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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 王東美(Tong-Mei Wang) | |
dc.contributor.author | Yu-Chun Lin | en |
dc.contributor.author | 林鈺淳 | zh_TW |
dc.date.accessioned | 2021-06-17T06:23:46Z | - |
dc.date.available | 2023-10-03 | |
dc.date.copyright | 2018-10-03 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-08-17 | |
dc.identifier.citation | Adell R, Lekholm U, Rockler BR, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981;10:387-416.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72108 | - |
dc.description.abstract | 實驗目的
過去五十多年來因牙科植體學的發展及骨整合植體的高成功率,使用牙科人工植體贋復缺牙區已是重建治療計畫中常見、優先的治療選擇。但如何有效並快速地建立植體初期穩定度及後續的骨整合,特別於骨質不佳的患者,仍是臨床醫師極富挑戰的課題。植牙區的骨質被認為是影響牙科植體成功率中最重要的因子之一。醫師常於植牙手術中利用鑽骨手感鑑定植牙區域骨質軟硬,進而採用不同的骨頭製備手術流程及植體設計。然而不同手術醫師之間界定骨質時並無客觀明確的標準,若依主觀鑽骨手感及過去累積的手術經驗診斷骨質,將不利於初學植牙的醫師對於骨質診斷的學習,亦可能對於植體初期穩定性、骨整合與植體長期成功率有直接的影響。 本實驗以客觀的生物力學測試骨塊 (Sawbone®) 及2-mm前導鑽針(Nobel Biocare Twist Drills, 2x7-15mm)測試從未有植牙經驗牙醫師的鑽骨手感,評估鑽骨手感是否能經由訓練計畫累積經驗、提升對於骨質診斷的準確度、並測試鑽骨手感是否會隨時間遺忘,以篩選出欲改善的對象,期望將來能於臨床植牙手術時應用,選擇較適合骨質的植體設計和鑽孔流程,以嘉惠患者。 實驗材料與方法 1. 受試者招募: 本實驗收錄25位無植牙經驗但領有牙醫師執照之臺灣大學醫學院附設醫院第一、二年住院醫師,其中含16位女性、9位男性,平均年齡:26.3歲,研究期間於2017年8月至2018年2月。招募方式為主持人詢問時自願參與,本研究計畫經臺大醫院研究倫理委員會審查核准(201612189RIND),受試者填具“研究受訪者說明及同意書”後安排時間進行測試,實驗結果以不具名呈現。 2. 實驗設計: 使用Sawbone®(Pacific Research Laboratories, Inc. Vashon, Washington, USA) 所出品的聚氨酯生物力學測試塊 (biomechanical test block) 模擬人體海綿骨樣本。本實驗使用之Sawbone®密度為5pcf、10pcf、15pcf、20pcf、30pcf、50pcf,pcf是密度單位pounds per cubic foot的縮寫。先將所有骨塊以電動線鋸機 (Micro bandsaw MBS 240/E, Proxxon®, Germany) 切割成尺寸16mm(長) X 16mm(寬) X 25mm(高)的長方體。標準模型製備是將切割好的5pcf、10pcf、15pcf、20pcf、30pcf長方體骨塊各一塊以指定順序用type IV die stone (100g powder:23c.c.water)包埋於圓形塑膠容器中並在骨塊表面貼上PVC膠帶,欲鑽孔處切割露出並以麥克筆塗黑,避免骨塊粗糙度影響受試者的判斷。每位受試者配有一標準模型,個體間及個體內的骨塊測試順序每次皆不相同。 使用的植牙手機為日本NSK Nakanishi公司出產的Surgic XT Plus machine (Mont Blanc 20:1 Push Button Dental Implant Handpiece Low Speed Contra-angle),設定轉速為1500rpm、扭力25N-cm。每位受試者提供全新的一支2-mm round bur及三支2-mm前導鑽針(Nobel Biocare, 2-mm twist drill with tip 2x7-15mm & diamond coating),2-mm round bur做欲鑽孔處的淺凹標記,而2-mm twist drill每次鑽骨製備深度皆為10mm,鑽孔後請受試者評估該骨塊硬度,並於問卷上長度為10公分的視覺類比樣表(Visual analog scale, VAS)標示出受試者認為該骨塊硬度位於100mm水平直線的位置,不能回頭參考及修改答案,測完不公佈結果。 