臺灣博碩士論文加值系統

研究目的：
牙科植體已廣泛應用於牙科治療中，但植體補綴物的支柱螺絲斷裂是常見的併發症之一，臨床上一旦發生支柱螺絲斷裂，要在口內將支柱螺絲取出的難度甚高。若支柱螺絲長度較短，斷裂在植體內部的部分也會較短，要將斷裂部分取出的難度也會較低。若發生支柱螺絲斷裂，臨床上另一作法是不取出斷裂部分，另取一較短長度之支柱螺絲直接鎖緊支柱。但較短長度的支柱螺絲是否能提供與完整長度支柱螺絲相同的夾緊力以維持支柱和植體間的穩定則尚不清楚。本研究目的即為藉由測量疲勞測試前後之支柱螺絲移除扭矩來比較不同長度支柱螺絲之穩定性。
材料與方法：
本研究使用IDEOSS系統之4mm直徑內接式植體及5mm直徑內接式植體。4mm直徑植體分為使用完整長度10圈螺紋支柱螺絲、較短長度8圈螺紋支柱螺絲及6圈螺紋支柱螺絲組別；5mm直徑植體分為使用完整長度10圈螺紋支柱螺絲及較短長度8圈螺紋支柱螺絲兩組。所有植體總共分為五組，每組含四個樣本。將植體以符合ISO 14801規範之方式包埋於夾具之中後，以廠商建議之扭力值由MODEL-2205NS扭力試驗儀鎖緊支柱螺絲兩次，中間間隔十分鐘，之後再以扭力測試儀測量支柱螺絲之初始移除扭矩。測得初始移除扭矩後，再次將支柱螺絲鎖緊，將特製金屬帽套上支柱，並以符合ISO 14801規範之方式於Instron E3000疲勞測試儀器進行疲勞測試。疲勞測試之頻率設定為15Hz，施力大小設定為以正弦函數方式變化之變動大小，最大施力值為219N，最小施力值為21.9N，施力之次數設定為30萬次，模擬補綴物使用一年之咬合次數。完成後，再以扭力測試儀測量疲勞測試後移除扭矩。
結果：
在初始移除扭矩方面，當使用完整長度10圈螺紋支柱螺絲時，5mm直徑植體之初始移除扭矩較4mm直徑植體大，且達顯著差異。但使用8圈螺紋支柱螺絲時便無顯著差異。在使用4mm直徑植體搭配6圈螺紋支柱螺絲組別中，四組樣本中有兩組樣本無法測得初始移除扭矩。而在疲勞測試後之移除扭矩方面，不論在4mm直徑植體或5mm直徑植體上，使用完整長度10圈螺紋支柱螺絲組別之移除扭矩和使用較短長度8圈螺紋支柱螺絲組別之移除扭矩都沒有顯著差異。
結論：
在模擬使用一年的咬合次數30萬次的疲勞測試下，不論是在4mm直徑植體或5mm直徑植體中，較短長度8圈螺紋的支柱螺絲和完整長度10圈螺紋支柱螺絲的穩定性都沒有顯著差異。

Purpose:
One of the major technical complications of fixed implant prosthesis is abutment screw fracture. It’s difficult to remove the fracture segment of abutment screw inside the implant body clinically. If we use a short abutment screw, it will be easier to remove the fracture segment inside the implant body once the abutment screw fractured. The relations between abutment screw length and abutment-implant joint stability has not been well studied. The purpose of this study is to evaluate the relations between abutment screw length and abutment-implant joint stability by measuring the screw initial remove torque value and post-cyclic loading remove torque value.
Material and method:
Twenty IDEOSS internal-connection implants were used. 12 were 4mm-diameter implant and 8 were 5mm-diameter implant. 4mm-diameter group was further separated into three groups: a group using full-length, 10 threads abutment screw, a group using shortened, 8 threads abutment screw and a group using 6 threads abutment screw. 5mm-diameter group was separated into two groups: a group using full-length, 10 threads abutment screw and a group using shortened, 8 threads abutment screw. The implant body were embed into aluminum jigs with epoxy resin and cement-type abutments were attached. Abutment screws were tightened twice with 10 minutes interval with suggested torque by manufactory with the MODEL-2205NS torque machine. The initial remove toque values were measured by the torque machine and were recorded then. After the initial remove torque values were recorded, abutment screws were re-tightened and custom-made metal caps were attached to the abutments. The implant assemblies were loaded with 21.9N-219N sinusoidally at a 15Hz frequency for 300,000 cycles, with corresponded to approximately 1 year of normal masticatory function. After cyclic loading, the post-loading remove torque values were measured with the torque machine and were recorded.
Results:
The initial remove torque value with 10-thread abutment screw of 5mm-diamter implant was greater than 4mm-diameter implant group. The initial remove torque value cannot be measured in two out of four samples in the 4mm-diameter implant with 6-thread abutment screw group. The post-loading remove torque values showed no significant differences between 10-thread abutment screw group and 8-thread abutment screw group in both 4mm-diameter implant and 5mm-diameter implant.
