bone. J Dent. 2002 Jan;30(1):41-6.
31. Meijer HJ, Starmans FJ, Steen WH, Bosman F. Loading conditions of endosseous
implants in an edentulous human mandible: a three-dimensional, finite-element study. J Oral Rehabil. 1996 Nov;23(11):757-63.
32. Holmes DC, Loftus JT. Influence of bone quality on stress distribution for endosseous implants. J Oral Implantol. 1997;23(3): 104-11.
33. Ishigaki S, Nakano T, Yamada S, Nakamura T, Takashima F. Biomechanical stress in bone surrounding an implant under simulated chewing. Clin Oral Implants Res. 2003 Feb;14(1):97-102.
34. Hansson S. Implant-abutment interface: biomechanical study of flat top versus conical. Clin Implant Dent Relat Res. 2000;2(1):33-41.
35. Wenz HJ, Lehmarm KM. A telescopic crown concept for the restoration of the partially edentulous arch: the Marburg double crown system. Int J Prosthodont. 1998 Nov-Dec; 11(6):541-50.
36. Lindstrom H, Preiskel H. The implant-supported telescopic prosthesis: a biomechanical analysis. Int J Oral Maxillofac Implants. 2001 Jan-Feb;16(1):34-42.
37. Weischer T, Mohr C. Implant-supported mandibular telescopic prostheses in oral cancer patients: an up to 9-year retrospective study. Int J Prosthodont. 2001 Jul-Aug;14(4): 329-34.
38. Porter JA Jr, Petropoulos VC, Brunski JB. Comparison of load distribution for implant overdenture attachments. Int J Oral Maxillofac Implants. 2002 Sep-Oct;17(5):651-62.
39. Papavasiliou G, Kamposiora P, Bayne SC, Felton DA. 3D-FEA of osseointegration percentages and patterns on implant-bone interfacial stresses. J Dent. 1997 Nov;25(6):485-91.
40. Lindquist LW, Rockier B, Carlsson GE. Bone resorption around fixtures in edentulous patients treated with mandibular fixed tissue-integrated prostheses. J Prosthet Dent. 1988 Jan;59(1):59-63.
41. White SN, Caputo AA, Anderkvist T. Effect of cantilever length on stress transfer by implant-supported prostheses. J Prosthet Dent. 1994 May;71(5):493-9.
42. Atwood DA. Reduction of residual ridges in the partially edentulous patient. Dent Clin
North Am. 1973 Oct;17(4):747-54.
43. Zitzmann NU, Marinello CP. A review of clinical and technical considerations for fixed and removable implant prostheses in the edentulous mandible. Int J Prosthodont. 2002 Jan-Feb;15(1):65-72. Review.
44. Weischer T, Schettler D,Mohr C. Implant-supported telescopic restorations in maxillofacial prosthetics. Int J Prosthodont. 1997 May-Jun;10(3):287-92.
45．朱希涛，主编。口腔修复学。第2版。北京：人民卫生出版社，1990．149．
46. Menicucci G, Mossolov A, Mozzati M, et al. Tooth-implant connection: some biomechanical aspects based on finite element analyses. Clin Oral Impl Res, 2002, 13:334-341.
47. Batenburg RH, Raghoebar GM,Van Oort RP,Boering G.Mandibular overdentures supported by two or four endosteal implants.a prospective,comparative study. Int J Oral Maxillofac Surg 1998;27(4):435-9.
48. Barbier L, Schepers E. Adaptive bone remodeling around oral implants under axial and nonaxial loading conditions in the dog mandible. Int J Oral Maxillofac Implants. 1997 Mar-Apr; 12(2):215-23.
49. Sadowsky SJ. Mandibular implant-retained overdentures: a literature review. J Prosthet Dent, 2001, 86(5):468-73.
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