本實驗共包含五次測試與兩次訓練,每一次測試提供五張視覺類比樣表問卷,每張紙上只有一個骨塊的硬度測試問卷。前測時會先告知受試者無鑽骨阻力定義為VAS=0 mm,之後請受試者鑽孔50pcf的骨塊並定義該骨塊的鑽骨手感為最硬 (VAS=100 mm),但未告知受試者該骨塊的密度數值是50pcf。 前測後立即進行第一次測試,測試完後立即進行第一次訓練,訓練內容是以10pcf、20pcf、50pcf的骨塊進行鑽孔練習,訓練前告知受試者骨塊10pcf與20pcf的硬度分別是10與20,但受試者並不知硬度單位是pcf,訓練順序為10pcf鑽孔五次、20pcf鑽孔五次、50pcf骨塊鑽孔一次並提醒受試者這是最硬的骨塊(VAS=100mm),之後在10pcf、20pcf骨塊來回各鑽孔五次,最後再於50pcf骨塊鑽孔一次。 第一次訓練後立即進行第二次測試,測試前請受試者於問卷上的視覺模擬量表先以15cm的鐵尺畫上受試者主觀感覺10pcf與20pcf骨塊的鑽骨手感位在100mm的水平位置,再進行測試,測試時請受試者將所鑽骨塊與訓練時10pcf、20pcf骨塊的硬度關係比較來評量。第三次測試是在第二次測試後一週,第四次測試在第三次測試後一個月,第四次測試後立即進行第二次訓練,訓練順序是10pcf鑽孔五次、20pcf鑽孔五次,最後於50pcf骨塊再鑽孔一次,訓練後立即進行第五次測試。 結果測量與統計:記錄群體受試者對於不同硬度骨塊的VAS鑽骨手感及敘述性統計,並以單一模擬骨塊的五次測試間進行paired t-test(雙尾檢定)評估訓練成效,且以One-way ANOVA檢定訓練後時間間隔的影響 (第二、三、四次測試) 與訓練次數的影響 (第一、二、五次測試),此外以散點圖(scatter plot)進行線性回歸分析群體受試者VAS與測試模擬骨塊密度間的關係以及估計值表準誤差的評估(standard error of estimate),而所有統計分析p-value設定在<0.05表示在統計學上具有差異。 實驗結果: 評估鑽骨手感趨勢,群體受試者能在第一、二、四、五次測試對於骨塊由軟到硬正確排序 (5pcf-30pcf),但在15pcf與20pcf可以觀察到直條圖重疊。骨塊硬度5pcf 以paired t-test檢定,在第二次測試 (經第一次訓練後) 與第四次測試間 (與第一次測試隔五週) 有統計上的顯著差異 (p<0.05) 、第三次測試 (與第一次訓練後隔一週) 與第四次 (與第一次測試隔五週)間有統計上的顯著差異 (p<0.05),顯示訓練後受試者對於5-pcf的鑽骨手感會接近客觀的骨密度值 (VAS=10mm),但隨時間增長手感會忘記且標準差增加。10pcf在第二次測試與第四次測試間、第三次測試與第四次測試間有統計上的顯著差異 (p<0.05)。15pcf/ 20pcf各項比較皆無統計上的差異。30pcf第二次測試與第五次測試有統計上的顯著差異 (p<0.05)。 以散點圖進行不同測試時間VAS與模擬骨塊密度進行線性回歸時,不同測試時間群體受試者的VAS與骨塊密度呈現線性關係,而估計值的標準差分析顯示受試者毫無經驗的第一次測試與其他次測試相比時,有大於10%的較大標準差。訓練時間間隔對於群體受試者鑽骨手感無顯著差異(p=0.08),訓練次數的影響無顯著差異 (p=0.5),個體受試者判別骨質的能力差別存在顯著差異。 結論 選用的模擬骨塊硬度其鑽骨手感存在差異,訓練後群體受試者對於5pcf的鑽骨手感會接近客觀的骨密度,但隨時間增長手感會忘記,15pcf與20pcf骨質的判定能力精準度經訓練並無增加,骨塊間差異級距對受試者鑽骨手感區分能力有影響而訓練間隔時間與訓練次數的影響不顯著,發展植牙訓練模組幫助牙醫師增進對於軟質骨質的硬度判定能力有其必要性。 | zh_TW |
dc.description.provenance | Made available in DSpace on 2021-06-17T06:23:46Z (GMT). No. of bitstreams: 1 ntu-107-R04422020-1.pdf: 12986408 bytes, checksum: e35b370783965139b2f66173df70e4cb (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 誌謝I
