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研究生:游國強
研究生(外文):Yu Kuo Chiang
論文名稱:牙齒動搖度與觸覺閾值相關性之研究
論文名稱(外文):Studies on the Relationship between Mobility and Tactile Sensitivity of Nature Dentition
指導教授:洪昭民
指導教授(外文):Hong Jau Min
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:牙醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:84
中文關鍵詞:牙齒動搖度觸覺閾值牙科植體
外文關鍵詞:tooth mobilitytactile receptionthresholdendosseous implant
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在口腔內,自然牙的生理性動搖度,依照牙齒位置及牙根形態會有不同,而除了生理性動搖度之外,咬合創傷及牙周附連喪失等原因,皆會引起動搖度之增加。另外,自然牙的牙周膜中存在著許多感覺受器,其中部分是司感覺功能( tactile sense )的。學者Lundqvist & Haraldson 1984指出自然牙所能感受到的最小厚度約在20 ~ 100μm,植體支持式牙橋部位則為50μm。雖然過去曾經有許學者,對牙齒的動搖度與觸覺閾值,分別有許多的研究與報告,但對其兩者之間的相互關係則是甚少提到,因此本實驗的目的,即在探討健康自然牙、牙周受損之自然牙、與健康自然牙對人工植牙三組受測者之間,其牙齒動搖度與觸覺閾值兩者的相對關係及比較。本實驗採用受測者共80名(男40名, 女40名),並依照所有受試者之牙周與咬合狀態將之區分為: A組(牙周正常組,男15名、女15名),即符合牙周附連喪失小於2 mm,探測深度小於 3 mm,及口內無牙周發炎狀況者;B組(牙周受損組,男15名、女15名),即符合牙周附連喪失大於2 mm,探測深度大於3 mm,及口內有或曾有牙周發炎狀況者;C組(自然牙與植體補綴對咬組,男10名、女10名),受測部位共30處。本實驗之方法即使用8μm及12μm咬合紙( ShimstockR )以主動測試法在受試者之門牙區、犬齒區、小臼齒區、及大臼齒區,各重複檢測5次,其在中心咬合位及側方咬合位對咬時,所能感受到的最小觸覺閾值(active threshold of tactile sensitivity),再以 Periotest R ( Simens Co. Germany ) 檢測各個牙齒的動搖度,並記錄及比較其在各式咬合形態和牙周狀態的動搖度與觸覺閾值,同時再進行統計及分析其兩者之間的相互關係。得到以下結果:
1.牙周正常組的觸覺閾值,前牙較後牙有顯著減少(p<0.05)(門牙8.2±0.8μm,大臼齒13.2±6.3μm),但在所有受測者之左右側及男女間並無顯著差異。2.牙周受損組的觸覺閾值,門牙區較大臼齒區小(p<0.05)(門牙18.2±6.8μm,大臼齒31.2±15.2μm)。3.植體補綴組的動搖度為三組中最小(p<0.05),而觸覺閾值在後牙區(33.0±6.0μm)明顯大於牙周正常組(p<0.05),但與牙周受損組並無顯著差異(p>0.05)。4.牙周正常組中動搖度顯著較牙周受損組為低(p<0.05)。5.牙周正常組中動搖度觸覺閾值普遍呈現低度正相關(r≦0.3),牙周受損組之動搖度與觸覺閾值則呈現高度正相關(r≧0.7) ,而植體補綴組則呈現負相關之情形(r=-0.57)。

The physiologic mobility are variant from different tooth positions and root morphologies. Besides physiologic tooth mobility, increased mobility may be caused by loss of periodontal support or trauma from occlusion. Another, the neural receptors with various morphologies and functions reside in the periodontium and the receptors are responsible for providing the highly sensitive and discriminatory oral tactile function which are excited by natural teeth. There were many studies on the tooth mobility and tactile threshold individually, but few mentioned about the effect of periodontal status on the tactile sensitivity of nature teeth and implants. The aim of this study was to examine the clinical correlation of tooth mobility and tactile threshold between the nature teeth and endosseous dental implants in different periodontal status. Eighty subjects, without any centric or ecentric occlusal interference nor with any active perio-dontal inflammation were selected in the study. According to the periodontal status, the subjects were divided into three categories: (1)A group ( Periodontal normal group,15 males and 15 females) with attachment loss less than 2 mm, probing depth less than 3 mm, and no active periodontal inflammation ; (2)B group ( Periodontal involved group,15 males and 15 females) with attachment loss more than 2 mm, probing depth more than 3 mm, and once involved with periodontal disease but have no active periodontal inflammation at present ; (3)C group( Implant group, consisted of 30 test sites,10 males and 10 females) with fixed implant restoration in one jaw and natural dentition in the opposite jaw. The 8μm and the 12μm articulating paper ( ShimstockR ) were used to examine the active threshold of tactile sensitivity at maximum intercuspation and lateral excursion jaw position. Each tested tooth was detected 5 times repeatedly at incisor﹑canine﹑first and 2nd premolar, as well as first and 2nd molar area of both sides. Then, Periotest R ( Simens Co. Germany ) was used to examine the tooth mobolity for 5 times on each tested tooth. The results are : 1. The threshold value of A and B groups is smaller in anterior tooth than in posterior tooth. 2. There is significant higher threshold value of tactile sensitivity in maximum intercuspation than in lateral excursion jaw position at each test site(p<0.05), except for C group. But no significant difference were found between threshold value of gender and both of the right and left sides in all tested groups(p>0.05). 3.Implant group has greater threshold value of posterior tooth (33.0±6.0μm)than that of A group(13.2±6.3μm) (p<0.05), but no statistical significance between Band C groups (p>0.05). 4.In this study the tooth mobility of A group was smaller than B group(p<0.05). 5.In the correlation between tactile threshold and tooth mobility, A group showed slight positive correlation (r≦0.3), B group showed stronger positive correlation (r≧0.7), and C group showed moderate negative correlation (r=-0.57) . Conclusion: (1)As the result of this study, the threshold value of periodontal involved teeth was higher than normal teeth, so more attention should be payed on occlusal adjustment while dealing with perio-dontal compromised patients. (2)In the lateral excursion, the tactile sensitivity of implant restoration was weaker than healthy natural dentition.Thus, the occlusal adjustment of implant restoration in lateral excursion must be carefully proceed-ing for eliminating horizontal stress on surrounding bone .

目 錄
壹. 中文摘要 ------------------------- 1 - 2
貳. 緒 論 --------------------------- 3 - 8
參. 文獻考察 ------------------------- 9 - 31
肆. 材料與方法 ---------------------- 32 - 36
伍. 結 果 -------------------------- 37 - 44
陸. 討 論 -------------------------- 45 - 51
柒. 結 論 -------------------------- 52 - 54
捌. 參考文獻 ------------------------ 55 - 60
玖. 附表與附圖 ---------------------- 61 - 82
壹拾. 英文摘要 ---------------------- 83 - 84

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