Conclusion:
Within the limitations of this study, short abutment screws provide the same abutment-implant connection stability as full-length abutment screws after cyclic loading.

誌謝……………………………………………………………………1
中文摘要…………………………………………………………………2
英文摘要…………………………………………………………………4
第一章 引言……………………………………………………………10
第二章 文獻回顧………………………………………………………13
2.1人工植牙支撐之局部固定式義齒……………………………13
2.2支柱螺絲的作用及原理………………………………………13
2.3支柱螺絲的鬆脫情形…………………………………………14
2.4支柱螺絲的乘載鬆弛…………………………………………16
2.5支柱螺絲的螺紋圈數與其穩定性……………………………17
2.6植體-支柱設計與支柱螺絲的穩定性…………………………19
第三章 研究目的………………………………………………………22
第四章 材料與方法……………………………………………………24
4.1 植體系統………………………………………………………24
4.2 研究相關材料…………………………………………………24
4.3 研究設計………………………………………………………24
4.3.1 目的……………………………………………………24
4.3.2 實驗用金屬帽之製作…………………………………24
4.3.3 實驗用植體之包埋……………………………………24
4.3.4 不同長度支柱螺絲之製備……………………………25
4.3.5 樣本X光影像檢查……………………………………25
4.3.6 初始移除扭矩之測量…………………………………25
4.3.7 疲勞測試………………………………………………26
4.3.8 疲勞測試後之移除扭矩測量…………………………27
4.4 統計分析………………………………………………………27
第五章 實驗結果………………………………………………………29
5.1 不同長度支柱螺絲之初始移除扭矩比較……………………29
5.1.1 4mm直徑植體組別……………………………………29
5.1.2 5mm直徑植體組別……………………………………30
5.2 不同尺寸植體之初始移除扭矩比較 ………………………30
5.2.1 10圈螺紋支柱螺絲組別 ………………………………30
5.2.2 8圈螺紋支柱螺絲組別…………………………………31
5.3 不同長度支柱螺絲於疲勞測試後之移除扭矩比較…………31
5.3.1 4mm直徑植體組別 ……………………………………31
5.3.2 5mm直徑植體組別 ……………………………………32
5.4 不同尺寸植體於疲勞測試後之移除扭矩比較………………32
5.4.1 10圈螺紋支柱螺絲組別 ………………………………32
5.4.2 8圈螺螺紋支柱螺絲組別………………………………33
5.5 各組疲勞測試前後之移除扭矩比較…………………………33
5.5.1 4mm直徑植體搭配10圈螺紋支柱螺絲………………33
5.5.2 4mm直徑植體搭配8圈螺紋支柱螺絲…………………34
5.5.3 5mm直徑植體搭配10圈螺紋支柱螺絲………………34
5.5.4 5mm直徑植體搭配8圈螺紋支柱螺絲…………………35
5.6 樣本X光影像檢查……………………………………………35
第六章 討論……………………………………………………………37
6.1 實驗設計………………………………………………………37
6.1.1 實驗模型設計…………………………………………37
6.1.2 初始移除扭矩測試……………………………………38
6.1.3 疲勞測試設計………………………………………… 39
6.2 結果討論………………………………………………………40
6.2.1 初始移除扭矩比較……………………………………40
6.2.1.1 不同長度支柱螺絲之初始移除扭矩比較………40
6.2.1.2 不同尺寸植體之初始移除扭矩比較……………42
6.2.2 疲勞測試後之移除扭矩比較………………………… 42
6.2.3 各組疲勞測試前後之移除扭矩比較………………… 44
6.2.3.1 4mm直徑植體搭配10圈螺紋支柱螺絲…………44
6.2.3.2 4mm直徑植體搭配8圈螺紋支柱螺絲…………45
6.2.3.3 5mm直徑植體搭配10圈螺紋支柱螺絲…………45
6.2.3.4 5mm直徑植體搭配8圈螺紋支柱螺絲…………45
6.2.4 4mm直徑植體搭配6圈螺紋支柱螺絲之實驗結果……46
第七章 研究限制與未來方向…………………………………………47
第八章 結論……………………………………………………………49
參考文獻……………………………………………………………… 50
圖次…………………………………………………………………… 53
表次…………………………………………………………………… 63

1. Pjetursson BE, Tan K, Lang NP, Bragger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res. 2004,15(6):625-42.
2. Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res. 2008,19(2):119-30.
3. Sakaguchi RL, Borgersen SE. Nonlinear contact analysis of preload in dental implant screws. Int J Oral Maxillofac Implants. 1995,10(3):295-302.
4. Bickford JH. An introduction to the design and behavior of bolted joints. New York: Marcel Dekker; 1995. 515-64.
5. Sopwith DG. The distribution of load in screw threads. Proc Inst Mech Eng 1948;159:373-83.
6. Alkan I, Sertgöz A, Ekici B. Influence of occlusal forces on stress distribution in preloaded dental implant screws. J Prosthet Dent. 2004,91(4):319-25.
7. Kim BJ, Yeo IS, Lee JH, Kim SK, Heo SJ, Koak JY. The effect of screw length on fracture load and abutment strain in dental implants with external abutment connections. Int J Oral Maxillofac Implants 2012,27:820-3.
