臺灣博碩士論文加值系統

近年來牙科植體的發展已瑧成熟，但卻仍缺乏一套有效裝置可以協助牙醫師評估植體於植入初期，以及在後續的骨癒合過程中的固持狀態。本研究乃分別利用動物實驗與體外模擬實驗，驗證以共振頻率為理論基礎所發展的牙科植體穩固度檢測系統。藉由量測人工植體在不同的穩固度下之共振頻率，以瞭解其未來臨床使用之特性。在為期12週的動物實驗之量測結果顯示，植體植入時的初始頻率與癒合時間及達高原期時的共振頻率上升比例之間，皆存在著近乎線性相關(y = -1583.9x + 12260, R2 = 0.6587及y = -25.949x + 4852.9, R2 = 0.812)，且當植入兔子脛骨中的植體之初始共振頻率值為1000~2000 Hz時，可由其量測值增加了90~130 %的量來判斷其已近乎完成癒合；而當植入時之初始共振頻率值為2000~3000 Hz時，或大於3000 Hz時，則可分別由其頻率值增加90 %及50 %來判斷其是否已接近完成癒合。此結果顯示在利用共振頻率法作為牙科植體穩固度參考依據時，可由初始量測值推估完成癒合的時間，並在此時進行第二次量測，再由其增加的比例來判斷骨癒合是否達到完成。且當植體骨整合失敗時，其共振頻率會有下降趨勢。由此可知，共振頻率法不僅可以偵測植體手術骨整合之進行，亦可早期診斷可能的失敗。預期此一新型牙科植體穩固度檢測方法將可成為牙醫師於臨床牙科植體手術時之輔助診斷工具。

In the past thirty years, there were numerous studies published on the stability of dental implant during osseointegration, but there have been still no valid and effective devices yet for dentists to determine the appropriate timing for prosthodontic loading of implants. Recently, implant stability assessment with resonance frequency (RF) has been discussed by numerous studies. However, due to the limit space of oral cavity, the traditional harmonic response method is not suitable for intra-oral practice. Therefore, in the present study, a novel device based on vibration theory developed by our lab was tested for clinical use in vivo and in vitro. The results of RF values show that there are nearly linear relationships between both the initial RF values (IRF) and the healing time and the increasing ratio of RF values (IRRF) at plateau (y = -1583.9x + 12260, R2 = 0.6587 and y = -25.949x + 4852.9, R2 = 0.812). These data demonstrate that the implants with IRF values located at 1000~2000 Hz, 2000~3000 Hz and more than 3000 Hz are stable when their IRRF values reach 90~130 %, 90 % and 50 %, respectively. Therefore, in the clinical practice, we may estimate the healing time of implant by the detected IRF values, and then, make the second detection at the estimated time to judge whether the implant heals from its IRRF value. Furthermore, the RF values might decrease when the osseointegration failed. That is, RF value of implant may help not only to monitor the process of osseointegration of implants, and make the early diagnosis of implant failure, but also estimate the timing of prosthodontic loading. With the optimal modification in the future, it will offer the dentist a useful tool for diagnosis of the dental implant surgery.

中文摘要……………….…………………………ii
英文摘要…………………………….……………iv
目錄………………………………….…………….vi
第一章 緒論………………………….………….1
第一節 研究動機與重要性….…....…..1
第二節 研究目的…………………..……9
第三節 研究假說……………..…..……10
第四節 名詞解說……………..…..……16
第二章 文獻回顧………………………………19
第一節 影響植牙手術成功的因素…..19
第二節 侵入性檢測法……………...…27
第三節 非侵入性檢測法……………...30
第三章 研究材料與方法……………….…….34
第一節 新型植體檢測系統簡介…..…34
第二節 標準音叉驗證實驗….…….….39
第三節 兔子體內實驗………….……...41
第四節 植體邊界狀態實驗….….….…49
第五節 骨癒合模擬實驗……………...53
第四章 研究結果……………….……….…….60
第一節 標準音叉驗證實驗….…….….60
第二節 兔子體內實驗………….……...61
第三節 植體邊界狀態實驗……..….…68
第四節 骨癒合模擬實驗……………...73
第五章 討論…….……………….……….…….76
第一節 標準音叉驗證實驗….…….….76
第二節 兔子體內實驗………………....80
第三節 植體邊界狀態實驗…….…..…89
第四節 骨癒合模擬實驗……………...94
第六章 結論…………………….……….……101
參考文獻………………………………….…….104
表一~表八………………….……..……………118
圖說………………………….………………….126
圖一~圖四十九………………………………..132

1. Wong FY, Pal S, Saha S. The assessment of in vivo bone condition in humans by impact response measurement. J Biomech, 16(10): 849-856, 1983.
