臺灣博碩士論文加值系統

中文摘要
自2009年開始，牙技人員正式納入衛生署管理，電腦輔助設計/製作（簡稱：CAD/CAM）也成為國內牙科趨勢，而國內牙體技術〈簡稱：牙技〉人員將可能面對透過牙科CAD/CAM系統大量生產，而取代大部分牙技人員的工作，國外的牙技人員也能透過網路製作國內所需的贋復物(簡稱：假牙)；若是未能及早輔導牙技人員轉型，這結果將可能導致國內牙技產業的生存危機。
本研究是以結構式問卷，探討牙技人員對於牙科CAD/CAM系統的知識、態度以及購買行為（接受度）及其相關影響因素。以結構式問卷對於106名開業牙技人員(包括已購買CAD/CAM系統者28名)，及128名受雇牙技人員進行調查。而對於不易量化的問題，則辦理專家會議，以期獲得一致性的共識，做為最後結論的參考。
問卷共發出600份，有效問卷回收234份，回收率39%。分析結果顯示：牙技所在未來5年內「不會購買」CAD/CAM系統的主要原因為：(1) CAD/CAM系統價格太高(61.1%)。(2)牙技所營業額太低(52.2%)。本科系畢業者「已購買」的比例超過七成，顯示相較於非本科系畢業者，本科系畢業者對於CAD/CAM系統的接受度較高(P=0.029)。對於預定購買CAD/CAM的時間點，選擇「五年以上」者，會花時間研究CAD/CAM的比例最低只有17.6% (P<0.001)；且其中有近1/4在最近一年內，沒有參加過任何與CAD/CAM有關的專業課程(P=0.010)。
目前(2013年)，一套CAD/CAM系統的價格約為250~300萬元。受訪的牙技人員當中，認為CAD/CAM價格要降至「50~100萬」才會考慮購買者，選擇「五年以上」者(51.3%)最高(P=0.002)。認為CAD/CAM「一定是」未來產業趨勢的受訪者，「已購買」CAD/CAM的比例(60.3%)最高(P=0.008)。顯示已購買者對CAD/CAM的期望最高。在「沒有看過」CAD/CAM系統的受訪者中，選擇「五年以上」的比例(10.9%)最高(P<0.001)。「已購買」者「一定會」支持政府輔導建立CAD/CAM產業聚落的比例 (32.1%)也最高(P=0.005)。
綜合以上研究結果顯示：「牙科CAD/CAM為未來趨勢，CAD/CAM系統將會取代大部份牙技人員的工作製程」。期望國內牙技人員認清自身所處的環境，對於相關CAD/CAM課程應該多花時間參加，最好親自去操作學習CAD/CAM系統，才會對此系統有更深入的了解和新的看法。隨著牙科快速成型(rapid prototyping)的應用，將建立在牙科CAD/CAM的普及之後，建議政府有關單位，應及早評估牙科CAD/CAM產業計畫，規畫牙技專區協助國內牙技設立國際牙科CAD/CAM產業聚落銜接牙科快速成型系統，深耕牙技數位化的發展，促進台灣牙技科技邁向全球化，現在正是最好時機。

Abstract
Computer-aided design and manufacturing (CAD/CAM) has become a popular trend in the dental industry of Taiwan. Dental technicians in Taiwan may soon face the possibility of CAD/CAM-facilitated mass production replacing most roles filled by dental technicians. Or, the manufacturing of dental prostheses may be outsourced overseas. If dental technicians are not provided with access to appropriate career guidance as soon as possible, this may pose a threat to the survival of the dental technology industry in Taiwan.
This study used a structured questionnaire to study the awareness, attitudes and purchasing behaviour of dental technicians with regard to CAD/CAM systems. We surveyed 106 dental technicians who had established their own dental laboratories (including 28 who had already purchased CAD/CAM systems) and 128 employed dental technicians. For issues that are difficult to quantify, we conducted expert forums to achieve a consistent consensus, which was used as reference for the final conclusion.
A total of 600 questionnaires were distributed and 234 were recovered, making a recovery rate of 39%. Analysis results revealed the following: The main reasons that dental laboratories chose not to purchase CAD/CAM systems are: (1) the price of CAD/CAM systems was too high (61.1%), and (2) the business revenue of the dental lab was too low (52.2%). More than 70% (P=0.029) of interviewed dental technology graduates had already purchased CAD/CAM, indicating that graduates of dental technology are more accepting of CAD/CAM systems. Among respondents who selected the option “in five or more years” when asked how soon they would purchase CAD/CAM systems, only 17.6% (P<0.001) indicated that they would invest time in research and nearly 25% (P=0.010) had not participated in any professional development course within the past year.
Among those respondents who indicated that they would consider purchasing CAD/CAM systems in five or more years, 53% (P=0.002) expressed that they would do so only if the price falls within NTD 0.5-1.0 million. Among respondents who indicated that they agreed CAD/CAM was “definitely” the future industry trend, 60.3% (P=0.008) had already purchased such systems. This indicates that existing owners of CAD/CAM have the highest expectations for these systems. Among those who responded that they had never seen any CAD/CAM system, 10.9% (P<0.001) indicated that they would consider purchasing CAD/CAM after five or more years. Among respondents who indicated that they would “definitely” support the government establishing a CAD/CAM industry cluster, 32.1% (P=0.005) had already purchased CAD/CAM systems.
In summary, the results above lead to the following conclusions: CAD/CAM is the future trend of the dental industry and will replace most of the manufacturing processes currently undertaken by dental technicians. Dental technicians in Taiwan should recognize this and invest more time into CAD/CAM-related courses. Dental technicians can gain a more in-depth understanding of and new perspective on CAD/CAM if they learn these systems through hands-on operations. The popularization of CAD/CAM in the dental industry has been accompanied by the increased application of rapid prototyping (3D printing). We recommend that relevant government institutes evaluate CAD/CAM industry programs as soon as possible and provide assistance in establishing an international CAD/CAM dental industry cluster linked with rapid prototyping systems. This is an excellent opportunity to invest in the development of digital dental technology and promote globalization of the dental technology industry in Taiwan.

