臺灣博碩士論文加值系統

問題敘述
邊緣深度提升為臨床解決牙齦下缺損之直接贗復時需要移除多餘健康齒質、取模困難度增加和贗復物黏著時難以將多餘黏著劑移除乾淨等問題。然目前並未有足夠的證據及長年的追蹤可以支持此技術的預後，僅少數體外實驗研究探討其各材料間交界面在經過疲勞測試後是否會破壞其外表面完整性，無法瞭解整體交界面的應力分佈。

研究目的
利用有限元素分析法，觀察上顎第一大臼齒在不同深度之遠心缺損施作邊緣深度提升並以陶瓷冠蓋體贗復後，且與未施作邊緣深度提升之模型作比較，來探討邊緣深度提升後之應力分佈。

研究材料與方法
利用微電腦斷層掃描及三維電腦輔助設計軟體，建構出人類上顎第一大臼齒模型，並切割出四組模型：遠心缺損至牙齦下1公釐、2公釐及3公釐三組，皆利用邊緣深度提升至牙齦上1公釐，包含冠蓋體、黏著層、複合樹脂、牙釉質及牙本質等組件；及遠心缺損至牙齦下2公釐，未使用邊緣深度提升，包含冠蓋體、黏著層、牙釉質、牙本質等組件。施予800牛頓及300牛頓的力量，模擬緊咬及咀嚼時的咬合力，分析複合樹脂與牙本質交界面的應力分佈。

結果
牙齦下2公釐之缺損，有施作邊緣深度提升之組別可以減低複合樹脂與牙本質交界面之平均等效應力及平均最大剪應力。亦觀察到四組模型在此交界面之遠心側會出現應力提升之現象，尤其在緊咬時，牙齦下3公釐的組別，最大剪應力會接近目前黏著系統所達之黏著強度。

結論
在有限元素的假設條件與限制下，可得出幾點結論：(1) 在缺損為2公釐以內時，施作邊緣深度提升可減少複合樹脂與牙本質交界面之應力集中的現象，(2) 當缺損達牙齦下3公釐時，不建議使用邊緣深度提升，(3) 有緊咬的患者亦不建議使用邊緣深度提升。

Statement of problem
Traditionally, if we want to restore the tooth with sub-gingival defect, there are some problems need to face, like remove too much sound tooth structure, hard to take impression, remove excessive cement difficulty. Recently, deep margin elevation technique become the solution for those problems. However, no sufficient evidences and long time clinical follow up to support the prognosis of deep margin elevation. Only some in vitro studies focus on margin integrity of interface between different materials, we could not understand the stress distribution of those interfaces.

Purpose
Using the finite element method to observe the stress distribution between interfaces of human upper first molar with deep margin elevation technique from different depth of distal sub-gingival defect and restored by ceramic onlay, and compared to a model only restored by onlay without deep margin elevation technique.

Material and methods
Combined micro computed tomography and three dimensional computer-aided design software to build up a human upper first molar model, then make four different models: sub-gingival 1mm, 2mm and 3mm distal defect, then build up to supra-gingival 1mm, each of those three models contains 5 parts: onlay, cement layer, composite resin, enamel and dentin. And one model which with distal sub-gingival defect restored by onlay directly, contains four parts: onlay, cement layer, enamel and dentin. Loading force with 800N and 300N to simulate the biting force of clenching and chewing, then observing the stress distribution of the interface between composite resin and dentin.

Result
Comparing sub-gingival 2mm models, with or without deep margin elevation technique. The model with deep margin elevation reduces the von mise’s stress and maximum shear stress of the interface between composite resin and dentin. Moreover, both two stress increased over distal side of the interface, especially in the model with sub-gingival 3mm defect while clenching, the maximum shear stress is equal to the bonding strength of modern bonding systems.

Conclusion
Within the limitation of finite element analysis, the following conclusion can be drawn: (1) when the defect within 2mm, using deep margin elevation technique can reduce the stress concentration between composite resin and dentin, (2) if the defect approach to 3mm, deep margin elevation technique is not recommended, (3) deep margin elevation technique is also not recommended for those patients with clenching.

目錄
中文摘要……I
Abstract……III
目錄……V
圖目錄……VIII
表目錄……X

第一章 緒論
1.1 前言……1
1.2 邊緣深度提升的發展……2
1.3 邊緣深度提升的評估
1.3.1 邊緣的連續性……3
1.3.2 生物性寬度的侵犯與否……5
1.4 研究目的……5

第二章 研究材料與方法
2.1 三維有限元素模型建立
2.1.1 樣本選擇與模型建立……6
2.1.2 三維醫學影像建模……6
2.1.3 實驗模型……7
2.2 有限元素模型建立與邊界條件設定
2.2.1 元素選擇……9
2.2.2 材料性質設定……9
2.2.3 模型網格化……10
2.2.4 介面接觸設定……11
2.2.5 拘束條件……12
2.2.6 施力條件……12
2.2.7 受力位置與面積設定……13
2.3 分析目標……14
2.4 收斂測試……15
2.5 模型比較……15

第三章 結果
3.1 收斂測試……17
3.2 模型比較……17
3.3 交界面承受負荷之應力表現
3.3.1 緊咬時之等效應力……18
3.3.2 緊咬時之最大剪應力……18
3.3.3 咀嚼時作為工作側之等效應力……19
3.3.4 咀嚼時作為工作側之最大剪應力……19

第四章 討論
4.1 三維模型的建立
4.1.1 微電腦斷層的應用……20
4.1.2 建模方式的討論……21
4.2 結果分析討論……22
4.3 有限元素分析……23
4.4 臨床意義……23

第五章 結論與臨床建議……25
附圖……26
附表……49
參考文獻……52
附錄(3Dslicer步驟)……58
光碟片(3維模型製作影片檔)


圖目錄
圖一、 微電腦斷層掃描影像……26
圖二、 3Dslicer中以閾值區分及建立牙釉質初始模型……27
圖三、 牙本質匯入Meshmixer軟體……28
圖四、 牙釉質匯入Meshmixer軟體……28
圖五、 三組施作邊緣深度提升之模型組件……29
圖六、 未施作邊緣深度提升之模型組件……30
圖七、 FreeCAD將模型實體化之操作……31
圖八、 實體模型匯入ANSYS及網格化之操作……32
圖九、 拘束條件示意圖……33
圖十、 緊咬時外力施予位置示意圖……33
圖十一、 咀嚼時外力施予位置示意圖……34
圖十二、 緊咬時外力條件示意圖……34
圖十三、 咀嚼時外力條件示意圖……35
圖十四、 收斂測試圖……35
圖十五、 模型比較應力圖……36
圖十六、 應力值顯示路徑示意圖……36
圖十七、 緊咬時等效應力分佈圖……37
圖十八、 緊咬時最大剪應力分佈圖……40
圖十九、 咀嚼時等效應力分佈圖……43
圖廿、 咀嚼時最大剪應力分佈圖……46


表目錄
表一、 模型分類……49
表二、 材料性質設定……49
表三、 模型元素與節點數量……50
表四、 收斂測試之結果數據……50
表五、結果總表……51

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