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研究生:李沛縈
研究生(外文):Pei Ying Lee
論文名稱:不同近心咬合遠心面(MOD)的修復體合併非齲蝕性齒頸缺損(NCCL)的修復體於人類上顎小臼齒的微滲漏現象
論文名稱(外文):Microleakage in Human Maxillary Premolar in Different Mesio-occlusal-distal (MOD) Restoration Combined with Non-caries Cervical Lesions (NCCL) Restoration
指導教授:林峻立林峻立引用關係
指導教授(外文):C. L. Lin
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:2009
畢業學年度:97
論文頁數:130
中文關鍵詞:冷熱循環測試壓力疲勞測試修復體
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背景
牙齒結構完整性會因齲蝕、外傷、磨耗及牙周病變等因素而產生缺損。當牙齒曾受到齲蝕MOD修復再進行NCCL修復時,其窩洞設計對修復體與牙齒力學的影響變得複雜,致使牙醫師使用直接法進行修復時常感到困惑。本研究的目的為了解小臼齒MOD與NCCL窩洞以複合樹脂修復時,所產生的生物力學行為,進而影響修復體的微滲漏現象。
方法
實驗選用大小相近的人類上顎小臼齒40顆,針對MOD窩洞深度1/2或2/3,NCCL窩洞深度1毫米或2毫米,NCCL窩洞角度45度或90度,共八組,以直接法進行複合樹脂修復,所有試件皆以冷熱循環(2,000次,攝氏5度-55度,置放時間30秒)與垂直壓力疲勞測試(20,000次,49牛頓),再以2﹪basic fuchsin dye,24小時,進行染色。在切片觀察中,觀察的界面包括MOD窩洞的咬合面中,頰側的軸面(MAB),腭側的軸面(MAP);MOD窩洞的鄰接窩洞中,近心側的牙齦面(MGM),遠心側的牙齦面(DGM);NCCL窩洞的咬合面(NO),牙齦面(NG)。以Mann-Whitney U test分析結果。
結果
MOD窩洞深度1/2在NCCL窩洞中的咬合面壁及牙齦壁(NO及NG)其微滲漏情形明顯高於深度2/3的窩洞(p=0.02)。NCCL窩洞深度1mm在NCCL窩洞中的咬合面壁(NO)的微滲漏情形明顯高於深度2mm的窩洞(p=0.01)。NCCL窩洞角度對所有界面的微滲漏皆無差異。進一步分析,NCCL窩洞的深度1mm比MOD窩洞的深度1/2易造成NCCL窩洞中的咬合面壁(NO)的微滲漏情形增加(odds ratio=13.2, p=0.02 vs odds ratio=10.8, p=0.03)。
結論
在垂直壓力下,MOD窩洞的深度不影響MOD修復體的微滲漏但會影響NCCL修復體的微滲漏。同時NCCL窩洞深度較淺,其NCCL修復體的微滲漏情形較嚴重。
Background
The restorative treatment of MOD cavity and NCCL cavity will result in microleakage and destruction of teeth. The microleakage causes post-operative sensitivity, second caries and failure of the restorations. The present study was to evaluate the impact of biomechanical change of the teeth after the restoration of MOD cavity and NCCL cavity on the microleakage.
Methods
In the present study, the depth of MOD cavity (1/2 or 2/3), depth of NCCL (1mm or 2 mm), and angle of NCCL cavity (45°or 90°)were used to define eight study groups (each group had five premolars). Direct composite resin restoration was used. After the thermocycling test (2000times, 5℃-55℃for 30 second), and vertical fatigue loading test (20,000times, 49N), the premolars were dyed with 2﹪basic fuchsin dye for 24 hours, and cut in to slice for further microscopic examination.
Results
The premolar with MOD cavity depth (1/2) had more microleakage than MOD cavity depth (2/3) in occlusal wall(NO)and gingival wall (NG)(p=0.02). The premolar with NCCL cavity depth (1mm) had more microleakage than those with NCCL cavity depth (2mm) in NO. The NCCL cavity angle did not increase microleakage in all section. After multivariate logistical regression, both NCCL cavity depth (1mm) and MOD cavity depth (1/2) increase the microleakage in NO (NCCL, odds ratio=13.2, p=0.02; MOD, odds ratio=10.8, p=0.03).
Conclusion
Under vertical loading, the depth of MOD cavity did not influence the microleakage of the MOD restoration, however, it would influence the microleakage of the NCCL restoration. The depth of NCCL cavity was shallower; the microleakage of the NCCL restoration was increased.
目錄
指導教授推薦書.........................
論文口試委員會審定書.........................
國家圖書館授權書...................iii
長庚大學授權書....................iv
誌謝..........................v
中文摘要.......................vi
英文摘要.......................viii
目錄 .........................x
表格目錄.......................xiii
圖片目錄.......................xiv

