臺灣博碩士論文加值系統

正中門齒間隙為混合齒列前期常見的現象，上顎正中區域的多生牙也常常在同時間發現。然而，在這個年紀進行埋伏性多生牙拔除手術，有時對年紀尚小的病人仍是一個較大的負擔。本研究希望了解上顎正中門齒已經萌發的孩童，有沒有埋伏性多生牙和上顎正中門齒間隙關聯性。此外，觀察在有多生牙的前提下，在不同年齡層的上顎正中門齒間隙的變化，減少不必要的多生牙拔除手術。
研究對象分為兩個部分，第一部份收集西元2002年1月至2005年1月至台中榮總兒童牙科就診，且上顎正中門齒已完全萌發的病人，比較有上顎前側區域多生牙及沒有多生牙的病人中，與上顎正中門齒間隙的有無是否有關聯性。第二部分回溯西元2005年11月1日起至2015年10月31日，在台中榮總就診，並診斷有多生牙的病患。依照放射線影像判斷是否有上顎正中門齒間隙，並依照不同年齡層以及不同的上顎前牙萌發狀態來分類，比較並觀察其中的變化。
第一部分的臨床結果發現，有無上顎正中區域的多生牙，有上顎門齒間隙的比例相差不大，統計結果沒有顯著差異。第二部分放射線影像的部分，在這些有上顎前側多生牙的病患中，上顎正中門齒間隙隨著年齡的增加以及上顎前牙的萌發，比例逐漸降低。
研究結果發現，在混合齒列前期發現的上顎正中門齒間隙，並非單純由上顎前側埋伏性多生牙所造成的，此外，即使在有埋伏性多生牙的孩童，上顎正中門齒間隙的比例會隨著年齡的增加而減少。
未來在臨床上，當我們發現有上顎前埋伏性多生牙時，如果沒有其它併發症像是門牙旋轉，或是造成恆牙無法萌發等情形時，可以繼續觀察正中門齒間隙的關閉情形，拔除多生牙並不是唯一的選擇。

Midline diastema is a normal feature in mixed dentition, and the supernumerary teeth in the premaxilla is not uncommon abnormality noted at the same developmental stage. However, it is inability of a young child to tolerate the surgical procedure. The prevalence of midline diastema in school age children with impacted supernumerary tooth was compared with those without impacted supernumerary tooth in our study. In addition, to observe the change of midline diastema in children with impacted supernumerary tooth along with the growth of the age and the eruption of permanent canines.
This study divided into two parts. The patients who visited the Outpatient department of Pediatric Dentistry in Taichung Veterans General Hospital from January 2002 to January 2005 were collected in the first part. Patients with two erupted maxillary permanent central incisors were included in this study. The percentage of midline diastema in school age children with impacted supernumerary teeth and without impacted supernumerary teeth were compared. Periapical radiograph of patients who visited Taichung Veterans General Hospital and diagnosed as supernumerary teeth were collected for ten years since November 1st in 2005 in the second part.
In the first part, it was noted that midline diastema is not related to impacted premaxillary supernumerary teeth in school age children. Furthermore, the percentage of midline diastema was decreased with age even in school age children with impacted premaxillary supernumerary teeth.
Midline diastema in mixed dentition was not simply caused by impacted supernumerary teeth and even in children with impacted supernumerary teeth, the prevelence of midline diastema was decreased with age.
Clinically, if a impacted supernumerary teeth in anterior maxilla, periodically follow up of the midline diastema can be suggested if the complications such as rotation and delay eruption of permanent incisors were not seen. Extraction of the impacted supernumerary teeth may not be the only choice.

目錄
誌謝………i
中文摘要………ii
英文摘要………iv
目錄………vi
表目錄………x
圖目錄………xii
第一章前言………1
第二章文獻探討………2
第一節多生牙………2
2.1.1多生牙的定義及分類………2
2.1.2多生牙的形成………3
2.1.3多生牙的盛行率………4
2.1.4多生牙造成的影響………5
2.1.5多生牙拔除的時機………10
2.1.6影響多生牙萌發的因素………12
2.1.7台灣孩童的多生牙現況………12
第二節正中門牙間隙………13
2.2.1正中門牙間隙的定義………13
2.2.2正中門牙間隙的形成原因………14
2.2.3正中門齒間隙對美觀的考量………17
2.2.4孩童正中門齒間隙的盛行率………18
2.2.5台灣孩童正中門齒間隙的盛行率………19
第三節正中門牙間隙與多生牙的關聯性………20
第三章研究動機與目的………21
第一節研究動機………21
第二節研究目的………22
第四章材料及方法………23
第一節臨床資料搜集與記錄………23
4.1.1樣本收集………23
4.1.2研究設計………23
第二節放射線影像的收集與記錄………24
4.2.1樣本收集………24
4.2.2上顎正中門齒間隙與多生牙的判讀與記錄………25
第三節統計分析………26
4.3.1檢查者組內信度………26
4.3.2檢查者組堅信度………26
4.3.3資料的統計與分析………27
第五章 研究結果………28
第一節檢查者判讀結果之信度………28
5.1.1檢查者組內信度………28
5.1.2檢查者組堅信度………28
第二節研究樣本………29
5.2.1臨床病例基本資料………29
5.2.2放射線影像篩選結果………30
5.2.3放射線影像基本資料………33
5.2.4臨床病例中上顎犬齒萌發與上顎正中門齒間隙的關聯性………38
5.2.5臨床病例中多生牙的有無與上顎正中門齒間隙的關聯性………40
5.2.6放射線影像中正中門齒間隙在各年齡層的分佈………42
5.2.7正中門齒間隙在上顎門齒、側門齒、以及犬齒萌發後的分佈情形………44
5.2.8正中門齒間隙在不同的多生牙形態的分佈情形………45
5.2.9正中門齒間隙在多生牙不同方向的分佈情形………46
5.2.10正中門齒間隙在多生牙與牙弓不同相對位置時的分佈情形………47
第六章 討論………48
第一節研究方法對盛行率的影響………48
6.1.1資料的收集方式………48
6.1.2樣本代表性………51
第二節檢驗結果………53
6.2.1犬齒萌發後的正中門齒間隙比例………53
6.2.2犬齒萌發前的正中門齒間隙比例………54
6.2.3正中門齒間隙的比例隨著年齡增長的改變………55
6.2.4正中門齒間隙和埋伏性多生牙形態、方位、相對位置的關聯性………57
第三節貢獻與限制………58
6.3.1貢獻………58
6.3.2限制………59
第七章結論………60
參考文獻………61

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