臺灣博碩士論文加值系統

研究目的︰
修復體的邊緣與內部密合度是最常被用來評估牙科修復體的指標。多數的CAD/CAM系統採用間接法取得口腔內資料，本實驗比較修復體咬合面高度變化、邊緣及內部密合度，評估直接與間接掃描模式對於CAD/CAM修復體的精確性的影響。

材料與方法︰
以金屬支台齒﹙048.160 ,ITI System; Straumann）取代牙齒25，分別利用Cerec 3D、Cerec inLab、Procera三個系統進行修復體設計。Cerec 3D以口內攝影機搭配感光粉末紀錄支台齒資料，Cerec inLab與Procera分別使用雷射掃描及機械式接觸掃描紀錄工作模型。Cerec 3D及Cerec inLab兩組使用材料是VITA MARK II，Procera則是氧化鋯。每組樣本數為5個，直接製成單顆牙冠不再進行後續處理以避免變形。試戴確定無干擾後將樣本定位回標準模型，利用三維立體測量儀量測咬合面座標，並標記切割線位置。樣本以磷酸鋅黏著劑固定，給予50穩定牛頓壓力直到固化完全，再以樹脂包埋進行多重切割，直接觀測內部及邊緣密合度（100X）。分別對咬合面高度變化、邊緣密合度、內部密合度設定統計模組，並將各因子之間交互作用併入模組﹙α=0.05﹚。樣本數若有未達常態分布或未能滿足中央極限定理的項目，則以無母數統計加以分析﹙α=0.05﹚。

結果︰
邊緣密合度平均為114.3±26.83μm，在不同面之間無差異性，Cerec 3D組顯著較大；內部密合度平均為123.2±35.93μm，其中Cerec 3D與Cerec inLab無差異性而Procera顯著較小，在不同面、高度與CAD/CAM系統間其內部密合度均有差異性。咬合面高度變化平均為112.0±110.25μm，在Procera與Cerec inLab無差異性而Cerec 3D顯著較大，在不同CAD/CAM系統、位置其咬合面高度變化均有差異性。

結論︰
直接掃描模式提供了臨床使用上的便利性，然而在本次實驗設定的條件下，其修復體精確性仍不及間接法。

Objective:
Internal and marginal fitness are the most commonly used parameters in measuring dental restorations. The majority of current CAD/CAM systems use indirect method to obtain intra-oral information. Change of occlusal height, marginal and internal fitness were used in this study to evaluate the influences of direct and indirect digital techniques for CAD/CAM restorations..

Materials & methods:
Implant analog (048.160, ITI System; Straumann) was used to replace the teeth 25. Three CAD/CAM systems, Cerec 3D, Cerec inLab and Procera systems were used in this study. For Cerec 3D system, intra-oral camera combined with anti-reflecting powder was used to collect abutment information; Cerec inLab and Procera use laser scan and mechanical contact digitalization respectively. VITA MARK II blocks were used for Cerec inLab and Cerec 3D systems while zirconia was used in procera. Each sample was made directly into the form of a single crown,five samples for each group. No post-treatments were made in order to avoid further deformities. All samples were fit back to the standard model to insure no interference present. 3D coordinate measuring machine was used to measure changes of occlusal surface and mark the location of cutting lines. Samples were set with zinc phosphate cement. Continuously static pressure of 50 Newton was applied until cement completely set. Multiple cutting methods were used to observe the internal and marginal fitness. Interactions between multiple factors, including marginal and internal fitness, different CAD/CAM systems, surfaces were incorporated into the statistical module settings (α = 0.05). If the sample size of statistic models cannot reach normal distribution and Central Limit Theorem, nonparametric statistics（Kruskal-Wallis/ Wilcoxon Rank Sum / Signed Rank Test） were used to analyze the data（α＝0.05）.

Results:
Mean marginal fitness was 114.3 ± 26.83μm, no difference between surfaces. Cerec 3D group was significantly larger while Cerec inLab and Procera did not difference from each other. Mean internal fitness was 123.2 ± 35.93μm, no difference between Cerec 3D and Cerec inLab groups. Internal fitness was significantly different between surfaces, height and CAD/CAM systems. Change in occlusal height had an average of 112.0 ± 110.25μm, Procera and Cerec inLab did not differ from each other and Cerec 3D group was significantly larger. Change in occlusal height was significantly different between occlusal measuring points and CAD/CAM systems.