中文摘要II AbstractVI 目錄IX 圖目錄XI 表目錄XII CHAPTER 1 緒論1 1.1 引言1 1.2 文獻回顧3 1.2.1初期穩定度與骨整合3 1.2.1.1評估植體穩定度的目的4 1.2.1.2影響植體穩定度的因素4 1.2.1.3改善植體穩定度的方法4 1.2.1.4植體骨整合的評估方法5 1.2.2 骨質條件6 1.2.2.1骨質分類7 1.2.2.2骨質密度對植體成功率的影響8 1.2.2.3臨床評估骨質的方法10 1.2.3 2-mm 前導鑽針 (twist drill) 對治療計劃的影響12 1.2.4牙科植體學教育13 1.2.4.1植牙廠商的植牙課程訓練13 1.2.4.2植牙訓練模組的發展13 CHAPTER 2 研究目的16 CHAPTER 3 研究方法及程序17 3.1 研究假說17 3.2 實驗材料及步驟17 3.3 統計分析19 CHAPTER 4 實驗結果20 CHAPTER 5 討論22 CHAPTER 6 結論25 CHAPTER 7 實驗限制及未來展望26 參考文獻65 圖目錄 圖 1. 實驗所使用之 SAWBONE®與標準模型27 圖 2. 實驗所使用之Proxxon®電動線鋸機28 圖 3. 實驗所使用之標準模型PE圓形塑膠容器, 及包埋模板28 圖 4. 實驗所使用之貼於石膏表面的PVC絕緣膠帶29 圖 5. 實驗所使用之NSK植牙手機30 圖 6. 本實驗所使用圓形鑽針與2-mm前導鑽針31 圖 7. 受試者說明問卷32 圖 8. 視覺評比量表與標示範例33 圖 9. 諾保科廠商建議根據骨質條件採用的鑽孔規則與植體設計34 圖10. 實驗測試流程37 圖11. 群體受試者VAS平均值與標準差38 圖12. 全對受試者VAS值38 圖13. 訓練前後成效評估 (X軸: pcf差別,Y軸:答對人次)39 圖14. 時間對訓練結果的影響 (X軸: pcf差別,Y軸:答對人次)40 圖15. 受試者第一次訓練後VAS變化分佈圖41 圖16. 線性回歸(骨塊評估趨勢與離散率)44 圖17. 個體受試者第一次受訓後標示10pcf/20pcf值與實際值的比較45 圖18. 群體受試者第一次受訓後標示10pcf/20pcf值與實際值的比較46 表目錄 表 1. 本實驗所使用的Sawbone®機械性質 47 表 2. 本實驗所設定的受試者骨塊鑽孔順序 48 表 3. 受試者內觀察與記錄圖表 49 表 4. 受試者描述性統計 50 表 5. 群體受試者VAS平均值與標準差 51 表 6. 全對受試者VAS值 52 表 7. 測試梯次與pcf差別題目答對人次 53 表 8. 測試梯次與pcf差別題目答錯受試者紀錄 53 表 9. -5pcf每一次測試的原始VAS值 54 表10. -10pcf每一次測試的原始VAS值 55 表11. -15pcf每一次測試的原始VAS值 56 表12. -20pcf每一次測試的原始VAS值 57 表13. -30pcf每一次測試的原始VAS值 58 表14. -5pcf paired t-test結果 59 表15. -10pcf paired t-test結果 (2rd & 4th test、3rd & 4th test) 60 表16. -30pcf paired t-test結果 (2nd & 5th test) 61 表17. -5pcf訓練次數的影響(1st &2nd& 5th test) 62 表18. -5pcf訓練時間間隔的影響(2nd &3rd& 4th test) 63 表19.–骨塊密度差異級距對受試者鑽骨手感判定答對率的影響 64 | |
dc.language.iso | zh-TW | |
dc.title | 評估以模擬骨塊訓練植牙手感區分骨質能力之可行性 | zh_TW |
dc.title | Evaluation of a Sawbone® training protocol in using tactile sensation to classify bone quality during implant surgery | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 林立德(Li-Deh Lin) | |
dc.contributor.oralexamcommittee | 洪志遠(Zhi-Yuan Hong) | |
dc.subject.keyword | 牙科人工植體,骨質,鑽骨手感,生物力學測試塊,牙科教育, | zh_TW |
dc.subject.keyword | dental implant,bone quality,tactile sensation,artificial bone blocks,dental education, | en |
dc.relation.page | 77 | |
dc.identifier.doi | 10.6342/NTU201800746 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-08-17 | |
dc.contributor.author-college | 醫學院 | 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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