臺灣博碩士論文加值系統

中文摘要
前言
垂直牙根斷裂定義為裂紋平行於牙根長軸的縱向分布，常見於根管治療過的牙齒。水平牙根斷裂定義為裂紋垂直或斜向於牙根長軸的斷裂。關於垂直牙根斷裂的臨床與放射線特徵仍有許多待研究之處，而發生在後牙未經外傷所致的水平牙根斷裂非常罕見。

研究目的
本研究的目的為收集垂直牙根斷裂與發生在後牙未經外傷所致的水平牙根斷裂之案例，進行人口統計學、臨床檢查、放射線特徵與診斷方式之分析。

研究材料與方法
本研究一共收集193顆垂直牙根斷裂牙(包括經根管治療和未經根管治療牙)，包含201個垂直斷裂牙根和178位患者；以及55顆發生在後牙未經外傷所致的水平牙根斷裂牙，包括58個水平斷裂牙根和50位患者。針對上述患者與斷裂牙所收集的資料，進行人口統計學、臨床檢查與放射線特徵的數據整理與統計分析。

結果
在本研究分析中，垂直牙根斷裂的案例有93位男性(52.25%)和85位女性(47.75%)，患者的年齡介於24-96歲之間(平均年齡為59.84歲)。其中165位患者(92.70%)在口腔內有一顆垂直牙根斷裂牙，12位患者(6.74%)有兩顆垂直斷裂牙，有1位患者(0.56%)同時出現四顆垂直斷裂牙。垂直牙根斷裂主要發生在下顎大臼齒(86顆斷裂牙佔44.56%)的近心牙根(73個斷裂牙根佔65.18 %)。臨床檢查發現垂直牙根斷裂牙通常有牙冠或牙橋修復體(152顆斷裂牙佔78.76%且p<0.01)、沒有膿腫(117顆斷裂牙佔60.62%且p<0.01)、沒有竇管(139顆斷裂牙佔72.02%且p<0.01)、具有≥5 mm的牙周囊袋(178顆斷裂牙佔92.23%且p < 0.01)、牙周囊袋存在斷裂牙根周圍(177顆牙齒佔99.44%且p<0.01)和相對完整的齒列(138位患者口內的缺牙數少於四顆佔81.18%且p<0.01)。大部分未經根管治療的垂直牙根斷裂牙均有咬耗的咬合面(28顆斷裂牙佔77.78%且p<0.01)。垂直牙根斷裂牙的放射線特徵包括大部分為經根管治療牙(157顆斷裂牙佔81.35%且p<0.01)、斷裂牙根內沒有釘柱(132顆斷裂牙佔68.39%且p<0.01)、牙周骨破壞(176顆斷裂牙佔91.19%且p<0.01)、牙根尖骨破壞(173顆斷裂牙佔89.64%且p<0.01)、根管空間變寬(125顆斷裂牙佔64.77%且p<0.01)、月暈狀放射線透射度(169顆斷裂牙佔87.56%且p<0.01)和牙周韌帶變寬(187顆斷裂牙佔96.89%且p<0.01)。在經根管治療和未經根管治療的垂直牙根斷裂族群中，下顎大臼齒的近心牙根均佔多數。
在後牙未經外傷所致的水平牙根斷裂牙案例中，患者包括27位男性(54.00%)和23位女性(46.00%)，患者的年齡介於50-70 歲之間(38位患者佔69.09%且p<0.01)。大部分發生在後牙未經外傷所致的水平牙根斷裂牙為未經根管治療牙(43顆斷裂牙佔78.18%且p<0.01)、沒有牙冠或牙橋修復體(45顆斷裂牙佔81.82%且p<0.01)和上顎大臼齒(27顆斷裂牙佔49.09%且p<0.01)。臨床檢查發現水平牙根斷裂牙大部分呈現有≥5 mm的牙周囊袋(49顆斷裂牙佔89.09%且p < 0.01)、患者診斷有全口慢性牙周炎(51位患者佔92.73%且p<0.01)和相對完整的齒列(36位患者口內的缺牙數少於四顆佔76.60%且p<0.01)。放射線特徵包括牙周骨破壞(49顆斷裂牙佔89.09%且p<0.01)、牙根尖骨破壞(38顆斷裂牙佔69.09%且p<0.01)以及牙根內沒有釘柱(50顆斷裂牙佔90.91%且p<0.01)。牙齒磨耗是另一個在大部分水平牙根斷裂牙均可見到的共同發現。

