臺灣博碩士論文加值系統

摘要
以往有關牙周病的文獻資料多侷限於各種牙周疾病的臨床牙周探測深度及臨床牙周附著水平的測量。關於比較國人侵犯性牙周炎患者(Aggressive periodontitis; AGP)齒槽破壞的程度，速率以及牙齒喪失率的評估，資料有限。有鑿於國人罹患牙周炎的年齡有逐年下降的趨勢，故本研究之目的在於測量評估美國牙周病學會(AAP)於1999年新分類出的侵犯性牙周炎患者(AGP)的X光齒槽骨喪失量及牙齒喪失率，並比較侵犯性牙周病（AGP）患者之X光齒槽骨累積喪失量(Cumulative alveolar bone loss rate ; CRABL)，年平均齒槽骨喪失量(Yearly radiographic alveolar bone loss rate ; YRABL)，與牙齒喪失率(Tooth loss rate ; TLR)與其他患者的差異。本研究之對象為在高醫牙周病科接受檢查治療的病人，從中篩選出60名AGP患者及10名健康成人做測量評估。收集研究對象全口X光片及基本資料，以牙周測微計分析(DEC)，分別計算牙齒之近心側與遠心側牙秞質牙骨質交界至齒槽骨高度的距離，並計算其與牙齒行使功能時間之比例，以及牙齒喪失數。
研究結果顯示：年齡(P<0.0001)，性別(P<0.0235)，疾病分類(P<0.0001)，及缺牙率(P<0.0001)均與X光齒槽骨累積喪失量有顯著相關。年平均齒槽骨喪失量有顯著相關的只有年齡及疾病分類兩因素(P<0.0001，P<0.0007)。年齡(P<0.0023)，疾病分類(P=0.0218)亦與缺牙率有顯著相關。隨年齡上升，缺牙率隨之上升。全面型牙周炎組的缺牙率約為健康成人組的20倍，而局部型牙周炎組約為健康成人組的5倍。X光齒槽骨累積喪失量隨著年齡增加而增加，且全面型牙周炎組較LAGP組嚴重。男性亦較女性來的嚴重。年平均齒槽骨喪失量隨著年齡增加而下降，且全面型牙周炎及局部型牙周炎組的年平均齒槽骨喪失量約為健康成人組的2~3倍。缺牙率高低順序為第一大臼齒>第二大臼齒>小臼齒>門齒>犬齒。侵犯型牙周炎組之X光齒槽骨累積喪失量、年平均齒槽骨喪失量百分 及年平均齒槽骨喪失量平均值最大(59.85%；2.24%；0.34mm)，局部侵犯型牙周炎組次之(41.3%；1.97%；0.3mm)，健康成人組最低(9.96%；0.08%；0.176mm)。
國內有關侵犯型牙周炎的齒槽骨破壞量與缺牙率的報告資料有限。因此，本研究可提供國人有關侵犯型牙周炎的齒槽骨破壞及性別，年齡，疾病分類及缺牙數互相關係的參考資料，有助於侵犯型牙周炎長期預後之診斷。

Abstract
In the past, most of the literatures relating to periodontitis are centered n measuring clinic periodontal periodontal probing depth and clinic periodontal attachment loss of the various periodontal diseases. The researches on the level and the rate of alveolar bone fracture, as well as the tooth loss rate of the aggressive periodontitis on natives are limited. As there is a trend that the natives who suffer from peiodontitis are gradually getting younger, the purpose of this research is aimed on the measurement and estimation of the X-ray cumulative alveolar bone loss and the tooth loss rate of the aggressive periodontitis (AGP) which were newly classified from AAP in 1999. Furthermore, from this study, the differences on the cumulative radiographic alveolar bone loss (CRABL), yearly radiographic alveolar bone loss (YRABL) and tooth loss rate (TLR) between AGP and other patients can also be compared and revealed.
The samples of this research were taken from the patients who received treatments in Kaohsiung Medical University. Sixty AGE patients and ten health adult patients were taken as samples for the study. The full mouth X-ray film and basic data of the samples were collected for calculating the distance between CEJ to the top of alveolar bone from the mesial side and distal side of the tooth and TLR respectively by DEC.
