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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭景暉(Jiiang-Huei Jeng) | |
dc.contributor.author | Hsueh-Jen Lin | en |
dc.contributor.author | 林學仁 | zh_TW |
dc.date.accessioned | 2021-06-15T03:52:46Z | - |
dc.date.available | 2010-09-09 | |
dc.date.copyright | 2010-09-09 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-07-07 | |
dc.identifier.citation | 柯源卿,生物統計導論,初版,合記圖書出版社,1993
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/44678 | - |
dc.description.abstract | 牙根表面撕裂(root surface split)包括牙骨質撕裂(cemental tear)與牙骨質牙本質撕裂(cementodentinal tear),臨床病例很罕見,因此在疾病的診斷及治療上往往仍停留在個別醫師之經驗法則。若從年齡增長所可能對牙周組織的成份及結構之影響來看,甚多學者均認為臨床實際的發生率可能遠高於目前的認知,造成臨床診斷率偏低最主要是因為牙根表面撕裂屬於一種特殊型態的牙根表面分裂,臨床上也會出現包括慢性牙周炎、瘻管或慢性根尖周圍炎等症狀而容易與牙周或根管方面的其他疾病混淆而誤診,因此在此動機下,希望透過有系統的收集牙根表面撕裂之相關資料後加以整理及分析,同時針對各種治療方法的預後進行評估,所得到的分析結果冀能增加臨床醫師對牙根表面撕裂的瞭解,進而提高診斷的正確率與治療的成功率。本回溯性報告是屬於多院區的臨床研究,自1987年起至2008年止分別自台大醫院牙髓病科、台北長庚紀念醫院牙科部、天主教耕莘醫院牙科部、彰化秀傳紀念醫院牙科部以及高雄長庚紀念醫院牙科部等院區收集樣本,共累計71例經直接檢視法或活體檢查法證實為牙根表面撕裂的分析樣本後,針對包括:性別、年齡、全身病史、牙位、主訴、臨床症狀、臨床檢查結果、放射線檢查結果、探測式手術檢查結果、活體檢查結果、以及治療的方法與預後等因子加以分析,以探討與牙根表面撕裂相關的各變項之影響程度。在單變項分析方面發現:牙周膿腫,牙周囊袋,牙周骨缺損,根尖骨缺損,斷片垂直位置,斷片形狀是顯著的臨床特性。而性別,年齡,牙位,咬耗是導致牙根表面撕裂的顯著致病因子。在全部分析樣本的相關性分析結果顯示:性別與斷片寬、性別與治療方法、年齡與咬耗、年齡與斷片位置(II)、年齡與竇管、牙位與斷片長、牙位與斷片位置(II)、牙位與正確診斷、斷片位置(II) 與斷片形狀、X光片上發現斷片與否與正確診斷共10組雙變項之間有顯著相關性存在。針對33例接受手術及非手術治療的研究樣本之羅吉斯迴歸分析的結果發現:(1) 斷片撕裂的垂直位置是預測治療結果的最重要因子,其次是治療方法;(2) 位在根尖1/3的的斷片治療結果成功率最低;(3) 手術治療的治療結果成功率比非手術治療高。在臨床的治療結果方面,當以改善臨床症狀及恢復牙齒功能視為臨床成功,則有93.9%的病例在治療後得到改善。因此,若能增加對牙根表面撕裂的瞭解,應可提高臨床診斷的正確率,使臨床醫師得以及早診斷出牙根表面撕裂並適時以手術治療介入,以提高牙齒保存的成功率。 | zh_TW |
dc.description.abstract | The differential diagnosis of root surface split was difficult even after an exhaustive history taking and comprehensive clinical and radiographic examinations. However, research which had empirically documented in etiology and clinical characteristics of root surface split was scant. Therefore, the objective of the NTU Root Surface Split Study project attempted to assess clinical characteristics, predisposing factors and treatment outcome of the tooth with root surface split. All of the 71 root surface split teeth, 10 were diagnosed by direct inspection on extracted tooth; 61 were diagnosed by histopathological examination. During which descriptive statistic, univariate analysis, bivariable analysis and logistic analysis were performed. Of the 71 teeth studied, 38 (53.5%) were extracted and were excluded. The remaining 33 teeth (46.5%) were examined for treatment outcome of healed, questioned or failed. Evidently, the results from univariate analysis revealed that thirteen variables of clinical characteristics were associated with the root surface split and ten variables of predisposing factors, which thus confirmed the variables, including swelling, periodontal bony destruction, periapical bony destruction, apicocoronal location, fragment shape, and separation mode, as the main clinical characteristics on the tooth with root surface split; as well as the variables, including gender, age, tooth type, and attrition, as the predominant predisposing factors on the tooth with root surface split. The results from bivariate analysis of the 71 study samples revealed statistically significant differences in gender, associated with separated fragment width, and treatment technique; in age, associated with sinus tract, attrition, and apicocoronal