臺灣博碩士論文加值系統

背景
製作單顆鑄造式贗復牙冠時，若牙齒修磨之抗力形不足，黏著的贗復牙冠可能鬆脫而導致臨床上失敗的結果。此體外實驗乃評估近遠心溝的存在與不同支台高度對抗力形不足大臼齒製作單顆贗復牙冠時對抗力形的影響。本實驗中黏著劑使用RelyX Unicem®，一種較新型的自黏著型改良式樹脂黏著劑。
方法
實驗選用60顆人類大臼齒，清潔包埋後以製作單顆贗復牙冠為目的，修磨成20度的支台夾角。所有牙齒分為六組，修磨出三種不同的支台高度，分別是2公厘，3公厘與4公厘高度，同時伴隨著一對近遠心溝的有無，每組各十顆牙齒。修磨好的牙齒每顆皆分別製作5%鈦合金的金屬覆蓋牙冠並予以黏著。每一顆牙冠皆在拉伸測試機上以呈45度角且等速控制條件下的側向推力測試其抗力形表現，直至牙冠鬆脫或牙齒斷裂為止，並記錄其最大推力值。
結果
在本實驗的參數設定下，當支台高度為2公厘與3公厘時，在支台上多修磨一對近遠心溝，與沒有修磨近遠心溝組相比，其側向推力最大值並無顯著差異；惟有在支台高度達4公厘時，多修磨出一對近遠心溝才會對抗力形有明顯的幫助(p=.043)。支台高度為2公厘的組別，無論有無增加修磨一對近遠心溝，其側向推力最大值皆與其它具有適當抗力形的組別有顯著差異，且得到的數值最小。
結論
修磨後支台高度為3公厘的牙齒合併使用自黏著型改良式樹脂黏著劑可以提供足夠的抗力形製作單顆贗復牙冠。在高度不及4公厘的支台上增加修磨一對近遠心溝對使用此種較新式黏著劑黏著的牙冠之抗力形無顯著的影響。

Inadequate resistance form in the preparation of teeth for single cast crowns may lead to clinical failures. This in-vitro study evaluates the effects of the proximal grooves and abutment height on the resistance of single cast crowns in molars with inadequate resistance forms. RelyX Unicem® cement, a self- adhesive modified-resin cement, was chosen for cementation. Sixty extracted human molars were prepared to possess 20 degree of total occlusal convergence for single casting crown fabrication. All teeth were divided into six groups and prepared according to three different axial heights: 2, 3, and 4 millimeters, with or without placing a pair of proximal grooves. Each group contains ten teeth. 5% Titanium alloy metal copings were casted and then cemented accordingly. Lateral dislodgement test for each crown was performed with increasing external force (NT) applied at a 45-degree angulation on a universal testing machine. The force required to dislodge the crown from the tooth or to break the core was recorded, and the results of different groups were compared. Kruskal Wallis tests and Mann-Whitney U tests (alpha=.05) were performed and the results were analyzed. The results disclosed that on the premise of using resin cement for cementation of single crown, adding proximal grooves on the abutment made no significant differences in groups with abutment heights of 2 mm and 3 mm; adding grooves increased dislodgement resistance significantly only in groups with 4 mm abutment height (p=.043). Mann-Whitney U tests revealed that 2 mm groups showed the least performance compared to other groups possessing adequate resistance, regardless of having proximal grooves or not. CONCLUSIONS: Prepared abutment height of 3 mm combined with using self-adhesive modified-resin cement provides adequate resistance for single cast crowns. Adding proximal grooves on abutments less than 4 mm in height has no significant influence in resistance for single cast crowns cemented with this more recently- used dental cement.

