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研究生:陳怡芬
研究生(外文):CHEN YI-FEN
論文名稱:根管治療之症候突發與其相關因素之研究根管治療之症候突發與其相關因素之研究
論文名稱(外文):endodontic flare-up and the associated factorsfactors endodontic flare up and the associated factors
指導教授:洪祥熙
學位類別:碩士
校院名稱:長庚大學
系所名稱:顱顏口腔醫學研究所
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:2007
畢業學年度:95
語文別:中文
中文關鍵詞:症候突發根管治療前瞻性牙髓病發生率操作者自發性過度封填操作者
外文關鍵詞:flare uproot canal treatmentvisitdataoverfill obturation
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根管治療後的症候突發對於病人與醫生而言,都是令人困擾的問題。本篇研究目的是以前瞻性設計的研究方法,統計在林口長庚醫院牙髓病科接受過根管治療的台灣病患中,發生根管治療術後症候突發(endodontic flare-up)的發生率以及評估與症候突發發生相關的因素對這次調查的影響。根管治療症候突發(endodontic flare-up),依美國牙髓病學會(Association of American Endodontic;AAE) 2003年的定義,為當患者在經過根管治療後,該部位發生術後嚴重疼痛或是腫賬,患者必須打電話或臨時到診間尋求緊急治療,這樣就被記錄為一次症候突發。在為期3 個月之調查,由牙髓病科兩位住院醫師(平均年資4年)及兩位主治醫師(平均年資10.5年)診治,總計共有 643顆患牙符合收集標準。患者的基本資料以及臨床跟X光資料都在患者初診時,由任一位操作者診斷記錄並治療完成。在整個調查期間,整體症候突發的發生率為2.0%。與症候突發的發生有關的因素為術前自發性疼痛(p=0.025);術前敲診痛(p=0.000 );根管過度封填(p=0.034);年齡(p=0.024);牙齒部位 (p=0.010);不同操作者(p=0.001)。然而患者性別與症候突發的發生沒有統計差異。由本篇研究之結果,我们推斷出症候突發的發生,與患者年齡尤其是40-49歲;牙齒部位在下顎第一大臼齒;以及臨床經驗較少之牙髓病科醫師明顯較多。而臨床經驗較少者,其病例之症候突發的發生,與術前疼痛症狀以及病例的年齡分佈相關。
ABSTRACT
Flare-up,an annoying complication following root canal treatment (RCT) ,is a frustrating experience to both patients and dentists。The purpose of this study was to evaluate the incidence of endodontic flare-up of Taiwanese patients at Chang Gung Memorial Hospital (CGMH), Linkou, Taiwan in a prospective survey。An unscheduled phone call and/or an emergency visit due to severe pain and/or swelling following RCT was defined as a flare-up。Six hundred and fifty-eight teeth were treated in the Endodontic Department by residents or attending doctors in a period of 3 months。 Patient’s demographics,and clinical and radiographic data were recorded at the time of the RCT。Results have shown that the overall incidence of flare-up is relatively lower (2.0%) than the other reports。The incidence of flare-up is significantly correlated with presenting symptoms of spontaneous pain (p = 0.025);percussion pain (p = 0.000); overfill obturation (p = 0.034) ;patient age (p = 0.024);tooth position( p = 0.010);the group of operator(p = 0.001)。However, there is no significant relation between the incidence of flare-up and gender,periapical diagnosis, pulpal diagnosis,or type of treatment。 The results have concluded that the occurrence of flare-up is significantly related to patient age especially between 40~49 yrs;tooth position on lower first molar;and different operator。The flare-up rate of the operator with less experiences is related to patient age and the pre-operative pain。
Key words:flare-up,root canal treatment,overfill obturation ,endodontist。
目 錄
指導教授推薦書………………………………………………………… i
口試委員會審定書…………………………………………………… ii
授權書……………………………………………………………… iii
誌謝…………………………………………………………………… iv
中文摘要……………………………………………………………… v
英文摘要……………………………………………………………… vi
本文目錄…………………………………………………………… vii
圖表目錄 ……………………………………………………………viii
第一章 緒論……………………………………………………………1
1.1研究背景與源由……………………………………………… 2
1.2相關文獻回顧………………………………………………… 4
1.2.1症候突發的可能機制…………………………………… 4
1.2.2症候突發的發生率 …………………………………… 12
1.2.3症候突發的相關因素 ………………………………… 20
1.3研究假說及目的 ………………………………………… 23
第二章 研究材料與方法…………………………………………24
2.1取樣方法及收集標準 ………………………………………25
2.2標準治療程序………………………………………………… 29
2.3排除於研究外的標準………………………………………… 35
2.4統計方法……………………………………………………… 36
第三章 結果 …………………………………………………… 38
3.1根管治療術後症候突發之發生率 ………………………… 39
3.2根管治療術後症候突發之可能相關因子 ………………… 39

3.3以可能影響症候突發的因素來對操作者A、B之病例群…42
第四章 討論……………………………………………………… 47
4.1症候突發之定義…………………………………………… 48
4.2研究設計…………………………………………………… 49
4.3統計考量…………………………………………………… 50
4.4研究結果之討論…………………………………………… 50
4.4.1發生率………………………………………………… 50
4.4.2年齡…………………………………………………… 51
4.4.3性別…………………………………………………… 52
4.4.4牙位…………………………………………………… 54
4.4.5牙髓診斷……………………………………………… 54
4.4.6根尖周圍組織診斷…………………………………… 56
4.4.7術前疼痛症狀………………………………………… 58
4.4.8過度封填……………………………………………… 60
4.4.9操作者………………………………………………… 62
第五章 結論與展望…………………………………………………68
參考文獻………………………………………………………………71
附錄與圖表…………………………………………………………… 88
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