臺灣博碩士論文加值系統

摘 要
過去有關牙周病的嚴重性及發生率方面的資料多侷限餘各種牙周疾病的臨床牙周探測深度及臨床牙周附著水平的測量。關於比較國人牙周健康者、成年型牙周炎患者（AP）及早發型牙周炎患者（EOP）三者之間齒槽骨破壞的程度及速度的評估，資料有限。本研究的目的在於測量評估早發型牙周炎(EOP)患者與成年型牙周炎(AP)患者的X光齒槽骨喪失量，並比較EOP、AP患者與牙周健康者之間X光齒槽骨累積喪失量(CRABL)及年平均量(YRABL)的差異。本研究之對象為1980年至2000年間在高雄醫學大學附設中和醫院牙周病科接受檢查與治療的病人，共1,075人，平均年齡46.70 ± 12.72歲，從中篩選出研究樣本包括小於30歲的EOP患者66名，31-50歲的Post-EOP組33名， 31-80歲的AP患者81名，及22名牙周健康者，共202人，合計4390顆牙齒。收集其全口根尖X光片，以數位掃描影像分析(DSRIA)，將影像放大7.5倍後，分別計算每顆牙齒之近心側與遠心側牙釉質牙骨質交界至齒槽骨高度的距離，並計算其與X光牙根長度之比例。
本研究結果節錄如下：1.年齡（p<0.01）、性別（p<0.05）、疾病種類（p<0.01）、牙齒位置（p<0.01）及缺牙數（p<0.01）分別與CRABL及YRABL有顯著相關；2. EOP組之CRABL平均值隨年齡增加而增加（R2 = 0.106, p < 0.05）； 3. EOP組之YRABL平均值隨年齡增加而降低（R2 = 0.065, p < 0.05）； 4. AP組之CRABL平均值隨年齡增加而增加 （R2 = 0.056, p < 0.05）； 5. AP組之YRABL平均值則隨年齡增加而降低（R2 = 0.249, p < 0.05）； 6. CRABL平均值最高的是EOP組（5.42 mm或40.17%），AP組次之（5.34 mm或37.41%），牙周健康組最低（1.33 mm或9.61%）；7. YRABL平均值最高的是EOP組（每年喪失0.31 mm或2.28%），AP組次之（每年喪失0.15 mm或1.07%），牙周健康組最低（每年喪失0.11 mm或0.82%）；8. EOP組與AP組之CRALB平均值之高低順序均為大臼齒＞門齒＞小臼齒＞犬齒。
關鍵字：X光齒槽骨喪失，牙周炎，數位化影像分析

Abstract
The purpose of the present study were as follows: (1) to determine the radiographic alveolar bone loss in early-onset periodontitis (EOP) cases and adult periodontitis (AP) cases in a selected Chinese population; and (2) to evaluate the difference of the cumulative radiographic alveolar bone loss (CRABL) and the yearly radiographic alveolar bone loss (YRABL) among subjects with EOP, AP, and healthy periodontium, respectively. The total 202 samples included EOP (99), AP (81), healthy periodontium (22) groups in this study were selected from a 1075 screened population independently of their periodontal conditions. Full-mouth series of standardized periapical intra-oral radiographs from 202 individuals, aged 17-80 years(mean ±SD:46.70 ±12.72), were enlarged 7.5 times. The distances between CEJ and alveolar bone level, both mesial and distal surfaces, were measured with digital scanning radiographic image analysis (DSRIA) equipped with calculus program. The results showed that: (1). the factors such as age (p < 0.01), gender (p < 0.05), disease types (p < 0.01), tooth types (p < 0.01), and number of missing teeth (p < 0.01) were significantly associated with the mean CRABL and the mean YRABL, respectively; (2). the mean CRABL of EOP group(R2 = 0.106, p < 0.05) and AP group(R2 =0.056, p < 0.05)increased with increased age; (3). the mean YRABL of EOP group (R2 = 0.065, p < 0.05) and AP group (R2 = 0.249, p < 0.05)decreased with increased age; (6). the mean CRABL was highest in the EOP group (5.42 mm or 40.17%), then the AP group (5.34 mm or 37.41%), and lowest in the periodontal healthy group(1.33 mm or 9.61%); (8). The mean YRABL was highest in the EOP group (0.31 mm or 2.28% per year), then the AP group (0.15 mm or 1.07% per year), and lowest in the periodontal healthy group (0.11 mm or 0.82% per year). We concluded that (1) the mean CRABL of the EOP, the AP, and the PH groups was 5.42mm, 5.34mm, and 1.33mm respectively; (2) the mean YRABL of the EOP, the AP, and the PH groups was 0.31mm, 0.15, and 0.11mm per year, respectively.