結論
本研究針對垂直牙根斷裂和後牙未經外傷所致的水平牙根斷裂進行人口統計學、臨床檢查、放射線特徵與診斷方式的分析，本研究結果將能提供臨床醫師更多資訊與診斷的輔助。當遇到特定族群的患者時，必須特別注意是否有牙根斷裂的發生。在同一位患者口內也有可能同時出現多顆牙根斷裂牙。因此需要仔細檢視臨床與放射線等協助診斷的細微特徵與關鍵。

關鍵字：垂直牙根斷裂、水平牙根斷裂、後牙、臨床檢查、放射線特徵

Abstract
Introduction: Vertical root fracture (VRF) is a root fracture extending along the longitudinal axis of the root and is often noted in endodontically treated teeth. For horizontal root fracture (HRF), the fracture line may extend either perpendicularly or obliquely across the long axis of the root. The clinical and radiographic characteristics of VRFs are not completely known. Cases of HRF in posterior teeth without dental trauma were scarcely reported.

Aim: This study explored the demographics, clinical and radiographic features, and diagnostic signs of endodontically and nonendodontically treated teeth with VRFs in Chinese patients and attempted to provide some indications that would facilitate an accurate diagnosis. Also, this study described the clinical characteristics and radiographic findings of HRF in posterior teeth without dental trauma.

Materials and Methods: A total of 193 teeth with 201 vertical fractured roots in 178 Chinese patients were investigated. Another total of 50 patients and 58 HRF cases in 55 posterior teeth were collected. The clinical examination records and radiographic images were reviewed in detail. The demography, clinical characteristics and radiographic examination were presented with descriptive statistics and statistical analysis.

Results: In the study of VRFs, a total of 93 male (52.25%) and 85 female (47.75%) patients aged between 24–96 years old (average = 59.84 years old) were included; 165 (92.70%), 12 (6.74%) and 1 (0.56%) patients exhibited 1 tooth, 2 teeth and 4 teeth with vertical fractured roots, respectively, in the dentition. VRFs occurred mainly in the mesial root (73 roots, 68.22 %) of the mandibular molars (86 teeth, 44.56%). Clinically, teeth with VRFs usually presented with crown and bridge restorations (152 teeth, 78.76%, p<0.01), without abscess (117 teeth, 60.62%, p<0.01), without sinus tract (139 teeth, 72.02%, p<0.01), with a periodontal probing depth ≥5 mm (178 teeth, 92.23%, p < 0.01), with pocket formation at fractured root area (177 teeth, 91.71%, p<0.01) and a relatively intact dentition (138 patients exhibited <4 missing teeth in the dentition, 81.18%, p<0.01). Most of the nonendodontically treated VRFs exhibited attrited occlusal surfaces. Radiographic characteristics of the teeth with VRFs were typically associated with prior root canal treatment (157 teeth, 81.35%, p<0.01), fractured root without post (132 teeth, 68.39%, p<0.01), periodontal bone loss (176 teeth, 91.19%, p<0.01), apical bone loss (173 teeth, 89.64%, p<0.01), widening of root canal space (125 teeth, 64.77%, p<0.01), with “halo” radiolucency lesion (169 teeth, 87.56%, p<0.01) and PDL widening (187 teeth, 96.89%, p<0.01). The mesial roots of the mandibular molars were most susceptible to VRFs in both endodontically and nonendodontically treated teeth.
In the study of HRF in posterior teeth without dental trauma, the number of males (27 patients, 54.00%) was similar to females (23 patients, 46.00%). The patients were predominantly between 50-70 years old (38 patients, 69.09%, p<0.01). Most of the HRF cases were found in nonendodontically treated teeth (43 teeth, 78.18%, p<0.01), without crown and bridge restorations (45 teeth, 81.82%, p<0.01), and maxillary molars (27 teeth, 49.09%, p<0.01). Fractured teeth usually presented with a periodontal probing depth ≥5 mm (49 teeth, 89.09%, p < 0.01), diagnosed with full mouth chronic periodontitis (51 patients, 92.73%, p<0.01), with a relatively intact dentition (36 patients exhibited <4 missing teeth in the dentition, 76.60%, p<0.01), periodontal bone loss (49 teeth, 89.09%, p<0.01), apical bone loss (38 teeth, 69.09%, p<0.01) and without post/core in the root canal (50 teeth, 90.91%, p<0.01). Tooth wear was another common clinical feature among these patients.

Conclusions: This study elucidated some clinical, radiographic and diagnostic features that would facilitate the identification and recognition of VRF and HRF in posterior teeth without dental trauma. As we encounter specific population, certain awareness should be emphasized. There is also the possibility of occurring multiple fractured teeth in the same patient. It is important to recognize that sometimes subtle findings may be the key factor that lead to the diagnosis.

