臺灣博碩士論文加值系統

良好的牙科美學規劃是指牙醫師、牙體技術師和患者間對於修復物的
表現具有相同共識。自然牙的光學特性為修復物重建上最難模擬的部分,
尤其需要專業技術和實務經驗並進才能予以完整呈現,目前臨床上常以數
位照片和比色數值作為染色評估的參考依據,但對於不同厚度和深色支臺
齒修復物重建的二矽酸鋰陶瓷貼片仍是一大挑戰,本研究討論不同透明度
之瓷塊(IPS e.max CAD,BL2,High translucency/Low translucency,以下簡
稱 HT/LT)在不同厚度(0.5、1.0、1.2 mm)陶瓷貼片進行二矽酸鋰專用(GC
Initial IQ Lustre Paste NF, L-V)和氧化鋯專用(GC Initial Zr Light Reflective
Liners, L-BL)染色劑後對於深色支臺齒(ND8)修復物之顏色表現。根據實驗
結果顯示,以 BL2瓷塊試片在 ND8支臺齒背景之 L*值(80)作為基準,高透
明度瓷塊(HT)經氧化鋯專用染色劑後相較於二矽酸鋰專用染色劑呈現較高
的 L*值表現。然而對於低透明度瓷塊(LT)來說,兩種染色劑間所表現出的
L*值則差異較小,此外,在陶瓷貼片厚度充足(1.2 mm)的狀況下,兩種染
色劑皆能達到 BL2之 L*值基準表現。此結果經由蒐集 5人臨床案例的色彩
資訊上也獲得驗證。顯示在深色支臺齒的修復物重建上,染色劑與厚度的
搭配將會影響最終修復物的美學表現。

Good dental esthetic planning means that there is a common understanding
on restoration performance between the dentist, dental technician and patient. The

optical properties of natural teeth are the most difficult for restorations to simu-
late, especially when both professional expertise and practical experience are re-
quired to present them completely. Currently, digital photographs and colorimetry

values are often used as a reference for color evaluation but there is still a big
challenge for lithium disilicate veneers of different thicknesses and reconstruction

of dark-colored abutment restoration. In this study, we examined the color perfor-
mance of dark-colored abutment (ND8) restoration when ceramic blocks (IPS

e.max CAD,BL2,High translucency/Low translucency,hereinafter referred
to as HT/LT) of different clarities were used for Lithium disilicate special paste
and Zirconia special paste coloring ceramic veneers with different thicknesses
(0.5, 1.0, 1.2 mm). The experimental results showed that using the L value (80)
of BL2 in the dark-colored abutment , such as ND8, background as a benchmark,
the high translucency ceramic block had a higher L value after Zirconia special
paste coloring compared with Lithium disilicate special paste coloring. However,
for the low translucency (LT) ceramic blocks, the difference in L-value between

the two coloring agents was smaller, and both stains were able to achieve the L-
value of BL2 when the veneer had sufficient thickness (1.2 mm). This result was

also confirmed in 5 clinical cases. It is clear that the combination of coloring agent
and thickness will affect the aesthetic performance of the final restoration in the
reconstruction of dark colored abutment.

致謝......................................................................................................................II
目錄.................................................................................................................... III
圖目錄.................................................................................................................VI
中文摘要............................................................................................................... 1
Abstract................................................................................................................ 2
第一章 前言.......................................................................................................... 3
第二章 研究背景.................................................................................................. 5
2.1. 牙齒與美學.......................................................................................... 5
2.2. 傳統複合樹脂材料.............................................................................. 7
2.3. 二矽酸鋰材料...................................................................................... 7
2.4. 比色系統.............................................................................................. 8
2.5. 修復物染色技巧................................................................................ 11
第三章 研究目的................................................................................................ 12
第四章 材料方法................................................................................................ 13
4.1. 實驗規劃............................................................................................ 13
4.2. 樣品準備............................................................................................ 13
4.3. 染色處理............................................................................................ 14
4.4. 比色資訊............................................................................................ 15
4.5. 支臺齒比色板.................................................................................... 16
4.6. eLAB 系統......................................................................................... 17
第五章 結果討論................................................................................................ 18
5.1. 瓷塊試片染色厚度觀察.................................................................... 18
5.2. 瓷塊試片染色前後之 L*值表現...................................................... 18
5.3. 瓷塊試片於 ND8 支臺齒背景下 L*值表現 .................................... 20
第六章 臨床驗證................................................................................................ 22
第七章 研究結論................................................................................................ 30
第八章 參考文獻................................................................................................ 31


