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研究生:陳柏融
研究生(外文):Po-Jung Chen
論文名稱:顴下嵴及頰棚矯正骨釘施打位置骨厚度之測量
論文名稱(外文):Bone Thickness of Infrazygomatic Crest and Buccal Shelf for Orthodontic Implant Placement
指導教授:况守信黃穰基黃穰基引用關係
指導教授(外文):Sou-Hsin KuangYong-Kie Wong
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床牙醫學研究所
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:2010
畢業學年度:98
語文別:中文
論文頁數:61
中文關鍵詞:顴下&顴下&顴下&顴下&顴下&顴下&顴下&顴下&
外文關鍵詞:miniscreworthodontic implantbone thicknesscone beam computed tomographyinfrazygomatic crestbuccal shelf
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目的:
分析上顎顴下嵴(infrazygomatic crest)及下顎頰棚(buccal shelf)矯正骨釘較常施打位置的骨厚度,以及與周圍解剖構造的相關距離,並且尋找安全的施打角度,以利臨床醫師施打矯正骨釘時,有一個參考的藍圖。
實驗材料及方法:
存取近藤悅子齒顎矯正診所2008年之牙科電腦斷層(CB MercuRay, Hitachi medical corporation, Tokyo, Japan)影像資料,從中選取20~40歲之成人病患並篩選符合納入條件之資料,使用三維影像重建及測量軟體(ImplantMax Version 4.0),進行影像重組後,測量上顎顴下嵴區域之頰側骨厚度和矯正骨釘施打的骨深度,並且測量最大安全角度;測量下顎頰棚區域之頰側骨厚度、傾斜角度以及最大安全角度;各測量區域皆分別測量兩個高度,包括距離齒槽脊4mm和6mm高度。
結果:
顴下嵴矯正骨釘施打之骨深度,無論是距離齒槽脊4mm或6mm高度,第二小臼齒與第一大臼齒間顯著比其他區域厚(4mm高度:8.1±2.2mm;6mm高度:6.6±2.1mm);顴下嵴區域矯正骨釘施打位置頰側骨厚度,第二大臼齒近心頰側處(4mm高度:3.6±1.0mm;6mm高度:3.3±1.0mm)顯著大於第一大臼齒近心頰側處;顴下嵴區域矯正骨釘施打最大安全角度,第二大臼齒近心頰側顯著大於第一大臼齒近心頰側,6mm高度處顯著大於4mm高度處。
頰棚區域,頰側骨厚度之測量,由第一大臼齒近心頰側處(4mm高度:1.3±0.4mm;6mm高度:1.6±0.7mm)至第二大臼齒遠心頰側處(4mm高度:6.5±1.4mm;6mm高度:7.3±1.5mm),逐漸增加;頰棚之傾斜程度,第一大臼齒區域(7.7±5.3°)顯著比第二大臼齒區域(38.2±10.9°)陡峭;頰棚區域矯正骨釘施打最大安全角度,第二大臼齒近心頰側顯著大於第一大臼齒近心頰側,6mm高度處顯著大於4mm高度處。
結論:
施打矯正骨釘於上顎顴下嵴區域,建議放置於第二小臼齒與第一大臼齒之間、第一與第二大臼齒之間或第二大臼齒近心頰側處;施打矯正骨釘於下顎頰棚區域,建議放置於第一大臼齒遠心頰側至第二大臼齒近心頰側區域。

Introduction:
The purpose of this study was to measure the bone thickness of maxillary infrazygomatic crest and mandibular buccal shelf for orthodontic implant placement. These measurements provide an anatomical map and guidance for orthodontists to insert miniscrew safely in the infrazygomatic crest and buccal shelf area.
Methods:
Cone beam computed tomographic records(CB MercuRay, Hitachi medical corporation, Tokyo, Japan) were obtained from Dr. Etsuko Kondo’s orthodontic clinic. From them, 20 to 40 years old adult patients were selected to reconstruct and measure. At infrazygomatic crest area, bone depth and buccal bone thickness and maximum safe angle for mini-implant insertion were measured. At buccal shelf area, buccal bone thickness and maximum safe angle for mini-implant placement and buccal shelf slope were measured. For each subject, the areas from second premolar to second molar were measured on both side and at 2 different levels(4mm and 6mm from alveolar crest).
Results:
Infrazygomatic crest bone depth between 2nd premolar and 1st molar(4mm level:8.1±2.2mm;6mm level:6.6±2.1mm) was deeper than any other areas. Significant more buccal bone of upper second molar(4mm level:3.6±1.0mm;6mm level:3.3±1.0mm) compared to upper first molar. Maximum safe angle at mesiobuccal area of 2nd molar was significant larger than at 1st molar mesiobuccal area. Maximum safe angle at 6mm level was larger than at 4mm level.
At the buccal shelf area, buccal bone thickness was increased gradually from 1st molar mesiobuccal area(4mm level:1.3±0.4mm;6mm level:1.6±0.7mm)to 2nd molar mesiobuccal area(4mm level:6.5±1.4mm;6mm level:7.3±1.5mm). The slope of buccal shelf at first molar(7.7±5.3°) was steeper than at second molar(38.2±10.9°). Maximum safe angle was significant larger at 2nd molar mesiobuccal area and 6mm level.

