臺灣博碩士論文加值系統

實驗目的:
本研究目的在了解咬合箔膜(Bausch arti-foil BK-25, Germany, 8m)、T-Scan(Tekscan Inc., South Boston, MA, USA)、The Dental Prescale System(DPS, Fuji FilmCo., Tokyo, Japan)三種咬合記錄材在相同的體外模型上咬合呈現結果的差異,以及改變咬合接觸時,觀察其咬合呈現,及了解他們與咬合高度、受力大小、與牙周膜模擬與否之間的相關性。
材料與方法:
以標準齒模中灌入模擬牙周膜的加成性矽膠模擬自然牙之咬合,固定在咬合
器上完成咬合調整至均勻咬合,並以模型掃描機掃描進行數位化建檔(model I),在標準齒模上的上顎左側第一大臼齒的齒位置換預製型支台齒(preformed abutment),同樣模擬牙周膜,注入加成性矽膠模擬自然牙,將支台齒的模型(model II)掃描建檔,製作出齒位 26 的電腦輔助設計/電腦輔助製造(CAD-CAM)純鈦金屬牙冠,設定不同咬合面高度為+40 m、原始高度、-40、-80、-120m 每組各五顆,兩組模型共 50 顆牙冠。以數位化建檔(model III),軟體中比對電腦輔助設計/電腦輔助製造的金屬牙冠咬合面高度(model I & III)。將上下對咬模型以客製化固定器固定於拉力測試機(Instron 5566, Instron Corp., Canton, MA, USA)上,進行 100 牛頓與 200牛頓的垂直受力測試,以模擬口內咬合測量時之受力。測量完自然牙組別後再將支台齒黏著模擬單顆植牙咬合,重複前述步驟進行受力測試。咬合箔膜與 T-scan、DPS 進行觀察分析。以簡單相關與簡單直線回歸分析比較測量之咬點面積、咬力大小在各咬合記錄之中的差異,以及牙冠高度、受力大小、矽膠模擬牙周膜等因素對檢測結果的影響。統計顯著之水準定義為 P<0.05。
結論:
1. 咬合箔膜、T-scan、和 DPS 在同樣咬力和測試環境下呈現出的咬合結果有相關性。
2. 牙冠高度增加對測量咬點的結果有影響,包含增加咬點面積、咬點數量,以及測得咬力增加。
3. 牙周膜存在會讓牙冠高度對受力的影響相關性下降,影響測量結果。

Research goal:
The purpose of this study was to investigate the occlusal contact on the same modelwith three different techniques: articulating foil, T-scan (Tekscan Inc., South Boston, MA,
USA), and the Dental Prescale System (DPS, Fuji Film Co., Tokyo, Japan). In addition,the study also explored the relationship between the occlusal contact and other factors,
including occlusal height, applied force, and periodontal ligament simulation.
Material and Methods:
Periodontal ligament simulation was done by adding additional silicone in the
standardized typodont model. After mounting on the articulator, occlusal adjustment to
even contact was done by articulating foil. Model scanning (model I) was then performed
with lab scanner (3Shape D800 lab scanner). Tooth 26 was changed to preformed
prepared abutment also with PDL simulation, and then model was scanning was done
again (model II) to fabricate CAD-CAM titanium crown on the tooth 26. This study used
model I as CAD model, and the metal crowns were fabricated with different levels of
occlusal crown height, such as initial height+40m, initial height, -40m, -80m, and -
120m. Each group contained 5 crowns. Two sets of models were established, with 50
crowns in total. The model with metal crown was then also scanned (model III). Model I
& model II were imported into the software (Geomagic Control X) and superimposed
through best fit algorithm, for analyzing the differences among crown height. Typodont
model was fixed on the universal testing machine (Instron 5566, Instron Corp., Canton,
MA, USA) via a customized fixator, and vertically loaded as a compression mode to 100N
or 200N, simulating the occlusal force intraorally. After testing the nature teeth group,
abutment of tooth 26 was cemented with dual-cured resin cement for implant condition simulation. the previous steps of compressive testing were then performed again.Observation of the occlusal of articulating foil, T-scan, DPS was done. Statistical analyseswere performed with descriptive statistics and linear regression, for understanding theinfluence of crown height, applied force, with/without PDL simulation to the results incontact area, contact force and the presented occlusion. (P<0.05)
Conclusions:
1. The presented occlusion by articulating foil, T-scan, and DPS under the same occlusal condition had correlation.
2. Increased crown height had an influence on occlusal contact measurement, including increased contact area, amount of contact point, and measured force.