表目錄

表 一、牙科比色的臨床困擾........................................................................... 9
表 二、瓷塊物理特性..................................................................................... 14
表 三、瓷塊與比色板色彩資訊..................................................................... 23
表 四、案例編號板資料................................................................................. 23


圖目錄

圖一、微笑線分類............................................................................................ 5
圖二、牙齒黃金比例........................................................................................ 6
圖三、等色面向[13] ......................................................................................... 6
圖四、牙科修復物的傳統與數位製程............................................................ 8
圖五、專用灰卡說明[34] ............................................................................... 10
圖六、整體研究架構...................................................................................... 13
圖七、瓷塊透明度表現.................................................................................. 15
圖八、瓷塊染色過程...................................................................................... 15
圖九、Ivoclar Vivadent IPS Natural Die Material 比色板(紅框為 ND8 支臺齒
比色板).......................................................................................................... 16

圖十、相機與灰卡的拍攝角度 (圖片來源:https://elabprime.com/photo-
protocol)......................................................................................................... 17

圖十一、試片縱切面觀察.............................................................................. 18
圖十二、瓷塊 HT 試片於染色前後之 L*值表現......................................... 19
圖十三、瓷塊 LT 試片於染色前後之 L*值表現.......................................... 20
圖十四、瓷塊 HT 試片染色燒結後於 ND8 支臺齒下之 L*值表現 ........... 21
圖十五、瓷塊 LT 試片染色燒結後於 ND8 支臺齒下之 L*值表現 ............ 21
圖十六、支臺齒色彩資訊蒐集...................................................................... 22
圖十七、修復物色彩資訊蒐集...................................................................... 22
圖十八、3 Shape 軟體厚度測量 .................................................................... 24
圖十九、案例一陶瓷貼片色彩資訊.............................................................. 25
圖二十、案例二陶瓷貼片色彩資訊.............................................................. 25
圖二十一、案例三 14-24 齒位陶瓷貼片色彩資訊....................................... 27
圖二十二、案例三 34-44 齒位陶瓷貼片色彩資訊....................................... 27
圖二十三、案例四陶瓷貼片色彩資訊.......................................................... 28
圖二十四、案例五陶瓷貼片色彩資訊.......................................................... 28

1 S.J. Chu, R.D. Trushkowsky, R.D. Paravina, Dental color matching instruments
and systems. Review of clinical and research aspects, Journal of Dentistry, 38,
e2-16 (2010).
2 L. Hallmann, P. Ulmer, M.D. Gerngross, J. Jetter, M. Mintrone, F. Lehmann,

M. Kern, Properties of hot-pressed lithium silicate glass-ceramics, Dental Ma-
terials, 35, 713-729 (2019).

3 R. Oguro, M. Nakajima, N. Seki, A. Sadr, J. Tagami, Y. Sumi, The role of

enamel thickness and refractive index on human tooth colour, Journal of Den-
tistry, 51, 36-44 (2016).

4 N. Barghi, R.E. Lorenzana, Optimum thicknesses of opaque and body porcelain,
The Journal of Prosthetic Dentistry, 48, 429-431 (1982).
5 W.J. O’Brien, K.S. Kay, K.M. Boenke, Sources of color variation on firing
porcelain, Dental Materials, 7, 170-173 (1991).
6 J.D. Brewer, D.A. Garlapo, E.A. Chipps, L.A. Tedesco, Clinical discrimination
between autoglazed and polished porcelain surfaces, The Journal of Prosthetic
Dentistry, 64, 631-634 (1990).

7 I.A. Hammad, R.S. Stein, A qualitative study for the bond and color of ceramo-
metals. Part II, The Journal of Prosthetic Dentistry, 65, 169-179 (1991).

8 A. Soim, M. Strimbu, A.V. Burde, B. Culic, D. Dudea, C. Gasparik, Translu-
cency and masking properties of two ceramic materials for heat-press technol-
ogy, Journal of Esthetic Restorative Dentistry, 30, E18-E23. (2018).

9 N.N. Shono, H.N.A. Al Nahedh, Contrast ratio and masking ability of three ce-
ramic veneering materials, Operative Dentistry, 37, 406-416 (2012).