第一章 緒論 ......................1
1.1 研究背景......................1
1.1.1 牙齒功能與結構及牙齒缺損因素概述 ........1
1.1.2 牙體修復治療 ..................6
1.1.3 MOD及NCCL修復體同時存在時可能之破壞原因...7
1.1.4 體外冷熱循環測試................11
1.1.5 壓力疲勞實驗測試................13
1.2 研究動機 .....................15
1.3 文獻回顧 .....................16
1.3.1文獻回顧目的..................16
1.3.2小臼齒MOD修復體之生物力學相關文獻.......17
1.3.3小臼齒NCCL修復體之生物力學相關文獻......20
1.3.4小臼齒同時存在MOD與NCCL修復體之生物力學相關文獻.......................21
1.3.5文獻回顧總結..................23
1.4 研究目的 .....................25

第二章 材料與方法...................26
2.1 研究流程概述 ...................26
2.2 小臼齒MOD及NCCL窩洞修復參數建立與組數確定 ..26
2.3 試件收集與包埋 ..................28
2.4 窩洞建立與複合樹脂修復 ..............29
2.5 冷熱循環測試 ...................32
2.6 垂直壓力疲勞測試 .................33
2.7 試件染色與切片 ..................34
2.8 切面觀察 .....................35
2.9 統計分析 .....................36

第三章 研究結果....................37

第四章 討論......................40
4.1 冷熱循環測試與壓力疲勞測試對微滲漏的影響 .....40
4.2 MOD窩洞深度對微滲漏的影響............42
4.3 NCCL窩洞深度與角度對微滲漏的影響.........44
4.4 各界面的微滲漏情形 ................46
4.5 本實驗的限制 ...................48

第五章 結論......................50
參考文獻.......................51

表目錄
表1-1、文獻比較-體外人類小臼齒測試結果.......64
表1-2、文獻比較-電腦模擬分析結果..........65
表2-1、各組參數設定.................66
表3-1、各組間牙齒大小................67
表3-2、各組不同界面微滲漏比較............67
表3-3、各參數與不同界面的比較............68
表3-4、影響NO處的微滲漏的因子...........69
表3-5、各界面的比較.................69

圖目錄
圖1-1、牙齒構造示意圖 ................70
圖1-2、造成齲蝕的因子 ................70
圖1-3、近心咬合遠心面(MOD)窩洞 ..........71
圖1-4、非齲蝕性齒頸部缺損(NCCL)窩洞........71
圖1-5、牙齒上同時有MOD及NCCL窩洞 ........72
圖1-6、剩餘齒質與修復體體積比例示意圖 ........72
圖1-7、小臼齒MOD窩洞示意圖.............73
圖1-8、NCCL窩洞示意圖................73
圖1-9、咬合面銀汞合金修復體與齒頸部玻璃離子體修復體的斷裂示意圖....................74
圖2-1、實驗流程表 ..................75
圖2-2、MOD窩洞參數設定...............76
圖2-3、NCCL窩洞參數設定...............76
圖2-4、小臼齒包埋 ..................77
圖2-5、窩洞建立 ...................77
圖2-6、窩洞複合樹脂修復 ...............78
圖2-7、冷熱循環機測試機 ...............78
圖2-8、垂直壓力疲勞測試 ...............79
圖2-9、試件染色 ...................80
圖2-10、試件二次包埋後切片..............80
圖2-11、試件所需觀察的界面..............81
圖3-1、各界面的微滲漏情形 ..............82
圖4-1、垂直施力對MOD窩洞深度的影響.........83
圖4-2、垂直施力對NCCL窩洞深度的影響 ........83
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