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研究生:林佩勳
研究生(外文):Pei-Hsun Lin
論文名稱:根管治療後剩餘齒質與根柱黏著界面缺陷對贗復牙齒力學行為探討
論文名稱(外文):Mechanical Behaviors of Complex Denture on the Defects of Adhesive Interface between Endodontically Treated Remaining Tooth and Post
指導教授:林峻立林峻立引用關係張晏祥張晏祥引用關係
指導教授(外文):Chun-Li LinYen-Hsiang Chang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:生物醫學工程學系
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:80
中文關鍵詞:根管治療黏著界面缺陷氣泡/空腔
外文關鍵詞:endodontical treatmentadhesive interface defectsvoid/bubble
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臨床上,受損過大或蛀牙傷及牙髓的牙齒,通常建議先進行根管治療,之後進行贗復治療。贗復治療中,置入玻璃纖維根柱,為目前廣為使用的治療方法。玻璃纖維根柱須配合黏著劑使用,黏著界面可能因使用者操作手法或黏著填充不完全等因素,使得根管內產生空腔/氣泡而造成界面缺陷並影響牙齒力學行為表現。因此,本研究將探討黏著介面缺陷(氣泡/空腔)對根管治療後牙齒結構強度之影響。首先,本研究將小臼齒進行臨床根管治療及贗復治療,並以Micro-CT觀察並重建氣泡及牙齒三維模型,紀錄氣泡發生位置及體積,接著以循環負載模擬口腔咬合對根管治療後牙齒進行體外力學試驗,最後利用Micro-CT觀察牙齒內部破壞情形並重建破壞後牙齒模型。在電腦模擬分析中,匯入牙齒模型進行力學模擬分析,觀察牙齒內部應力分布並與實驗前後結果相互驗證。研究結果顯示當氣泡大於4.36E-02mm3且發生於舌側時會有應力提升現象,比無氣泡模型最少高出1倍的應力,而實驗後觀察發現氣泡位置皆有破壞發生,由此可見氣泡分布位置及大小會影響產生破壞的位置,進而導致牙齒結構強度降低。
Clinically, tooth which were severely damaged or had the tooth decay reach to pulp are usually recommended for endodontic therapy before prosthetic restoration. Placing the fiber post into root canal to reinforce tooth structure was widely used. Glass fiber post should be use with adhesive system, therefore the bonding interface was of great importance in the therapy. The interface may be affected by several factors like the bubble/void formation inside cement space, the operating skills, and the incompletion of root canal filling. In this study, the effects of the adhesive interface defects on the structural strength of tooth after endodontic therapy would be discussed. The sample tooth (human premolar, n=10) would take the endodontic therapy and the prosthetic restoration in the clinics, and the samples were scanned by Micro-CT in order to contain the 3D models of bubble in cement and tooth. The position and volume of the bubble were recorded. Also, the teeth were subjected to the in vitro mechanical test after root canal therapy with circular load. Finally, the internal destruction of the teeth was observed by Micro-CT and reconstructed the damage tooth model. The experiment results would be compared with the finite element (FE) analysis to verify the internal stress distribution. The results showed that when the bubble is greater than 4.36E-02mm3 and occurs in the tongue side the stress would be at least one time higher than the bubble-free model. And after the experiment, the destruction in structure would be found in the bubble position. Therefore, we could conclude that the distribution of bubbles position and the size would affect the location of occurrence, which led to reduction in the tooth structural strength.