3. The existence of PDL simulation would lessen the influence of crown height to applied force, leading to non-significant results.

CONTENTS

口試委員會審定書 #
誌謝 2
中文摘要 3
ABSTRACT 6
CONTENTS 9
Chapter 1 緒論 17
1.1 引言 17
1.2 文獻回顧 18
1.2.1 咬合指示工具/咬合記錄材(Occlusal indicator) 18
1.2.2 定性咬合記錄材的選擇(Selection of the qualitative indicators) 26
1.2.3 定量型咬合記錄材(Quantitative indicators) 26
1.2.4 統整比較表格 32
Chapter 2 研究目的 33
Chapter 3 材料與方法 34
3.1 研究假說 33
3.2 測試工具 34
3.2.1 咬合箔膜 34
3.2.2 The Dental Prescale System(DPS, Fuji Film Co., Tokyo, Japan) 34
3.2.3 T-Scan III computerized occlusal analysis system (Tekscan Inc., South Boston, MA, USA) 34
3.3 模擬自然齒列之模型與數位化建檔 34
3.4 支台齒(abutment) 26 之模型與數位化建檔 35
3.5 補綴物的製作 35
3.5.1 牙冠高度改變之受測齒位選擇 35
3.5.2 電腦輔助設計/電腦輔助製造(CAD-CAM)之全金屬牙冠製作 35
3.6 實驗模型製備 36
3.6.1 模擬自然牙26與金屬牙冠之模型製備 39
3.6.2 模擬植體26與金屬牙冠之模型製備 40
3.7 模型轉移、動態施力機設定 40
3.7.1 夾具固定與模型轉移 40
3.7.2 施力點的選擇及施力機設定 41
3.8 前導實驗 36
3.9 測試順序 41
3.9.1 實驗模型取得 41
3.9.2 數位檔建立與分組 42
3.9.3 受測步驟 42
3.10 觀察分析 42
3.10.1 咬合箔膜咬點記錄 42
3.10.2 T-scan咬點與相對咬力記錄 43
3.10.3 DPS咬點與咬力記錄 43
3.11 統計分析 43
Chapter 4 實驗結果 44
4.1 前導實驗結果 37
4.1.1 軟體疊合與模型掃描機誤差 37
4.1.2 小範圍疊圖的準確性 37
4.1.3 鈦金屬牙冠咬合面高度誤差 38
4.1.4 設計檔(model I) 與電腦設計(CAD)牙冠外型數位影像疊合確認 39
4.2 觀察分析 44
4.2.1 咬合箔膜咬點面積分布分析 44
4.2.2 咬合箔膜與T-scan分佈相關性分析(Fig.22 & Fig.25) 44
4.2.3 咬合箔膜與DPS分佈相關性分析(Fig.23 & Fig.26) 44
4.2.4 T-scan上受牙冠高度影響產生的受力時序性變化 45
4.3 量化統計分析 45
4.3.1 咬合箔膜咬點面積 45
4.3.2 DPS 齒位26之面積(ImageJ計算 & DPS內建計算) 46
4.3.3 齒位26之DPS受力 46
4.3.4 齒位26之DPS平均壓力 47
4.3.5 齒位26之最大壓力 47
4.3.6 DPS 全牙弓的(full arch)受力 vs牙冠高度 48
4.3.7 DPS 全牙弓的(full arch)面積 vs牙冠高度 48
4.3.8 DPS 全牙弓的(full arch)受力與實際受力值比較 48
Chapter 5 討論 50
5.1 實驗設計與模型、牙冠製作、實驗的誤差與限制 50
5.1.1 牙周膜模擬(PDL simulation) 50
5.1.2 模型、夾具與牙冠設計及其限制 50
5.2 施力方式之選擇 51
5.3 咬合記錄材特性與其限制 52
5.4 影響掃瞄準確度的因素 52
5.5 結果分析 53
5.5.1 咬合箔膜咬點面積 53
5.5.2 DPS 齒位26之面積(ImageJ計算 & DPS內建計算) 53
5.5.3 齒位26之DPS受力 54
5.5.4 齒位26之DPS平均壓力與最大壓力、全牙弓的(full arch)受力與面積 54
5.5.5 T-scan與咬合箔膜之觀察分析 55
Chapter 6 總結 56
Chapter 7 實驗設計之限制與未來展望 57
參考文獻 122

1. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clin Oral Implants Res. 2005;16:26-35
2. Schulte W. Implants and the periodontium. Int Dent J. 1995;45:16-26.
3. Gronas DG. A carborundum stripping technique for the occlusal adjustment of cuspless teeth. J Prosthet Dent 1970;23:218-226
4. Kerstein RB, Radke J. Clinician accuracy when subjectively interpreting articulating paper markings. Cranio. 2014;32:13-23.