The results of this research are listed below:
Age (P<0.0001), sex (P<0.0235), Disease Classification (P<0.0001), and Tooth Loss Rate (P<0.0001) have remarkable correction with CRABL %.Only the factors of Age and Disease Classification have notable links with YRABL%.Age (P<0.0023), and Disease Classification (P=0.0218) also have distinguished correlations with tooth loss rate. As the age increases, the tooth loss rate increases. The tooth loss rate of the AGP group is twenty times more than the healthy adult group is about five times more than the health adult group.CRABL % increases along with the age. The CRABL % of the AGP group is more critical than LAGP group and the male group is also more serious than the female group.YRABL % decreases along with the age. The YRABL % of AGP group and LAGP group is about 2~3 times than the healthy adult group.The highest tooth loss rate is the molar, followed by the second molar, premolar, incisor and then the canine.The highest average of CRABL % and YRABL % is the Aggressive Periodontitis Group (59.85%;2.24%), followed by the Localized Aggressive Periodontitis Group (41.3%;1.97%), and finally the Healthy Adult Group (9.96%;0.08%).

目錄
第一章 緒論 1
研究背景 1
研究目的 3
第二章 文獻探討 5
慢性牙周炎與侵犯性牙周炎之分類比較 5
齒槽骨破壞機制 8
牙周評估方式 9
侵犯型牙周炎齒槽骨破壞及牙齒喪失之相關研究 14
第一節 侵犯型牙周炎患者之X光齒槽骨破壞 14
第二節 侵犯型牙周炎與慢性牙周炎及牙周健康者之牙齒喪失比較 17
第三章 材料與方法 23
樣本收集(Sample collection) 23
研究材料與方法(Materials and mechods) 23
研究步驟 24
第一節 X光齒槽喪失(radiographic alveolar bone loss ; RABL)測量 25
第二節 X光齒槽喪失的年平均量(YRABL)的計算 25
第三節 測量值可靠性及再現性檢定 26
資料處理與分析 27
研究限制 28
第四章 研究結果 29
精準度及再現性檢驗 29
齒槽骨破壞量(CRABL%)的評估 30
第一節 侵犯型牙周患者累積齒槽骨破壞量及平均齒槽骨破壞量與年齡、性別、分類、及缺牙率的關係 30
第二節 近心、遠心及累積齒槽骨破壞率及平均齒槽骨破壞量與年齡、性別、分類、及缺牙率的關係 31
第三節 侵犯型牙周炎患者近心，遠心及年平均齒槽骨破壞率與年齡，性別分類，及缺牙數的關係 32
缺牙數的評估 33
第一節 缺牙與年齡，性別及疾病分組的關係 33
累積齒槽骨破壞率量與年齡、疾病分類、缺牙數之間的相互關係(Table 16,17,18,19,20,21) 34
年平均齒槽骨破壞率量與年齡、疾病分類、缺牙數之間 36
的關係(表 22,23,24,25,26,27) 36
牙齒總類分析 37
第五章 討論 39
數位牙周測微計分析法 39
影響齒槽骨破壞率的因素 41
影響缺牙數的因素 44
第六章 結論 47
參考文獻 48
圖目錄
FIG 1:SCHEMATIC DRAWING OF THE REFERENCE POINTS OF MOLAR TEETH CORRELATED WITH THE MEASUREMENT OF RADIOGRAPHIC ALVEOLAR BONE LOSS(RABL) 52
FIG 2:RELATIONSHIP BETWEEN YRABL(%) AND AGE OF SUBJECTS. 88
FIG 3: :RELATIONSHIP BETWEEN YRABL(%) AND SEX OF SUBJECTS. 89
FIG 4:RELATIONSHIP BETWEEN YRABL(%) AND DIFFERENT DISEASE OF SUBJECTS. 91
FIG 5: :RELATIONSHIP BETWEEN MISSING TEETH(%) AND AGE OF SUBJECTS. 92
FIG 6:RELATIONSHIP BETWEEN MISSING TEETH(%) AND SEX OF SUBJECTS. 93
FIG 7:RELATIONSHIP BETWEEN MISSING TEETH(%) AND THE DIFFERENT DISEASE GROUP. 94
表格目錄
TABLE 1:CHRONOLOGY OF HUMAN DENTITION FOR ROOT COMPLETED 53
Table 2 : 精準度檢驗 ………………………………………………………..54
TABLE 3-1: DESCRIPTION OF THE TOTAL SAMPLES(N=70) 55
TABLE 3-2: DESCRIPTION OF THE AGGRESSIVE PERIODONTITIS (N=60) 56
TABLE 3-3: PREVALENCE OF AGGRESSIVE PERIODONTITIS FOR DISTAL, MESIAL AND CUMULATIVE RADIOGRAPHIC ALVEOLAR BONE LOSS IN EVERY ITEM. 57