Conclusion:
At infrazygomatic crest area, safe zone for placement of a miniscrew is between 2nd premolar and 1st molar, 1st and 2nd molar or 2nd molar mesiobuccal area.
At buccal shelf area, miniscrew is recommended for installation between 1st molar distobuccal and 2nd molar mesiobuccal area.

摘要 i
Abstract iii
第一章 緒論 1
1.1 研究背景 1
1.2 錨定的裝置(Anchorage preparation) 2
1.2.1 傳統的錨定裝置 2
1.2.2 暫時性的錨定裝置(temporary anchorage devices) 3
1.2.3 矯正骨釘放置時的風險 4
1.2.4 矯正骨釘的臨床應用 6
1.3 錐狀射束電腦斷層掃描儀 6
1.3.1 電腦斷層掃描儀之演進 6
1.3.2 市售錐狀射束電腦斷層掃描儀比較 8
1.3.3 錐狀射束電腦斷層掃描儀對齒顎矯正治療的貢獻與影響 9
1.4 矯正骨釘施打位置骨厚度測量 10
1.5 研究目的 17
第二章 研究材料與方法 18
2.1 研究樣本 18
2.1.1 研究樣本來源 18
2.1.2 研究樣本之篩選 18
2.2 研究軟體 19
2.3 研究流程和方法 19
2.3.1 影像重組以及頭部定位 19
2.3.2 上顎顴下嵴區域之測量 20
2.3.3 下顎頰棚區域之測量 21
2.3.4 信度測試 22
2.3.5 統計分析方法 22
第三章 結果 24
3.1 上顎顴下嵴區域矯正骨釘施打位置骨深度 24
3.2 上顎顴下嵴區域矯正骨釘施打位置頰側骨厚度 25
3.3 上顎顴下嵴區域矯正骨釘施打最大安全角度 25
3.4 下顎頰棚區域矯正骨釘施打位置頰側骨厚度 26
3.5 下顎頰棚區域矯正骨釘施打位置傾斜角度 26
3.6 下顎頰棚區域矯正骨釘施打最大安全角度 26
3.7 測量值信度與誤差之計算 27
第四章 討論 28
4.1 上顎顴下嵴區域 28
4.1.1 上顎顴下嵴區域矯正骨釘施打位置 28
4.1.2 上顎顴下嵴區域矯正骨釘施打位置骨深度 29
4.1.3 上顎顴下嵴區域矯正骨釘施打位置頰側骨厚度 31
4.1.4 上顎顴下嵴區域矯正骨釘施打安全角度 31
4.1.5 上顎顴下嵴區域矯正骨釘施打臨床建議 32
4.2 下顎頰棚區域 33
4.2.1 下顎頰棚區域矯正骨釘施打位置 33
4.2.2 下顎頰棚區域矯正骨釘施打位置頰側骨厚度 33
4.2.3 下顎頰棚區域矯正骨釘施打位置傾斜角度 34
4.2.4 下顎頰棚區域矯正骨釘施打安全角度 35
4.2.5 下顎頰棚區域矯正骨釘施打臨床建議 35
4.3 研究之樣本蒐集及測量 36
第五章 結論 38
參考文獻 39
附錄 47
圖一: ImplantMax 4.0影像重組及測量軟體介面 47
圖二: 頭部定位以及咬合平面調整 47
圖三: 顴下嵴矯正骨釘施打位置骨深度測量(4mm高度) 48
圖四: 顴下嵴矯正骨釘施打位置骨深度測量(6mm高度) 48
圖五: 顴下嵴矯正骨釘施打位置頰側骨厚度測量(4mm高度) 49
圖六: 顴下嵴矯正骨釘施打位置頰側骨厚度測量(6mm高度) 49
圖七: 顴下嵴矯正骨釘施打最大安全角度(4mm高度) 50
圖八: 顴下嵴矯正骨釘施打最大安全角度(6mm高度) 50
圖九: 頰棚矯正骨釘施打位置頰側骨厚度測量(4mm高度) 51
圖十: 頰棚矯正骨釘施打位置頰側骨厚度測量(6mm高度) 51
圖十一: 頰棚傾斜角度測量 52
圖十二: 頰棚矯正骨釘施打最大安全角度測量(4mm高度) 53
圖十三: 頰棚矯正骨釘施打最大安全角度測量(6mm高度) 53
圖十四: 上顎顴下嵴區域矯正骨釘施打位置骨骼型態 54
圖十五: 下顎頰棚區域矯正骨釘施打位置骨骼型態 54

表一: 市售錐狀射束電腦斷層掃描儀各機型比較 55
表二: CB MercuRay之四種拍攝模式 56
表三: 顴下嵴矯正骨釘施打位置骨深度(4mm高度) 57
表四: 顴下嵴矯正骨釘施打位置骨深度(6mm高度) 57
表五: 顴下嵴矯正骨釘施打位置頰側骨厚度 58
表六: 顴下嵴矯正骨釘施打最大安全角度 58
表七: 頰棚矯正骨釘施打位置頰側骨厚度(4mm高度) 59
表八: 頰棚矯正骨釘施打位置頰側骨厚度(6mm高度) 59
表九: 頰棚傾斜角度 60
表十: 頰棚矯正骨釘施打最大安全角度 60
表十一: 測量誤差之計算(Dahlberg’s formula) 61


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