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研究生： 鄭律文
Cheng, Lu-Wen
論文名稱： 缺牙區的分布對電腦輔助設計製作之多單位氧化鋯義齒支架密貼性的影響
The influence of edentulous area’s distribution on the marginal and internal fit of CADCAM multi-unit zirconia framework
指導教授： 陳永崇
Chen, Yung-Chung
共同指導教授: 林啟倫
Lin, Chi-Lun
學位類別： 碩士
Master
系所名稱： 醫學院 - 口腔醫學研究所
Institute of Oral Medicine
論文出版年： 2020
畢業學年度： 108
語文別： 中文
論文頁數： 33
中文關鍵詞： 氧化鋯 、義齒支架設計 、內部縫隙 、邊緣差異
外文關鍵詞： Zirconia, Framework design, Internal gap, Marginal discrepancies
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    • 氧化鋯材料近年來被廣泛用作全陶瓷贋復體的義齒支架材料。使用電腦輔助設計製造(CAD/CAM)技術和氧化鋯高溫燒結過程，是目前主流的氧化鋯義齒支架製作流程。但是氧化鋯在燒結過程中會產生約20-25%的體積收縮，可能會導致義齒支架邊緣和內部縫隙過大的問題。目前對於長徑距之氧化鋯義齒支架其密貼性與燒結收縮體積變化的影響之相關研究仍是不足的。因此，本研究設計模擬不同缺牙情況的離體實驗，製作五單位之長徑距氧化鋯義齒支架，觀察其邊緣及內部密貼性的表現，期望作為臨床在選擇氧化鋯義齒支架為贋復治療時的參考方向。
    本研究設計三種臨床缺牙情況作為實驗組—上顎犬齒及第一小臼齒缺失、上顎側門齒及第一小臼齒缺失、以及上顎側門齒及犬齒缺失。依據缺牙情況設計製作實驗模型，再進行氧化鋯義齒支架的設計製作，每個實驗組製作十組的五單位氧化鋯義齒支架作為實驗樣本(n=10)。使用Computer-aided replica technique量測義齒支架和實驗模型支柱牙之間的邊緣暨內部縫隙，將得到的數據結果用one-way ANOVA進行統計分析，比較各組之間有無顯著的差異。
    本研究結果顯示，三種缺牙情況的氧化鋯義齒支架皆在內部咬合面的區域有較大的縫隙值表現，邊緣密貼性的表現可符合在臨床可接受之範圍。另外比較三組實驗組的支柱牙邊緣暨內部縫隙的差異，發現義齒支架的橋體分布會對義齒支架的縫隙大小造成影響。表示氧化鋯燒結過程的體積收縮變化可能會對縫隙大小造成影響。

    Dimensional discrepancies of a long-span zirconia framework may result from unfavorable sintering shrinkage or different edentulous conditions. The purpose of this study was to evaluate the marginal and internal fit of five-unit zirconia frameworks with various distributions of pontics after sintering process.
    Three experimental groups with different edentulous conditions were designed as follows: Group A- missing maxillary lateral incisor and canine; Group B- missing maxillary lateral incisor and first premolar; and Group C- missing maxillary canine and first premolar, was fabricated. After sintering, the specimens were examined using Computer-aided replica technique to evaluate their marginal and internal discrepancies. Five critical regions were measured, including mesial marginal gap (MMG), mesial axial wall (MAW), occlusal surface (OS), distal axial wall (DAW) and distal marginal gap (DMG). The data of the measurements were statistically analyzed with 1-way ANOVA (α=.05).
    The results showed that the largest discrepancies in all groups appeared at the occlusal surface. In the comparison of the discrepancies in the terminal abutments between the experimental groups, statistical differences were found in MAW, OS, DAW (ρ<.05). In the comparison of the discrepancies in the non-terminal abutments, statistical differences were found in MMG, MAW, OS (ρ<.05). Due to the unfavorable sintering shrinkage of zirconia, the largest deformation of the zirconia framework appeared at the occlusal surface. The pontics’ distribution can cause the dimensional discrepancies after sintering process.

    摘要 I Extended Abstract II 致謝 VII 表目錄 X 圖目錄 XI 第一章、緒論 1 1.1 牙科贋復體之概論 1 1.1.1 牙科贋復體發展應用之回顧 1 1.1.2 牙科用陶瓷材料之介紹及分類 2 1.1.3 氧化鋯材料性質之介紹與發展 3 1.2 氧化鋯假牙贋復體應用之回顧 4 1.2.1 氧化鋯假牙贋復體於牙科臨床的製作流程 4 1.2.2 氧化鋯假牙贋復體於牙科臨床應用之回顧 6 1.3 氧化鋯贋復體縫隙表現之文獻回顧 7 1.3.1 氧化鋯贋復體的邊緣及內部縫隙表現 7 1.3.2 燒結收縮和缺牙情況對於氧化鋯贋復體的縫隙表現之影響 7 1.3.3 檢測縫隙大小的實驗方法之回顧 8 第二章、材料與方法 11 2.1 研究流程 11 2.2 製備實驗模型 11 2.2.1 設計三種缺牙情況 11 2.2.2 製備人工牙模型 12 2.2.3 設計數位實驗模型 13 2.2.4 製備PMMA實驗模型 14 2.3 製備氧化鋯義齒支架 14 2.3.1 電腦輔助設計加工(CAD/CAM)製程 14 2.3.2 燒結製程 15 2.4 測量邊緣及內部縫隙 16 2.4.1 取得樣本之義齒支架縫隙複製物(Replica) 16 2.4.2 掃描實驗模型暨複製物之數位影像，並於軟體進行影像編輯 16 2.4.3 使用電腦輔助方式在數位軟體進行縫隙量測 17 第三章、實驗結果 20 3.1 各實驗組之邊緣暨內部縫隙之敘述統計 20 3.1.1 右上犬齒、第一小臼齒缺失 (11-12-X-X-15) 20 3.1.2 右上側門齒、第一小臼齒缺失 (11-X-13-X-15) 20 3.1.3 右上側門齒、犬齒缺失 (11-X-X-14-15) 21 3.1.4 各實驗組的橋體側與非橋體側支柱牙的邊緣暨內部縫隙之敘述統計 22 3.2 各實驗組的終端支柱牙與非終端支柱牙之統計分析 23 3.2.1 實驗組間終端支柱牙的縫隙平均值比較之統計分析 23 3.2.2 實驗組間非終端支柱牙的縫隙平均值比較之統計分析 23 3.3 各實驗組的橋體側與非橋體側縫隙之統計分析 23 第四章、討論 25 4.1 各實驗組之邊緣暨內部縫隙之比較 25 4.2 不同缺牙分布情況對於義齒支架邊緣暨內部密貼性之影響 26 4.2.1 實驗組間終端支柱牙與非終端支柱牙的縫隙平均值之統計分析比較 26 4.2.2 實驗組間的橋體側與非橋體側縫隙平均值之統計分析比較 27 4.2.3 與過往文獻比較討論實驗結果 27 4.3 結論 28 參考文獻 29

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