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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47288完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 林立德 | |
| dc.contributor.author | Chia-Chun Chen | en |
| dc.contributor.author | 陳家駿 | zh_TW |
| dc.date.accessioned | 2021-06-15T05:53:40Z | - |
| dc.date.available | 2010-09-09 | |
| dc.date.copyright | 2010-09-09 | |
| dc.date.issued | 2010 | |
| dc.date.submitted | 2010-08-18 | |
| dc.identifier.citation | 1. BouSerhal C, Jacobs R, Quirynen M, van Steenberghe D. Imaging technique selection for the preoperative planning of oral implants: a review of the literature. Clin Impl Dent and Relate Res 2002;4: 3, 156-172
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47288 | - |
| dc.description.abstract | 緒論： 人工植牙運用於臨床牙科治療已有四十年的歷史，現今對於成功植牙治療的定義，已由過去注重骨整合成功，而進展至要求植體種植於適當的位置。隨著電腦輔助導引系統的成熟發展，目前利用各類電腦導引系統，可以將術前植體規劃位置轉移至實際植體種植位置，減少傷害到重要器官的機率，達成植體及植體補綴物生物力學、美學上的良好結果。 研究動機： 目前的文獻報告皆證實電腦輔助導引系統可以提供臨床所需的導引精準度，在規劃植體與實際植體間，植體距離及角度誤差分別約1 ~ 1.5mm及6 ~ 7°。但醫師在使用特定系統時，最關心的不是誤差平均值，而是該系統可能產生的最大誤差，最大誤差往往是造成植體治療失敗的主因。規劃植體與實際植體間的誤差為植牙治療流程中所有步驟偏差的累積，但現今文獻多為探討整體誤差，針對個別步驟的研究較少，其中探討手術模板保存條件及時間的文獻報告仍相當缺乏。 實驗目的： 本實驗目的在探討不同保存條件和存放時間，對於丙烯酸合成樹脂手術模板導引精準度的影響。 實驗材料與方法：
本實驗備製4個相同的上顎石膏模型，每個模型皆於右上第二小臼齒與第二大臼齒缺牙區埋入兩植體複製體，利用此4個標準模型分別製作4個丙烯酸合成樹脂手術模板(共16個)，模板上以植體補綴物暫時性支台代替套筒，並於製作完後依不同相對濕度(70%或100%)保存條件分成兩組(每組8個)，每個石膏模型或模板上都有三顆直徑5mm陶瓷圓珠，作為將來誤差計算時空間定位的基準。在每個模板製作完、1天、3天、7天及1個月後5個時間點進行電腦斷層拍攝，全部16個模板共完成80次拍攝，每次拍攝前必須先將人工植體固定於模板上暫時性支台，並配戴至石膏模型相對應位置。之後運用ImplantMax4.0軟體系統進行誤差計算，以每個模板之第一次電腦斷層影像作為控制組，依兩組參考點定位(石膏模型或模板)，分別記錄每次影像間植體的距離及角度誤差，最後以ANOVA進行統計分析(P = 0.05)。 實驗結果： 以手術模板參考點定位，在70%相對溼度下，保存1天、3天、7天和1個月後，模板的誤差平均值在植體頸部分別為0.078、0.092、0.082、0.094mm，尖端分別為0.127、0.152、0.137、0.184mm，角度分別為0.87、1.01、0.99、1.07°；在100%相對溼度下，誤差平均值在植體頸部分別為0.085、0.079、0.081、0.097mm，尖端分別為0.126、0.144、0.137、0.180mm，角度分別為0.77、0.91、1.04、0.99°，1個月的保存期間於不同濕度條件下，各類誤差之間皆沒有統計上的差異(P > 0.05)。以石膏模型參考點定位，在70%相對溼度下，保存1天、3天、7天和1個月後，模板的誤差平均值在植體頸部分別為0.073、0.093、0.083、0.108mm，尖端分別為0.138、0.162、0.149、0.184mm，角度分別為0.95、1.01、1.01、1.09°；在100%相對溼度下，誤差平均值在植體頸部分別為0.090、0.091、0.086、0.079mm，尖端分別為0.142、0.169、0.163、0.150mm，角度分別為0.78、0.96、1.06、0.84°，1個月的保存期間於不同濕度條件下，各類誤差之間皆沒有統計上的差異(P > 0.05)。不同參考點定位之間，各類誤差皆沒有統計上的差異(P > 0.05)。 結論： 在本研究的實驗設計下，丙烯酸合成樹脂手術模板於不同濕度條件下，一個月的保存期間內仍能維持穩定的導引精準度。 | zh_TW |
| dc.description.abstract | Objectives: An acrylic implant surgical guide stent may shrink during storage and affect the accuracy of implant surgery. The aim of this study was to investigate the accuracy of surgical stent after different durations in different storage conditions. Material and methods: Two implant replicas were placed at second premolar and second molar positions in four duplicated maxillary stone models with missing right second premolar and molars. Corresponding temporary cylinders were attached to the implant replicas and embedded into an acrylic stent fabricated on the model. Four stents were fabricated on each model and sixteen stents were divided into two storage conditions (70%, 