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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/17059完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 林立德(Li-Deh Lin) | |
| dc.contributor.author | Ming-Hsun Tsai | en |
| dc.contributor.author | 蔡明訓 | zh_TW |
| dc.date.accessioned | 2021-06-07T23:55:00Z | - |
| dc.date.copyright | 2013-09-24 | |
| dc.date.issued | 2013 | |
| dc.date.submitted | 2013-08-26 | |
| dc.identifier.citation | 參考文獻：
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/17059 | - |
| dc.description.abstract | 在牙科的臨床工作上，經常會面對到病人因缺乏足夠的骨量而無法成功地置放人工牙根，因此文獻上對於這樣的情形提出很多種在進行植牙之前的手術治療方式，包刮牽引成骨術、引導式骨再生術、自體骨移植和使用生長因子和選擇適合的載體。但是現在對於垂直齒槽骨再生及和植體周圍骨缺損的骨再生，在現代牙科植體學中還是一項困難的挑戰。本研究的目的即是研究骨形成蛋白二在一種人工合成骨塊為載體，來修復植體周圍骨缺損的潛力和效益性。
本實驗中使用了十隻健康的米格魯雄性成犬，六十個表面經多孔鈦金屬氧化處理的人工植體（TiUnite, 4.0 x 8.5 mm; Nobel Biocare, Sweden）植入到六十個下顎骨的齒槽骨缺損（高度為四毫米、長度為十毫米），人工牙根植入的深度為四毫米，留下四點五毫米的齒槽骨上植體周圍的骨缺損。這六十個骨缺損為隨機分布到五個組別（負控制組、人工骨塊組、其他三組分別為每毫升五、二十、五十微克骨形成蛋白二於人工骨塊）和兩個時間點（四周與八週）。為了觀察即量化新生骨的形成，實驗動物的螢光骨染色標定分別於手術當天注射四環黴素、三週後注射鈣黃綠素、六週後注射茜草素紅。牙科根尖放射線照射在術後當下、四週及八週進行。微電腦斷層照射則是於動物犧牲後取下標本後進行並且以軟體分析骨量。 在大部分骨缺損區的癒合情形都相當良好，除了某些區域有軟組織的併發症，而最後有螺絲帽露出的情形，但並沒有其他的發炎反應。放射線學檢查和微電腦斷層在都顯示在八週後，含有骨形成蛋白二的組別在人工植體周圍的垂直高度的骨再生都有不錯的效果。其中每毫升五十微克骨形成蛋白二於人工骨塊的這組在四週擁有最高的佳的骨再生結果（但未達統計顯著差異）、而在八週則是其中每毫升二十微克骨形成蛋白二於人工骨塊的這組的骨再生能力會好。 本研究建立的實驗動物模型是為了評估在人工植體周圍的垂直高度骨再生能力，人工骨塊於本實驗中扮演的角色是當做一個骨引導作用的支架和骨形成蛋白二的載體，且能對骨再生有效的影響，而骨形成蛋白二的濃度和時間點對於骨再生的質量及範圍有顯著的影響。 | zh_TW |
| dc.description.abstract | In daily practice, the clinician is often confronted with bony situations that do not allow placing a dental implant because of a lack of sufficient bone volume. Various treatment options have been described in the literature to augment bone before implant placement including distraction osteogenesis, guided bone regeneration, grafting with autogenous bone, use of growth factors with appropriate carriers. However, vertical ridge augmentation and bone regeneration in peri-implant bone defect still remain a major challenge in current implant dentistry. The purpose of this study is to evaluate the potential and efficacy of an artificial bone composite as a carrier of rhBMP-2 in repairing peri-implant critical size defect.
