臺灣博碩士論文加值系統

支台齒的數目是缺牙區贗復的重要關鍵，目前只有自體齒移植及人工植牙技術可增加缺牙區支台齒的數目。人工植牙因為成功率高且技術簡單，已是目前廣為認同之技術，但是昂貴的價格及長時間的癒合則是其臨床實行上的問題。而自體齒移植之癒合時間短，加上花費也較人工牙根低廉，正可解決上述的兩個問題，但是自體齒移植的缺點是技術較困難，且在應用上有許多限制。隨著科技的進步，利用組織工程技術，以誘導牙周組織癒合，使得自體齒移植突破了過去的限制。
本研究以狗之單根牙為自體齒移植實驗模式，並將牙釉基質衍生物塗抹於牙根表面後，再置入齒槽底，觀察牙根表面牙周韌帶細胞之活性與牙周組織之再生；另外也結合可吸收性組織再生膜，進行牙周組織引導再生。實驗結果顯示，結合組織工程技術的自體齒移植可獲得的結果包括(1)較少的牙根吸收(2)促進移植後牙周韌帶纖維的生成及加快移植後之組織癒合速度，(3)促進牙骨質的再生，(4)獲得與新生牙骨質垂直嵌合之牙周韌帶關係(5)促進齒槽骨的重塑速度(6)促進新生齒槽骨及新附連的生成

Dental implant and autotransplantation of tooth are the only two practical ways to increase the number of abutment tooth over the edentulous region. High successful rate and friendly technical procedures are the well known advantage of dental implant. However, high price and long healing period are its major problems. Comparing to dental implant, autotransplantaion is cheaper and has shorter healing period (about 3 weeks), there are still many clinical limitations of autotransplantation. Besides, high technical sensitivity is the another problem of it. In order to overcome the limitation of autotransplantation, the concept of tissue engineering has been proposed.
In this study, we developed a transplanted the single-root-teeth of beagle dog translaterally as the animal model. The enamel matrix derivative (Emdogain®) was applied onto the root surface and the recipient socket before the teeth were transplanted. Consequently, the junction of the tooth and socket were covered with the biodegradable membrane (Atrisorb®). No special treatment had been done in the control group. After 4 and 8 weeks, the dogs were sacrificed. The teeth and their surrounding periodontal tissues were prepared for histological observation.
All teeth were clinical success after transplantation by showing normal mobility, no periodontal pocket and no metallic sound. Root resorption, however, was noted in every root from both control and test group under microscope examination. The control group was obviously more serious. Comparing between the control and test group, the benefit of application of tissue engineering are summarized as following: (1) less root resorption, (2) increased the rate of healing process and production of PDL, (3)increased the rate of remodeling of cementum and alveolar bone,(4) Sharpey’s fibers formation noted in the most root surface in test group, (5)increase new attachment formation and (6)more bone support

正文目錄----------------------------------------------------------------------------I
表目錄-----------------------------------------------------------------------------III
圖目錄-----------------------------------------------------------------------------IV
中文摘要---------------------------------------------------------------------------V
英文摘要--------------------------------------------------------------------------VI
第一章、前言----------------------------------------------------------------------1
第二章、文獻探討---------------------------------------------------------------3
壹、 自體齒移植之實驗模式---------------------------------------3
貳、 自體齒移植之臨床限制---------------------------------------6
參、 引導組織再生術----------------------------------------------11
肆、 可吸收性組織再生膜於自體齒移植之應用-------------13
伍、 牙釉基質衍生物----------------------------------------------14
第三章、材料與方法----------------------------------------------------------17
壹、 實驗動物準備-------------------------------------------------17
貳、 實驗動物分組及手術進行方式----------------------------17
動物實驗流程圖----------------------------------------------19
參、 標本製作-------------------------------------------------------20
肆、 染色-------------------------------------------------------------20
一、 藥品--------------------------------------------------------20
二、 染色步驟--------------------------------------------------22
三、 Modified Masson-Godner染色對照表-------------23
伍、 組織型態學分析----------------------------------------------23
第四章、結果-------------------------------------------------------------------24
壹、臨床檢查發現---------------------------------------------------24
貳、顯微鏡鏡檢發現------------------------------------------------24
一、 第四周之控制組(矢狀切面)---------------------------24
二、 第四周之實驗組(矢狀切面)---------------------------26
三、 八週之控制組(矢狀及水平切面)---------------------27
四、 八週之實驗組(矢狀及水平切面)---------------------28
第五章、討論-------------------------------------------------------------------31
壹、實驗設計--------------------------------------------------------31
貳、實驗結果--------------------------------------------------------33
第六章、結論------------------------------------------------------------------39
參考文獻------------------------------------------------------------------------40

