臺灣博碩士論文加值系統

臨床上以瓷牙鑲面方式復形日漸普遍。回顧臨床觀察文獻1到10年的瓷牙鑲面的失敗率在3到42%，常見的失敗情形為瓷牙鑲面的破裂、微裂隙及脫落。機械力對瓷牙鑲面的探討文獻豐富，熱應力的影響之文獻則極少。本研究以三維有限元素法探討溫度變化對於三種瓷牙鑲面切端設計的影響，並以電阻應變計實驗做有效性印證。建立三種不同瓷牙鑲面設計〔羽毛形(feather)、弧形(chamfer)、方形(buttjoint)〕之上顎正中門牙的三維實體模型。施予模擬攝氏67及7度之飲食溫度。熱傳導分析發現熱傳導時間10秒鐘足夠複合體熱充分傳遞，熱傳導模式由瓷牙鑲面往牙髓方向依序內傳遞，樹脂黏合劑的切端兩側溫度變化量最大溫度上升和下降時，有相似的熱傳導模式。此外三種切端修形方式之熱傳導模式也相似。溫度變化的確對瓷牙鑲面-樹脂黏合劑-齒質複合體造成熱應力，溫度上升和下降時，熱應力分布相似，三種切端修形方式之熱應力分布相似。瓷牙鑲面之最大張應力出現在舌側面齒頸部區域，樹脂黏合劑層的剪應力出現在唇側面齒頸部。單次溫度變化(最大值為0.128MPa)對瓷牙鑲面造成的張應力沒有超過破裂的臨界值，長期反覆則預期會產生疲勞現象。關鍵詞：瓷牙鑲面、三維有限元素法、熱應力

In recent years, the porcelain laminate veneer had become a more popular application. However, fracture, microleakage and debonded of the porcelain laminate veneer are still the critical problems that usually affect the success rate of it. Cyclic thermal fatigue and function has demonstrated a significant influence of the luting composite and ceramic in crack propensity of porcelain laminate veneers (PLV). The purpose of this study was to define the potential parameters associated with the development of cracks in PLV. Finite element method (FEM) was used for the thermal stress analysis of the porcelain-luting composite-tooth complex during the thermal variations of ingesting food and drinks. The thermal loading conditions were assessed 67°C (30° positive loading) and 7 °C (30° negative loading) on the exterior nodes coronal to the cementoenamel junction. Temperature gradients and distributions of three PLV designs did not show any significant difference. The thermal change did induce an internal stress in the porcelain-luting composite-tooth complex. The maximal principal stress were concentrated at cervical margin of the veneer-cement interface. The maximum shear stress of the cement was concentrated at cervical margin of the veneer-cement interface.

第一章緒論……………………………………………………………1
第一節研究背景…………………………………………….....1
第二章文獻回顧………………………………………………………5
第一節前牙區的復形與瓷牙鑲面的發展…………………....5
第二節瓷牙鑲面的臨床評估重點及預後…………………....6
第三節黏著複合體：牙齒/樹脂黏合劑/陶瓷………………….7
第四節應力及熱應力分析對於贗復物的重要性……….…..18
第五節瓷牙鑲面臨床應用的考量……………………….…..22
第六節文獻回顧總結………………………………….……..23
第七節研究動機及目的……………………………….……..24
第三章材料與方法……………………………………………………25
第一節蒐集上顎正中門牙……………………………………25
第二節包埋上顎正中門牙………………….………………..26
第三節製作上顎正中門牙瓷牙鑲面……………….………..26
第四節電阻應變計的黏貼…………………………………...26
第五節施與溫度變化及記錄………………………………...27
第六節牙齒包埋切片………………………………….……..27
第七節切片之影像處理………….…………………………..27
第八節有限元素模型建立……………….…………………..28
第九節模型有效性測試……………………….……………..28
第十節初步實驗………………………………………………29
第十一節三種切端設計的熱傳導及熱應力分析……………30
第四章結果……………………………………………………………31
第一節有效性驗證結果……………………………………...31
第二節初步實驗結果……………………….………………..31
第三節有限元素分析熱傳遞結果…………..………………32
第四節有限元素分析熱應力結果…………………………..33
第五節有限元素法分析樹脂黏合劑層之剪應力結果……..35
第五章討論……………………………………………………….…36
第一節有限元素法………………………………………….……36
第二節建立標準模型………………………………………..…..37
第三節有限元素模型的建立..…………………………………..38
第四節施予溫度差、部位、時間與熱應力之邊界條件的設定…39
第五節有效性驗證數值的探討………………………………….41
第六節熱傳遞時間之探討……………………………………….42
第七節熱傳遞之探討…………………………………………....42
第八節不同修形方式瓷牙鑲面之熱應力探討……………..…..43
第九節溫度上升及下降之間………………..…………………..45
第十節結合應力及熱應力之綜合考量………………….……..46
第十一節臨床應用的考量……………………………………….48
第六章結論與未來展望……………………………………………...50
參考文獻……………………………………………………………….52
表格…………………………………………………………………….60
圖形…………………………………………………………………….63

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