Ten healthy male adult beagle dogs were used. Sixty titanium porous-oxide surface-modified implants (TiUnite, 4.0 x 8.5 mm; Nobel Biocare, Sweden) were inserted into 60 critical size mandibular alveolar defects (10 mm in width, 4 mm in height). Four millimeters of the implants were placed within the surgically reduced alveolar ridge, creating 4.5 mm, supra-alveolar, peri-implant defects. The 60 defects with dental implants were randomly distributed to 5 groups (empty, artificial bone composite only, bone composite with 5, 20 and 50 μg rhBMP-2) and 2 healing times (4 and 8 weeks). The animals were administered fluorescent bone labels (Tetracycline at first day of operation, calcein at 3 weeks, and alizarin red at 6 weeks) for a qualitative evaluation of bone formation. Periapical x-ray were taken immediately post-surgery (baseline), and at weeks 4 and 8. Micro-CT data were obtained after euthanasia and analyzed using CTan software. Healing processes of most of the bone defect sites areas were uneventful except some went through soft tissue complications and ended up with cover screw exposure without other signs of inflammation. Both x-ray and micro-CT data showed significantly improved vertical bone regeneration around dental implants at week 8 in groups containing rhBMP-2. Bone composites containing 50μg rhBMP-2 revealed the best bone regeneration at week 4. However, the performance of composites with 20μg rhBMP-2 exceeded any other groups at week 8. An animal model was established to evaluate vertical bone regeneration around dental implants. The artificial bone composite used in our study may act as an osteoconductive scaffold and a carrier of rhBMP-2, which effectively contributed to bone regeneration. The dosage of rhBMP-2 exerted a great influence on the timing and extent of bone regeneration | en |
| dc.description.provenance | Made available in DSpace on 2021-06-07T23:55:00Z (GMT). No. of bitstreams: 1 ntu-102-R99422031-1.pdf: 3240400 bytes, checksum: fe6237c8e0b7a9dca0c32fd2b0021551 (MD5) Previous issue date: 2013 | en |
| dc.description.tableofcontents | 目 錄
誌謝……………………………………………………………………………….………………. ii 中文摘要……………………………………………………………………………………...… iii 英文摘要………………………………………………………………………………………... iv 目錄………..……………………………………………………………………………………... v 第一章 序論…………………………………………………………………………….. 1 第一節：前言……………………………………………………………………………… 1 1.1.1牙科植體之發展與現況…………………………………………………………… 1 1.1.2 補骨材料的發展…………………………………………………………………… 1 1.1.3 補骨術式的發展…………………………………………………………………… 2 1.1.4生物醫學之發展…………………………………………………………………… 2 第二節：研究動機 ………………………………………………………………………… 3 第三節：論文架構 ………………………………………………………………………… 3 第二章 文獻回顧 ………………………………………………………………………… 4 第一節：骨整合的作用機轉 ……………………………………………………………… 4 第二節：骨形成蛋白二 …………………………………………………………………… 5 第三節：骨形成蛋白二之載體…………………………………………………………… 8 2.3.1載體之生物相容性…………………………………………………………………… 9 2.3.2載體之骨引導性……………………………………………………………………… 9 2.3.3載體之生物活性……………………………………………………………………… 9 2.3.4從載體釋放骨形成蛋白之動力學……………………………………………………10 2.3.5載體之降解………………………………………………………………………… 10 2.3.6載體之幾何學……………………………………………………………………… 11 第四節：人工骨塊：氫氧磷灰石及磷酸三鈣………………………………………… 11 第五節：骨形成蛋白二和人工骨塊應用於骨科及牙科植體試驗………….