Key words : radiographic alveolar bone loss, periodontitis, digital image analysis

論 文 目 次
第一章 前 言……………………………………………………….1
第一節 早發性牙周炎………………………………………… 1
第二節 X光齒槽骨喪失……………………………………… 4
第三節 研究目的……………………………………………….7
第二章 文 獻 回 顧…………………………………… …………...8
第一節 早發型牙周炎之X光齒槽骨破壞型態………….…8
第二節 成年型牙周炎患者與牙周健康成人之X光齒槽
骨破壞……………………………………….……..10
第三章 材 料 與 方 法………………………………………….13
第一節 研究樣本收集（sample collection）……………….13
第二節 研究材料與方法（Materials and methods）…………15
第三節 研究步驟（Procedures）……………………………..15
第四節 資料處理與析…………………………….…………20
第四章 研 究 結 果………………… ………………………….. ..21
第一節 前趨研究結果……………………………………… 21
第二節 疾病種類、性別、牙齒位置、部位、年齡及缺牙
數目與X光齒槽骨累積喪失量及X光齒槽骨喪
失年平均量的多重迴歸分析………………………21
第三節 缺牙數與疾病分組關係……………………………23
第四節 X光齒槽骨喪失量的分佈….………………………25
第五節 性別與X光齒槽骨喪失及X光齒槽骨喪失的年
平均量的關係……………………………………….27
第六節 近遠心側與X光齒槽骨累積喪失量及X光齒槽骨
喪失的年平均量的關係…………………….………30
第七節 牙齒位置及種類與X光齒槽骨喪失及X光齒槽骨
喪失的年平均量的關係………………………….…32
第八節 年齡與X光齒槽骨喪失及X光齒槽骨喪失年平均
量的關係…………………………………………….45
第九節 各疾病組與X光齒槽骨喪失及X光齒槽骨喪失的
年平均量的關係………………………………….…56第十節 牙根長度完成後年齡與X光齒槽骨累積喪失量及
X光齒槽骨喪失年平均量的關係………………….59
第十一節 早發型牙周病之齒槽骨破壞型態與性別、年齡及
牙齒種類的關係…………………………………...62
第五章 討 論 …….………………………………………………64
第六章 結 論……………...………………………………………81
參考文獻……………………….………………………………………82
附錄…………………………………………………………………….88
圖 表 目 次
Fig 1 The schematic drawing of the reference pointsof molar teeth correlated
with the measurement of radiographic alvelar bone loss (RABL) ………. 88
Fig 2 Relationship between cumulative radiographic alveolar bone loss
(mm) and age of subjects in different disease types………………………….89
Fig 3 Relationship between cumulative radiographic alveolar bone loss (%)
and age of subjects in different disease types……………………………...90
Fig 4 Relationship between yearly radiographic alveolar bone loss (mm) and
age of subjects in different disease types……………………………..……91
Fig 5 Relationship between yearly radiographic alveolar bone loss (%) and
age of subjects in different disease types…………………………………..92
Fig 6. The comparison of mean cumulative radiographic alveolar
bone loss of individuals among different disease groups ………………..…93
Fig 7. The comparison of mean yearly radiographic alveolar bone
loss of individuals among different disease groups…….…………………...94
Fig 8 Relationship between cumulative radiographic alveolar bone loss (mm)
and age after root completed of subjects in different disease types……….95
Fig 9 Relationship between cumulative radiographic alveolar bone loss (%)
and age after root completed of subjects in different disease types………...96
Fig 10 Relationship between yearly radiographic alveolar bone loss (mm)
and age after root completed of subjects in different disease types……..97
Fig 11 Relationship between yearly radiographic alveolar bone loss (%)
and age after root completed of subjects in different disease types……...98
Table 1. Description of the population ( the total number of the
radiographically examined patients 1980-2000)…………………………99
Table 2. Chronology of human dentition………………………………………....100
Table 3. Multiple regression for cumulative radiographic alveolar bone
loss and yearly radiographic alveolar bone loss……...…………………101
Table 4 .Comparison of the mean number of missing teeth between males
and females in the periodontal disease groups………………………….102
Table 5 . Comparison of the mean number of missing teeth between
males and females in the periodontal disease groups………………….103
Table 6. Prevalence of missing teeth in maxillary teeth in the periodontal
disease groups by tooth type…………………………………………….104
Table 7. Frequencies of teeth with CRABL values 0-2mm, 2-4mm, 4-6mm,
>6mm, in different disease groups…………………………………...…105
Table 8. Prevalence of teeth with advanced CRABL(≧6mm) of subjects
in different periodontal disease groups by tooth types………………….106
Table 9 . The mean cumulative radiographic alveolar bone (CRABL,
mm ) in subjects with periodontal disease types by gender.…………...107
Table 10 . The mean radiographic alveolar bone ( % ) in subjects with
periodontal disease types by gender…………………………….……108
Table 11 . The mean yearly radiographic alveolar bone loss (mm per year)
in subjects with periodontal disease types by gender.……………..…109
Table 12 . The mean yearly radiographic alveolar bone loss (% per year)
in subjects with periodontal disease types by gender ………………..110
Table 13. The mean cumulative radiographic alveolar bone loss ( mm ) in
maxillary teeth of subjects with periodontal disease types by
