實驗背景及目的：上顎前牙區的齒間乳突 (interdental papilla) 存在或萎縮是美觀與否的關鍵，也是牙醫師與患者所特別關心的。本實驗的目的是要評估年紀、性別及齒間區域決定齒間乳突存在及其長度的因子。
方法：102個上顎前牙區齒間乳突的X光根尖片來自30位成人，其恆牙完整萌出，牙齦健康，且上顎前牙排列整齊。應用放射線不可透性物質塗在齒間乳突尖及牙齦黏膜交接 (mucogingival junction) 處，輔助X光片的判讀。並利用電腦軟體 (Image J) 計算距離和斷面面積。以一般估計方程式 (General estimating equation (GEE)) 分析所有數值。
結果：齒間乳突的存在和牙齒接觸點 (contact point) 到齒槽骨嵴 (bone crest) 有顯著相關 (odds ratio = -9.8; p < 0.001)。齒間乳突的長度和牙齒接觸點到齒槽骨嵴的距離 (r = 0.11, p < 0.05)，角化牙齦 (keratinized gingiva) 的寬度 (r = 0.14, p < 0.001)，和齒縫間隙面積 (embrasure area; r = 0.05, p < 0.05) 有顯著的統計相關。
結論：X光根尖片合併輔助放射線不可透性物質可以用來評估齒間乳突存在和其長度的決定性因子。在上顎前牙的區域，牙齒接觸點到齒槽骨嵴的距離是決定齒間乳突存在與否的決定性因子。如牙齒接觸點到齒槽骨嵴的距離每增加1 mm，齒間乳突的存在就降低9.77倍。齒間乳突的長度和牙齒接觸點到齒槽骨體的距離、角化牙齦的寬度以及齒間隙縫面積有明顯的相關。而角化牙齦的寬度是決定齒間乳突長度最重要的因子。如角化牙齦寬度每增加1 mm，齒間乳突長度就增加0.14 mm。

Background and Purposes: The presence of interdental papillae in the maxillary anterior region is a key esthetic factor and of great concern to dentists and patients. The aims of this study were to investigate whether demographic characteristics and interdental area variables could affect the presence and length of the interdental papilla.
Methods: Periapical radiographs of 102 interdental papillae between maxillary anterior teeth were obtained in 30 adults who had fully erupted permanent dentition, healthy gingiva, and well-aligned maxillary anterior teeth. A radiopaque material was placed on the tip of the interdental papilla and the mucogingival junction, which enabled it to be visualized on the radiograph. Distances and cross-sectional areas relating to interdental papillae were measured with software (Image J). All measurements were analyzed with GEE (General estimate equation).
Results: The presence of the interdental papilla was significantly related to the distance from the contact point to the bone crest (odds ratio = -9.8; p < 0.001). The length of the interdental papilla was also significantly related to the distance from the contact point to the bone crest (r = 0.11, p < 0.05), the width of the keratinized gingiva (r = 0.14, p < 0.001), and the embrasure area (r = 0.05, p < 0.05).
Conclusions: Periapical radiography combined with the use of a radiopaque material can be used to investigate determinants of the presence and length of an interdental papilla. In the anterior maxillary region, the contact point-bone crest distance is the determinant for the presence of a papilla. For example, the incidence of papillary presence decreased by 9.77 times for each 1-mm increase in the contact point-bone crest distance. The papillary length was significantly associated with the contact-point-bone crest distance, keratinized gingival width, and embrasure area. The width of the keratinized gingiva is the strongest determinant for the length of a papilla. For example, the papillary length increased by 0.14 mm for each 1-mm increase in the keratinized gingival width.

CONTENTS

Chapter 1 INTRODUCTION……………………………………1
Chapter 2 SYSTEMATIC REVIEW…………………………….3
2.1 Introduction….…….………………………………….3
2.2 Methods………….…………………………………………4
2.2.1 Search Strategy…………………………………….4
2.2.2 Selection Criteria…………………………………4
2.2.3 Data Collection and Analysis………………….5
2.3 Results…………………………………………………….5
2.3.1 Relationship of Papillary Presence..………5
2.3.2 Quality Analysis…………………………………….8
2.4 Discussion………………………………………………..9
Chapter 3 AIMS and HYPOTHESES…………………………12
3.1 Aims…………………………………………………………12
3.2 Hypotheses……………………………………………….12
Chapter 4 METHODS………………………………………….13
4.1 Patients………………………………………………...13
4.2 Data Collection……………………………………….14
4.3 Statistical Analysis…..………………………….15
Chapter 5 RESULTS……………………………………………18
5.1 Study Population………………………………………18
5.2 Relationship of Papillary Presence……………18
5.3 Relationship of Papillary Length………………19
Chapter 6 DISCUSSION………………………………………20
6.1 Radiography Method……………………………………20
6.2 Papillary Presence…..………………………………21
6.3 Papillary Length……..……………………..………25
6.4 Clinical Implication..………………………………27
6.5 Limitations of the Study….………………………28
Chapter 7 CONCLUSIONS…………………………………….30
REFERENCES………………………………………………………30
TABLES 1 through 6………………………………………….38
FIGURES 1 through 4…………………………………………49

LIST of TABLES
Table 1. Included studies relating to the presence of interdental papilla…………………………………………38
Table 2. Quality evaluation of the included studies…………...…............................42
Table 3. Demographic characteristics and interdental area data of study population…………………………………44
Table 4. GEE multivariable logistic regression for papillary presence for the 102 papillae……………………………………….............46
Table 5. GEE multivariable linear regression for papillary length for the 102 papillae…………………………….47
Table 6. Incidence of papillary presence or not by the contact point-bone crest distance for the 102 papillae…………................................48

LIST of FIGURES
Figure 1. Clinical photograph showing the radiopaque materials (Temp-bond™) on the tips of the papillae and the mucogingival junction between the teeth...........................................49
Figure 2. Periapical radiograph showing the measured distance........................................50
Figure 3. Periapical radiograph showing the measured area……........................................51
Figure 4. Periapical radiograph showing the measured ratio…….......................................52

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