location; in tooth type, associated with separated fragment length, apicocoronal location, and initial diagnosis accuracy; in radiopaque image, associated with initial diagnosis accuracy; in apicocoronal location, associated with separated fragment shape. Additive bivariable analysis on the 33 examined subsamples of teeth revealed statistically significant differences in treatment outcome, associated with separated fragment length and apicocoronal location as significance level interpreted at the 0.05; besides, with treatment technique as significance level interpreted at the 0.1. Logistic regression analysis identified significant outcome predictors: (1) apicocoronal location of the separated fragment on apical 1/3 (odds ratio [OR], 0.083; confidence interval [CI], -5.227─0.257) and on middle 1/3 (OR, 1.333; CI, -1.752 – 2.328), and (2) treatment technique (OR, 0.2; CI, -3.41 – 0.192). Treatment outcome was better in tooth which separated root fragment was located on middle 1/3 than on apical 1/3. Although, treatment technique was suggested as an outcome predictor in tooth with root surface split, it should be required confirmation from randomized controlled trials. Consequently, for obtaining enormous amount of empirical evidence to allow assessment with better power, continuation of the project in cumulating data would be necessary. | en |
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dc.description.tableofcontents | 總目錄
第一章 前言..................... .......................1 第二章 文獻回顧.................. ......................5 2.1.文獻的搜尋方式................. ....................5 2.2.牙骨質的形成及分類................................. 5 2.2.1.牙骨質的形成................................... 5 2.2.2.牙骨質的分類....................................7 2.3.牙骨質牙本質交界…..................................9 2.4. 牙根表面撕裂的定義、診斷及治療.....................9 2.5.易發的牙位...........................................11 2.6. 牙根表面撕裂的影響因子..............................11 2.6.1.年齡...............................................11 2.6.2.外傷...............................................12 2.6.3.過度咬合壓力.......................................12 2.6.4.咬合傷害...........................................13 2.6.5.牙骨質厚度增加.....................................13 2.6.6.牙骨質的礦物質化...................................13 2.6.7.牙骨質牙本質交接面的結合力.........................14 2.6.8.牙本質的疲勞強度...................................14 2.6.9.根管治療過的牙齒...................................15 2.6.10. 組織修復能力的減弱...............................16 2.7. 牙根表面撕裂的位置..................................16 2.8.疾病的發展...........................................16 2.9. 牙根表面撕裂的預後及追蹤檢查........................17 第三章 研究動機與目的..................................19 第四章 材料方法與研究步驟..............................20 4.1.樣本的蒐集……….....................................20 4.1.1.樣本的定義.........................................20 4.1.2.樣本的蒐集、分類、診斷與治療...................... 20 4.2.資料記錄…………….................................…21 4.2.1.病人的人口學資料...................................21 4.2.2.全身病史...........................................22 4.2.3.牙科病史...........................................22 4.2.4.主訴及臨床症狀.....................................22 4.2.5.臨床檢查...........................................22 4.2.6.放射線檢查.........................................24 4.2.7.探測手術檢查….....................................24 4.2.8.活體檢查...........................................25 4.2.9.