摘要
電腦輔助工程設計/製造系統已逐漸應用於牙體復形治療上，主要優點為節省治療的時間然而經根管治療後大範圍缺陷的牙齒其臨床的治療方式是施與牙冠復形，但以牙冠復形的方式復形勢必需要修形較多的健康齒質，但如果只給予嵌體的方式做復形其牙體抵抗斷裂的強度恐有疑慮，因此衍生出探討不同的復形體設計方式對不同窩洞形式的影響，因此本研究針對不同窩洞形式及復形體設計進行深入的參數化探討。本研究整合逆向工程及電腦輔助模擬分析等技術，建構三維小臼齒之有限元素模型並進行驗證實驗，並引入可靠度的數值分析及破壞試驗的音洩分析，針對四種接受根管治療的窩洞(MO、MOD、MODP、MODPB)及四種不同復形法(嵌體/冠蓋體、根柱強化復形體、咬頭覆蓋復形體強化設計及牙冠)共進行十五組的參數討論。比較有限元素分析剩餘齒質應力值結果發現在MO窩洞及MOD窩洞下嵌體及嵌體強化設計約為咬頭覆蓋復形體強化設計的6-8倍而咬頭覆蓋復形體強化設計與牙冠設計約在5%以內；MODP窩洞下冠蓋體、冠蓋體強化設計及牙冠設計為咬頭覆蓋復形體強化設計的3.40倍、3.41倍及1.4倍；MODPB窩洞下冠蓋體強化設計及牙冠設計為咬頭覆蓋復形體強化設計的0.97倍及1.48倍，可靠度分析結果在MO窩洞、MOD窩洞及MODP窩洞下嵌體/冠蓋體及嵌體/冠蓋體強化設計破壞機率較咬頭覆蓋復形體強化設計與牙冠設計高； MODPB窩洞下各復形設計破壞機率差異不大，音洩之破壞結果發現在MO窩洞下嵌體、咬頭覆蓋復形體強化設計及牙冠之破壞負載分別為275.9N、584.8N及594.56 N；在MOD窩洞下嵌體、咬頭覆蓋復形體強化設計及牙冠之破壞負載分別為249.81N、584.714 N及484.376 N。根據本研究之結果經過統計後在MO窩洞及MOD窩洞下咬頭覆蓋復形體強化設計及牙冠為較佳的復形方式，而MODP窩洞及MODPB窩洞之各復形方式並無太大差異。

Abstract
In clinical method for restoration of endodontically treated teeth usually uses crown to cover all cusps, the main reason is that crown restoration may reduce the stress concentration and protect the coronal structure of tooth. Several reinforce methods were suggested on restoration to reduce the risk of fracture. More recently, some study shows preserve more remaining structure of tooth may increase the fracture resistance, and inlays could provide enough internal reinforcement of teeth without occlusal coverage. However it still not clear whether the fracture resistance of tooth is fully treated after these restoration. The aim of this study was to investigate whether endodontically treated premolar under different cavity preparation could archived by different restoration. Using reversing engineering method a 3D finite element model of maxillary premolar were generated to analyze inclusive of four cavities(MO, MOD, MODP and MODPB) and four restorative designs (inlay/onlay, endo- inlay/onlay, endo-crown and crown). The probability analysis of numerical method and the fracture test of acoustic emission were recommended to validate the finite element result. Comparing the maximal principle stress on remaining tooth could find that under MO and MOD cavity, the inlay and endo-inlay design were 6-8 time higher than endo-crown, and the difference between endo-crown and crown were within 5%. In MODP cavity, the maximal principle stress of onlay, endo-onlay and crown were higher than endo-crown 3.40times, 3.41times and 1.4times, respectly. In MODPB cavity, the maximal principle stress of endo-crown and crown were higher than onlay design 1.03times and 1.48times, respectly. In probability analysis, the failure probability of MO、MOD and MODP cavity using inlay/onlay, endo-inlay/endo-only were higher than crown design, the failure probability of MODPB cavity using onlay, endo-crown or crown were slightly difference. The fracture test of acoustic emission analysis, the fracture resistance of MO cavity was recorded as follows: 275.9N for inlay, 584.8N for endo-crown and 594.56N for crown, and the fracture resistance of MOD cavity was recode as follows: 249.81N for inlay,584.714N for endo-crown and 484.376N for crown. Regarding numerical result and experimental result in vitro, the endodontically treated premolar with MO and MOD cavity using endo-crown or crown restoration were recommended in this study, and the endodontically treated premolar with MODP and MODPB cavity were little difference in onlay, endo-crown or crown restoration.