tooth type………………………………………………………………111
Table 14. The mean cumulative radiographic alveolar bone loss ( mm ) in
mandibular teeth of subjects with periodontal disease types by
tooth type……………………………………………………………. 112
Table 15. The mean cumulative radiographic alveolar bone loss ( % ) in
maxillary teeth of subjects with periodontal disease types by
tooth type……………………………………………………………..113
Table 16. The mean cumulative radiographic alveolar bone loss ( % ) in
mandibular teeth of subjects with periodontal disease types
by tooth type……………………………………………………….114
Table 17. The mean yearly radiographic alveolar bone loss ( mm ) in
maxillary teeth of subjects with periodontal disease types
by tooth type. ……………………………………………………….115
Table 18. The mean yearly radiographic alveolar bone loss ( mm ) in
mandibular teeth of subjects with periodontal disease types
by tooth type. ……………………………………………………….116
Table 19. The mean yearly radiographic alveolar bone loss ( % ) in
maxillary teeth of subjects with periodontal disease types by
tooth type. …………… ….……………………………………… .117
Table 20. The mean yearly radiographic alveolar bone loss ( % ) in
mandibular teeth of subjects with periodontal disease types
by tooth type. …………………………………...…………………..118
Table 21. Comparison of mean cumulative radiographic alveolar bone
loss ( mm ) in maxillary teeth among subjects with early
onset periodontitis by age………………………………….………..119
Table 22. Comparison of mean cumulative radiograpic alveolar bone
loss ( mm ) in mandibular teeth among subjects with early
onset periodontitis by age……………………………….…………..120
Table 23. Comparison of mean cumulative radiographic alveolar bone
loss ( mm ) in maxillary teeth among subjects with adult
periodontitis by age…………………………………………………121
Table 24 . Comparison of mean cumulative radiographic alveolar bone
loss ( mm ) in mandibular teeth among subjects with adult
periodontitis by age…………………………………………………122
Table 25. Comparison of mean cumulative radiographic alveolar bone
loss( % ) in maxillary teeth among subjects with early-
onset periodontitis by age. ……………………………….……..…123
Table 26. Comparison of mean cumulative radiographic alveolar bone
loss ( % ) in mandibular teeth of subjects with early onset
periodontitis by age. …………………………………………….….…124
Table 27. Comparison of mean cumulative radiographic alveolar bone
loss( % ) in maxillary teeth among subjects with adult
periodontitis by age…………………………………………………125
Table 28. Comparison of mean cumulative radiographic alveolar bone
loss( % ) in mandibular teeth among subjects with adult
periodontitis by age……………………………………………..126
Table 29. Comparison of mean yearly radiographic alveolar bone
loss( mm ) in maxillary teeth among subjects with early-
onset periodontitis by age………………………………….………127
Table 30. Comparison of mean yearly radiograpic alveolar bone loss
( mm ) in mandibular teeth among subjects with early onset
periodontitis by age. ……………………………………...……….128
Table 31. Comparison of mean yearly radiographic alveolar bone loss
( mm ) in maxillary teeth among subjects with adult
periodontitis by age. ……………………………………….……….129
Table 32 . Comparison of mean yearly radiographic alveolar bone loss
( mm ) in mandibular teeth among subjects with adult
periodontitis by age………………………………………..………..130
Table 33. Comparison of mean yearly radiographic alveolar bone loss
( % ) in maxillary teeth among subjects with early-onset
periodontitis by age………………………………………….…….131
Table 34. Comparison of mean yearly radiographic alveolar bone loss
( % ) in mandibular teeth of subjects with early onset
periodontitis by age…………………………………………….…...132
Table 35. Comparison of mean yearly radiographic alveolar bone
loss( % ) in maxillary teeth among subjects with adult
periodontitis by age……………………………………………..…133
Table 36. Comparison of mean yearly radiographic alveolar bone
loss( % ) in mandibular teeth among subjects with adult
periodontitis by age…………………………………………….….134
Table 37-1. Distribution of subjects with EOP types…………………………….135
Table 37-2. Individual mean age in subjects with EOP types………………....…136
Table 37-3. The mean radiographic alveolar bone loss(%)in subjects with
EOP types……………………………………………………….….137
Table 37-4 The mean cumulative radiographic alveolar bone loss(%) in
subjects with EOP by tooth type…………………………………..138

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