2. Oka H, Yamamoto T, Saratani K, Kawazoe T. Application of mechanical mobility of periodontal tissues to tooth mobility examination. Med & Biol Eng & Comput, 27: 75-81, 1989.
3. Thomson WT. Theory of vibration with applications. 3rd ed, Prentice-Hall Inc, NY, 1988.
4. Rao SS. Mechanical Vibrations. 2nd ed, Addison-Wesley Inc, NY, 1990.
5. Noyes DH, Solt CW. Measurement of mechanical mobility of human incisors with sinusoidal forces. J Biomech, 6: 439-442, 1973.
6. Oka H, Yamamoto T, Saratani K, Kawazoe T. Application of mechanical mobility of periodontal tissues to tooth mobility examination. Med & Biol Eng & Comput, 27: 75-78, 1989.
7. Oka H, Yamamoto T, Saratani K. Automatic diagnosis of tooth mobility for clinical use. Med Prog Through Technol, 16(3): 117-24, 1990.
8. Okazaki M, Fukumoto M, Takahashi J. Damped oscillation analysis of natural and artificial periodontal membranes. Ann Biomech Eng, 24: 234-240, 1996.
9. Lee SY, Huang HM, Lin CY, Shih YH. In vivo and in vitro natural frequency analysis of periodontal conditions, an innovative method. J Periodont, 71: 632-640, 1999.
10. Kaneko T et. al. Acoustoelectric technique for assessing the mechanical state of the dental implant-bone interface. J Biomed Mater Res, 20: 169-176, 1986.
11. Kaneko T. Assessment of the interfacial rigidity of bone implants from vibrational signals. J Mater Sci, 22: 3495-3502, 1987.
12. Kaneko T. Comparison between acoustic and mechanical tapping methods for assessing the interfacial states of bone implants. J Mater Sci, 24: 2820-2824, 1989.
13. Kaneko T. Pulsed oscillation technique for assessing the mechanical state of the dental implant-bone interface. Biomaterials, 12: 555-560, 1991.
14. Kaneko T. Assessment of the dental implant-bone interface from a pulsed microvibration. J Mater Sci Lett, 10: 185-187, 1991.
15. Meredith N, Alleyne D, Cawley P. Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis. Clin Oral Impl Res, 7: 261-267, 1996.
16. Meredith N, Book K, B Friberg, Jemt T, Sennerby L. Resonance frequency measurements of implant stability in vivo. Clin Oral Impl Res, 8: 226-233, 1997.
17. Sennerby L, Meredith N. Resonance frequency analysis: Measuring implant stability and osseointegration. Compendium, 19(5): 493-502, 1998.
18. Elias JJ, Brunski JB, Scarton HA. A dynamic modal testing technique for noninvasive assessment of bone-dental implant interfaces. Int J Oral Maxillofac Implants, 11(6): 728-734, 1996.
19. Huang HM, Chiu CL, Yeh CY, Lin CT, Lee SY. Early detection of implant healing process using resonance frequency analysis. Clin Oral Impl Res 14: 1, 2003.
20. Huang HM, Lee SY, Yeh CY, Lin CT. Resonance frequency assessment of dental implant stability with various bone qualities: a numerical approach. Clin Oral Impl Res 13: 65-74, 2002.
21. Huang HM, Chiu CL, Yeh CY, Lee S.Y. Factors influencing the resonance frequency of dental implants. J Oral Maxillofac Surg 61, 2003.