TABLE 3-4: PREVALENCE OF AGGRESSIVE PERIODONTITIS FOR DISTAL, MESIAL AND YEARLY RADIOGRAPHIC ALVEOLAR BONE LOSS IN EVERY ITEM. 58
TABLE 3-5: PREVALENCE OF MISSING TEETH FOR TOTAL SAMPLES IN EVERY ITEM. 59
TABLE 4-1: MULTI-WAY ANOVA FOR DISTAL CRABL, MESIAL CRABL AND CRABL LOSS. 60
TABLE 4-2: MULTI-WAY ANOVA FOR DISTAL YRABL, MESIAL YRABL AND YRABL (YEARLY RADIOGRAPHIC ALVEOLAR BONE LOSS). 61
TABLE 4-3: MULTI-WAY ANOVA FOR MISSING TEETH. 62
TABLE 5:COMPARISON OF THE MEAN NUMBER OF DISTAL CRABL , MESIAL CRABL AND CRABL IN THE AGE GROUPS 63
TABLE 6:COMPARISON OF THE MEAN NUMBER OF DISTAL CRABL , MESIAL CRABL AND CRABL IN THE SEX GROUPS 64
TABLE 7:COMPARISON OF THE MEAN NUMBER OF DISTAL CRABL , MESIAL CRABL AND CRABL IN THE PERIODONTAL DISEASE GROUPS 65
TABLE 8:COMPARISON OF THE MEAN NUMBER OF DISTAL CRABL , MESIAL CRABL AND CRABL IN THE MISSING TEETH GROUPS 66
TABLE 9:COMPARISON OF THE MEAN NUMBER OF DISTAL YRABL , MESIAL YRABL AND YRABL IN THE AGE GROUPS 67
TABLE 10:COMPARISON OF THE MEAN NUMBER OF DISTAL YRABL , MESIAL YRABL AND YRABL IN THE SEX GROUPS 68
TABLE 11COMPARISON OF THE MEAN NUMBER OF DISTAL YRABL , MESIAL YRABL AND YRABL IN THE PERIODONTAL DISEASE GROUPS 69
TABLE 12: COMPARISON OF THE MEAN NUMBER OF DISTAL YRABL , MESIAL YRABL AND YRABL IN THE MISSING TEETH GROUPS 70
TABLE 13: COMPARISON OF THE MEAN NUMBER OF MISSING TEETH IN THE AGE GROUPS 71
TABLE 14: COMPARISON OF THE MEAN NUMBER OF MISSING TEETH IN THE SEX GROUPS 72
TABLE 15:COMPARISON OF THE MEAN NUMBER OF MISSING TEETH IN THE PERIODONTAL DISEASE GROUPS 73
TABLE 16:COMPARISON OF THE MEAN NUMBER OF CRABL BETWEEN FEMALE AND MALE IN THE AGE GROUPS 74
TABLE 17:COMPARISON OF THE MEAN NUMBER OF CRABL BETWEEN FEMALE AND MALE IN THE DISEASE GROUPS 75
TABLE 18:COMPARISON OF THE MEAN NUMBER OF CRABL BETWEEN FEMALE AND MALE IN THE MISSING TEETH GROUPS 76
TABLE 19:COMPARISON OF THE MEAN NUMBER OF CRABL BETWEEN AGP AND LAGP IN THE AGE GROUPS 77
TABLE 20: COMPARISON OF THE MEAN NUMBER OF CRABL BETWEEN AGP AND LAGP IN THE MISSING TEETH GROUPS 78
TABLE 21:COMPARISON OF THE MEAN NUMBER OF CRABL IN THE AGE GROUP BY MISSING TEETH GROUPS 79
TABLE 22: COMPARISON OF THE MEAN NUMBER OF YRABL BETWEEN FEMALE AND MALE IN THE AGE GROUPS 80
TABLE 23:COMPARISON OF THE MEAN NUMBER OF YRABL BETWEEN FEMALE AND MALE IN THE DISEASE GROUPS 81
TABLE 24:COMPARISON OF THE MEAN NUMBER OF YRABL BETWEEN FEMALE AND MALE IN THE MISSING TEETH GROUPS 82
TABLE 25:COMPARISON OF THE MEAN NUMBER OF YRABL BETWEEN AGP AND LAGP IN THE AGE GROUPS 83
TABLE 26: COMPARISON OF THE MEAN NUMBER OF YRABL BETWEEN AGP AND LAGP IN THE MISSING TEETH GROUPS 84
TABLE 27:COMPARISON OF THE MEAN NUMBER OF YRABL IN THE AGE GROUP BY MISSING TEETH GROUPS 85
TABLE 28: MISS TEETH RATIO IN ALL TEETH 86
TABLE 29: YRABL% IN ALL TEETH 87

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