臺灣博碩士論文加值系統

當代常用的矯正治療方法可分為：傳統固定式矯正與活動式隱形牙套矯正兩大系統，相較於傳統固定式矯正裝置，目前對於隱形牙套的生物力學研究較少，臨床治療上顯示使用隱形牙套來移動牙齒大部分是做傾斜移動（tipping）為主，然而我們仍希望隱形牙套可以達到牙齒整體性移動（bodily movement），因此，本研究以體外模型，於犬齒已後退至小臼齒拔牙空間情況下，模擬前牙四顆牙齒往後將剩餘拔牙空間關閉之四顆門牙移動之變化，並比較在不同前牙角度下，前牙之移動與電腦規劃之差異。
本研究方法，利用目前用於臨床隱形矯正之透明膜片，對於三種不同門齒角度分別做：（1）Normal組：整體（bodily movement）後縮 （2） Flare組：傾斜移動（tipping）與後縮 （3） Retroclined組：牙根扭轉（root torque）與後縮，透過量測牙冠水平及垂直向的移動量，以及牙齒角度的改變量來做比較。步驟為先於體外設計前牙後縮之齒模、經掃瞄後進行牙齒移動規劃、3D列印序列移動之齒模、以膜片壓印出矯正透明牙套、於體外由前述設計前牙後縮之齒模進行各階段之裝戴膜片，並以數位口掃機掃描各階段之牙齒移動影像、進行計算、分析、比對前牙之移動變化。
研究結果顯示，水平向移動在重複性五次實驗中都有相似的移動趨勢，垂直向與角度則在不同次實驗中出現較大偏差，不同次的實驗偏差與膜片已產生形變有關，移動的可預測性也就降低。各組與原始電腦設計比較可發現，在Normal組出現預期外的舌側傾斜（4.3°）及更多的牙冠後移（127%）；Flared組也是有比預計多的牙冠後移（105%）及舌側傾斜（136%）；Retroclined組也有比預計多的牙冠後移（137%），應做牙根轉矩（4.62°）卻只出現些微牙根轉矩（0.03°）。
結語：利用隱形矯正治療拔牙關閉空間，即案例做門牙後縮在沒有添加其他附件下，原始正常門牙角度的樣本希望達到整體後縮，結果產生的移動是舌側傾斜且水平後縮，比預計還多（127%）；原始門牙角度較外展的樣本希望達到舌側傾斜加上整體後縮，結果是做舌側傾斜運動為主，也有比預計多的牙冠後移（105%）及舌側傾斜（136%）；而原始門牙角度較內縮的樣本希望達到牙根轉矩與後縮，結果發現牙根轉矩量很少，可得知實際上在沒有其他輔助之下牙根轉矩是很難達到的。由本次研究可得知，隱形矯正較難達到牙根轉矩效果，因此需要考慮添加Power Ridge 或是其他附件（attachment），而舌側傾斜與整體移動也未能完全依照電腦設計模擬移動，在臨床上或許還是會有重新口掃設計（refinement）的可能。

The current orthodontic treatment can be performed by two systems: traditional fixed appliance by brackets and aligners. The studies about aligner biomechanics are less than fixed appliance. In the past, aligners mainly movement were tipping. The effect of crown and root to move together is less than ideal. However, some extraction cases need root movement and anterior retraction at the same time.

This study uses three groups with different incisor angle: (1) bodily movement retraction (2) tipping and retraction (3) root torque and retraction compare the anteroposterior and vertical movement of the crown, and root inclination of the central and lateral incisor during the distalized movement of the four incisors after the distalization of the canine to the extraction space.

Use the FORM 2 SLA 3D laser curing printer to print the resin blocks of the bilateral canine, the second premolars, the first molars, and the second molars of the upper jaw. Typodont wax is used for embedding the metal teeth which is the four incisors of the upper jaw. Use the 3Shape Ortho Analyzer to simulate the virtual setup of the incisor retraction with three different angle groups, and then use the FORM 2 SLA 3D laser light curing printer to print out the models. Thermoforming machine produced by BIOSTAR to press the three different groups models using DURAN®T by SCHEU.

We found that in extraction cases, four incisors generally moved follow the virtual setup. In horizontal vector, the crown retracted slightly more than the virtual setup. More crown tipping movement than the virtual setup. The torque is the most difficult movement to achieve.

中文摘要 ii
英文摘要 Abstract iii
誌謝或序言 iv
目錄 v
表目錄 vi
圖目錄 vii
第一章、緒論 1
1.1 隱形矯正的發展 1
1.2 隱形矯正臨床步驟 1
1.3 隱形矯正與傳統矯正之差異 1
1.4 隱形矯正的適應症與拔牙案例之效果 2
1.5 實驗動機與目的 4
第二章、實驗材料與方法 5
2.1 3D列印樹脂塊的製備 5
2.2 實驗組模型及膜片製作 5
2.3 模擬牙齒移動之實驗步驟 6
2.4 前牙移動量之測量 7
2.5 統計分析 7
第三章、結果 8
3.1 Normal組數據趨勢 8
3.2 Flare組數據趨勢 8
3.3 Retroclined組數據趨勢 9
3.4 Normal組與原始電腦設計的比較 9
3.5 Flare組與原始電腦設計的比較 10
3.6 Retrocline組與原始電腦設計的比較 11
3.7 綜合結果 11
第四章、討論 12
4.1 Normal組移動達成率探討 12
4.2 Flare組移動達成率探討 12
4.3 Retroclined組移動達成率探討 13
4.4 使用typodont wax對垂直向實驗結果造成的影響 13
4.5 使用同一膜片重複實驗與使用全新膜片的比較 14
4.6 隱形牙套與根尖吸收問題 14
第五章、結論 15
參考文獻 16
附錄一、表 20
附錄二、圖 26
附錄三、FORM 2 SLA 3D雷射光固化印表機產品資訊（ Formlabs） 98
附錄四、BIOSTAR 高效率氣壓熱塑成型機資訊 100
附錄五、SCHEU的DURAN®T 膜片資訊 101

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