Keyword: Vertical root fracture, horizontal root fracture, posterior teeth, clinical characteristics, radiographic features

Table of Content
中文摘要………………………………………………………………………………...i
Abstract………………………………………………………………………………...iii
Table of Content………………………………………………………………………...v
List of Figures………………………………………………………………………...viii
List of Tables……………………………………………………………………………x
Abbreviations List……………………………………………………………………xii
Chapter I Background…………………………………………………………………1
1.1 Vertical root fractures………………………………………………………......…1
1.2 Horizontal root fractures in posterior teeth without dental trauma……………….2
Chapter II Introduction and Literature Review……………………………………...3
2.1 Classification of root fractures……………………………………………………3
2.2 Vertical root fractures……………………………………………………………..3
2.2.1 Definition……………………………………………………………………..3
2.2.2 Incidence……………………………………………………………………...3
2.2.3 Diagnosis and diagnostic methods…………………………………………...5
2.2.4 Etiology and predisposing factors……………………………………………9
2.2.5 Clinical features……………………………………………………………..12
2.2.6 Radiographic characteristics………………………………………………...14
2.2.7 Histology……………………………………………………………………17
2.2.8 Treatment……………………………………………………………………18
2.3 Horizontal root fractures in posterior teeth without dental trauma……………...18
2.3.1 Definition……………………………………………………………………18
2.3.2 Incidence…………………………………………………………………….18
2.3.3 Diagnosis and diagnostic methods………………………………………….19
2.3.4 Etiology and predisposing factors…………………………………………..20
2.3.5 Clinical features……………………………………………………………..22
2.3.6 Radiographic characteristics………………………………………………...22
2.3.7 Treatment……………………………………………………………………23
Chapter III Research Purposes………………………………………………………24
3.1 Vertical root fractures……………………………………………………………24
3.2 Horizontal root fractures in posterior teeth without dental trauma……………...24
Chapter IV Materials and Methods………………………………………………….26
4.1 Vertical root fractures……………………………………………………………26
4.1.1 Case collection………………………………………………………………26
4.1.2 Parameters record…………………………………………………………...26
4.1.3 Statistical analysis…………………………………………………………..31
4.2 Horizontal root fractures in posterior teeth without dental trauma……………...33
4.2.1 Case collection………………………………………………………………33
4.2.2 Parameters record…………………………………………………………...33
4.2.3 Statistical analysis…………………………………………………………..36
Chapter V Results……………………………………………………………………..38
5.1 Vertical root fractures……………………………………………………………38
5.1.1 Descriptive statistics………………………………………………………...38
5.1.2 Statistical analysis…………………………………………………………..40
5.2 Vertical root fractures in endodontically and nonendodontically treated teeth….42
5.2.1 Descriptive statistics………………………………………………………...42
5.2.2 Statistical analysis…………………………………………………………..48
5.3 Horizontal root fractures in posterior teeth without dental trauma……………...52
5.3.1 Descriptive statistics………………………………………………………...52
5.3.2 Statistical analysis…………………………………………………………..53
Chapter VI Discussion………………………………………………………………...56
6.1 Vertical root fractures and comparison between endodontically and nonendodontically treated fractured teeth …………………………………………..56
6.1.1 Demography………………………………………………………………...56
6.1.2 Clinical data…………………………………………………………………57
6.1.3 Clinical examination data…………………………………………………...59
6.1.4 Radiographic examination data……………………………………………..61
6.1.5 Diagnostic method…………………………………………………………..64
6.1.6 Prevention…………………………………………………………………...65
6.2 Horizontal root fractures in posterior teeth without dental trauma……………...67
6.2.1 Demography………………………………………………………………...67
6.2.2 Clinical data………………………………………………………………....68
6.2.3 Clinical examination data…………………………………………………...69
6.2.4 Radiographic examination data……………………………………………..70
6.2.5 Prevention…………………………………………………………………...70
6.3 Comparison of vertical root fractures in endodontically and nonendodontically treated teeth and horizontal root fractures in posterior teeth without dental trauma...71
6.3.1 Demography………………………………………………………………...71
6.3.2 Clinical data…………………………………………………………………72
6.3.3 Clinical examination data…………………………………………………...72
6.3.4 Radiographic examination data……………………………………………..73
Chapter VII Conclusions……………………………………………………………..75
7.1 Vertical root fractures…………………………………………………………....75
7.2 Horizontal root fractures in posterior teeth without dental trauma……………...76
Chapter VIII Future Work…………………………………………………………...78
8.1 Vertical root fractures……………………………………………………………78
8.2 Horizontal root fractures in posterior teeth without dental trauma……………...79
References………………………………………………………………………...……80
Figures…………………………………………………………………………………91
Tables…………………………………………………………………………………134

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