Table of Contents
指導教授推薦書 ii
口試委員會審定書 iii
國家圖書館授權書 iv
長庚大學博碩士論文著作授權書 v
致謝 vi
中文摘要 vii
Abstract ix
Table of Contents xi
CHAPTER 1 Introduction 1
1.1 Background 1
1.2 Motivations 2
1.3 Literatures review 2
1.3.1 Objectives of Literatures review 2
1.3.2 Literatures review: Taper (total occlusal convergence, TOC ) 3
1.3.3 Literatures review: Height (occlusocervical dimension, OC dimension) 4
1.3.4 Literatures review: Auxiliary features 5
1.3.5 Literatures review: Cement types 7
1.3.6 Summary of reviewed studies and related limitations 9
1.3.7 Objectives 11
CHAPTER 2 Materials and Methods 13
2.1 Study protocol 13
2.2 Parameters and variables settings 13
2.3 Sample collection, mounting and measurements 13
2.4 Specimen grouping and labeling 14
2.5 Tooth preparation 14
2.6 Metal copings fabrication and cementation 15
2.7 Lateral dislodgement test on a universal testing machine 16
CHAPTER 3 Results 17
CHAPTER 4 Discussion and Limitation 19
4.1 Discussion 19
4.1.1 Self-adhesive modified-resin cement chosen for this study 19
4.1.2 Effects of abutment height and proximal grooves on resistance 20
4.1.3 Material and method selection 21
4.1.4 TOC selection and preparation standardization 22
4.1.5 Standardization and fabrication for metal copings 23
4.1.6 Clinical correlation 24
4.1.7 Lateral dislodgement force vs. Masticatory force 24
4.2 Limitations 25
CHAPTER 5 Conclusion 28
References 29

Table List
Table 1-1 Summarized reviewed literatures-TOC as a factor on resistance 31
Table 1-2 Summarized reviewed literatures-height and TOC as factors on resistance 32
Table 1-3 Literatures review: Guidelines for adequate resistance and retention forms 33
Table 1-4 Summarized reviewed literatures-axial modification/auxiliary feature as a factor affecting retention or resistance for single tooth preparations 34
Table 1-5 Summarized reviewed literatures-cement type as a factor affecting retention or resistance for single tooth preparations 36
Table 2-1 Study protocol 38
Table 2-2 Bucco-lingual widths (mm) of teeth for each group 39
Table 2-3 Comparison of buccal-lingual widths of teeth among six groups. 40
Table 3-1 Dislodgement force for each specimen (N) 41
Table 3-2 Comparison of dislodgment force between pared groups. 42

Figure List
Figure 1-1 Occlusal forces on teeth 43
Figure 1-2 Resistance form 43
Figure 1-3 Limited abutment height in molar areas 44
Figure 2-1a High-speed handpiece hold by a fixed arm 45
Figure 2-1b Protractor and electronic caliper 45
Figure 2-2 Background paper showed 20 degrees of TOC 46
Figure 2-3 Standard preparation with proximal grooves 47
Figure 2-4 Design of metal coping. 48
Figure 2-5 Resin index of coping 49
Figure 2-6 Fabricated metal copings 49
Figure 2-7 Lateral dislodgement tests on a universal testing machine 50
Figure 2-8 Dislodgment of coping 51
Figure 2-9 Dislodgement force recorded 51
Figure 3-1 Boxplot of dislodgment forces for 6 groups 52
Figure 3-2 Boxplot of dislodgment forces for 3 groups without proximal grooves 53
Figure 3-3 Boxplot of dislodgment forces for 3 groups with proximal grooves 54