10 A.M.E. Marchionatti, V.F. Wandscher, M.M. May, M.A. Bottino, L.G. May,
Color stability of ceramic laminate veneers cemented with light-polymerizing

32

and dual-polymerizing luting agent: A split-mouth randomized clinical trial,
The Journal of Prosthetic Dentistry, 118, 604-610 (2017).
11 A. Czigola, E. Abram, Z.I. Kovacs, K. Marton, P. Hermann, J. Borbely, Effects
of substrate, ceramic thickness, translucency, and cement shade on the color
of CAD/CAM lithium-disilicate crowns, Journal of Esthetic and Restorative
Dentistry, 31, 457-464 (2019).
12 M.M.M. Gresnigt, M.S. Cune, J. Schuitemaker, S.A.M. van der Made, E.W.
Meisberger, P. Magne, M. Ozcan, Performance of ceramic laminate veneers
with immediate dentine sealing: An 11 year prospective clinical trial, Dental
Materials, 135, 1042-1052 (2019).

13 D. Epstein, B. Herzberger, I. Rentschler, Beauty and the brain: biological as-
pects of aesthetics /edited by Ingo Rentschler, Barbara Herzberger and David

Epstein, Birkhauser, Basel: Basel, (1988).
14 A.H.L. Tjan, G.D. Miller, J.G.P. The, Some esthetic factors in a smile, The
Journal of Prosthetic Dentistry 51, 24-28 (1984).
15 J. Langlois, L. Kalakanis, A. Rubenstein, A. Larson, M. Hallam, M. Smoot,

Maxims or myths of beauty? A meta-analytic and theoretical review, Psycho-
logical Bulletin, 126, 390-423 (2000).

16 E.I. Levin, Dental esthetics and the golden proportion, Journal of Prosthetic
Dentistry, 40, 244-252 (1978).
17 王啟榮,色彩學-等色相面、色調、色立體-遊戲式學習,2020。
https://www.gameislearning.url.tw/article_content.php?getb=11&foog=999.
18 R.C. Sproull, Color matching in dentistry: Part 2. Practical applications of the
organization of color, Journal of Prosthetic Dentistry, 29, 556-566 (1973).
19 M. Peumans, B. Van Meerbeek, P. Lambrechts, G. Vanherle The 5-year clini-

33

cal performance of direct composite additions to correct tooth form and posi-
tion. I. Esthetic qualities, Clinical Oral Investigations, 1, 12-18 (1997).

20 A.M.E. Marchionatti, V.F. Wandscher, M.M. May, M.A. Bottino, L.G. May,
Color stability of ceramic laminate veneers cemented with light-polymerizing
and dual-polymerizing luting agent: A split-mouth randomized clinical trial,
The Journal of Prosthetic Dentistry, 118, 604-610 (2017).
21 A.C. Meijering, N.H.J. Creugers, F.J.M. Roeters, J. Mulder, Survival of three
types of veneer restoratioms in a clinical trial: a 2.5-year interim evaluation,
Journal of Dentistry,26, 563-568 (1998).
22 M.M.M. Gresnigt, M.S. Cune, K. Jansen, S.A.M. van der Made, M. Özcan
Randomized clinical trial on indirect resin composite and ceramic laminate
veneers: up to 10-year findings, Journal of Dental Sciences, 86, 102-
109 (2019).
23 H. Rudolph, M.R.S. Graf, K. Kuhn, S. Rupf-Köhler, A. Eirich, C. Edelmann,

S. Quaas, R.G. Luthardt, Performance of dental impression materials: bench-
marking of materials and techniques by three-dimensional analysis, Dental

Materials Journal, 34, 572-584 (2015).
24 F. Duret, J.L. Blouin, B. Duret, CAD-CAM in dentistry, The Journal of the
American Dental Association, 117, 715-20 (1988).
25 T. Miyazaki, Y. Hotta, J. Kunii, S. Kuriyama, Y. Tamaki, A review of dental

CAD/CAM: current status and future perspectives from 20 years of experi-
ence, Dental Materials Journal, 28, 44-56 (2009).

26 P.C. Guess, R.A. Zavanelli, N.R. Silva, E.A. Bonfante, P.G. Coe-
lho, V.P. Thompson, Monolithic CAD/CAM lithium disilicate versus ve-
neered Y-TZP crowns: comparison of failure modes and reliability after fa-
tigue, The International Journal of Prosthodontics, 23, 434-442 (2010).