100% humidity). Three ceramic balls were attached to each model and stent as markers for CT image-fusing-analysis. CT-images were taken immediate after stent fabrication and after 4 storage durations (1, 3, 7 days, 1month). The missing right posterior region was removed from the model and two corresponding implants were attached to the stent placed on the model before CT imaging. An image-fusing analyzing technique was used to analyze the changes of implant position and angle relative to the two sets of ceramic markers(model’s and stent’s respectively) after different storage durations. Two-way repeated measures ANOVA was used for statistics analysis. Results:
Using the ceramic balls of stents as markers for image-fusing-analysis, the changes of implant position and angle were measured. After storage durations of 1, 3, 7 days, and 1month in 100% humidity, the mean displacement of implant head was 0.085, 0.079, 0.081,and 0.097mm, respectively; the mean displacement of implant apex was 0.126, 0.144, 0.137, and 0.180mm, respectively; the angle deviation was 0.77, 0.91, 1.04, and 0.99 °, respectively. After storage durations of 1, 3, 7 days, and 1month in room humidity, the mean displacement of implant head was 0.078, 0.092, 0.082, and 0.094mm, respectively; the mean displacement of implant apex was 0.127, 0.152,0.137, and 0.184mm, respectively; the angle deviation was 0.87, 1.01, 0.99, and 1.07°, respectively. No statistically significant difference was found after different durations in two storage conditions. Using the ceramic balls of models as markers for image-fusing-analysis, the changes of implant position and angle were measured. After storage durations of 1, 3, 7 days, and 1month in 100% humidity, the mean displacement of implant head was 0.090, 0.091, 0.086,and 0.079mm, respectively; the mean displacement of implant apex was 0.142, 0.169, 0.163, and 0.150mm, respectively; the angle deviation was 0.78, 0.96, 1.06, and 0.84 °, respectively. After storage durations of 1, 3, 7 days, and 1month in room humidity, the mean displacement of implant head was 0.073, 0.093, 0.083, and 0.108mm, respectively; the mean displacement of implant apex was 0.138, 0.162, 0.149, and 0.184mm, respectively; the angle deviation was 0.95, 1.01, 1.01, and 1.09°, respectively. No statistically significant difference was found after different durations in two storage conditions. Neither was between two different sets of ceramic markers attached to models and stents, respectively. Conclusions: The data suggest the accuracy of acrylic surgical stents were maintained within 1 month in 70% and 100% humidity conditions. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T05:53:40Z (GMT). No. of bitstreams: 1 ntu-99-R96422015-1.pdf: 4993983 bytes, checksum: fb2d31fb6a6bcd01e96d628804c3ec1a (MD5) Previous issue date: 2010 | en |
| dc.description.tableofcontents | 口試委員會審定書 Ⅰ