22. Huang HM, Pan LC, Lee SY, Chiu CL, Fan KS, Ho KN. Assessing the implant/bone interface using natural frequency analysis: an in vitro study. Oral Surg Oral Med Oral Pathol 90: 285-291, 2000.
23. Lee S.Y, Huang HM, Pan LC, Lin CT, Ho KN, Fan KS. Resonance frequency assessment of dental implant stability with various bone qualities. Chin Den J 19: 183-192, 2000.
24. Lee S.Y, Ou KL, Chen CF, Huang HM, Wu WF, Chou CP. Development of Piezoelectric Microsensor in Monitoring Stability of Dental Implants. Chin Den J. 2003. (in press).
25. Huang HM, Cheng KY, Cheng PY, Chen HC, Chen JL, Lian RY, Lee S.Y. The design and verification of stability detecting device for dental implant. Chin Den J. 2003. (in press).
26. Brunski JB. Biomechanical factors affecting the bone-dental implant interface. Clin Mater10: 153-201, 1992
27. Brunski J.B. "The Influence of Force, Motion, and Related Quantities on the Response of Bone to Implants," in Non-Cemented Total Hip Arthroplasty (R. Fitzgerald, Jr., ed.), Raven Press Ltd., New York, pp. 7~21, 1988.
28. Jaffin RA, Bemlan CL. The excessive loss of Brånemark fixtures in type Ⅳ bone. J Periodontol 62: 2-4, 1991
29. Chiu CL. Natural frequency assessment of boundary conditions and osseointegration for dental implants. M.S.D. Thesis, Taipei Medical University, 2000.
30. Thomson WT. Normal mode vibration of continuous systems. In “Theory of Vibration with Applications” 3rd ed, Thomson WT ed, Prentice-Hall, NY, pp. 221-224, 1988.
31. Lekholm U, Zarb GA. Patient selection and preparation, in Brånemark P-I, Zarb GA, Albrektsson T (eds): Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence, 1985: 199-209. 1985.
32. Adell R. Clinical results of ossteointergrated implants supporting fixed prothesis in edentulous jaw. J Prosthet Dent 50:251-254, 1983.
33. Adell R. Surgical procedures. In: Brånemark PI, Zarb G, Albrektsson T (ed). Osseointegration in Clinical Dentistry. Chicago: Quintessence 232, 1985.
34. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. A long-term follow-up study of osseointegrated implantsin the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 5:347-359, 1990.
35. Adell R, Lekholm U, Brånemark PI. Surgical procedures, in Brånemark PI, Zarb GA, Albrektsson T(eds):Osseointegration in Clinical Dentistry.Chicago, Quintessence Publ Co, pp 211-232, 1985.
36. Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 10:387-416, 1981.
37. Johansson CB, Albrektsson T. Integration of screw implants in the rabbits:A one-year follow-up of removal torque of titanium implants. Int J Oral Maxillofac Implants 2: 69-75, 1987.
38. Kirsch A, Mentag PJ. The IMZ endosseous two phase implant system:A complete oral rehabilitation treatment concept. J Oral Implantol 12: 576-589, 1986.
39. Albrektsson T, Sennerby L. State of the art in oral implant. J Clin Periodontol 18: 474-481, 1991.
40. Brånemark PI, Hansson B-O, Adell R, Breine U, Lindstrom J, Hallen O, Ohman A. Ossteointergrated implants in the treatment of the edetulous jaw. Experience from a 10-year period. Scand J Plast Reconst Surg, 11(suppl 16): 1-132, 1977.
41. Albrektsson T, Jansson T, Lekholm U. Ossteointergrated implants. Dent Clin North Am 30: 151-177, 1986.
42. Laney WR. Selecting edentulous patients for tissue-integrated prostheses. Int J Oral Maxillofac Implants 1: 129-138, 1986.
43. Beumer J, Lewis SG. Patient selection and treatment planning. The Brånemark Implant System: Clinical and Laboratory Procedure. pp. 15-29, 1989.
44. Albreksson T. On long-term maintenance of the osseointegrated response. Aust Pristhet J 7: 15-24, 1993.
45. Frigerg B, Jemt T, Lekholm U. Early failures in 4641 consecutively placed Brånemark dental implants. A study from stage 1 surgery to the connection of completed prostheses. Int J Oral Maxillofac Implants 6: 142-146, 1991.