目錄
指導教授推薦書…………………………………………………………
口試委員審定書…………………………………………………………
博碩士論文電子檔案授權書…………………………………………..iii
長庚大學博碩士紙本論文著作授權書………………………………..iv
謝誌…………………………………………………………………...…v
中文摘要………………………………..……………………………... vi
英文摘要…………………………..…………………………………..viii
目錄………………………………………………….…………………..x
圖片目錄………………………...………………………………..….. xiv
表格目錄……………………………..………….………………….. xviii
第一章 緒論……………………………………………………………..1
1.1前言…………………………………………………………………..1
1.1.1牙齒結構………………………………………………………1
1.1.2齲齒原因………………………………………………………3
1.1.3根管治療………………………………………………………4
1.1.4缺損復形………………………………………………………6
1.1.5電腦輔助設計/製造系統…………………………………….11
1.1.6復形體設計…………………………………………………..18
1.1.7分析方法……………………………………………………...22
1.2研究動機……………………………………………………………27
1.3文獻回顧……………………………………………………………28
1.3.1根管治療……………………………………………………..28
1.3.2MOD窩洞……………………………………………………29
1.3.3根柱強化設計………………………………………………..31
1.3.4可靠度及音洩分析…………………………………………..33
1.3.5文獻總結……………………………………………………...37
1.4研究目的……………………………………………………………39
第二章 研究方法………………………………………………………40
2.1研究流程圖…………………………………………………………40
2.2研究參數設定………………………………………………………41
2.3逆向工程……………………………………………………………47
2.4有限元素分析法……………………………………………………51
2.4.1收斂性測試…………………………………………………...51
2.4.2靜態分析……………………………………………………...52
2.5模型驗證實驗……………………………………………………….55
2.5.1有限元素………………………………………………………55
2.5.2體外驗證………………………………………………………56
2.6可靠度分析………………………………………………………….59
2.6.1韋伯方程式驗證………………………………………………59
2.6.2材料性質測定…………………………………………………61
2.7音洩及破壞實驗…………………………………………………….68
2.7.1小臼齒試件製備……………………………………………...69
2.7.2實驗架設……………………………………………………...73
第三章 結果……………………………………………………………78
3.1有限元素分析………………………………………………………78
3.1.1模型建構……………………………………………………...78
3.1.2收斂結果……………………………………………………...80
3.1.3驗證實驗結果………………………………………………...82
3.1.4靜態分析結果………………………………………………...84
3.2可靠度之破壞機率預測……………………………………………95
3.2.1韋氏函數驗證結果………………………………………...…95
3.2.2牙釉質之材料性質測定結果………………...………………98
3.2.3程式化韋氏參數…………………………………………….100
3.2.4破壞機率分析結果………………………………………….102
3.3音洩及破壞實驗結果……………………………………………..112
3.3.1破壞負載結果……………………………………………….112
3.3.2音洩初始破壞結果………………………………………….115
3.3.3斷面破壞…………………………………………………….121
第四章 討論…………………………………………………………..124
4.1電腦模擬分析……………………………………………………..125
4.1.1有限元素模型……………………………………………….125
4.1.2電腦模擬分析之結果探討………………………………….127
4.2可靠度破壞機率分析……………………………………………..129
4.3音洩及破壞實驗……………………………….………………….131
4.4研究假設與限制……………………………….………………….134
第五章 結論與未來展望………………………….………………….136
5.1結論…………………………………………….………………….136
5.2未來展望……………………………………….………………….138
第六章 參考文獻……………………………….…………………….139