8. Yeo IS, Lee JH, Kang TJ, Kim SK, Heo SJ, Koak JY, Park JM, Lee SY. The effect of abutment screw length on screw loosening in dental implants with external abutment connections after thermocycling. Int J Oral Maxillofac Implants 2014,29:59-62.
9. Palmqvist S, Swartz B. Artificial crowns and fixed partial dentures 18 to 23 years after placement. Int J Prosthodont. 1993,6(3):279-85.
10. Kerschbaum T, Haastert B, Marinello CP. Risk of debonding in three-unit resinbonded fixed partial dentures. J Prosthet Dent. 1996,75(3):248-53.
11. Romeo E, Lops D, Margutti E, Ghisolfi M, Chiapasco M, Vogel G. Long-term survival and success of oral implants in the treatment of full and partial arches: a seven-year prospective study with the ITI dental implant system. Int J Oral Maxillofac Implants 2004,19:247–259.
12. McGlumphy EA, Mendel DA, Holloway JA. Implant screw mechanics. Dent Clin North Am. 1998,42(1):71-89.
13. Winkler S, Ring K, Ring JD, Boberick KG. Implant screw mechanics and the settling effect: Overview. J Oral Implantol 2003,29:242-5.
14. Lang LA, Kang B, Wang RF, Lang BR. Finite element analysis to determine implant preload. J Prosthet Dent. 2003,90(6):539-46.
15. Dellinges MA, Tebrock OC. A measurement of torque values obtained with hand-held drivers in a simulated clinical setting. J Prosthodont. 1993,2(4):212-4.
16. Jaarda MJ, Razzoog ME, Gratton DG. Providing optimum torque to implant prostheses: a pilot study. Implant Dent. 1993,2(1):50-2.
17. Theoharidou A, Petridis HP, Tzannas K, Garefis P. Abutment screw loosening in single-implant restorations: a systematic review. Int J Oral Maxillofac Implants 2008,23:681-90.
18. Cho SC, Small PN, Elian N, Tarnow D. Screw loosening for standard and wide diameter implants in partially edentulous cases: 3- to 7-year longitudinal data. Implant Dent. 2004,13(3):245-50.
19. Jörnéus L, Jemt T, Carlsson L. Loads and designs of screw joints for single crowns supported by osseointegrated implants. Int J Oral Maxillofac Implants. 1992,7(3):353-9.
20. Bakaeen LG, Winkler S, Neff PA. The effect of implant diameter, restoration design, and occlusal table variations on screw loosening of posterior single-tooth implant restorations. J Oral Implantol. 2001,27(2):63-72.
21. Siamos G, Winkler S, Boberick KG. Relationship between implant preload and screw loosening on implant-supported prostheses. J Oral Implantol. 2002,28(2):67-73.
22. Haack JE, Sakaguchi RL, Sun T, Coffey JP. Elongation and preload stress in dental implant abutment screws. Int J Oral Maxillofac Implants. 1995,10(5):529-36.
23. Binon PP. Implants and components: entering the new millennium. Int J Oral Maxillofac Implants 2000,15:76-94.
24. Stockton LW. Factors affecting retention of post systems: a literature review. J Prosthet Dent. 1999,81(4):380-5.
25. Choi JH, Yang JH, Cho WP, Lee JB. The influence of abutment screw length and repeated tightening on screw loosening in dental implant. J Korean Acad Prosthodont 2006,44:432-42.
26. Mohammed HH, Lee JH, Bae JM, Cho HW. Effect of abutment screw length and cyclic loading on removal torque in external and internal heximplants. J Adv Prosthodont. 2016,8(1):62-9.
27. Shin HM, Huh JB, Yun MJ, Jeon YC, Chang BM, Jeong CM. Influence of the implant-abutment connection design and diameter on the screw joint stability. J Adv Prosthodont. 2014,6(2):126-32.
28. Kim KS, Han JS, Lim YJ. Settling of abutments into implants and changes in removal torque in five different implant-abutment connections. Part 1: Cyclic loading. Int J Oral Maxillofac Implants 2014;29:1079-84.
29. Robert M. Jones. Mechanics of composite materials. New York: Brunner-Routledge; 1999. 101-2
30. Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981,10(6):387-416.
31. Weber HP, Buser D, Fiorellini JP, Williams RC. Radiographic evaluation of crestal bone levels adjacent to nonsubmerged titanium implants. Clin Oral Implants Res. 1992,3(4):181-8.
32. Breeding LC, Dixon DL, Nelson EW, Tietge JD. Torque required to loosen single-tooth implant abutment screws before and after simulated function. Int J Prosthodont. 1993,6(5):435-9.
33. Graf H. Bruxism. Dent Clin North Am. 1969,13(3):659-65.
34. Bakke M. Bite force and occlusion. Seminars in Orthodontics. 2006,12:120-126.
35. Gibbs CH, Mahan PE, Lundeen HC, Brehnan K, Walsh EK, Holbrook WB. Occlusal forces during chewing and swallowing as measured by sound transmission. J Prosthet Dent. 1981,46(4):443-9.