46. Carlsson L, Rostlund T, Albrektsson B, Albrektsson T. Removal torque for polished and rough titanium implants. Int J Oral Maxillofac Implants 3: 21-24, 1988.
47. Carlsson L, Rostlund T, Albrektsson B, Albrektsson T, Brånemark PI. Osseointergration of titanium implants. Acta Ortho Scand 57: 285-289, 1988.
48. Albrektsson T, Zarb G, Worthington P, Eriksson A. The long-term efficacy of currently used dental implants. A review and proposed criteria for success. Int J Oral Maxillofac Implant 1: 11-25, 1986.
49. Meredith N, Friberg B, Aparicio C, Sennerby L. Relationship between contact time measurements and PTV values when using the Periotest to measure implant stability. Int J Prosthodont 11: 269-275, 1998.
50. Heller JG. Bradley T, Estes MS. Biomechanical study of screws in the lateral masses:Variable affecting pull-out resistance. J Bone Joint Surg(Am) 78: 1315-1321, 1996.
51. Compston JE. Osteoporosis. Clin Endocrinol 33: 653-682, 1990.
52. Melton LJ. Epidemoiology of osteoporosis redicting who is at risk. Ann NY Acad Sci 592: 441-442, 1990.
53. Lee MJ, Hoffman R. Correlation of chemistry and history risk-factors for osteoporosis. Ann NY Acad Sci 592: 441-442, 1990.
54. Thomas KA, Cook SD. An evaluation of variables influencing implant fixation by direct bone apposition. J Biomed Mater Res 19: 875-901, 1985.
55. Kirsch A, Donath K. Tierexperimntelle untersuchungen zur bedeutung der mikromorphologie von Titanimplantatoberflhen. Forschr Zahnztl Implantol 1: 35-40, 1984.
56. Skalak R. Biomechanical consideration in osseointegrated prostheses. J Prosthet Dent 49: 843-848, 1983.
57. Uhthoff K. Mechanical factors influencing the holding powers of screws in compact bone. J Bone Joint Surg 55B: 633-638, 1973.
58. Schatzker JC, Horne JC, Sumner-Smith G. The effects of movement on holding of screws in bone. Clin Orthop 111: 257-235. 1975.
59. Biesbrock R, Edgerton M. Evaluation of the clinical predictability of hydro xyapatite-coated endosseous dental implants:A review of the literature. Int J Oral Maxillofac Implants 6: 712-720, 1995.
60. Yacker J, Klein T. The effect of irrigation on osteotomy depth and bur diameter. Int J Oral Maxillofac Implants 11: 634-638, 1996.
61. Matthews LS, Hirscch C. Temperayure measured in human cortical bone when drilling. J Bone Joint Surg(Am) 54: 297-308, 1972.
62. Lavell C, Wedgewood D. Effect of internal irrigation on frictional heat generated from bone drilling. J Oral Surg 38: 499-503, 1980.
63. Tetsch P. Development of raised temperature after osteotomies. J Maxillofac Surg 2: 141-145, 1974.
64. Eriksson RA, Albrektsson T. Thermal injury to bone: A vital microscopic description of heat effects. J Oral Surg 11: 115-121, 1982.
65. Eriksson RA, Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury: A vital microscopic study in the rabbit. J Prosthet Dent 50: 101-107, 1983.
66. Eriksson RA, Albrektsson T. The effect of heat on bone regeneration: An experimental study in the rabbit using the bone growth chamber. J Oral Maxillofac Surg 42: 705-711, 1984.
67. Krause WR, Bradbury DW, Kelly JE. Temperature elevation in orthopedic cutting operation. J Biomech 15: 167-175, 1982.
68. Eichler J, Berg R. Temperatureinwirkung auf die kompakta beim bohren, Gewindeschneiden und Eindrehen von Schrauben. Z Orthop 110: 909-1013, 1972.