確認診斷的標準…….................................25 4.2.10.確認診斷的正確性..................................26 4.2.11.病人的治療........................................26 4.2.12.追蹤觀察..........................................27 4.2.13.預後..............................................27 4.3.統計分析.............................................27 4.3.1.資料處理…………….................................27 4.3.1.1.資料的整理、分組與編碼...........................27 4.3.1.2.資料輸入………...................................28 4.3.1.3.資料的分析……….................................28 4.3.2.單變項分析………….................................28 4.3.3.雙變項分析………….................................28 4.3.4.羅吉斯迴歸模式…….................................29 第五章 結果..............................................30 5.1.累計的病患人數及牙齒顆數...........................30 5.2.敘述性統計的結果……….............................30 5.3.單變項分析結果.......................................31 5.3.1.人口學資料.........................................31 5.3.2.臨床基本資料.......................................31 5.3.3.臨床檢查...........................................32 5.3.4.放射線檢查.........................................34 5.3.5.手術檢查….........................................35 5.3.6.活體檢查...........................................36 5.3.7.治療方式...........................................37 5.3.8.追蹤檢查...........................................38 5.3.9.預後….............................................38 5.4.雙變項分析結果.......................................38 5.5.羅吉斯迴歸分析結果...................................39 5.5.1.治療結果與囊袋深度的羅吉斯迴歸分析.................40 5.5.2.治療結果與牙周骨缺損的羅吉斯迴歸分析...............40 5.5.3.治療結果與斷片面積的羅吉斯迴歸分析.................41 5.5.4.治療結果與斷片垂直位置(II)的羅吉斯迴歸分析.........41 5.5.5.治療結果與治療方法的羅吉斯迴歸分析.................42 第六章 討論..............................................44 6.1.樣本的蒐集………..............................…...44 6.1.1.累計的樣本數目前最多,資料的收集最有系統且完整 44 6.1.2.樣本排除的標準較嚴謹...........................44 6.2.敘述性統計的討論...................................45 6.3.單變項分析.........................................46 6.3.1.性別...........................................46 6.3.2.年齡...........................................46 6.3.3.全身性疾病.....................................47 6.3.4.牙位...........................................47 6.3.5.主訴...........................................49 6.3.6.外傷病史.......................................49 6.3.7.咬合傷害.......................................50 6.3.8.矯正治療.......................................50 6.3.9.咬合習慣.......................................50 6.3.10.瘻管..........................................51 6.3.11.膿腫..........................................51 6.3.12.囊袋深度......................................51 6.3.13.電髓測試......................................52 6.3.14.贋復物........................................52 6.3.15.對咬狀況......................................53 6.3.16.齒列完整性....................................53 6.3.17.咬耗..........................................53 6.3.18.X光片看到斷片.................................54 6.3.19.牙周骨缺損....................................54 6.3.20.根尖骨缺損....................................54 6.3.21.牙齒是否曾接受根管治療........................55 6.3.22.曾接受根柱處理................................56 6.3.23.斷片長........................................56 6.3.24.斷片寬........................................56 6.3.25.斷片厚........................................57 6.3.26.斷片位置(I) –平面位置........................57 6.3.27.斷片位置(II) –垂直位置.......................58 6.3.28.