5. Babu RR, Nayar SV. Occlusion indicators: A review. J Indian Prosthodont Soc. 2007; 7:170-4.
6. Malone WFP, Koth DL. Tylman’s theory and practice of fixed prosthodontics (8th ed.). St. Louis, MO: Ishiyaku. EuroAmerica. 1989
7. Brizuela-Velasco A, Álvarez-Arenal Á, Ellakuria-Echevarria J, del Río-Highsmith J, Santamaría-Arrieta G, Martín-Blanco N. Influence of articulating paper thickness on occlusal contacts registration: a preliminary report. Int J Prosthodont. 2015
8. Saad MN, Weiner G, Ehrenberg D, Weiner S. Effects of load and indicator type upon occlusal contact markings. J Biomed Mater Res B Appl Biomater, 2008;85:18–22.
9. Dawson PE. Functional occlusion: from TMJ to smile design. St. Louis, MO: CV Mosby. 2007
10. Qadeer S, Kerstein RB, Yung-Kim RJ, Huh JB, Shin SW. Relationship between articulation paper mark size and percentage of force measured with computerized occlusal analysis. J Adv Prosthodont. 2012;4:7–12.
11. Carey JP, Craig M, Kerstein RB, Radke J. Determining a relationship between applied occlusal load and articulation paper mark area. Open Dent J. 2007;1:1–7.
12. Millstein P, Maya A. An evaluation of occlusal contact marking indicators. J Am Dent Assoc. 2001;132:1280–86.
13. Zuccari AG, Oshida Y, Okamura M, Paez CY, Moore BK. Bulge ductility of several occlusal contact measuring paper based and plastic-based sheets. Biomed Mater Eng. 1997;7:265-70.;28:360-2.
14. Anderson GC, Schulte JK, Aeppli DM. Reliability of the evaluation of occlusal contacts in the intercuspal position. J Prosthet Dent. 1993;70:320-3.
15. Panigrahi D, Satpathy A, Patil A, Patel G. Occlusion and occlusal indicating materials. Int. J. Appl. Dent. Sci.. 2015;1,23-26.
16. Reiber T, Fuhr K, Hartmann H, Leicher D. Recording pattern of occlusal indicators. I. Influence of indicator thickness, pressure, and surface morphology. Dtsch Zahnarztl Z. 1989;44:90-3.
17. Schelb E, Kaiser DA, Brukl CE. Thickness and marking characteristics of occlusal registration strips. J Prosthet Dent. 1985;54:122–26.
18. Harper KA, Setchell DJ. The use of shimstock to assess occlusal contacts: a laboratory study. Int J Prosthodont. 2002;15:347-52.
19. Toledo MF, Jóias RP, Marques-Iasi YS, Neves AC, Rode Sde M. Thickness and marking quality of different occlusal contact registration strips. J Appl Oral Sci. 2014;22:516-21.
20. Tejo SK, Kumar AG, Kattimani VS, Desai PD, Nalla S, Chaitanya K K. A comparative evaluation of dimensional stability of three types of interocclusal recording materials-an in-vitro multi-centre study. Head Face Med. 2012;8:27.
21. Millstein PL, Clark RE, Myerson RL. Differential accuracy of silicone-body interocclusal records and associated weight loss due to volatiles. J Prosthet Dent. 1975;33:649-54.
22. Rapuano JA, Vinton PW. Recording centric relation with an interocclusal wax check bite registration. J Acad Gen Dent. 1971;19:24-9.
23. Delong R, Ko CC, Anderson GC, Hodges JS, Douglas WH. Comparing maximum intercuspal contacts of virtual dental patients and mounted dental casts. J Prosthet Dent. 2002;88:622-30.
24. Ehrlich J, Taicher S. Intercuspal contacts of the natural dentition in centric occlusion. J Prosthet Dent. 1981;45:419-21.
25. Millstein PL. An evaluation of occlusal wax indicators. J Prosthet Dent.1985;53, 570–73.
26. Millstein PL, Clark RE, Kronman JH. Determination of the accuracy of wax interocclusal registration Part II. J Prosthet Dent 1973;29:40-45.
