臺灣博碩士論文加值系統

牙周病為人類最常患有的疾病之一，其最主要之致病因子為牙菌斑。除了患者自身清潔習慣外，在口內仍有許多因牙齒型態或是復型物會造成牙菌斑的堆積，並可視為牙周病的局部貢獻因子。在牙齒型態之中，亞洲人大約有四分之一到五分之一的人口比例在下顎第一大臼齒具有遠心舌側牙根，一旦有根岔的侵犯，牙周病的進程及治療計畫皆會受到遠心牙根的存在而影響。因此能準確判斷出根叉侵犯與否為牙周病治療中不可或缺的一環。
本研究目標藉由分析放射學影像因影像重疊以及牙齒型態結構特色所形成之矢狀陰影，進而預判在具有遠心舌側牙根之下顎第一大臼齒的遠心根叉之侵犯。本研究共納入了140位來三軍總醫院牙周病科接受牙周病治療並且具有下顎第一大臼齒遠心舌側牙根之患者。所有受試者皆接受牙周臨床檢查及牙科放射影像學拍攝，經由臨床檢查探測確認根叉侵犯程度，放射學影像經牙周醫師判讀，將矢狀陰影的成像作分類及分析，計算出其做為診斷根叉侵犯之敏感度及特異度，並探討其準確性是否受到臨床檢查數值之影響。

Periodontal disease is one of the most common diseases that affects human, and dental biofilm is its main etiology. In addition to the patient's own oral hygiene habits, there are still many developmental or anatomical abnormalities in the mouth that can cause the accumulation of dental plaque, which can be regarded as a local contributing factors to periodontal disease. In regard to tooth anatomy, about one-quarter to one-fifth of the population of Asians have a disto-lingual root in the mandibular first molar. Once the furcation area is invaded, the progression and treatment plan of periodontal disease will be affected by the existence of disto-lingual root. Therefore, it is an indispensable part of periodontal treatment assessment to accurately judge the status of furcation involvement.
The goal of this research is to analyze the furcation arrows observed on the radiographic film due to the overlapping effect of 2-D radiographs and the characteristics of the tooth anatomy and structure, and then predict the status of the distal furcation of the mandibular first molar with disto-lingual root. This study included 140 patients who has at least one mandibular molar with disto-lingual root and came to the Department of Periodontology of the Tri-Services General Hospital for periodontal treatment. All subjects underwent periodontal clinical examination and dental radiographic imaging, and the extent of furcation involvement was confirmed through clinical probing. The radiographic images were evaluated by periodontists, and the furcation arrows images were further classified and analyzed. Then, the sensitivity and specificity of the furcation arrow as a diagnostic marker was calculated.

正文目錄
頁
第一章、文獻回顧 1
第一節、牙周病之簡介 1
第二節、牙周病之位點特異性 4
第三節、根叉侵犯之於牙周病的影響 6
第四節、下顎恆牙第一大臼齒遠心舌側牙根 8
第五節、根叉侵犯之臨床診斷 11
第六節、放射影像學檢查於牙科治療之輔助 13
第七節、放射影像學上之矢狀陰影於臨床之意義 14

第二章、研究動機及目的 16
第一節、研究動機 16
第二節、研究目的 16

第三章、研究材料與方法 18
第一節、研究重要性 18
第二節、研究設計 18
第三節、放射線學影像評估 22
第四節、統計分析 25

第四章、研究結果 27
第一節、研究個案之特性分析 27
第二節、矢狀陰影之盛行率及其在根叉侵犯與否之分佈 29
第三節、矢狀陰影評估者之間及評估者內之可信度評估。 31
第四節、矢狀陰影與根叉侵犯之關聯 32
第五節、放射線影像拍攝方式於矢狀陰影判斷準確度之影響 35
第六節、利用矢狀陰影判斷根叉侵犯最佳之切點 36
第七節、矢狀陰影作為診斷依據時之準確性 37

第五章、討論 38

 
表目錄
表 1：本研究納入病患之人口學資料分佈 44
表 2：評估者間可信度 45
表 3：評估者內可信度 46
表 4：矢狀陰影出現與根叉侵犯等級之關連 47
表 5：正照時於ROC曲線各節點之診斷表現 48
表 6：近心偏移照時於ROC曲線各節點之診斷表現 49
表 7：矢狀陰影於正照時之診斷準確度 50
表 8：矢狀陰影於近心偏移照時之診斷準確度 51

 
圖目錄
圖 1：受試者篩選流程圖 52
圖 2：矢狀陰影之分級 53
圖 3：矢狀陰影各級別之盛行率 54
圖 4：於有無根叉侵犯組別間，矢狀陰影出現之分佈 55
圖 5：使用矢狀陰影診斷根叉侵犯，於正照及近心偏移照射之ROC曲線 56
 

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