圖片目錄
圖1-1口腔上下顎之正視圖…………………………………………….2
圖1-2牙齒的基本構造………………………………………………….3
圖1-3根管治療………………………………………………………….5
圖1-4傳統牙冠製作方式………………………………………………10
圖1-5 DCS電腦輔助設計/製造系統………………………………….12
圖1-6德國KaVo電腦輔助設計/製造系統……………………………13
圖1-7 CEREC系統……………………………………………………..14
圖1-8牙冠復形體………………………………………………………19
圖1-9嵌體及冠蓋體……………………………………………………20
圖1-10根柱強化設計…………………………………………………..21
圖1-11有限元素分析流程……………………………………………..23
圖1-12 3D有限元素模型………………………………………………29
圖1-13四種支台及牙冠設計………….……………………………….32
圖2-1研究流程圖………………………………………………………40
圖2-2設計參數示意圖…………………………………………………43
圖2-3MOD窩洞之復形體設計示意圖………………………………..43
圖2-4逆向工程…………………………………………………………47
圖2-5小臼齒齒影像……………………………………………………49
圖2-6負載條件及邊界條件示意圖……………………………………54
圖2-7電腦模擬分析之負載條件及邊界條件示意圖…………………55
圖2-8電腦模擬分析之應變規含跨區域示意圖………………………56
圖2-9模型驗證實驗示意圖…………………………………………...58
圖2-10韋氏曲線……………………………………………………….61
圖2-11切片流程示意圖……………………………………………….65
圖2-12材料性質實驗流程…………………………………………….67
圖2-13窩洞及復形體製備流程……………………………………….71
圖2-14黏著流程……………………………………………………….73
圖2-15試件架設……………………………………………………….75
圖2-16軟體操作設定介面…………………………………………….75
圖2-17音洩訊號圖…………………………………………………….76
圖2-18音洩及破壞實驗示意圖……………………………………….76
圖2-19音洩及破壞分析圖…………………………………………….77
圖3-1上顎第二小臼齒之有限元素模型及材料性質…………………79
圖3-2參數化MOD窩洞及復形體強化設計模型……………………79
圖3-3四種分割線段方式之網格化……………………………………81
圖3-4觀測節點示意圖…………………………………………………81
圖3-5模型收斂曲線……………………………………………………82
圖3-6MO窩洞之牙釉質應力分佈圖………………………………….85
圖3-7MO窩洞牙本質應力分佈圖…………………………………….86
圖3-8MO窩洞黏著層應力分佈圖…………………………………….86
圖3-9MOD窩洞牙釉質應力分佈圖…………………………………..88
圖3-10MOD窩洞牙本質應力分佈圖…………………………………88
圖3-11MOD窩洞黏著層應力分佈圖………………………………….89
圖3-12MODP窩洞牙釉質應力分佈圖………………………………..90
圖3-13MODP窩洞牙本質應力分佈圖………………………………..91
圖3-14MODP窩洞黏著層應力分佈圖………………………………..91
圖3-15MODPB窩洞牙釉質應力分佈圖………………………………93
圖3-16MODPB窩洞牙本質應力分佈圖………………………………93
圖3-17MODPB窩洞黏著層應力分佈圖………………………………94
圖3-18二維固定局部義齒之有限元素模型………………………….96
圖3-19二維固定局部義齒之應力分佈圖…………………………….96
圖3-20固定局部義齒之破壞機率…………………………………….97
圖3-21牙釉質測定之韋氏參數……………………………………….99
圖3-22韋氏涵數之程式化介面………………………………………100
圖3-23韋氏涵數之VBA程式碼介面……………………………….101
圖3-24MO窩洞與不同復形方式之各材料破壞機率預測………….103
圖3-25MO窩洞與不同復形方式之破壞機率預測………………….104
圖3-26MOD窩洞與不同復形方式之各材料破壞機率預測………..106
圖3-27MOD窩洞與不同復形方式之破壞機率預測………………..106
圖3-28MODP窩洞與不同復形方式之各材料破壞機率預測………108
圖3-29MODPB窩洞與不同復形方式之破壞機率預測…………….109
圖3-30MODP窩洞與不同復形方式之各材料破壞機率預測………111
圖3-31MODPB窩洞與不同復形方式之破壞機率預測……………..111
圖3-32破壞負載長條圖………………………………………………114
圖3-33音洩初始破壞長條圖…………………………………………118
圖3-34 音洩訊號例圖………………………………………………..120
圖3-35破壞斷面 …………………………………………………….123
圖4-1音洩之初始破壞與破壞機率比較圖…………………………..133









表格目錄
表一 本研究參考之韋伯二參數………………………………………34
表二 研究參數列表……………………………………………………45
表三 電腦模擬分析之材料特性表……………………………………52
表四 實驗分組表………………………………………………………68
表五 收斂測試…………………………………………………………80
表六 體外驗證及有限元素驗證分析結果……………………………83
表七 MO窩洞與復形設計之應力值………………………………….85
表八 MOD窩洞與復形設計之應力值………………………………..87
表九 MODP窩洞與復形設計之應力值………………………………90
表十MODPB窩洞與復形設計之應力值……………………………..92
表十一 牙釉質材料性質測定之應力值………………………………98
表十二 破壞負載……………………………………………………..112
表十三 負載結果變異數分析………………………………………..113
表十四 負載結果多重比較…………………………………………..113
表十五 音洩初始破壞負載…………………………………………..115
表十六 音洩初始破壞負載結果變異數分析………………………..116
表十七 音洩初始破壞負載多重比較………………………………..117
表十八 斷裂型態……………………………………………………..122

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