27. Gazit E, Fitzig S, Lieberman MA. Reproducibility of occlusal marking techniques; J Prosthet Dent. 1986; 55:505-09.
28. Davies S, Al-Ani Z, Jeremiah H, Winston D, Smith P. Reliability of recording static and dynamic occlusal contact marks using transparent acetate sheet. J Prosthet Dent 2005;94:458-461.
29. Babu RR, Nayar SV; Occlusion indicators: A review: J Ind Prosthodont Soc 2007;7:170-174
30. Sharma A, Rahul GR, Poduval ST, Shetty K, Gupta B Rajora V. History of materials used for recording static and dynamic occlusal contact marks: a literature review. J Clin Exp Dent 2013;5:48-53
31. Ingervall B. Tooth contacts on the functional and nonfunctional side in children and young adults. Arch. Oral Biol.. 1972;17:191-200.
32. Eames WB, Wallace SW, Suway NB, Rogers LB. Accuracy and dimensional stability of elastomeric impression materials. J Prosthet Dent. 1979;42:159-62.
33. Baba K, Tsukiyama Y, Clark GT. Reliability, validity, and utility of various occlusal measurement methods and technique. J Prosthet Dent. 2000;83:83-89
34. Ziebert GJ, Donegan SJ. Tooth contacts and stability before and after occlusal adjustment. J Prosthet Dent. 1979;42:276-281.
35. Kerstein RB, Grundset K. Obtaining measurable bilateral simultaneous occlusal contacts with computer analyzed and guided occlusal adjustments. Quintessence Int 2001;32:7-8.
36. Somkuwar K. A descriptive quantitative computerized occlusal analysis system: T scan. Int J Adv Res. 2015;3:508-513.
37. Maness WL, Benjamin M, Podoloff R, Bobick A, Golden RF. Computerised occlusal analysis: A new technology. Quintessence Int 1987;18:287-292.
38. Brawley RE, Sedwink HJ. Gnathodynamometer. Am J Orthod. 1938;24:256–58.
39. Howell AH, Manly RS. An electronic strain gauge for measuring oral forces. J. Dent. Res. 1948;27:705–12.
40. Andrew LB, Aero B. Margins of safety for forces on the human dentition. The J Prosthet Dent. 1967;18:261–66.
41. Sandberg CL, Yules RB. The bite-ometer. Arch Otolaryngol. 1969;89:682-4.
42. Kerstein, RB. Time-sequencing and force-mapping with integrated electromyography to measure occlusal parameters. In A. Daskalaki (Ed.), Informatics in Oral Medicine. 2010;88-110.
43. Watt DM. Recording the sounds of tooth contact: a diagnostic technique for evaluation of occlusal disturbances. Int Dent J. 1969;19:221-38.
44. Kifune R, Honma S, Hara K. The development of a new occlusal sound checker. Nihon Shishubyo Gakkai Kaishi. 1985;27:482-91.
45. Mir SN, Choudhary A, Jagadeesh HG. Occlusal indicators – chasing blue marks? a review. TMU J. Dent.2014;1:92-95.
46. Qadeer S. Limitations of traditional non-digital occlusal indicators when compared to T-Scan computerized occlusal analysis. In: Handbook of Research: Computerized Occlusal Analysis Technology Applications in Dental Medicine, Ed. RB Kerstein, Chapter 2, Vol.1, IGI Global, USA.
47. Kerstein RB, Lowe M, Harty M, Radke J. A Force reproduction analysis of two recording sensors of a computerized occlusal analysis system. Cranio. 2006;24:15-24.
48. Thumati P. Digital analysis of occlusion using T-Scan III in orthodontics. J Indian Orthod Soc. 2016;50:196-201. 49. Trpevska V, Kovacevska G, Benedeti A, Jordanov B.T-Scan III system diagnostic tool for digital occlusal analysis in orthodontics – a modern approach. Contributions. Sec. Med. Sci. 2014;35:155-160.
50. Koos B, Godt A, Schille C, Göz G. Precision of an instrumentation-based method of analyzing occlusion and its resulting distribution of forces in the dental arch. J Orofac Orthop. 2010;71:403-10.
51. Reza Moini M, Neff PA. Reproducibility of occlusal contacts utilizing a computerized instrument. Quintessence Int. 1991;22:357-360
52. Garrido Garcia VC, Garcia Cartagena A, Gonzalez Sequeros O. Evaluation of occlusal contacts in maximum intercuspation using the T-scan system; J Oral Rehabil 1997;24:899-903.
53. Lyons MF, Sharkey SW, Lamey P-J. An evaluation of the T-Scan computerized occlusal analysis system. Int J Prosthodont. 1991;5:166–72.