34

27 T. Miyazaki, Y. Hotta, J. Kunii, S. Kuriyama, Y. Tamaki, A review of dental

CAD/CAM: Current status and future perspectives from 20 years of experi-
ence, Dental Materials Journal, 28, 44-56 (2009).

28 R. Winter, Visualizing the natural dentition, Journal of Esthetic and Restora-
tive Dentistry, 5, 102-117 (1993).

29 W.D. Kingery, D.R. Uhlmann, H.K. Bowen, Introduction to ceramics. 2nd ed.
New York: John Wiley & Sons, 646-76 (1976).
30 R.D. Paravina, M.M. Pérez, R. Ghinea, Acceptability and perceptibility

thresholds in detistry: a comprehensive review of clinical and research appli-
cations, Journal of Esthetic and Restorative Dentistry, 31, 103-112 (2019).

31 A. Vichi, C. Louca, G. Corciolani, Color related to ceramic and zirconia resto-
rations: a review, Dental Materials, 27, 97-108 (2011).

32 M.N. Carney, W.M.Johnston, Appearance differences between lots and Brands
of Similar Shade Designations of dental composite resins, Journal of Esthetic
and Restorative Dentistry, 29, E6-E14 (2017).
33 A. Yoshida, L. Miller, J.D. Da Silva, S. Ishikawa-Nagai Spectrophotometric
analysis of tooth color reproduction on anterior all-ceramic crowns: part 2:
color reproduction and its transfer from in vitro to in vivo, Journal of Esthetic
and Restorative Dentistry, 22, 53-63 (2010).

34 S. Hein, J. Tapia, P. Bazos eLABor_aid: a new approach to digital shade man-
agement, Journal of Esthetic and Restorative Dentistry, 12, 186-202 (2017).

35 L. Hallmann, P. Ulmer, M.D. Gerngross, J. Jetter, M. Mintrone, F. Lehmann,

M. Kern, Properties of hot-pressed lithium silicate glass-ceramics, Dental Ma-
terials, 35, 713-729 (2019).

36 G.D. Finlayson, S.D. Hordley, and P.M. Hubel, Color by correlation: a simple,

35

unifying framework for color constancy, IEEE Transactions on Pattern Anal-
ysis and Machine Intelligence, 23, 1209-1221 (2001).

37 S. Hein, D. Modric, S. Westland, M. Tomecek, Objective shade matching,

communication, and reproduction by combining dental photpgraphy and nu-
meric shade quantification, Journal of Esthetic and Restorative Dentistry, 33,

107-117 (2021).
38 S. Hein, D. Modric, S. Westland, M. Tomecˇek, Objective shade matching,

communication, and reproduction by combining dental photography and nu-
meric shade quantification, Journal of Esthetic and Restorative Dentistry, 1–

11 (2020).

39 A. Vichi, M. Ferrari, C.L. Davidson, Influence of ceramic and cement thick-
ness on the masking of various types of opaque posts, Journal of Prosthetic

Dentistry, 83, 412-417 (2000).
40 F. Tabatabaian, A. Jafari, M. Namdari, M. Mahshid, Influence of coping and
veneer thickness on the color of zirconia-based restorations on different implant
abutment background, The Journal of Prosthetic Dentistry, 121, 327-332
(2019).
41 I.J. Kim, Y.K. Lee, B.S. Lim, C.W. Kim, Effect of surface topography on the
color of dental porcelain, Journal of Materials Science: Materials in Medicine,
14, 405-409 (2003).
42 A. Obregon, R.J. Goodkind, W.B. Schwabacher, B. Chem, Effect of opaque
and porcelain surface texture on the color of ceramometal restorations,Journal
of Prosthetic Dentistry, 46, 330-340 (1981).

43 W.J. O’Brien, Double layer effect and other optical phenomena related to es-
thetics, Dental Clinics of North America, 29, 667-672 (1985).

36

44 R.W.G. Hunt, M.R. Pointer, Colorimetry with digital cameras. Measuring Col-
our. 4th ed. Wiley (2011).

45 S. Hein, M. Zangl, The use of a standardized gray reference card in dental
photography to correct the effects of five commonly used diffusers on the

color of 40 extracted human teeth, The International Journal of Esthetic Den-
tistry, 2, 246-259 (2016).

46 Chu SJ. Precision shade technology: contemporary strategies in shade selec-
tion. Practical Procedures & Aesthetic Dentistry, 14, 79-83 (2002).