69. Henschel CJ. Heat impact of revolving instruments on vital dentin tubules. J Dent Res 22: 323-333, 1943.
70. Peyton FA. Temperature rise and cutting efficiency of rotating instruments. NY Dent J 18: 439-450, 1952.
71. Horkirk JA, Rusiniak K. Investigation of variable factors in drilling bone. J Oral Surg 35: 968-973, 1977.
72. Abouzgia B, James F. Temperature rise during drilling through bone. Int J Oral Maxillofac Implants 12: 342-353, 1997.
73. Tanaka, Sawaki, Nimi. Effects of bone tapping on osserintegration of screw dental implants. Int J Oral Maxillofac Implants 5: 541-547, 1994.
74. Ueda M, Matsuki M. The relationship between insertion torque and removal torque analyzed in fresh temporal bone. Int J Oral Maxillofac Implants 4: 442-447, 1991.
75. Albrektsson T, Jacobsson M. Bone-metal interface in osseointegration. J Prosthet Dent 57: 597-607, 1987.
76. Tjellstr A, Jacobsson M, Albreksson T. Removal torque of osseointegrated craniofacial implant: A clinical study. Int J Oral Maxillofac Implants 3: 287-289, 1988.
77. Albrektsson T, Albrektsson B. Osseointegration of bone implants: A review of an alternative mode of fixation. Acta Orthop Scand 58: 567-577, 1987.
78. Donath K. Die Trenn-dunnschliff-Technik zur Herstellung histologischer Praparate von nicht schneidbaren Geweben und Materialien. Der Praparator 34: 197-206, 1988.
79. Sennerby L, Thomsen P, Ericson LE. Early tissue response to titanium implants inserted in rabbit cortical bone. Part1: Ligth microscopic observations. J Mater Sci Mater Med 4: 240-250, 1993.
80. Sennerby L, Thomsen P, Ericsson L. A morphometric and biomechanic comparison of titanium implants inserted in rabbit cortical and cancellous bone. Int J Oral Maxillofac Impl 7: 62-71, 1992.
81. Sennerby L, Thomsen P, Ericson LE. Ultrastructure of the bone-titanium interface in rabbits. J Mater Sci 3: 262-271, 1992.
82. Ericsson I, Johansson CB, Bystedt H, Norton MR. A histomorphometric evaluation of bone-to-implant contact on machine-prepared and roughened titanium dental implants. Clin Oral Impl Res 5: 202-206, 1994.
83. Albreksson T. Dental implants: A review of clinical approaches .APS Bull pp7-25, 1985.
84. Johansson CB, Sennerby L, Albrektsson T. A removal torque and histomorphometric study of bone tissue reactions to commercially pure titanium and vitallium implants. Int J Oral Maxillofac Implants 6: 437-441, 1991.
85. Wennerberg A, Albrektsson T, Andersson B, Krol JJ. A histomorphometric and removal torque study of screw-shaped titanium implants with three different surface topographies. Clin Oral Impl Res 6: 24-30, 1996.
86. Sullivan DY, Sherwood RL, Collins TA, Krogh PHJ. The reverse-torque test: A clinical report. Int Oral Maxillofac Implants 11: 179-185, 1996.
87. Goheen L, Vermilyea G. Torque generated by handheld screwdrivers and mechanical torquing devices for ossesintegrated implants. Int J Oral Maxillofac Implants 2: 149-155, 1994.
88. Sunden S, Grondahal K. Accuracy and precision in the radiographic diagnosis of clinical instability in Brånemark dental implants. Clin Oral Impl Res 6: 220-226,1995.
89. Sunden S, Grondahl K, Grondahl H-G. Accuracy and precision in the radiographic diagnosis of clinical instability in Brånemark dental implants. Clin Oral Impl Res 6: 220-226, 1995.
90. Caulier H, Naert I, Jansen A. The relationship of some histologic parameter, radiographic evaluations ,and Periotest measurements of oral implants: An experimental animal study. IntJ Oral Maxillofac Implants 3: 380-386, 1997a.
91. Caulier H, Naert I, Kalk W. The relationship of some histologic parameters, radiographic evaluations, and periotest measurement of oral implants: an experimental animal study. Int J Oral Maxillofac Implants 12: 380-386, 1997b.