……… … 14 第三章 實驗材料與方法…………………………………………………………………….. 17 第一節：實驗動物…………………………………………………………………………… 17 第二節：骨形成蛋白二……………………………………………………………………… 17 第三節：人工骨塊……………………………………………………………………..…….. 17 第四節：實驗模型建立與實驗分組………………………………………………………… 18 第五節：手術過程及方法…………………………………………………………………… 18 3.5.1 拔牙手術…………………………………………………………………………… 19 3.5.2 第一次及第二次植牙手術…………………………………………………………… 19 3.5.3 骨染色………………………………………………………………….…………… 20 第六節：動物之犧牲與標本取得………………………………………………..………… 20 3.6.1 動物之犧牲手術……………………………………………………………………… 20 3.6.2 標本之取得……………………………………………………..…………………… 21 第七節：放射線學檢查及其影像分析方法……………………………..…..……………… 21 第八節：為電腦斷層掃描及其影像分析方法………………………..…..………………… 22 第四章 結果………………………………………………………..…..…..….…………….. 23 第一節：臨床傷口觀察及實驗動物存活率……………..………………………………… 23 第二節：放射線影像分析之結果……………………………..…………………………… 23 4.2.1 四週之放射線影像分析………………………………..…..………………………… 23 4.2.2 八週之放射線影像分析………………………………………..…..………………… 24 4.2.3 四週與八週之比較……………………………………………………..…..……...… 25 第三節：微電腦斷層影像分析……………………………………………………………… 25 4.3.1 四週之微電腦斷層影像分析……………………………..………………………… 25 4.3.2 八週之微電腦斷層影像分析…………………………..…………………………… 26 4.3.3 四週與八週之比較………………………………..…..…..……………………….… 26 第五章 討論………………………………………….……....…..………………………….. 27 第一節：術後傷口及存活率探討………………..………………………………………… 27 第二節：放射線影像檢查之探討………………..………………………………………… 27 第三節：微電腦斷層掃描影像之探討…………………..………………………………… 28 第四節：放射線影像檢查與微電腦斷層掃描之比較……..…..………………………….. 28 第五節：骨形成蛋白二濃度之探討…………………..…..…..…..…..…..……………… 28 第六節：實驗設計限制之探討…………………..…..…..…..…..…..…..………………. 30 第六章 結論與展望………………………………..….……………………………………. 31 參考文獻……………………………………………………………………………….……… 72 圖目錄 圖一：實驗模型示意圖…..…..………………………………………………………….. 32 圖二：實驗之時間軸示意圖…..…..……………………………………………………… 32 圖三：實驗動物拔牙手術六週後之左下顎頰側觀…..…..…………………………….. 33 圖四：實驗動物拔牙手術六週後之左下顎咬合面觀…..…..………………………….. 33 圖五：做一半圓切線後皮瓣翻開，露出齒槽骨之頰側觀…..…..…………………….. 34 圖六：做一半圓切線後皮瓣翻開，露出齒槽骨之咬合面觀…..…..……………………. 34 圖七：以電動骨鋸製造出長十公釐、深四公釐的骨缺損區之頰側觀…..…..……….. 35 圖八：以電動骨鋸製造出長十公釐、深四公釐的骨缺損區之咬合面觀…..…..…….. 35 圖九：將人工牙根植入骨缺損區正中央之頰側觀…..…..………………………….…. 36 圖十：將人工牙根植入骨缺損區正中央之咬合面觀…..…..………………….……… 36 圖十一：將加入骨合成蛋白二的人工骨塊置入到植體周圍之頰側觀…..….……….. 37 圖十二：將加入骨合成蛋白二的人工骨塊置入到植體周圍之咬合面觀…..…..……… 37 圖十三：以4-0尼龍縫線將傷口一級縫合後之頰側觀…..…..………………………… 38 圖十四：以4-0尼龍縫線將傷口一級縫合後之咬合面觀…..…..……………………… 38 圖十五：四週的負控制組之放射線影像…..…..………………………….……………. 39 圖十六：八週的負控制組之放射線影像…..…..…………………………..…………… 39 圖十七：四週的控制組之放射線影像…..…..…………………………..……………… 40 圖十八：八週的控制組之放射線影像…..…..…………………………..……………… 40 圖十九：四週的5μg/ml骨形成蛋白二之放射線影像…..…..………………………… 41 圖二十：八週的5μg/ml骨形成蛋白二之放射線影像…..…..………………………… 41 圖二十一：四週的20μg/ml骨形成蛋白二之放射線影像…...…………………………..42 圖二十二：八週的20μg/ml骨形成蛋白二之放射線影像.…..…………………………..42 圖二十三：四週的50μg/ml骨形成蛋白二之放射線影像…..…..………………….. 43 圖二十四：八週的50μg/ml骨形成蛋白二之放射線影像…..…..…………………….. 43 圖二十五：四週於平台底部放射線影像分析之柱狀圖…..…..……………………… 44 圖二十六：四週於第一個螺紋處放射線影像分析之柱狀圖…..…..………………….. 44 圖二十七：四週於第二個螺紋處放射線影像分析之柱狀圖…..…..………………….. 45 圖二十八：四週於第三個螺紋處放射線影像分析之柱狀圖…..…..……………………. 45 圖二十九：八週於平台底部放射線影像分析之柱狀圖…..…..…………………………. 