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系統識別號 U0007-2807201014384700
論文名稱(中文) 以合成骨取代物植入阻生下顎第三大臼齒拔牙後窩洞以減少牙周骨缺損
論文名稱(英文) Synthetic Bone Substitutes for Prevention of Periodontal Defects after Impacted Mandibular Third Molar Extraction
校院名稱 臺北醫學大學
系所名稱(中) 牙醫學系碩博士班
系所名稱(英) School of Dentistry
學年度 98
學期 2
出版年 99
研究生(中文) 吳家佑
研究生(英文) Chia-Yu Wu
學號 M204097001
學位類別 碩士
語文別 中文
口試日期 2010-07-15
論文頁數 94頁
口試委員 委員-王敦正
指導教授-李勝揚
委員-黃彥華
中文關鍵字 阻生第三大臼齒  合成骨取代物  導引骨再生術 
英文關鍵字 impacted third molar  synthetic bone substitute  guided bone regeneration 
學科別分類
中文摘要 目的:本研究目的在評估使用不同骨取代物(硫酸鈣/非晶型磷酸鈣雙相複合材,低結晶型氫氧磷灰石/ s-三鈣磷酸鹽雙相複合材,膠原蛋白材料)填入下顎阻生第三大臼齒拔牙後窩洞,評估對於減少第二大臼齒牙周缺損的效益。

方法與材料:共20位受試者參與並完成試驗。共40個下顎阻生第三臼齒分成4組:硫酸鈣/非晶型磷酸鈣雙相複合材組,低結晶型氫氧磷灰石/ s-三鈣磷酸鹽雙相複合材組,膠原蛋白材料組及空白對照組。在拔牙前及拔牙試驗後3,6,12週測量下顎第二大臼齒臨床牙周囊袋深度。測量數值以平均值 ± 標準差計算及呈現。顯著差界值為P < 0.05。各組之差異以變異數分析(ANOVA)作統計,各組間不同時間點以配對t檢定進行統計分析。

結果:硫酸鈣/非晶型磷酸鈣雙相複合材組、低結晶型氫氧磷灰石/ s-三鈣磷酸鹽雙相複合材組、膠原蛋白材料組及空白對照組之下顎第二大臼齒遠心側牙周囊袋探測深度,在拔除阻生下顎第三大臼齒前分別為3.70 ± 1.16 mm、2.70 ± 0.82 mm、3.70 ± 1.49 mm、4.60 ± 0.82 mm;而在下顎第三大臼齒拔牙試驗後第12週,各組之第二大臼後遠心側牙周囊袋探測深度分別為2.80 ± 0.63 mm、2.50 ± 0.85 mm、4.90 ± 0.99 mm、4.50 ± 0.82 mm。各組於拔牙後第12週減少的牙周囊袋深度與術前探測值之比率則為24.3%、7.4%、-32.4%、2.2%。硫酸鈣/非晶型磷酸鈣雙相複合材組及低結晶型氫氧磷灰石/ s-三鈣磷酸鹽雙相複合材組在降低第二大臼齒牙周囊袋的成效優於膠原蛋白材料組及空白對照組,並有統計學上的意義(p < 0.05)。

結論: 本研究之結論支持合成骨取代物:硫酸鈣/非晶型磷酸鈣雙相複合材及低結晶型氫氧磷灰石/ s-三鈣磷酸鹽雙相複合材,填入下顎阻生第三大臼齒拔牙後窩洞,可以有效減少下顎第二大臼齒遠心側發生牙周囊袋發生的機會。
英文摘要 Purpose: The objective of this study was to evaluate the efficacy of different synthetic bone substitutes, calcium sulfate/amorphous calcium phosphate(CaSO4/ACP), poorly crystalline hydroxyapatite/ s-tricalcium sulfate (PC-HAp/ s-TCP), collagen sponge, for the prevention of second molar periodontal defects after extraction of an adjacent impacted mandibular third molar.

Method: Twenty patients (twelve male and eight female) patients with bilateral impacted mandibular third molars were selected to participate in the study. The forty extraction sockets were divided into 4 groups: empty control group, CaSO4/ACP group, PC-HAp/ s-TCP group, and collagen sponge group. Clinical pocket depth of the mandibular second molars were recorded at 3, 6, 12 weeks after the surgery. Data were calculated and reported as mean ± SD, and the significance level was set at p < 0.05. Repeated-measures analysis of variance (ANOVA) was used to detect the treatment and time effect among all groups. Paired t test was used to compare the result at different observation periods.

Results: The pocket depth measurements for the CaSO4/ACP, PC-HAp/ s-TCP, collagen sponge and empty control groups were 3.70 ± 1.16, 2.70 ± 0.82, 3.70 ± 1.49, 4.60 ± 0.82, respectively, before the surgery and 2.80 ± 0.63 mm, 2.50 ± 0.85 mm, 4.90 ± 0.99 mm, 4.50 ± 0.82 mm, respectively, at 12 weeks after the surgery. The pocket depth reduction/baseline pocket depth ratios were 24.3%, 7.4%, -32.4%, 2.2%, respectively, for the CaSO4/ACP, PC-HAp/s-TCP, collagen sponge, and empty control groups, at 12 weeks after surgery. CaSO4/ACP, PC-HAp/s-TCP as bone substitutes reduced the pocket depth more effectively than collagen sponge and empty control groups and the result is statistically significant.

Conclusion: The results obtained in this study support the use of synthetic bone substitute, CaSO4/ ACP and PC-HAp/ s-TCP, to prevent future periodontal defects of the second molar adjacent to the third molar extraction socket.
論文目次 標題………………………………………………………………………………i
審定書…………………………………………………………………………ii
上網授權書………………………………………………………………iii
誌謝……………………………………………………………………………iv
目錄………………………………………………………………………………v
表目錄……………………………………………………………………viii
圖目錄…………………………………………………………………………ix
中文摘要………………………………………………………………………xi
英文摘要…………………………………………………………………xiii
第一章 緒論…………………………………………………………………1
1.1. 背景……………………………………………………………1
1.2. 文獻回顧……………………………………………………2
1.3. 研究假說…………………………………………………15
1.4. 研究目的…………………………………………………16
第二章 研究材料與方法..……………………………………17
2.1. 人體試驗委員會……………………………………17
2.2. 研究對象…………………………………………………17
2.3. 研究設計…………………………………………………17
2.4. 材料…………………………………………………………18
2.5. 手術步驟…………………………………………………19
2.6. 資料收集…………………………………………………19
2.7. 統計分析…………………………………………………19
第三章 結果…………………………………………………………………21
第四章 討論…………………………………………………………………23
4.1. 導引骨再生術…………………………………………23
4.2. 再生膜於阻生下顎第三大臼齒拔牙後窩洞處導引骨再生術的功能……………………………………………………………………………………23
4.3. 預防性抗生素的使用……………………………24
4.4. 與動物實驗的比較…………………………………26
4.5. 合成骨取代物作為細胞支架的角色……27
第五章 結論與展望 …………………………………………………29
第六章 參考資料…………………………………………………………30
第七章 附錄…………………………………………………………………41
7.1 表…………………………………………………………………41
7.2 圖…………………………………………………………………51
7.3 人體試驗許可證明……………………………………77
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