誌謝 Ⅱ 中文摘要 Ⅲ 英文摘要 Ⅴ 第一章 緒論 1 第一節 研究背景 1 第二節 文獻回顧 3 一 應用錐體射線電腦斷層影像於植牙治療 3 二 手術導引模板於植牙手術之應用 4 三 電腦斷層影像輔助植牙手術之現況 7 四 本研究使用之電腦輔助導引軟體-ImplantMax4.0 14 第三節 研究動機 15 第四節 研究目的 17 第二章 實驗材料與方法 18 第一節 實驗軟體系統及儀器 18 一 使用i-CAT cone-beam CT進行電腦斷層攝影 18 二 規劃植體位置及分析之軟體-ImplantMax4.0 18 第二節 實驗步驟 19 一 實驗模型備製 19 二 手術模板製作 20 三 電腦斷層攝影 20 四 ImplantMax4.0之空間定位系統誤差 21 五 ImplantMax4.0分析植體位置誤差 22 六 資料統計分析 23 第三章 實驗結果 24 第一節 ImplantMax4.0定位及計算之系統誤差 24 一 重複選取陶瓷圓珠之基礎誤差 24 二 重複規劃植體步驟之基礎誤差 24 第二節 保存時間對於模板導引精準度之影響 24 第三節 不同保存條件下隨時間產生之導引誤差 26 第四節 保存條件及時間對於模板配戴之影響 27 第四章 討論 29 第一節 電腦規劃階段 29 一 電腦斷層影像資料的匯集及軟體重組 29 二 影像軟體系統之定位精度 30 第二節 手術前階段 32 一 手術模板之製作 32 二 手術模板及套筒設計因素之影響 33 三 保存條件及保存時間 34 第三節 手術及誤差驗證階段 35 一 手術模板穩定度與固持性 35 二 手術模板重複配戴時之空間定位 36 三 臨床手術鑽孔因素 37 四 誤差驗證之理論及方式 38 第四節 總結 39 第五章 結論 40 第六章 文獻回顧 41 圖目錄 圖1 利用量角器調整手術模板之文獻報告 51 圖2 利用析量器調整手術模板之文獻報告 51 圖3 傳統手術模板驗證精準度之文獻報告 52 圖4 利用磁性固定的傳統手術模板之文獻報告 52 圖5 STL模板與傳統模板之精準度比較 53 圖6 電腦輔助鑽孔手術模板與傳統模板之精準度比較 53 圖7 電腦輔助導引系統之分類 54 圖8 IGI電腦導航系統之裝置 55 圖9 IGI電腦導航系統之特殊定位裝置 55 圖10 電腦導航系統顯示於螢幕中之同步導引 56 圖11 快速原型技術製作之實體模型 5 圖12 快速原型技術之原理 57 圖13 雷射光合高分子成型手術模板 57 圖14 不同套筒模式之手術模板 58 圖15 電腦輔助鑽孔系統之特殊鑽頭及鑽床裝置 58 圖16 Med3D電腦輔助鑽孔系統 59 圖17 回顧性文獻中電腦輔助導引系統之誤差 60 圖18 ImplantMax4.0之贗復設計視窗模式 61 圖19 牙齒、骨頭、黏膜支持型手術模板之精準度比較 61 圖20 i-CAT® cone-beam CT設備 62 圖21 本實驗中記錄之誤差定義 62 圖22 實驗流程及分組 63 圖23 實驗模型及手術模板備製 64 圖24 ImplantMax軟體規劃植體及計算誤差 65 圖25 保存時間對於手術模板導引精準度的影響 67 圖26 不同濕度保存條件下隨時間產生的導引誤差 68 圖27 不同參考點分析對於手術模板配戴的影響 69 圖28 下顎與照射方向角度對線性測量精準度之影響 70 圖29 電腦斷層拍射時影響定位精準度之因素 70 圖30 STL模型與原始模型之差異 70 圖31 不同濕度環境下對樹脂變形程度之影響 71 圖32 利用原影像模板轉移植體位置之誤差驗證方式 71 表目錄 表1 植牙治療流程中可能產生誤差之步驟(一) 72 表2 植牙治療流程中可能產生誤差之步驟(二) 72 表3 各種影像之診斷價值 73 表4 傳統影像之臨床應用性 73 表5 傳統手術模板之精準度報告 74 表6 電腦輔助導引技術和傳統模板之精準度比較報告 74 表7 目前植牙手術之電腦輔助導引系統 75 表8 電腦輔助導航裝置之精準度文獻報告-活體外研究 76 表9 電腦輔助導航裝置之精準度文獻報告-臨床試驗 76 表10 STL手術模板之精準度文獻報告-活體外研究 79 表11 STL手術模板之精準度文獻報告-臨床試驗 77 表12 電腦輔助鑽孔手術模板之精準度文獻報告-活體外研究 78 表13 電腦輔助鑽孔手術模板之精準度文獻報告-臨床試驗 79 表14 各類電腦輔助導引系統之最大誤差報告 80 表15 不同支持型手術模板之精準度比較(一) 80 表16 不同支持型手術模板之精準度比較(二) 80 表17 不穩定手術模板產生之異常誤差值 81 表18 重複選取參考點(registration)之系統誤差 81 表19 重複規劃植體步驟(re-plan)的系統誤差 82 表20 保存時間對於手術模板導引精準度之影響 82 表21 不同濕度保存下隨時間產生之導引誤差-模板參考點 83 表22 不同參考點下保存條件及時間對模板導引之影響 83 表23 不同濕度保存下隨時間產生之導引誤差-模型參考點 84 表24 不同參考點下手術模板各類誤差隨時間之影響 84 表25 不同模板之設計於導引精準度之影響 85 表26 多組不同內徑套筒導引於精準度之影響 85 表27 套筒重複使用下之導引誤差 86 表28 回顧性文獻-電腦輔助導引系統之誤差 86 表29 各步驟可能產生之誤差 87 | |
| dc.language.iso | zh-TW | |
| dc.subject | 人工植牙 | zh_TW |
| dc.subject | 精準度 | zh_TW |
| dc.subject | 手術模板 | zh_TW |
| dc.subject | Implant | en |
| dc.subject | accuracy | en |
| dc.subject | surgical stent | en |
| dc.title | 不同保存時間及條件對於植牙手術模板導引精準度之影響 | zh_TW |
| dc.title | Accuracy of Implant Surgical Stent with Different Storage Durations and Conditions | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 98-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 王兆麟,洪志遠 | |
| dc.subject.keyword | 人工植牙,手術模板,精準度, | zh_TW |
| dc.subject.keyword | Implant,surgical stent,accuracy, | en |
| dc.relation.page | 88 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2010-08-18 | |
| 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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