92. Salonen M, Oikarinen K, Virtanen K, Pernu H. Failures in the osseointegration of endosseous implants. IntJ Oral Maxillofac Implants 8: 92-97, 1993.
93. Borchers L, Reichart P. Three-dimensional stress distribution around implant at different stages of interface development. J Dent Res 62: 155-159, 1983.
94. Schulte W. The new Periotest method. Compend Suppl (12) S410: 5415-5417, 1988.
95. Schulte W, Lukas D, Maunz M, Steppeler M. Periotest for measuring periodontal characteristics correlation with periodontal loss. J Periodontal Res 27: 184-190, 1992.
96. Olive J, Aparicio C. The Periotest Method as a Measure of Osseointegrated Oral Implant Stability. The International J. of Oral & Maxillofacial Implants 5(4): 390-399, 1990.
97. Teerlinck J, Quirynen M, Darius P. Periotest: An objective clinical diagnosis of bone apposition toward implants. Int J Oral Maxillofac Implants 6: 55-61, 1991.
98. Elias J, Brunski JB, Scarton HA. A dynamic modal testing technique for noninvasive assessment of bone-dental implant interface. Int J Oral Maxilofac Implants 11(6): 728-734, 1996.
99. Ericsson I, Lekholm U, Brånemark P-I, Lindhe J, Glantz P-O and: A clinical evaluation of fixed bridge restorations supported by the combination of teeth and osseointegrated titanium implants. J Clin Periodontol 1986; 13: 307-312.
100. Shillingburg, Hobo, Whitsett. Fundamentals of fixed prosthodontics. Quintence book: 17-25, 1981.
101. Wang MS . Clinical investation resonance frequency in human teeth. Taipei medical college Master theory, 2000.
102. Friberg B, Sennerby L, Meredith N, Lekholm U. A comparison between cutting torque and resonance frequency measurements of maxillary implants. A 20-month clinical study. Int. J. Oral Maxillofac. Surg. 1999; 28: 297-303.
103. Lazzara RJ. Immediate implant placement into extraction sites: Surgical and restorative advantages. Int J Periodont Rest Dent 1989; 9:335-343.
104. Parel SM, Triplett RG. Immediate fixture placement: Atreatment plaming altermative Int J Oral Maxillofac Implants 1990; 5:337-345.
105. Friberg B., Sennerby L, Roos J.& Lekholm U. Ideatification of bone quality In conjunction with insertion of titanium implants. Clinical Oral implants Research 6:213-219, 1995.
106. Friberg,B.,Sennerby,L..Roos J. ,Johonsson, P., Strid, K-G Lekholm, U. Evaluation of bone density using cutting resistance measurements and radiography Clinical Oral implants. 1995.
107. Rasmusson L, Meredith N, Cho I.H., Sennerby L. The influence of simultaneous vs delayed placement on the stability of titanium implants in only bone grafts. A histologic and biomechanic study in the rabbit. Int. J. Oral Maxillofac. Surg.1999; 28:224-231.
108. Brånemark R.A Biomechanical Study of Osseointegration (thesis).Goteborg:Univ of Goteborg, 1996.
109. Meredith N, Book K, Friberg B, Jemt T, Sennerby L. Resonance frequency measurements of implant stability in vivo: A crosssectional and longitudinal study of resonance frequency measurements on implants in the edentulous and partially dentate maxilla. Clin Oral Impl Res 8: 226-233, 1997
110. Friberg B, Sennerby L, Meredith N, Lekholm U. A comparison between cutting torque and resonance frequency measurements of maxillary implants: A 20-month clinical study. Int J Oral Maxillofac Surg 28: 297-303, 1999.
111. Friberg B, Sennerby L, Lindén B, Gröndahl K, Lekholm U. Stability measurements of one-stage Brånemark implants during healing in mandibles: A clinical resonance frequency analysis study. Int J Oral Maxillofac Surg 28: 266-272, 1999.
112. Sennerby L, Meredith N. Analisi della frequenza di risonanza (RFA). Conoscenze attuali e implicazionz cliniche in Osteointegrazione e carico immediate. Milano: Masson SpA, 2002:19-32.