致謝......I
摘要......II
ABSTRACT......III
目錄......IV
圖目錄......VII
表目錄......X
第一章 緒論......1
1.1研究背景......1
1.1.1根管治療概述......1
1.1.2根管治療失敗原因......4
1.1.3黏著界面缺陷之發生原因......6
1.2研究動機......9
1.3文獻回顧......10
1.3.1牙科黏著層影像觀察方式......10
1.3.2氣泡/空腔之分布位置及體積定義......15
1.3.3氣泡/空腔對黏著層之力學行為探討......18
1.3.4文獻總結......21
1.4研究目的......22
第二章 研究方法......23
2.1研究流程概述......23
2.2根管治療後剩餘齒質模型建立......25
2.2.1牙齒蒐集篩選......25
2.2.2根管治療試件備置......28
2.2.3氣泡尺寸定義......31
2.3根管治療後剩餘齒質之力學檢測......33
2.3.1贗復牙齒試件備置......33
2.3.2體外力學測試......36
2.4電腦模擬分析......38
2.4.1牙齒分析模型......38
2.4.2有限元素分析......42
第三章 研究結果......52
3.1根管治療後剩餘齒質之力學檢測結果......52
3.1.1體外力學實驗結果......52
3.1.2實驗前後模型觀察結果......54
3.2電腦模擬分析......55
3.2.1模型分析結果......55
第四章 研究討論......68
4.1實驗前後觀察與模型分析結果之討論......68
4.1.1牙齒內部破壞情況與分析結果比對......68
4.1.2氣泡/空腔存在對於牙齒結構強度影響之討論......70
4.2研究限制......74
第五章 結論......75
參考文獻......76


圖目錄
圖1-1、牙齒基本構造圖......3
圖1-2、根管及贗復治療過程圖......3
圖1-3、根管治療後牙齒破壞情形(A)牙冠脫落[33];(B)根柱脫落[32] ......5
圖1-4、黏著界面破壞情形(A)根柱剝離[34];(B)微滲漏[8]......5
圖1-5、氣泡/空腔形成因素(A)臨床操作手法;(B)黏著填充不完全......8
圖1-6、牙齒破壞示意圖......8
圖1-7、氣泡影像觀察(SEM)......12
圖1-8、氣泡影像觀察(MICRO-CT)......14
圖1-9、根管位置分布(牙冠、中段、根管底部)[14]......16
圖1-10、氣泡分布位置(舌頰側)......16
圖1-11、氣泡分布位置(牙冠、中段、根管底部)......16
圖1-12、實驗後氣泡影像[19]......19
圖1-13、骨水泥破壞情形[20]......19
圖1-14、氣泡周圍應力分布圖[17]......20
圖2-1、研究流程圖......24
圖2-2、符合條件之牙齒示意圖......26
圖2-3、牙齒特徵測量示意圖......26
圖2-4、根管治療試件備置流程(A)根管修形;(B)牙齒酸蝕;(C)馬來膠填充;(D)圍箍製作;(E)根柱置入;(F)冠心修復......29
圖2-5、圍箍及冠心尺寸示意圖......30
圖2-6、氣泡模型建構流程(A)試件掃描;(B)氣泡圈選;(C)氣泡模型建立......32
圖2-7、復形牙齒試件備製流程(A)金屬牙冠加工;(B)牙冠黏著復形;(C)人工PDL製作;(D)試件包埋固定......34
圖2-8、牙冠尺寸設計......35
圖2-9、PDL厚度設計......35
圖2-10、實驗試件與機台架設圖......37
圖2-11、牙齒分析模型建構流程......39
圖2-12、牙齒3D模型(N=10)......40
圖2-13、牙齒分析模型......41
圖2-14、有限元素模型邊界負載條件設定(由SAMPLE9作為代表)...... 43
圖2-15、有限元素模型網格化......43
圖2-16、SAMPLE1網格模型......47
圖2-17、SAMPLE2網格模型......47
圖2-18、SAMPLE3網格模型......48
圖2-19、SAMPLE4網格模型......48
圖2- 20、SAMPLE5網格模型......49
圖2- 21、SAMPLE6網格模型......49
圖2-22、SAMPLE7網格模型......50
圖2-23、SAMPLE8網格模型......50
圖2-24、SAMPLE9網格模型......51
圖2-25、SAMPLE10網格模型......51
圖3-1、SAMPLE1實驗前後模型與分析結果......56
圖3-2、SAMPLE2實驗前後模型與分析結果......57
圖3-3、SAMPLE3實驗前後模型與分析結果......58
圖3-4、SAMPLE5實驗前後模型與分析結果......59
圖3-5、SAMPLE6實驗前後模型與分析結果......60
圖3-6、SAMPLE7實驗前後模型與分析結果......61
圖3-7、SAMPLE9實驗前後模型與分析結果......62
圖3-8、SAMPLE10實驗前後模型與分析結果......63
圖4-1、疲勞曲線圖......72



表目錄
表1-1、大型氣泡體積表......17
表2-1、牙齒尺寸紀錄表......27
表2-2、氣泡體積篩選統計......32
表2-3、有限元素分析之材料性質表......44
表2-4、各模型之網格元素及節點數量......46
表3-1、力學實驗結果......53
表3-2、實驗與分析結果統計表......64
表3-3、氣泡周圍應力差異表......66
表3-4、根柱位移量差異表......67
表4-1、氣泡分布位置......70
表4-2、實驗分析值-曲線值對照表......73
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