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研究生:楊冠儀
研究生(外文):Kuan-Yi Yang
論文名稱:三牙根的下顎第一大臼齒之牙根型態及臨床意義
論文名稱(外文):Topographic and clinical significance of mandibular first molar with 3-roots
指導教授:侯桂林
指導教授(外文):Guey-Lin Hou
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:109
中文關鍵詞:三牙根下顎第一大臼齒X光齒槽骨喪失量牙根主幹高度根叉入口直徑第三牙根的鑑別根叉病變發生率
外文關鍵詞:three-rooted mandibular first molarradiographic alveolar bone losstopographyfurcation involvementthird root diagnosis
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摘 要
牙根的數目及型態,對於牙科的治療一向息息相關,尤其是下顎第一大臼齒,因為它的位置及功能(function),在整個齒列中佔有很重要的地位。關於下顎第一大臼齒三個牙根的發生情形,提到的文獻並不多,關於中國人下顎第一大臼齒三個牙根發生的情況、三個牙根的解剖構造、X光照射之角度以及與牙周病的關係,則尚未有學者研究發表。所以本篇的研究目的則是要研究台灣華人下顎第一大臼齒三個牙根的發生情況、X光片診斷及其與牙周病的關係。
本研究樣本分為二部分,X光片與拔下的牙齒:A.) X光片收集來自1999年一月至2001年十二月間,在高雄醫學大學附設中和紀念醫院牙周病科接受診療而拍攝之符合標準平行法的常規全口X光片(full mouth radiographs),得到349名符合研究條件的患者為母群體,包含588顆下顎第一大臼齒,統計三個牙根的發生率及其與X光牙周附連喪失量的關係;B.)拔下牙齒部分隨機取自高雄醫學大學附設中和紀念醫院牙周病科、保存科及一般診所,因嚴重的牙周病或齲齒而無法治療所拔下來的牙齒,共268顆下顎第一大臼齒為母群體,統計三個牙根的發生率、測量牙根的解剖型態及探討如何可照出最清楚的第三個牙根。
本研究的結果如下:(1)下顎第一大臼齒三個牙根的發生率,介於12.6 %;至20.1 %之間。(2)第三個牙根的發生位置及走向,皆是位於遠心舌面(distolingual side)。(3)三個牙根的下顎第一大臼齒有高比例的根叉病變發生(63.9 %)。遠心面的X光齒槽骨喪失年平均量(% / yr.)明顯大於近心面,且遠心面根叉病變明顯多於頰舌面。下顎第一大臼齒的第三個牙根可視為牙周病的輔助因素(cofactor)。(4)三個牙根的下顎第一大臼齒遠心面牙根主幹高度介於全牙根長的1/3至1/2之間。頰面牙根主幹高度明顯大於二牙根下顎第一大臼齒的頰面牙根主幹,舌面牙根主幹則和二牙根下顎第一大臼齒相似。三牙根下顎第一大臼齒的三個根叉入口直徑較兩牙根的兩個根叉入口直徑大,使用牙周刮器能完全進入根叉入口的百分比較高。(5)拍攝X光片時向近心偏移15度,最能在可接受的變形量範圍內,得到最高的第三牙根辨識率。
關鍵語:三牙根下顎第一大臼齒、X光齒槽骨喪失量、牙根主幹高度、根叉入口直徑、第三牙根的鑑別、根叉病變發生率

Abstract
A great number of reports documented that the tooth and root morphology are most importance for periodontal therapy. Little or limited information about the prevalence, topography, radiographic diagnosis of molars with three roots, as well as what effect of the 3-rooted mandibular first molar on the periodontitis, is available. The purpose of this investigation was to study the prevalence, topography, radiographic diagnosis of 3-rooted mandibular first molar, as well as the relationship between 3-rooted mandibular first molar and localized periodontitis. The sample pool consisted of periapical radiographs before treatment and teeth examination after extraction. The radiographs, which selected from full-mouth series of standardized periapical intra-oral radiographs, consisted of 349 individuals with a total of 588 mandibular first molars. The 268 extracted teeth obtained from both local dental practices and Department of Periodontics and Endodontics in Kaohsiung Medical University Hospital. Prevalence of 3-rooted teeth, assessment of radiographic alveolar bone loss (RABL), root morphology, and radiographic diagnosis of the mandibular first molars were evaluated. The results showed that: (1) the prevalence of three-rooted mandibular first molar was 12.6 % ~ 20.1 % ; (2) the mandibular first molars with 3rd root is characterized as separated, conical in section, divergent, and located at distolingual side; (3) the prevalence of 3-rooted mandibular first molars with furcation involvement was 63.9 % ; (4) statistical analysis revealed that 3-rooted mandibular first molar has a significantly greater YRABL at distal surface than at the mesial surface; (5) the entrance of distal furcation at the 3 rooted mandibular first molar was wider than the majority of the working end of periodontal instruments; (6) a 15º radiograph with mesial cone shift revealed a better clear image of the 3rd root. Based on the above findings, we can concluded that mandibular first molars with 3 roots appeared to be a high risk factor for predisposing to periodontitis.
Key words: three-rooted mandibular first molar, radiographic alveolar bone loss, topography, furcation involvement, third root diagnosis