Conclusion:
Direct digitalization technique simplified clinical procedures while, less accuracy and precision for direct method comparing with indirect digitalization method was noticed under our experimental limitation

中文摘要..............................I
Abstract..............................III
第一章................................1
第一節研究背景........................1
第一節研究背景........................4
第二節研究目的........................5
第二章文獻回顧........................5
第一節 Cerec、Procera系統的相關研究...5
第二節精準度的相關研究................10
第三節 材料的相關研究.................16
第三章材料與方法......................20
第一節實驗材料........................20
第二節實驗流程........................22
第三節統計方法........................27
第四章結果............................28
第五章討論............................31
第一節實驗結果分析....................31
第二節實驗設計探討....................37
第六章結論............................42
參考文獻..............................43
附表..................................50
附圖..................................56

1.Young JM, Altschuler BR. Laser holography in dentistry. Journal of Prosthetic Dentistry. 1977; 38: 216-225.
2.Fransson B, Oilo G, Gjeitanger R. The fit of metal-ceramic crowns, a clinical study. Dental Materials. 1985; 1: 197-199.
3.Yeo IS, Yang JH, Lee JB. In vitro marginal fit of three all-ceramic crown systems. Journal of Prosthetic Dentistry. 2003; 90: 459-464.
4.Conrad HJ, Seong WJ, Pesun IJ. Current ceramic materials and systems with clinical recommendations: a systematic review.. Journal of Prosthetic Dentistry. 2007; 98: 389-404.
5.Olthoff LW, Van Der Zel JM, De Ruiter WJ, Vlaar ST, Bosman F. Computer modeling of occlusal surfaces of posterior teeth with the CICERO CAD/CAM system. Journal of Prosthetic Dentistry. 2000; 84: 154-162.
6.Mörmann WH. The evolution of the CEREC system. Journal of the American Dental Association. 2006; 137 Suppl: 7S-13S.
7.Bindl A, Mörmann WH. Clinical and SEM evaluation of all-ceramic chair-side CAD/CAM-generated partial crowns. European Journal of Oral Sciences. 2003; 111: 163-169.
8.Mou SH, Chai T, Wang JS, Shiau YY. Influence of different convergence angles and tooth preparation heights on the internal adaptation of Cerec crowns. Journal of Prosthetic Dentistry. 2002; 87: 248-255.
9.Nakamura T, Dei N, Kojima T, Wakabayashi K. Marginal and internal fit of Cerec 3 CAD/CAM all-ceramic crowns. International Journal of Prosthodontics. 2003; 16: 244-248.
10.Iwai T, Komine F, Kobayashi K, Saito A, Matsumura H. Influence of convergence angle and cement space on adaptation of zirconium dioxide ceramic copings. Acta Odontologica Scandinavica. 2008; 66: 214-218.
11.Akbar JH, Petrie CS, Walker MP, Williams K, Eick JD. Marginal adaptation of Cerec 3 CAD/CAM composite crowns using two different finish line preparation designs. Journal of Prosthodontics 2006; 15: 155-163.
12.Lee KB, Park CW, Kim KH, Kwon TY. Marginal and internal fit of all-ceramic crowns fabricated with two different CAD/CAM systems. Dental Materials Journal. 2008; 27: 422-426.
13.Bindl A, Mörmann WH. Marginal and internal fit of all-ceramic CAD/CAM crown-copings on chamfer preparations. Journal of Oral Rehabilitation. 2005; 32: 441-447.
14.Reich S, Wichmann M, Nkenke E, Proeschel P. Clinical fit of all-ceramic three-unit fixed partial dentures, generated with three different CAD/CAM systems. European Journal of Oral Sciences. 2005; 113: 174-179.
15.Bindl A, Mörmann WH. Fit of all-ceramic posterior fixed partial denture frameworks in vitro. International Journal of Periodontics & Restorative Dentistry. 2007; 27: 567-575.
16.Bindl A, Richter B, Mörmann WH. Survival of ceramic computer-aided design/manufacturing crowns bonded to preparations with reduced macroretention geometry. International Journal of Prosthodontics. 2005; 18: 219-224.
17.Andersson M, Razzoog ME, Odén A, Hegenbarth EA, Lang BR. Procera: a new way to achieve an all-ceramic crown. Quintessence International. 1998; 29: 285-296.
18.May KB, Russell MM, Razzoog ME, Lang BR. Precision of fit: the Procera AllCeram crown. Journal of Prosthetic Dentistry. 1998; 80: 394-404.
19.Boening KW, Wolf BH, Schmidt AE, Kästner K, Walter MH. Clinical fit of Procera AllCeram crowns. Journal of Prosthetic Dentistry. 2000; 84: 419-424.
20.Denissen H, Dozić A, van der Zel J, van Waas M. Marginal fit and short-term clinical performance of porcelain-veneered CICERO, CEREC, and Procera onlays. Journal of Prosthetic Dentistry. 2000; 84: 506-513.
21.Suárez MJ, González de Villaumbrosia P, Pradíes G, Lozano JF. Comparison of the marginal fit of Procera AllCeram crowns with two finish lines. International Journal of Prosthodontics. 2003; 16: 229-232.
22.Odman P, Andersson B. Procera AllCeram crowns followed for 5 to 10.5 years: a prospective clinical study. International Journal of Prosthodontics. 2001;14: 504–509.
