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標題: | 傳統樹脂熱聚合方式與數位方式製作全口活動義齒基底密合度之比較:體外實驗 Evaluation of Denture Base Adaptation by Conventional Heat-cured PMMA Method and Digital Method: An In Vitro Study |
作者: | Chih-Yuan Hsu 許植淵 |
指導教授: | 楊宗傑(Tsung-Chieh Yang) |
關鍵字: | CAD/CAM切削,3D列印,熱聚合樹脂,全口活動義齒,義齒基底密合度,真實度, CAD/CAM milled,3D printing,injection molding,pack and press,complete denture,denture base adaptation,trueness, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 實驗目的: 本研究目的在檢測數位化技術與傳統樹脂熱聚合方式製作全口活動義齒於義齒基底密合度 (denture base adaptation)之差異性。
材料與方法: 將上下顎全口無牙標準模型翻模後製作石膏模型,在上顎的前方齒槽嵴 (anterior ridge crest)中心點及兩側粗隆 (tuberosity),下顎的前方齒槽嵴 (anterior ridge crest)中心點及兩側後方齒槽嵴 (posterior ridge crest)埋入直徑4mm的金屬球並翻製成鈷鉻合金 (cobalt-chrome alloy)金屬模型,作為後續實驗的參考模型。以3D桌掃機 (D900 3D scanner, 3shape, Copenhagen, Denmark)掃描金屬參考模並以軟體設計厚度為2mm之義齒基底,後續以CAD/CAM切削 (POLYWAX組、YAMAHACHI組)、3D列印 (BV005組、NextDent組)、樹脂注射成型 (injection molding)以及壓縮成型 (Pack & Press)熱聚合方式進行義齒基底之製作,每組上下顎各製作10個 (共計120個)。義齒基底密合度之測試方式為:1. 以5公斤重垂直力施加並測量義齒基底與金屬參考模型之間之矽膠印模材於訂定參考點之厚度。2. 掃描各組之義齒基底並與金屬參考模型掃描檔影像疊合分析組織面 (intaglio surface)。統計方式使用單因子變異數分析 (One-way ANOVA),再以Bonferroni法作事後比較檢定 (post-hoc test) ,有意義水準設於p<0.05。 實驗結果: 若以印模材厚度表示義齒基底和模型之間的間隙,在上顎的結果顯示 在各組別中,間隙最小都出現在兩側粗隆 (tuberosity) (0.193~0.452mm),而最大出現在後障 (post dam) (0.684~1.833mm);根據不同義齒基底製作方式的結果顯示,CAD/CAM切削產生的間隙最小,而3D列印產生的間隙比樹脂熱聚合方式來的大。根據數位影像疊合方式檢測的結果顯示:在六個參考位置中有五個位置顯示CAD/CAM切削義齒基底的真實度 (trueness)最大,Pack & Press在其中一個位置 (正中顎縫)的真實度最大。 在下顎的結果顯示:3D列印 (BV005組)產生的間隙最小,其次是CAD/CAM (POLYWAX),然而3D列印 (NextDent組)跟CAD/CAM (YAMAHACHI組)表現的結果是類似的。樹脂熱聚合方式不論是注射成型 (injection molding)還是壓縮成型 (Pack & Press)均顯示出最大的間隙。根據數位影像疊合方式檢測的結果顯示:在五個參考位置中,其中有三個位置顯示CAD/CAM切削義齒基底的真實度最大,Injection在其中兩個位置的真實度最大。 根據數位影像疊合方式檢測的結果,不論上下顎均顯示:CAD/CAM切削、注射成型 (injection molding)及壓縮成型 (Pack & Press)方式在義齒組織面的真實度沒有顯著差異,然而3D列印方式顯示出最低的真實度。 結論: 在本實驗有限的條件下,對於全口義齒基底在密合度檢測的結果,使用薄膜厚度測量方式測量參考位置間隙大小,CAD/CAM切削方式不論是在上顎或下顎,產生的間隙都小於樹脂熱聚合方式。3D列印方式在下顎產生的間隙小於樹脂熱聚合方式,而在上顎的話表現與樹脂熱聚合方式可以得到相似的結果。使用數位影像疊合方式檢測下,CAD/CAM切削方式製作義齒基底的組織面真實度和樹脂熱聚合方式沒有顯著差異,而兩種方式相較3D列印方式都有較高的真實度。 Objective: The purpose of this in vitro study was to compare the denture base adaptation of conventionally manufactured (Pack & Press, injection molding), 3D printing and CAD/CAM milled techniques for fabricating complete dentures to determine which process produces the most accurate adaptation. Materials and Methods: Two edentulous maxillary and mandibular models were fabricated by cobalt-chrome alloy. Three reference spheres (4mmx4mmx4mm) were added on the bilateral tuberosities, anterior crest at the midline at maxillary ridge and on the bilateral posterior crests, anterior crest at the midline at mandibular ridge respectively. The models were scanned by 3Shape D900 scanner (3Shape, Copenhagen, Denmark) and designed with a 2mm thickness denture base (3Shape CAD Design Software). Denture bases were fabricated by four different manufacturing techniques and materials: CAD/CAM milled (POLYWAX & YAMAHACHI), 3D printing (BV005 & NextDent), injection molding and Pack & Press. Denture base adaptation was assessed by both conventional and digital method. In conventional way, coated the internal surface of each denture base with silicone impression material and placed onto the master model under a 5 kgf axial load. Adaptation of the reference location was assessed by measuring the thickness of intervening layer of silicone impression material with the dial thickness gauge (547-400S, Mitutoyo Corp., Tokyo, Japan) between the base and the master model. In digital way, the trueness of the intaglio surface was assessed by superimposition of the test and reference scanning data. Results: At maxilla, according to conventional method, no matter which technique was used the bilateral tuberosities showed the minimum thickness and the post dam area showed the maximum thickness. The CAD/CAM milled technique had the most accurate adaptation on the reference area. The 3D printing group showed larger gap than conventional group. At mandible, according to conventional method, 3D printing (BV005) group showed the best adaptation, followed by CAD/CAM (POLYWAX) group. Heat cured resin method had the least adapted result among all techniques. According to digital superimposition, the overall results showed that there was no significant difference in the trueness of the intaglio surfaces between CAD/CAM milled, injection molding and pack & press groups. 3D printing group showed the lowest trueness among all groups. Conclusions: Within the limitation of the study, the conclusions are The CAD/CAM milled and conventional heat cured methods were more accurate denture fabrication techniques when compared with 3D printing denture base processing technique. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69144 |
DOI: | 10.6342/NTU201801765 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床牙醫學研究所 |
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