54. Kumagai H, Suzuki T, Hamada T, Sondang P, Fujitani M, Nikawa H. Occlusal force distribution on the dental arch during various levels of clenching. J Oral Rehabil. 1999;26:932–35.
55. Misirlioglu M, Nalcaci R, Baran I, Adisen MZ, Yilmaz S. A possible association of idiopathic osteosclerosis with excessive occlusal forces. Quintessence Int. 2014;45:251–8.
56. Kwak YY, Jang I, Choi DS, Cha BK. Functional evaluation of orthopedic and orthodontic treatment in a patient with unilateral posterior crossbite and facial asymmetry. Korean J Orthod. 2014;44:143–53.
57. Hsu M, Palla S, Gallo LM. Sensitivity and reliability of the T-scan system for occlusal analysis. J Craniomandib Disord Facial Oral Pain. 1992;6:17-23.
58. Koos B, Höller J, Schille C, Godt A. Time-dependent analysis and representation of force distribution and occlusion contact in the masticatory cycle. J Orofac Orthop. 2012;73:204-14.
59. da Silva Martins MJ, Caramelo FJ, da Fonseca JAR, Nicolau PMG. In vitro study on the sensibility and reproducibility of the new t-scan® III HD system. RPEMDCM 2014, 55:14–22.
60. Kon K, Shiota M, Sakuyama A, Ozeki M, Kozuma W, Kawakami S, et al. Evaluation of the Alteration of Occlusal Distribution in Unilateral Free-End and Intermediate Missing Cases. J Oral Implantol. 2017;43:3-7.
61. Hidaka O, Iwasaki M, Saito M, Morimoto T. Influence of clenching intensity on bite force balance, occlusal contact area, and average bite pressure. J Dent Res. 1999;78:1336-44.
62. Alkan A, Keskiner I, Arici S, Sato S. The effect of periodontal surgery on bite force, occlusal contact area and bite pressure. J Am Dent Assoc. 2006;137:978-83.
63. Moroi A, Ishihara Y, Sotobori M, Iguchi R et al. Changes in occlusal function after orthognathic surgery in mandibular prognathism with and without asymmetry. Int J Oral Maxillofac Surg. 2015;44:971-6.
64. Goto TK, Yamada T, Yoshiura K. Occlusal pressure, contact area, force and the correlation with the morphology of the jaw-closing muscles in patients with skeletal mandibular asymmetry. J Oral Rehab. 2008;35:594–603.
65. Asami T, Ishizaki A, Ogawa A, Kwon H, Kasama K, Tanaka A, Hronaka S. Analysis of factors related to tongue pressure during childhood. Dent Oral Craniofacial Res. 2017;3
66. Sirimai S, Riis DN, Morgano SM. An in vitro study of the fracture resistance and the incidence of vertical root fracture of pulpless teeth restored with six post-and-core systems. J Prosthet Dent 1999;81:262-9.
67. Soares CJ, Martins LR, Pfeifer JM, Giannini M. Fracture resistance of teeth restored with indirect-composite and ceramic inlay systems. Quintessence Int 2004;35:281-6.
68. Brosh TNP, Vardimon AD, Pilo R. Appropriateness of viscoelastic soft materials as in vitro simulators of the periodontal ligament. J Oral Rehabil. 2011;38:929-39
69. Soares CJ, Pizi ECG, Fonseca RB, et al. Influence of root embedment material and periodontal ligament simulation on fracture resistance tests. Braz Oral Res. 2005;19:11–6.
70. Yoshida N, Koga Y, Peng CL, Tanaka E, Kobayashi K. In vivo measurement of the elastic modulus of the human periodontal ligament. Med Eng Phys. 2001;23:567–72.
71. Anderson DJ. Measurement of stress in mastication. Part I. J Dent Res. 1956;35:664–70
72. Li H, Lyu P, Wang Y, Sun Y. Influence of object translucency on the scanning accuracy of a powder-free intraoral scanner: A laboratory study. J Prosthet Dent. 2017;117:93-101.
73. Soares CJ, Pizi EC, Fonseca RB, Martins LR. Influence of root embedment material and periodontal ligament simulation on fracture resistance tests. Braz Oral Res 2005;19:11-6
74. Schuyler CH, Fundamental principles in the correction of occlusal disharmony, natural, and artificial. J Am Dent Assoc. 1935;22:1193.
75. Stern K, Kordaß B, Comparison of the Greifswald Digital Analyzing System with the T-Scan III with respect to clinical reproducibility for displaying occlusal contacts. J CranioMand Func. 2010;2:107-19.