23.Fradeani M, D''Amelio M, Redemagni M, Corrado M. Five-year follow-up with Procera all-ceramic crowns. Quintessence International. 2005; 36: 105-113.
24.Dahlmo KI, Andersson M, Gellerstedt M, Karlsson S. On a new method to assess the accuracy of a CAD program. International Journal of Prosthodontics. 2001; 14: 276-283.
25.Persson AS, Odén A, Andersson M, Sandborgh-Englund G. Digitization of simulated clinical dental impressions: virtual three-dimensional analysis of exactness. Dental Materials. 2009; 25: 929-936.
26.Rudolph H, Luthardt RG, Walter MH. Computer-aided analysis of the influence of digitizing and surfacing on the accuracy in dental CAD/CAM technology. Computers in Biology and Medicine. 2007; 37: 579-587.
27.Luthardt RG, Bornemann G, Lemelson S, Walter MH, Hüls A. An innovative method for evaluation of the 3-D internal fit of CAD/CAM crowns fabricated after direct optical versus indirect laser scan digitizing. International Journal of Prosthodontics. 2004; 17: 680-685.
28.McGarry T, McHugh B. Comparison of the results of four users of a contemporary CAD/CAM system. Prosthetics and Orthotics International. 2007; 31: 27-35.
29.Balkaya MC, Cinar A, Pamuk S. Influence of firing cycles on the margin distortion of 3 all-ceramic crown systems. Journal of Prosthetic Dentistry. 2005; 93: 346-355.
30.Groten M, Axmann D, Pröbster L, Weber H. Weber H. Determination of the minimum number of marginal gap measurements required for practical in-vitro testing. Journal of Prosthetic Dentistry. 2000; 83: 40-49.
31.Rahme HY, Tehini GE, Adib SM, Ardo AS, Rifai KT. In vitro evaluation of the "replica technique" in the measurement of the fit of Procera crowns. The Journal of Contemporary Dental Practice. 2008; 9: 25-32.
32.Gassino G, Barone Monfrin S, Scanu M, Spina G, Preti G. Marginal adaptation of fixed prosthodontics: a new in vitro 360-degree external examination procedure. International Journal of Prosthodontics. 2004; 17: 218-223.
33.Holmes JR, Bayne SC, Holland GA, Sulik WD. Considerations in measurement of marginal fit. Journal of Prosthetic Dentistry. 1989; 62: 405-408.
34.Christel P, Meunier A, Heller M, Torre JP, Peille CN. Mechanical properties and short-term in-vivo evaluation of yttrium-oxide-partially-stabilized zirconia. Journal of Biomedical Materials Research. 1989; 23: 45-61.
35.Guazzato M, Albakry M, Swain MV, Ironside J. Mechanical properties of In-Ceram Alumina and In-Ceram Zirconia. International Journal of Prosthodontics. 2002; 15: 339-346.
36.Raigrodski AJ. Contemporary materials and technologies for all-ceramic fixed partial dentures: a review of the literature. Journal of Prosthetic Dentistry. 2004; 92: 557-562.
37.Beuer F, Schweiger J, Edelhoff D. Digital dentistry: an overview of recent developments for CAD/CAM generated restorations. British Dental Journal. 2008; 204: 505-511.
38.Shearer B, Gough MB, Setchell DJ. Influence of marginal configuration and porcelain addition on the fit of In-Ceram crowns. Biomaterials. 1996; 17: 1891-1895.
39.Edelhoff D, Ozcan M. To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation. Clinical Oral Implants Research. 2007;18 Suppl 3:193-204.
40.Hung SH, Hung KS, Eick JD, Chappell RP. Marginal fit of porcelain-fused-to-metal and two types of ceramic crown. Journal of Prosthetic Dentistry 1990; 63: 26-31.
41.Cruz MA, Sorenson JA, Johnson WK. Effect of venting and seating techniques on the cementation of complete coverage restorations. Operative Dentistry. 2008; 33: 690-695.
42.American Dental Association. ANSI/ADA Specification No. 8 for zinc phosphate cement. In: Guide to dental materials and devices 6th Chicago: American Dental Association; 1972–1973
43.Wilson PR. Crown behaviour during cementation. Journal of Dentistry. 1992; 20: 156-162.
44.Hartung F, Kordass B. Comparison of the contact surface pattern between virtual and milled Cerec 3D full-ceramic crowns. International Journal of Computerized Dentistry 2006; 9: 129-136.
45.Polansky R, Lorenzoni M, Haas M, Wimmer G, Arnetzl G. Functional quality of molar crown occlusal surfaces in the different design modes of Cerec 2. International Journal of Computerized Dentistry. 2003; 6: 151-162.
46.Wiedhahn K. The optical Cerec impression--electronic model production. International Journal of Computerized Dentistry. 1998; 1: 41-54.
47.Mehl A, Ender A, Mörmann W, Attin T. Accuracy testing of a new intraoral 3D camera. International Journal of Computerized Dentistry. 2009; 12: 11-28.
48.Vlaar ST, van der Zel JM. Accuracy of dental digitizers. International Dental Journal. 2006; 56: 301-309.
49.Persson M, Andersson M, Bergman B. The accuracy of a high-precision digitizer for CAD/CAM of crowns. Journal of Prosthetic Dentistry. 1995; 74: 223-229.