臺灣博碩士論文加值系統

齒顎矯正的診斷如同其他醫學專科一樣，需要收集病人的許多資料，綜合歸納整理出病人的問題列表，然後才能確定其診斷與擬定治療計畫。齒顎矯正學收集的病人資料可能來自：一、問卷與面談，二、臨床評估，三、分析、評估診斷記錄。隨著近年來電腦科技的蓬勃發展，資料數位化儼然是一股無法抵擋的趨勢。現今大多的醫療紀錄都以數位的格式記錄、儲存與管理。在齒顎矯正的診斷與治療記錄方面，數位相片、數位放射線影像也已經行之有年。近年發展的數位齒模可望能取代牙科的實體診斷記錄「石膏齒模」。本研究目的是利用現有之軟硬體設施來製作數位齒模，並以例行性的齒模分析項目為探討參數，比較傳統石膏齒模與數位齒模的差異，探討以此方式製成之數位齒模，其取代石膏齒模的可行性。
本研究樣本為28位牙齒數目完整、無固定牙橋贋復病人的上下顎石膏齒模。使用游標尺測量石膏齒模，而雷射掃描儀VIVID 9i與逆向工程軟體Rapidform 2006用以製作與測量數位齒模。共測量14項探討變數，分成組內組與組間組兩組討論，以SPSS軟體進行配對樣本t檢定的統計分析，p值設為0.05。
組內組的結果顯示大多數探討變數在數位與石膏齒模間無顯著的差異。組間組的結果顯示近三分之一的探討變數在數位與石膏齒模間有統計上顯著的差異。個別牙齒的部份，不論是數位或石膏齒模，不同測量者間測量數值的最大最小值差距可高達2 mm。
數位齒模相較於傳統石膏齒模有許多優點。唯有建置的設備成本頗高，現今大多是送至商業公司製作。組間組雖有近三分之一的變數有統計上顯著的差異，但是不同測量者間的差異（數位與石膏齒模的標準差）大於數位與石膏齒模間的差值，顯示數位與石膏齒模間的差異無臨床意義。測量工具（游標尺或軟體點選）與影像品質（凸起雜訊）是造成本研究數位與石膏齒模間差異的主要原因。單就本研究探討的變數來看，本研究方法製成的數位齒模在臨床上可取代傳統石膏齒模的測量。其它的測量項目則仍需進一步的試驗。

Same as medicine, orthodontic doctors needed to collect lots of patients’ data to conclude the problem list. Then, they could decide the diagnosis and the treatment plan. The data collected might be from the questionnaire and interview, clinic examinations, and diagnostic records. Along with the development of computer technique, digitization was a trend unable to stop. Now, most medical records were recorded, stored and managed in digital form. For orthodontic diagnosis and treatment plan, digital photography and digital radiography had been taken many years. The digital dental models developed recently might replace the cast models in dentistry. The purpose of this study was to assess the difference between the digital dental models and cast models, and the possibility that the digital replace the cast models.
28 sets of cast models were scanned using the VIVID 9i laser digitizer. The digital model were produced and measured by the Rapidform 2006 software. 14 parameters were measured and the study was divided into 2 groups (intra-examiner and inter-examiner). The results were analyzed by paired t test and the P value was 0.05.
The result of intra-examiner group indicated that there was no significant difference in most parameters between digital models and cast models. The result of inter-examiner group indicated that there was significant difference in almost 1/3 parameters between digital models and cast models.
Comparing to cast models, there were lots of advantage using digital models. But the equipments were too expensive. In inter-examiner group, although there was significant difference between digital models and cast models, the difference among examiners was lager. That indicated the difference was not clinically significant. Measuring tools and the quality of images were the main cause of the difference between digital models and cast models. According to the parameters we measured, digital models and cast models were not clinic different.

本文摘要 I
ABSTRACT III
致謝 V
目錄 VI
圖目錄 IX
表目錄 XI
第一章 前言 1
第一節 研究背景 1
第二節 齒顎矯正診斷之介紹 2
2.1 問卷與面談 2
2.2 臨床檢查 5
2.3 診斷記錄 8
第三節 牙齒模型分析之介紹 12
3.1 對稱性 12
3.2 空間分析 12
3.3 牙齒尺寸分析 15
第四節 三維數位影像之介紹 16
4.1 三維數位影像之發展 16
4.2 傳統三維數位影像 19
4.2.1 電腦斷層掃描（Computed tomography） 19
4.2.2 核磁共振（Magnetic resonance imaging） 19
4.3 當代三維數位影像 20
4.3.1 錐狀射束電腦斷層掃描（Cone beam computed tomography） 20
4.3.2 結構光（Structured light） 20
4.3.3 立體攝影法（Stereophotogrammetry） 22
4.3.4 雷射掃描 22
4.4 三維數位影像於齒顎矯正之應用 26
第五節 數位齒模之文獻回顧 28
5.1 數位齒模的發展 28
5.2 數位齒模的製作 30
5.3 數位齒模與傳統石膏齒模的比較 31
5.4 數位齒模的應用 32
第六節 研究動機與目的 34
第二章 材料與方法 35
第一節 樣本的選取與製作 35
第二節 研究材料 35
第三節 研究方法與設計 37
3.1 數位齒模之製作 37
3.2 驗證試驗 39
3.3 測量組別 40
3.4 測量方法 40
3.5 研究流程 42
第四節 探討變數與統計方法 43
第三章 結果 45
第四章 討論 48
第一節 驗證試驗 48
第二節 數位齒模的影像品質 49
第三節 組內組 50
第四節 組間組 51
第五節 研究限制與缺失 54
第五章 結論 56
第六章 未來展望 58
參考資料 60

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