1. Tsukiboshi M. Autogenous tooth transplantation: a reevaluation. Int J Periodontics Restorative Dent 1993;13(2):120-49.
2. Tsukiboshi M. Autotransplantation of teeth: Quintessence, 2001.
3. Hurzeler MB, Quinones CR. Autotransplantation of a tooth using guided tissue regeneration. J Clin Periodontol 1993;20(7):545-8.
4. Clokie CM, Yau DM, Chano L. Autogenous tooth transplantation: an alternative to dental implant placement? J Can Dent Assoc 2001;67(2):92-6.
5. Marin PD. The avulsed tooth--the best implant. Ann R Australas Coll Dent Surg 2000;15:243-6.
6. Nethander G. Autogenous free tooth transplantation by the two-stage operation technique. An analysis of treatment factors. Acta Odontol Scand 1998;56(2):110-5.
7. Northway WM, Konigsberg S. Autogenic tooth transplantation. The "state of the art". Am J Orthod 1980;77(2):146-62.
8. Terheyden H, Gerhardt U, Konig J. [Long-term follow-up of tooth transplantation from the functional and periodontal viewpoint]. Fortschr Kiefer Gesichtschir 1995;40:84-7.
9. Fuss Z. Successful self-replantation of avulsed tooth with 42-year follow-up. Endod Dent Traumatol 1985;1(3):120-2.
10. Cleary P, Spolnik K, Barton P. The avulsed tooth: a treatment rationale. J Ir Dent Assoc 1986;32(1):7-10.
11. Pogrel MA. Evaluation of over 400 autogenous tooth transplants. J Oral Maxillofac Surg 1987;45(3):205-11.
12. Andreasen JO, Paulsen HU, Yu Z, Bayer T, Schwartz O. A long-term study of 370 autotransplanted premolars. Part II. Tooth survival and pulp healing subsequent to transplantation. Eur J Orthod 1990;12(1):14-24.
13. Czochrowska EM, Stenvik A, Bjercke B, Zachrisson BU. Outcome of tooth transplantation: survival and success rates 17-41 years posttreatment. Am J Orthod Dentofacial Orthop 2002;121(2):110-9; quiz 193.
14. Andreasen JO. Periodontal healing after replantation and autotransplantation of incisors in monkeys. Int. J. Oral Surg 1981;10:54-61.
15. Andreasen JO, L.Kristerson. The effect of limited drying or removal of the periodontal ligment. Periodontal healing after replantation of mature permanent incisors in monkey. Acta Odontol. Scand 1981;39:1-13.
16. Andreasen JO, Andreasen FM. Essentials of traumatic injuries to the teeth: Munksgaard, 2000.
17. Nethander G, Andersson JE, Hirsch JM. Autogenous free tooth transplantation in man by a 2-stage operation technique. A longitudinal intra-individual radiographic assessment. Int J Oral Maxillofac Surg 1988;17(5):330-6.
18. Andreasen JO. Relationship between cell damage in the periodontal ligment after replantation and subsequent development of root resorption. A time-related study in monkeys. Acta Odontol. Scand 1981;39:15-25.
19. Lien SE, Polson AM, H.A.Zander. Relationship between periodontal injury, selective cell repopulation and ankylosis. J Periodontal Res 1974;45(10):725-730.
20. Nyman S, Lindhe J, Karring T, Rylander H. New attachment following surgical treatment of periodontal disease. J clin Periodontol 1982;9:257-265.
21. Dowell P, Moran J, Quteish D. Guided tissue regeneration. Br Dent J 1991;171(5):125-7.
22. Bouchard P, Giovannoli JL, Mattout C, Davarpanah M, Etienne D. Clinical evaluation of a bioabsorbable regenerative material in mandibular class II furcation therapy. J Clin Periodontol 1997;24(7):511-8.
23. Chung CP, Kim DK, Park YJ, Nam KH, Lee SJ. Biological effects of drug-loaded biodegradable membranes for guided bone regeneration. J Periodontal Res 1997;32(1 Pt 2):172-5.
24. Tseng C-C, Huang C-C, Yuan K. Current status and clinical application of Atrisorb absorbable regeneration material. Chin J Periodontol 1999;4:97-103.
25. Hermann JS, Buser D. Guided bone regeneration for dental implants. Curr Opin Periodontol 1996;3:168-77.
26. Hamamoto Y, Kawasaki N, Jarnbring F, Hammarstrom L. Effects and distribution of the enamel matrix derivative Emdogain in the periodontal tissues of rat molars transplanted to the abdominal wall. Dent Traumatol 2002;18(1):12-23.
27. Yoneda S, Itoh D, Kuroda S, et al. The effects of enamel matrix derivative (EMD) on osteoblastic cells in culture and bone regeneration in a rat skull defect. J Periodontal Res 2003;38(3):333-42.
28. Chano L, Tenenbaum HC, Lekic PC, Sodek J, McCulloch CA. Emdogain regulation of cellular differentiation in wounded rat periodontium. J Periodontal Res 2003;38(2):164-74.
29. Kawana F, Sawae Y, Sahara T, et al. Porcine enamel matrix derivative enhances trabecular bone regeneration during wound healing of injured rat femur. Anat Rec 2001;264(4):438-46.
30. Gestrelius S, Lyngstadaas SP, Hammarstrom L. Emdogain--periodontal regeneration based on biomimicry. Clin Oral Investig 2000;4(2):120-5.
31. Filippi A, Pohl Y, von Arx T. Treatment of replacement resorption with Emdogain--preliminary results after 10 months. Dent Traumatol 2001;17(3):134-8.
32. Iqbal MK, Bamaas N. Effect of enamel matrix derivative (EMDOGAIN) upon periodontal healing after replantation of permanent incisors in beagle dogs. Dent Traumatol 2001;17(1):36-45.
33. Lam K, Sae-Lim V. The effect of Emdogain gel on periodontal healing in replanted monkeys' teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97(1):100-7.
34. Araujo M, Hayacibara R, Sonohara M, Cardaropoli G, Lindhe J. Effect of enamel matrix proteins (Emdogain') on healing after re-implantation of "periodontally compromised" roots. An experimental study in the dog. J Clin Periodontol 2003;30(10):855-61.
35. Anderson AW, Sharav Y, Massler M. Periodontal reattachment after tooth replantation. Periodontics 1968;6(4):161-7.
36. Monsour FN, Adkins KF. A radiographic assessment of autologous tooth transplants in dogs. J Oral Maxillofac Surg 1983;41(1):24-33.