斷片形狀......................................58 6.3.29.斷裂方式......................................59 6.3.30.組織的撕裂位置…..............................59 6.3.31.軟組織........................................60 6.3.32.正確診斷......................................61 6.3.33.治療方式......................................61 6.3.34.預後..........................................62 6.4.雙變項的分析結果...................................62 6.4.1.顯著相關的組別.................................63 6.4.2.弱相關的組別...................................65 6.4.3.與預後相關之預估變數...............................66 6.5.羅吉斯迴歸分析………...............................67 6.5.1.治療結果與囊袋深度.............................67 6.5.2.治療結果與牙周骨缺損...........................67 6.5.3.治療結果與斷片面積.............................67 6.5.4.治療結果與斷片垂直位置(II).....................67 6.5.5.治療結果與治療方法......... ...................68 6.5.6.羅吉斯迴歸分析的結果之討論.....................68 第七章 結論..............................................70 第八章 未來展望..........................................71 圖目錄 圖1:篩選樣本的流程圖....................................72 圖2:篩選樣本的簡化流程圖................................73 圖3:疑似牙根表面撕裂之初始病例…........................74 圖4:臨床病例─X-片之證據(I)…...........................75 圖5:臨床病例─X-片之證據(II)…..........................75 圖6:臨床病例─X-片之證據(III)….........................75 圖7:臨床病例─直接檢視法………..........................76 圖8:臨床病例─探測式手術法(I)….........................76 圖9:臨床病例─探測式手術法(II)…........................77 圖10:臨床病例─活體檢查法...............................77 圖11:臨床病例─非牙根表面撕裂之病例...................…78 圖12:臨床病例─放射線檢查結果….......................…79 圖13:臨床病例─手術檢查結果--斷片撕裂的水平位置.......…80 圖14:臨床病例─手術檢查結果--斷片撕裂的垂直位置….....…81 圖15:臨床病例─斷片撕裂的方式……....................….82 圖16:臨床病例─組織切片下的撕裂位置….................…82 圖17:臨床病例─翻瓣手術移除斷片….....................…83 圖18:臨床病例─治療結果(I)………........................83 圖19:臨床病例─治療結果(II)…….........................84 圖20:臨床病例─治療結果(III)…..........................84 表目錄 表1:曾發表過與牙根表面撕裂相關的英文文章及其內容........85 表2:針對牙根表面撕裂所設計的牙科病歷.. .................86 表3:分析變項的分類....... ..............................87 表4:敘述性統計(Descriptive Statistics)的分析結果. ......87 表5:單變項分析:原始樣本與分析樣本之女性與男性的樣本數及百 分比分配...... ..........................................87 表6:單變項分析:原始樣本與分析樣本之病人各年齡層分組的樣本數及百分比分配.......................................... 88 表7:單變項分析:分析樣本之病人各年齡層分組的樣本數及百分比分配.................................................... 88 表8:單變項分析:原始樣本與分析樣本中各類全身性疾病的分組樣本數及百分比分配.........................................88 表9:單變項分析:原始樣本與分析樣本之牙齒個別牙位的分組樣本數及百分比分配...........................................89 表10:單變項分析:原始樣本與分析樣本之牙齒牙位重分組後的分組 樣本數及百分比分配...................................... 90 表11:單變項分析:原始樣本與分析樣本各種主訴之分組樣本數及百 分比分配................................................ 90 表12:單變項分析:原始樣本與分析樣本之牙齒是否曾有外傷病史的 分組樣本數及百分比分配.................................. 90 表13:單變項分析:原始樣本與分析樣本之牙齒曾否發生咬合傷害病 史的分組樣本數及百分比分配.... ..........................91 表14:單變項分析:原始樣本與分析樣本之牙齒是否接受過矯正治療 的分組樣本數及百分比分配................................ 91 表15:單變項分析:原始樣本與分析樣本之牙齒其咬合習慣的分組樣 本數及百分比分配........................................ 91 表16:單變項分析:原始樣本與分析樣本之牙齒其臨床檢查時出現竇 管的分組樣本數及百分比分配.............................. 91 表17:單變項分析:原始樣本與分析樣本之牙齒其臨床檢查時出現膿 腫的分組樣本數及百分比分配...............................92 表18:單變項分析:原始樣本與分析樣本之牙齒不同牙周囊袋深度的 分組樣本數及百分比分配.................................. 92 表19:單變項分析:原始樣本與分析樣本之牙齒不同牙周囊袋深度重 分組後,分組的樣本數及百分比分配情形.................... 