論 文 目 次
第一章 前 言. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
第一節 研究背景. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
第二節 研究目的 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
第二章 文 獻 回 顧. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
第一節 下顎第一大臼齒三個牙根的發生率. . . . . . . . . . . . . . .6
第二節 X光齒槽骨喪失的測量. . . . . . . . . . . . . . . . . . . . . . . . 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(Materials). . . . . . . . . . . . . . . . . . . . . . . . . . . 15
第三節 研究步驟(Procedures). . . . . . . . . . . . . . . . . . . . . . . . . .17
第四節 資料處理與分析. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
第五節 研究限制. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
第四章 研 究 結 果. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
第一節 前趨研究結果. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
第二節 下顎第一大臼齒三個牙根的發生率. . . . . . . . . . . . . . .31
第三節 三牙根下顎第一大臼齒的X光齒槽骨喪失量. . . . . . 33
第四節 下顎第一大臼齒三個牙根的解剖構造. . . . . . . . . . . . .35
第五節 第三個牙根的X光片鑑定法. . . . . . . . . . . . . . . . . . . . .39
第五章 討 論. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
第一節 發生率的比較. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
第二節 牙齒解剖構造對於牙周病的重要性. . . . . . . . . . . 46
第三節 近遠心X光齒槽骨喪失量的比較. . . . . . . . . . . . . 51
第四節 關於數位放射線影像分析法. . . . . . . . . . . . . . . . . 53
第六章 結 論. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
參考文獻. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
附錄. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
附圖目次
圖一、第三牙根的X光片tracing . . . . . . . . . . . . . . . . . . . . . . . . . . 67
圖二、X光齒槽骨累積喪失量. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
圖三、牙周刮器工作面與根叉入口的關係. . . . . . . . . . . . . . . . . . . 69
圖四、遠心頰面根與遠心舌面根不完全重疊組. . . . . . . . . . . . . . . 70
圖五、遠心頰面根與遠心舌面根完全重疊組. . . . . . . . . . . . . . . . . 71
圖六、相機腳架及腳架上的平台. . . . . . . . . . . . . . . . . . . . . . . . . . . 72
圖七、X光機的刻度. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
圖八、X光機向近心或遠心偏移. . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
圖九、X光機向近心偏移的角度. . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
圖十、三牙根下顎第一大臼齒的性別分佈. . . . . . . . . . . . . . . . . . . .76
圖十一、三牙根下顎第一大臼齒的左右側分佈. . . . . . . . . . . . . . . . 77
圖十二、三牙根下顎第一大臼齒的對稱性. . . . . . . . . . . . . . . . . . . .78
圖十三、三牙根下顎第一大臼齒單側發生時左右側的分佈. . . . . . 79
圖十四、三牙根下顎第一大臼齒發生率由X光片與拔下牙齒統計的比較. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
圖十五、三牙根下顎第一大臼齒根叉病變的發生率. . . . . . . . . . . 81
圖十六、遠心舌面根的分佈. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
圖十七、三個根叉入口的尺寸分佈. . . . . . . . . . . . . . . . . . . . . . . . . .83
圖十八、整體根叉入口的尺寸分佈. . . . . . . . . . . . . . . . . . . . . . . . . .84
圖十九、各個尺寸的根叉入口分佈. . . . . . . . . . . . . . . . . . . . . . . . . 85
圖二十、第三牙根根尖1/3完全露出. . . . . . . . . . . . . . . . . . . . . . . 86
圖二十一、第三牙根根尖1/3不算完全露出. . . . . . . . . . . . . . . . . . 87
圖二十二、第三牙根完全露出. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
圖二十三、第三牙根根尖露出的各角度分佈. . . . . . . . . . . . . . . . . .89
圖二十四、第三牙根完全露出的各角度分佈. . . . . . . . . . . . . . . . . . 90
附表目次
Table 1-1 Prevalence of mandibular first molars with 3-roots in Mongoloid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Table 1-2 Prevalence of mandibular first molars with 3-roots in Eurasian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Table 1-3 Prevalence of mandibular first molars with 3-roots in Negroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 93
Table 1-4 Prevalence of mandibular first molars with 3-roots in Caucasian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Table 1-5 Prevalence of mandibular first molars with 3-roots in Chinese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 95
Table 2 Chronology of human dentition . . . . . . . . . . . . . . . . . . . . .. 96
Table 3 Mean and standard deviation of lower one third of the blade of curette and working end of scaling tip. . . . . . . . . . . . ..97
Table 4 Distribution and prevalence of 3-rooted mandibular first molars by gender (radiographic examination). . . . . . . . . .98
Table 5 Distribution and prevalence of 3-rooted mandibular first molar of right and left jaw by radiographic examination . .99
Table 6 Prevalence of mandibular first molars with unilateral and/or bilateral 3-roots by gender (radiographic examination). . .100
Table 7 Prevalence of unilateral 3-rooted mandibular first molars in individuals with bilateral mandibular first molars by right or left side in radiographic examination . . . . . . . . . . . . . . . . .101
Table 8 Prevalence of 3-rooted mandibular first molar from extracted teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Table 9 Radiographic alveolar bone loss of 3-rooted mandibular first molars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Table 10 Prevalence of three-rooted mandibular first molars with furcation involvement of buccal or distal side . . . . . . . . 104
Table 11 Mean and standard deviation of root length in 3-rooted mandibular first molars . . . . . . . . . . . . . . . . . . . . . . . . . 105
Table 12 Mean and standard deviation of root trunk length in 3-rooted mandibular first molars . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Table 13 Distribution and prevalence of furcation entrance dimension in the mandibular first molars with 3 roots . . . . . . . . . . . 107
Table 14 The relationship between shift angle and radiographic assessment in molars with 3 roots - apical third exposure of distolingual root. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Table 15 The relationship between shift angle and radiographic assessment in molars with 3 roots - distolingual root complete exposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

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早發型牙周炎與成年型牙周炎之X光齒槽骨累積喪失量及年平均喪失速率- 數位掃瞄X光影像分析 研究生 林貞儀 撰 2001年六月

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