1. Trier AC, Parker MH, Cameron SM, Brousseau JS. Evaluation of resistance form of dislodged crowns and retainers. The Journal of prosthetic dentistry 1998;80(4):405-9.
2. The Glossary of Prosthodontic Terms. The Journal of prosthetic dentistry 2005;94:69.
3. Wiskott HW, Nicholls JI, Belser UC. The effect of tooth preparation height and diameter on the resistance of complete crowns to fatigue loading. The International journal of prosthodontics 1997;10(3):207-15.
4. Cameron SM, Morris WJ, Keesee SM, Barsky TB, Parker MH. The effect of preparation taper on the retention of cemented cast crowns under lateral fatigue loading. The Journal of prosthetic dentistry 2006;95(6):456-61.
5. Bowley JF, Kieser J. Axial-wall inclination angle and vertical height interactions in molar full crown preparations. Journal of dentistry 2007;35(2):117-23.
6. Gilboe DB, Teteruck WR. Fundamentals of extracoronal tooth preparation. Part I. Retention and resistance form. The Journal of prosthetic dentistry 1974.
7. Shillingburg HT HS, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of Fixed Prosthodontics. 1997:p. 120, 39-42, 51-52.
8. Johnson GH, Lepe X, Zhang H, Wataha JC. Retention of metal-ceramic crowns with contemporary dental cements. Journal of the American Dental Association 2009;140(9):1125-36.
9. Uy JN, Lian JN, Nicholls JI, Tan KB. Load-fatigue performance of gold crowns luted with resin cements. The Journal of prosthetic dentistry 2006.
10. Proussaefs P. Crowns cemented on crown preparations lacking geometric resistance form. Part II: effect of cement. Journal of prosthodontics 2004;13(1):36-41.
11. Goodacre CJ, Campagni WV, Aquilino SA. Tooth preparations for complete crowns: an art form based on scientific principles. The Journal of prosthetic dentistry 2001.
12. Shillingburg HT HS, Whitsett LD. Fundamental of fixed prosthodontics
1981:p. 79.
13. Rosenstiel SF LM, Fujimoto J. Contemporary fixed prosthodontics. 1995:p. 137-38, 70-73, 84-85, 229.
14. Wilson AH, Jr., Chan DC. The relationship between preparation convergence and retention of extracoronal retainers. Journal of prosthodontics : official journal of the American College of Prosthodontists 1994.
15. Kent WA, Shillingburg HT, Jr., Duncanson MG, Jr. Taper of clinical preparations for cast restorations. Quintessence international 1988;19(5):339-45.
16. Parker MH, Gunderson RB, Gardner FM, Calverley MJ. Quantitative determination of taper adequate to provide resistance form: concept of limiting taper. The Journal of prosthetic dentistry 1988;59(3):281-8.
17. Nordlander J, Weir D, Stoffer W, Ochi S. The taper of clinical preparations for fixed prosthodontics. The Journal of prosthetic dentistry 1988;60(2):148-51.
18. Dodge WW, Weed RM, Baez RJ, Buchanan RN. The effect of convergence angle on retention and resistance form. Quintessence international 1985.
19. Bowley JF, Stockstill JW, Attanasio R. A preliminary diagnostic and treatment protocol. Dental clinics of North America 1992;36(3):551-68.
20. Parker MH, Calverley MJ, Gardner FM, Gunderson RB. New guidelines for preparation taper. Journal of prosthodontics 1993.
21. Woolsey GD, Matich JA. The effect of axial grooves on the resistance form of cast restorations. Journal of the American Dental Association 1978;97(6):978-80.
22. Lu PC, Wilson P. Effect of auxiliary grooves on molar crown preparations lacking resistance form: a laboratory study. Journal of prosthodontics 2008;17(2):85-91.
23. Potts RG, Shillingburg HT, Jr., Duncanson MG, Jr. Retention and resistance of preparations for cast restorations. The Journal of prosthetic dentistry 1980;43(3):303-8.
24. Proussaefs P, Campagni W, Bernal G, Goodacre C, Kim J. The effectiveness of auxiliary features on a tooth preparation with inadequate resistance form. The Journal of prosthetic dentistry 2004.
25. Bowley JF, Lai WF. Surface area improvement with grooves and boxes in mandibular molar crown preparations. The Journal of prosthetic dentistry 2007.
26. Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for fixed prosthodontics. The Journal of prosthetic dentistry 1999.
27. Wiskott HW, Nicholls JI, Belser UC. The relationship between abutment taper and resistance of cemented crowns to dynamic loading. The International journal of prosthodontics 1996.
28. Ayad MF, Johnston WM, Rosenstiel SF. Influence of tooth preparation taper and cement type on recementation strength of complete metal crowns. The Journal of prosthetic dentistry 2009.
29. Christensen GJ. Should resin cements be used for every cementation? Journal of the American Dental Association (1939) 2007.
30. Browning WD, Nelson SK, Cibirka R, Myers ML. Comparison of luting cements for minimally retentive crown preparations. Quintessence international 2002;33(2):95-100.
31. Zidan O, Ferguson GC. The retention of complete crowns prepared with three different tapers and luted with four different cements. The Journal of prosthetic dentistry 2003.
32. Sipert CR, Sampaio AC, Trindade IE, Trindade AS, Jr. Bite force evaluation in subjects with cleft lip and palate. Journal of applied oral science : revista FOB 2009.
33. Koc D, Dogan A, Bek B. Effect of gender, facial dimensions, body mass index and type of functional occlusion on bite force. Journal of applied oral science : revista FOB 2011.
34. Pizolato RA, Gaviao MB, Berretin-Felix G, Sampaio AC, Trindade Junior AS. Maximal bite force in young adults with temporomandibular disorders and bruxism. Brazilian oral research 2007.
35. Cosme DC, Baldisserotto SM, Canabarro Sde A, Shinkai RS. Bruxism and voluntary maximal bite force in young dentate adults. The International journal of prosthodontics 2005.