92 表20:單變項分析:原始樣本與分析樣本之牙齒其電髓測試結果的分 組樣本數及百分比分配.............. ......................92 表21:單變項分析:原始樣本與分析樣本之牙齒有無製做贋復物之分 組樣本數及百分比分配.....................................93 表22:單變項分析:原始樣本與分析樣本之牙齒其對咬牙有無製做贋 復物之分組樣本數及百分比分佈情形........................ 93 表23:單變項分析:原始樣本與分析樣本之病人口中牙齒的齒列狀況 之分組樣本數及百分比分佈情形............................ 93 表24:單變項分析:原始樣本與分析樣本之病人口中牙齒的咬耗狀況 之分組樣本數及百分比分佈情形...... ......................94 表25:單變項分析:原始樣本與分析樣本之病人在X光片中發現放射 線不透性的斷片之分組樣本數及百分比分佈情形.............. 94 表26:單變項分析:原始樣本與分析樣本之病人在X光片中發現牙周 骨破壞之分組樣本數及百分比分佈情形...................... 94 表27:單變項分析:原始樣本與分析樣本之病人在X光片中發現根尖 骨破壞之分組樣本數及百分比分佈情形...................... 94 表28:單變項分析:原始樣本與分析樣本之病人牙齒曾接受過根管治 療之分組樣本數及百分比分佈情形...........................95 表29:單變項分析:原始樣本與分析樣本之病人牙齒曾接受過根柱處 理之分組樣本數及百分比分佈情形.......................... 95 表30:單變項分析:分析樣本之牙齒取出之斷片長度之分組樣本數及 百分比的分佈情形.........................................95 表31:單變項分析:分析樣本之牙齒取出之斷片長度重分組後之分組 樣本數及百分比的分佈情形................................ 96 表32:單變項分析:分析樣本之牙齒取出之斷片寬度之分組樣本數及 百分比的分佈情形.......... ..............................96 表33:單變項分析:分析樣本之牙齒取出之斷片寬度以2mm為間隔 重分組之分組樣本數及百分比的分佈情形.................... 96 表34:單變項分析:分析樣本之牙齒取出之斷片面積之分組樣本數及 百分比的分佈情形........................................ 97 表35:單變項分析:分析樣本之牙齒取出之斷片厚度之分組樣本數及 百分比的分佈情形........................................ 97 表36:單變項分析:分析樣本之牙齒取出之斷片的水平位置之分組樣 本數及百分比的分佈情形.................................. 97 表37:單變項分析:分析樣本之牙齒取出之斷片的垂直位置之分組樣 本數及百分比分佈情形.................................... 98 表38:單變項分析:分析樣本之牙齒取出之斷片形態之分組樣本數及 百分比的分佈情形...... ..................................98 表39:單變項分析:分析樣本之牙齒取出之斷片其斷裂方式之分組樣 本數及百分比的分佈情形.................................. 98 表40:單變項分析:分析樣本之牙齒取出之斷片其組織病理學下的斷裂位置之分組樣本數及百分比的分佈情形.................... 99 表41:單變項分析:分析樣本之牙齒受斷片誘導而形成的軟組織之分 組樣本數及百分比的分佈情形.............................. 99 表42:單變項分析:分析樣本之牙齒初步判斷與最後診斷之正確性的 分組樣本數及百分比的分佈情形............................ 99 表43:單變項分析:分析樣本之牙齒各種治療方法之分組樣本數及百 分比的分佈情形......................................... 100 表44:單變項分析:分析樣本排除拔除牙齒後之重分組其預後之分組 樣本數及百分比的分佈情形............................... 100 表45:單變項影響因子的分組樣本數、百分比分配以及分組的檢定結果..................................................... 101 表46:雙變項分析:性別與不同影響因子間相關性之分析結果..105 表47:雙變項分析:年齡與不同影響因子間相關性之分析結果..108 表48:雙變項分析:牙位與不同影響因子間相關性之分析結果. 111 表49:雙變項分析:斷片位置(II)與不同影響因子間相關性之分析結 果. ................................................... 114 表50:雙變項分析:X-光片發現斷片與診斷的正確間相關性之分析 結果................................................... 114 表51:雙變項分析:齒列的完整性與不同影響因子間相關性之分析 結果.. .................................................115 表52:雙變項分析:分析樣本中不同影響因子間雙變項檢定結果總 表..................................................... 116 表53:雙變項分析:研究樣本中預後與不同影響因子間相關性之檢定 結果................................................... 117 表54:牙根表面撕裂的牙齒預後(治療結果)的羅吉斯迴歸模式..119 參考文獻............................................... 120 | |
dc.language.iso | zh-TW | |
dc.title | 牙根表面撕裂症:病人的齒位分佈,臨床特性,致病因子與影響治療預後因素的研究 | zh_TW |
dc.title | Root Surface Split: Tooth Position, Clinical Characteristics, Predisposing Factors and Treatment Outcome | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 林俊彬(Chun-Ping Lin),張淑惠(Shu-Hui Chang) | |
dc.contributor.oralexamcommittee | 陳朝寶(Chiu-Po Chan) | |
dc.subject.keyword | 牙根表面撕裂,牙骨質撕裂,牙骨質牙本質撕裂,牙周炎,根尖周圍炎,牙骨質牙本質交界, | zh_TW |
dc.subject.keyword | root surface split,cemental tear,cementodentinal tear,periodontitis,apical periodontitis,cementodentinal junction., | en |
dc.relation.page | 125 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2010-07-07 | |
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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