目錄
論文審定同意書..........................................i
誌謝....................................................ii
中文摘要................................................iv
Abstract................................................vi
目錄....................................................ix
圖目錄..................................................xi
表目錄..................................................xii
附件目錄................................................xiv
第一章 緒論............................................1
第一節 研究背景與動機...............................1
第二節 研究目的.....................................4
第二章 文獻探討........................................5
第一節 牙體技術人員.................................6
第二節 CAD/CAM系統的應用............................12
第三節 CAD/CAM所用的材料－以二氧化鋯為例............27
第四節 傳統製作與利用CAD/CAM製作的時間比較..........30
第三章 研究方法.........................................32
第一節 研究架構.....................................32
第二節 名詞界定.....................................33
第三節 研究假說.....................................34
第四節 研究對象.....................................36
第五節 研究工具.....................................36
第六節 研究步驟.....................................38
第七節 資料處理與統計分析...........................39
第八節 研究對象的權益保護...........................40
第四章 結果.............................................42
第一節 樣本回收......................................42
第二節 樣本特性......................................43
第三節 牙技人員對CAD/CAM的接受度及影響因素的描述.....43
第四節 牙技人員對CAD/CAM影響因素和接受度的相關分析...46
第五節 任職的牙技所未來幾年內會購買CAD/CAM設備之預測
因素及勝算比..................................48
第五章 討論.............................................59
第一節 研究結果討論..................................59
第二節 研究特色.........................................67
第三節 研究限制.........................................67
第六章 結論與建議......................................68
第一節 結論..........................................68
第二節 建議..........................................69
參考文獻................................................71


圖目錄
圖1 傳統製作與牙科CAD/CAM系統牙橋贋復物的製作流程圖....16
圖2 1994年牙科CAD/CAM加工機雛型........................19
圖3 攝於2013年德國科隆國際牙展的CAD/CAM之相關產品......20
圖4 傳統與CAD/CAM牙體技術製作在台灣的工作環境的比較圖..20
圖5 廠商所提供CAD/CAM牙科掃描機與植體..................24
圖6 NobelGuide™ 牙科植體復位的完整治療概念.............25
圖7 現代化的生產設備，高精密研磨製程生產NobelProcera
Implant 產品.......................................26
圖8 從樣本的橫切面間距，測量出P1-4位置的間隙寬度.......29


表目錄
表1 依考選部統計的專技高(特)考牙體技術師報考人數暨錄取
及格人數...........................................11
表2 依考選部統計的特種考試牙體技術生報考人數暨錄取及格
人數...............................................12
表3 CEREC® CAD/CAM 發展史..............................22
表4 世界各地牙科CAD/CAM系統的二氧化鋯的使用............23
表5 由縫隙寬度的四個測量點所得到的最小值，中數，平均值
，最大值和標準差...................................29
表6 一般牙技師實際製作3顆瓷牙牙橋所需時間，以傳統製作與
利用CAD/CAM設計製作的時間比較......................31
表7 受訪牙技人員的基本資料分佈.........................50
表8 影響牙技人員對購買CAD/CAM系統之內在因素分佈........51
表9 影響牙技人員購買CAD/CAM之外在環境因素分佈..........51
表10 牙技所不會購買CAD/CAM系統的原因，按影響之重要性排列
...................................................52
表11 牙技人員對CAD/CAM的認知分佈........................53
表12 牙技人員對CAD/CAM的態度分佈........................54
表13 牙技人員對購買CAD/CAM相關行為分佈..................54
表14 牙技人員對政府的建議分佈...........................55
表15 牙技人員購買CAD/CAM時間的相關因素..................55
表16 牙技人員對於電腦輔助設計製作(CAD/CAM)的接受度與公司
未來幾年內會購買CAD/CAM設備的相關性................56
表17 牙技人員對CAD/CAM的影響因素與公司未來幾年內會購買
CAD/CAM設備的相關性...............................57
表18 任職的牙技所未來幾年內會購買CAD/CAM設備之預測模式及
勝算比.............................................58
表19 快速成型技術，依成型製作技術分類...................88


附件目錄
附件1 同意臨床試驗證明書...............................75
附件2 專家會議記錄.....................................76
附件3 研究問卷說明.....................................81
附件4 研究問卷.........................................82
附件5 快速成型(rapid prototyping, RP)..................85

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