臺灣博碩士論文加值系統

許多的研究結論已經指出咬合傷害是牙周破壞的輔助因子，而大臼齒牙根形態對於牙周病的進行也有明顯的影響。對於大臼齒咬合面磨損量、牙根外形以及咀嚼習慣與牙周附連喪失間的關係，資訊則付之闕如。本研究以高雄醫學大學附設中和紀念醫院牙科初診轉診至牙周病科接受檢查與治療的44名病患為研究樣本，收集自1998年9月至2000年3月間以標準平行法拍攝所得的上下顎大臼齒根尖X光片以及石膏模型，共計292顆大臼齒，分析其X光牙周附著喪失量（RAL）、平均X光牙周附著喪失量（RAL/AD），以及咬合小面磨損面積，並將牙根外形分類為cone-shaped與non cone-shaped，咀嚼習慣分為unilateral chewers與bilateral chewers。本研究的結果顯示：（１）磨損時間（AD）與咬合磨損面積、RAL分別有中度（p < 0.0001）及較弱（p < 0.05）的相關性。（２）男性咬合磨損量平均值明顯大於女性（p < 0.05）；RAL平均值沒有性別差異（p > 0.05），而女性的RAL/AD平均值明顯大於男性（p < 0.05）。（３）上顎大臼齒的牙根外形分佈無性別差異，下顎大臼齒則有明顯的性別差異（cone-shaped女＞男，p < 0.05）。（４）第一大臼齒與第二大臼齒的平均咬合磨損量與RAL/AD分別呈現弱（p > 0.05）以及中度（p < 0.0001）的正相關性。（５）所有cone-shaped大臼齒的RAL/AD平均值均明顯高於non cone-shaped（p < 0.05）；而cone-shaped與non cone-shaped的根叉病變（FI）分佈皆為class I > class II > class III，但無統計學上的明顯差異（p > 0.05）。（６）牙根主幹形態對於RAL、RAL/AD以及根叉病變分佈均無明顯影響（p > 0.05）。（７）單邊咀嚼會使大臼齒cone-shaped牙根的RAL/AD明顯增加，對於RAL則沒有明顯影響。（８）吸菸只會明顯增加上顎大臼齒的RAL/AD，但對於大臼齒的RAL則沒有明顯影響。

Numerous studies concluded that occlusal trauma is a cofactor of periodontal breakdown. The shapes of molar roots also have significant influence on the progression of periodontal disease. Little or limited information about the relationships among occlusal attrition dimension (OAD), root shape, chewing habit and periodontal attachment loss in molars is available. The sample pool of the present study consisted of 44 individuals, ages 19 to 66 years ( mean age = 40.0±10.6 years), with a totally 292 teeth. The mean RAL (named as RAL/AD) was first introduced in this study. The objectives of the present study were to evaluate : (1) the relationship between OAD and RAL/AD in molars. (2) the influence of molar root shape (cone-shaped or non cone-shaped) on the RAL and RAL/AD. (3) the influence of unilateral chewing habit on the RAL and RAL/AD. The results were summarized as follows : (1) The attrition duration (AD) have positive correlation with OAD and RAL. (2) Male exhibited greater (p<0.05) occlusal attrition than female. The difference of RAL in gender revealed no statistical significance, whereas the means of RAL/AD in female were significantly greater (p<0.05) than in male. (3) The distribution of root shape in gender revealed statistical non-significance in maxillary molars, whereas the prevalence of cone-shaped roots significantly increased (p<0.05) in the mandibular molars for female. (4) A positive relationship between OAD and RAL/AD was noted in both the first and the second molar. (5) The RAL/AD were significantly greater (p<0.05) on cone-shaped molars than those on non cone-shaped molars. (6) The absence of relationship between root trunk type and RAL, RAL/AD and the distribution of FIs was found. (7) Unilateral chewing significantly increase the RAL/AD in molars (p<0.05), but not the RAL. (8) The maxillary molars exhibited significantly greater amount of RAL/AD in the smoking group (p<0.05), whereas the RAL in all molars was not influenced by smoking.

第一章 前 言 …………………………………………………………… 1
第一節 研究的重要性 ………………………………………… 1
第二節 研究目的 ………………………………………………… 3
第二章 文獻回顧 ……………………………………………………… 5
第一節 咬合磨損、夜間磨牙與牙周病 ……………………… 5
第二節 附連高度喪失的測量 ………………………………… 6
第三章 材料與方法 …………………………………………………… 12
第一節 研究樣本收集 ………………………………………… 12
第二節 研究材料與方法 ……………………………………… 13
第三節 研究步驟 ………………………………………………… 14
第四節 資料處理與分析 ……………………………………… 22
第五節 研究限制 ………………………………………………… 23
第四章 研究結果 ……………………………………………………… 24
第一節 前驅研究結果 ……………………………………………… 24
第二節 咬合磨損面積、X光牙周附連喪失量、平均X光牙周附連
喪失量與磨損時間、性別的關係 ………………………… 26
第三節 牙根形態的分佈與性別上的差異 ………………………… 28
第四節 平均咬合磨損量與平均X光牙周附連喪失量的關係 ……… 29
第五節 平均X光牙周附連喪失量、根叉病變程度與牙根外形的關係 29
第六節 平均X光牙周附連喪失量、根叉病變程度與牙根主幹形態
的關係 ……………………………………………………… 30
第七節 X光牙周附連喪失量、平均X光牙周附連喪失量與咀嚼
習慣的關係 …………………………………………… 31
第八節 吸菸與否對於RAL、RAL/AD的影響 ………………… 35
第五章 討 論 …………………………………………………………… 36
第一節 關於再現性檢驗 ……………………………………… 36
第二節 關於數位放射線影像分析法 ………………………… 36
第三節 咬合磨損面積、RAL、RAL∕AD與磨損時間、性別的關係 41
第四節 牙根形態的分佈與性別的關係 ……………………… 42
第五節 平均咬合磨損量與平均X光牙周附著喪失量的關係 ………… 43
六節 平均X光牙周附著喪失量、根叉病變程度與牙根外形的關係 44
第七節 平均X光牙周附著喪失量及根叉病變程度與牙根主幹
形態的關係 ……………………………………………… 45
第八節 咀嚼習慣對於X光牙周附著喪失量、平均X光牙周附著
喪失量的影響 ………………………………………… 45
第九節 吸菸與否對於RAL、RAL/AD的影響 ………………… 46
第六章 結 論 …………………………………………………………… 49
參考文獻 …………………………………………………………………… 51
附 錄 ………………………………………………………………………… 57

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