46 圖三十：八週於第一個螺紋處放射線影像分析之柱狀圖…..…..…………………….. 46 圖三十一：八週於第二個螺紋處放射線影像分析之柱狀圖…..…..………………….. 47 圖三十二：八週於第三個螺紋處放射線影像分析之柱狀圖…..…..………………….. 47 圖三十三：負控制組之四週與八週各水平面放射線影像比較之柱狀圖…..…..…… 48 圖三十四：控制組之四週與八週各水平面放射線影像比較之柱狀圖…..…..……….. 48 圖三十五：5μg/ml rhBMP-2之四週與八週各水平面放射線影像比較之柱狀圖... 49 圖三十六：20μg/ml rhBMP-2之四週與八週各水平面放射線影像比較之柱狀圖.…. 49 圖三十七：50μg/ml rhBMP-2之四週與八週各水平面放射線影像比較之柱狀圖…. 50 圖三十八：四週之各組別於各水平面放射線影像比較之柱狀圖…..…..………………. 50 圖三十九：八週之各組別於各水平面放射線影像比較之柱狀圖…..………………….. 51 圖四十：八週微電腦斷層影像比較之柱狀圖…..…..…………………………..……… 51 圖四十一：八週微電腦斷層影像比較之柱狀圖…..…..……………………..………… 52 圖四十二：四週與八週微電腦斷層影像比較之柱狀圖…..…..………………………… 52 表目錄 表一：實驗設計及預計樣本數表 …..…..…………………………………………….. 53 表二：實驗分組組數及臨床觀察軟組織併發症一覽表…..…..……………………… 53 表三：放射線學影像之四週描述性統計一覽表…..…..…………………………..…… 54 表四：放射線學影像之八週描述性統計一覽表…..…..………………………….……… 55 表五：放射線學影像之四週與八週變異數分析一覽表…..…..………………………. 56 表六：放射線學影像之四週與八週變異數分析一覽表（去除負控制組）…..….…….. 57 表七：放射線學影像之四週與八週變異數分析一覽表（去除負控制組及控制組）….. 58 表八：放射線學影像之四週與八週變異數分析一覽表（去除負控制組及控制組，平台 底部至第三螺紋處之加總）…………………………..…………………………… 59 表九：放射線學影像之四週於平台底部事後檢定一覽表…..…..…………………….. 60 表十：放射線學影像之四週於第一螺紋處事後檢定一覽表…..…..………………….. 61 表十一：放射線學影像之四週於第二螺紋處事後檢定一覽表…..…..……………….. 62 表十二：放射線學影像之四週於第三螺紋處事後檢定一覽表…..….………………… 63 表十三：放射線學影像之八週於平台底部事後檢定一覽表…..…..………………….. 64 表十四：放射線學影像之八週於第一螺紋處事後檢定一覽表…..…..…………………. 65 表十五：放射線學影像之八週於第二螺紋處事後檢定一覽表…..…..…………………. 66 表十六：放射線學影像之八週於第三螺紋處事後檢定一覽表…..…..………………. 67 表十七：微電腦斷層影像之四週與八週描述性統計一覽表…..…..………………….. 68 表十八：微電腦斷層影像之四週與八週變異數分析一覽表…..…..………………….. 68 表十九：微電腦斷層影像之四週與八週變異數分析一覽表（去除負控制組）….….. 69 表二十：微電腦斷層影像之四週與八週變異數分析一覽表（去除負控制組及控制 組）…..…..………………………..………………………………………………… 69 表二十一：微電腦斷層影像之四週事後檢定一覽表…..…..………………..……… 70 表二十二：微電腦斷層影像之八週事後檢定一覽表…..…..………………………..… 71 | |
| dc.language.iso | zh-TW | |
| dc.subject | 動物活體試驗 | zh_TW |
| dc.subject | 骨形成蛋白二 | zh_TW |
| dc.subject | 人工植體 | zh_TW |
| dc.subject | 人工骨塊 | zh_TW |
| dc.subject | 垂直高度齒槽骨再生 | zh_TW |
| dc.subject | 臨界性骨缺損 | zh_TW |
| dc.subject | critical size defect | en |
| dc.subject | in vivo animal study | en |
| dc.subject | bone morphogenetic protein-2（BMP-2) | en |
| dc.subject | dental implatns | en |
| dc.subject | artificial bone block | en |
| dc.subject | vertical ridge augmentation | en |
| dc.title | 骨形成蛋白二與人工骨塊應用於牙科植體周圍齒槽骨再生試驗 | zh_TW |
| dc.title | Evaluation of rhBMP-2 based artificial bone composite in peri-implant alveolar bone regeneration : Radiographic analysis | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 101-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 王若松,洪志遠 | |
| dc.subject.keyword | 骨形成蛋白二,人工植體,人工骨塊,垂直高度齒槽骨再生,臨界性骨缺損,動物活體試驗, | zh_TW |
| dc.subject.keyword | bone morphogenetic protein-2（BMP-2),dental implatns,artificial bone block,vertical ridge augmentation,critical size defect,in vivo animal study, | en |
| dc.relation.page | 88 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2013-08-27 | |
| dc.contributor.author-college | 牙醫專業學院 | zh_TW |
| dc.contributor.author-dept | 臨床牙醫學研究所 | zh_TW |
| 顯示於系所單位： | 臨床牙醫學研究所 | |
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