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中华口腔医学研究杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 1 -9. doi: 10.3877/cma.j.issn.1674-1366.2023.01.001

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三维打印钛种植体性能及临床应用的研究进展
黄石头1, 魏洪波1, 李德华1,†()   
  1. 1. 军事口腔医学国家重点实验室，口腔疾病国家临床医学研究中心，陕西省口腔生物工程技术研究中心，第四军医大学口腔医院种植科，西安　710032
  • 收稿日期:2022-10-22 出版日期:2023-02-01
  • 通信作者: 李德华

Research progress on mechanical and osseointegration properties of three-dimensional printed titanium implants

Shitou Huang1, Hongbo Wei1, Dehua Li1,†()   

  1. 1. State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Implantology, School of Stomatology, the Fourth Military Medical University, Xi′an 710032, China
  • Received:2022-10-22 Published:2023-02-01
  • Corresponding author: Dehua Li
  • Supported by:
    National Key R & D Program of China(2017YFB1104100)
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黄石头, 魏洪波, 李德华. 三维打印钛种植体性能及临床应用的研究进展[J]. 中华口腔医学研究杂志(电子版), 2023, 17(01): 1-9.

Shitou Huang, Hongbo Wei, Dehua Li. Research progress on mechanical and osseointegration properties of three-dimensional printed titanium implants[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2023, 17(01): 1-9.

种植牙是目前临床应用较为广泛的缺牙修复方式。种植体是种植治疗过程中的关键材料之一，以机械减材加工为主要生产方式。近年来，金属三维打印技术的出现和发展为口腔种植体的制造提供了另一种方法，三维打印钛种植体逐渐成为口腔种植领域的一个研究方向。本文阐述了可用于制备钛合金种植体的三维打印技术及其优缺点，并着重论述三维打印钛合金种植体力学、骨结合性能及临床应用的研究进展。

关键词: 三维打印, 钛种植体, 力学性能, 骨结合

Implant is one of the key materials in the implant treatment process. Subtractive manufacturing is the main mode of production for implants. In recent years, the emergence and development of metal three-dimensional (3D) printing technology have provided an alternative method for the manufacturing of dental implants. Powder bed melting is one of the metal 3D printing technologies and most widely used in the biomedical field. Among them, selective laser melting (SLM) is the mainstream process of powder bed melting, which has strong comprehensive properties and broad application prospects. It has been found that 3D printing titanium implants have better mechanical properties than castings and are close to forgings, but there is a problem with mechanical properties anisotropy that needs to be optimized to meet the requirements of dental implant materials. In terms of biological characteristics, it has been proved that 3D printing technology does not affect the biocompatibility of titanium materials. Researchers demonstrated that 3D printed titanium implants have similar or even better osseointegration properties than the conventional titanium implants in three aspects: healthy animals, disease animal models and human experiments. Finally, the problems existing in 3D printed titanium implants are summarized and further research is envisioned.

Key words: 3D printing, Titanium implant, Mechanical properties, Osseointegration
表1 加工钛合金种植体的三维打印技术[1,6,10]
技术类别 成型精度（μm） 优点 缺点
DMLS 20~35 成型件尺寸精度高，机械性能强。 成型件内部孔隙率相对高，需要昂贵复杂的后处理。
SLM 20~35 成型件尺寸精度高，表面质量佳，致密度高，力学性能好，加工余量小。 需要支撑结构，成形过程中，容易出现球化和翘曲，成型件内部残余应力大，必须进行去应力退火，打印速度偏慢。
EBM 40~50 成型件残余应力低，较高的零件密度、强度，成型速度更快，翘曲、变形的风险较低。 精度偏低，表面粗糙度过高，加工余量大。
表2 不同工艺所制备钛合金的拉伸性能[9,13,14]
工艺类别 状态 屈服强度（MPa） 抗拉强度（MPa） 延伸率（%）
SLM 成型态 1 065 1 241 6
DMLS 成型态 1 122 1 158 2.1~5.5
EBM 成型态 992 ± 8 890 ± 12 16 ± 0.8
钛合金锻件（GB/T 13810-2017） 退火态 ≥860 ≥960 ≥10
表3 构建三维打印钛种植体表面微纳复合形貌的方法
作者 年份 构建方法 主要结果
Maher等[41] 2021 对选择性激光熔化（SLM）钛种植体进行阳极氧化后，将试样浸入50 mL NaOH（1 mol/L）中，然后置于160 ℃的烤炉中，时间0.5~6 h。随后，冷却至室温，并用超纯水冲洗3次。再将样品在0.6 mol/L盐酸溶液中浸泡1 h，然后在300 ℃的管式炉中常压下焙烧3 h。 电子显微镜下观察种植体具有独特的双重微纳形貌，由微米级球形特征和垂直排列的纳米级柱状结构组成。种植体表面转变为超亲水表面，已测不出接触角。与对照组相比，处理后的种植体增加了模拟体液（SBF）中的羟基磷灰石类矿物沉积，此外，人成骨样细胞（NHBC）在纳米/微结构上表现出很强的黏附性，并表现出更大的矿化倾向。
Shu等[46] 2021 在室温下，用φ=30%双氧水和φ=30%盐酸（体积比1∶2.5）对SLM种植体进行纳米化处理36 h，然后用蒸馏水彻底冲洗。 纳米化处理的SLM种植体的接触角小于5°，显示出较高的亲水性能。细胞实验显示，在5 d时纳米修饰种植体有丝分裂相关基因（PINK1、Parkin、LC3B、LAMP1）表达增强，14 d时成骨相关基因（Runx2、Ocn）表达增强。在骨形成的早期阶段，纳米修饰的SLM种植体表现出比对照组更高的骨与种植体接触。
Le等[47] 2021 SLM种植体在70 ℃的φ=66.3%硫酸和φ=10.3%盐酸的混合物中浸泡1 h，然后在600 ℃的电炉中加热1 h，自然冷却。 酸热混合处理提高了SLM种植体的亲水性，接触角仅为1°。在模拟体液中浸泡样品时，只有酸热混合处理SLM钛种植体在其表面完全形成球状沉淀，而其他样品没有任何沉积。RT-PCR定量检测成骨相关基因的结果表明，酸热混合处理表面的MC3T3-E1细胞通过ALP、OCN、Runx2和OPN的表达显著增加，在基因水平上表现出更强的成骨分化倾向。
Xu等[48] 2018 对SLM种植体进行阳极氧化处理，形成了二氧化钛纳米管阵列，然后通过电化学沉积将磷酸钙纳米颗粒嵌入到纳米管或纳米管之间。 牙龈上皮细胞和牙龈成纤维细胞在阳极氧化和电化学沉积组的黏附、增殖及黏附相关基因表达显著高于对照组（仅阳极氧化组和未处理组）差异有统计学意义。
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