- 學位論文
慢性牙周炎與侵犯型牙周炎之X光牙周附連喪失速率 ---- 使用數位式電子游標測微尺測量之治療前、後的長期研究
Radiographic periodontal attachment loss rate in chronic and aggressive periodontitis ---- A longitudinal study using electronic digimatic caliper before and after periodontal therapy
摘要
本研究目的主要為1) 探討牙根完成時間參考法與定期追蹤法所計算出X光牙周附連喪失速率之異同。2) 比較自牙根完全形成至來院求診後第一次拍攝全口X光片時、牙根完全形成至第二次拍攝全口X光片期間與前後兩次X光檢查 (時距五年以上)，三段時期之平行法根尖X光牙周附連喪失速率之異同。3) 比較慢性牙周炎、侵犯型牙周炎、牙周健康者、牙齒有無splinting或者伴隨咬合傷害的患者，不同部位，治療與未治療，兩次X光檢查之X光牙周附連喪失量與速率的差異。 本研究收集1981至2001年間，高雄醫學大學附設中和紀念醫院牙周病科曾接受兩次間隔五年以上之常規標準平行法全口X光片攝影檢查之患者53位，其中男性29名、女性24名，年齡分佈於20-66歲，平均37.70 (±11.58) 歲進行研究。以放大鏡將X光影像放大3.5倍，數位式電子游標測微尺 (electronic digimatic caliper) 測量每一顆牙齒 (第三大臼齒除外) 之近遠心的X光牙周附連累積喪失量 (cumulative radiographic periodontal attachment loss；CRPAL) 及牙根長度，計算出X光牙周附連年喪失量 (yearly radiographic periodontal attachment loss；YRPAL)。 所得結果如下：一、不論在各個疾病分類與期間，初期出現較嚴重齒槽骨喪失的位置 (site)，平均往後破壞速度亦較快，即severe組＞moderate組 ＞mild組。二、裝置有固定牙橋加以連結 (splint) 之牙齒X光牙周附連平均改變速率 (±標準差) 為獲得0.10 (±0.19) mm/yr.，而無任何固定裝置之牙齒為喪失0.05 (±0.13) mm/yr.，二者相差0.15 mm/yr. (p = 0.0120)。顯示splinting在減緩牙周破壞速率上是有顯著幫助的，甚至還能夠造成牙周附連的生長。三、不論上下顎，出現二級咬合傷害 (STFO) 的牙齒X光牙周附連喪失速率明顯大於無二級咬合傷害者 (P < 0.0001)。四、有回診者的X光牙周附連喪失年平均量相較於未回診者明顯較小。五、廣泛侵犯型牙周炎組之CRPAL平均值最大 (5.52±3.27 mm)，慢性牙周炎組次之 (4.82±3.47 mm)，局部侵犯型牙周炎組再次之 (4.47±3.47 mm)，牙周健康組最低 (1.05±0.59 mm)。六、局部侵犯型牙周炎組之YRPAL 平均值最大 (0.23±0.24 mm/yr.)，廣泛侵犯型牙周炎組次之 (0.22±0.16 mm/yr.)，慢性牙周炎組再次之 (0.12±0.09 mm/yr.)，牙周健康組最低 (0.07±0.06 mm/yr.)。 本研究結論摘要如下: 1) 初期出現較嚴重齒槽骨喪失的位置，平均往後破壞速度亦較快。2) splinting在減緩牙周破壞速率上具有顯著幫助，甚至能夠造成牙周附連的生長。3) 出現二級咬合傷害 (STFO) 的牙齒X光牙周附連喪失速率明顯大於無二級咬合傷害者。4) 回診者的X光牙周附連喪失年平均量相較於未回診者明顯較小。5) 廣泛侵犯型牙周炎組之CRPAL平均值最大，慢性牙周炎組次之，局部侵犯型牙周炎組再次之，牙周健康組最低。 關鍵語: 數位式電子游標測微尺 (electronic digimatic caliper)、X光牙周附連累積喪失量 (CRPAL)、X光牙周附連年喪失量 (YRPAL)
並列摘要
The aim of the present study was to assess the cumulative radiographic periodontal attachment loss (CRPAL) and yearly radiographic periodontal attachment loss (YRPAL) of different disease groups over 5 years or more. A total of 53 subjects, who had taken two sets of full-mouth standarized paralleling radiographs with separated periods of 5 years or more in Kaohsiung Medical University Hospital during 1981-2001, were collected for the past 20 years. The radiographic periodontal attachment levels at mesial and distal aspects of teeth were assessed by measuring the distance between cemento-enamel junction and the bone crest using a electronic digimatic caliper (EDC) under a 3.5X magnified radiographs. The results revealed that 1) in the absence of periodontal therapy, sites with more advanced attachment loss are more likely to undergo further breakdown than sites which have less attachment loss; 2) there was a significant (p=0.0120) of 0.15 mm mean attachment level gains in the teeth with bridge splinting (mean attachment gain = 0.10±0.19 mm/yr.) as compared to the teeth without bridge splinting (mean attachment loss = 0.05±0.13 mm/yr.); 3) teeth with secondary trauma from occlusion (STFO) showed a significantly higher loss rate than teeth without STFO; 4) patients with a periodic recall (3-4 times/yr.) showed a significantly lower loss rate than patients without periodic recalls; 5) mean CRPAL was highest in the generalized aggressive periodontitis (GAgP) group (5.52±3.27 mm), then the chronic periodontitis (CP) group (4.82±3.47 mm), and the localized aggressive periodontitis (LAgP) group (4.47±3.47 mm) followed, and lowest in the periodontal healthy (PH) group (1.05±0.59 mm); 6) mean YRPAL was highest in the LAgP group (0.26±0.25 mm/yr.), then the GAgP group (0.20±0.13 mm/yr.), and the CP group (0.12±0.09 mm/yr.) followed, and lowest in the periodontal healthy group (0.07±0.06 mm/yr.). The conclusions were summarized as follows: 1) sites with more advanced attachment loss are more likely to undergo further breakdown; 2) there was a significant attachment level gains in the teeth with bridge splinting as compared to the teeth without bridge splinting; 3) teeth with secondary trauma from occlusion (STFO) showed a significantly higher loss rate than teeth without STFO; 4) patients with a periodic recall showed a significantly lower loss rate; 5) mean CRPAL was highest in the generalized aggressive periodontitis group, then the chronic periodontitis group, and the localized aggressive periodontitis group followed, and lowest in the periodontal healthy group. Key words: periodontitis; electronic digimatic caliper; cumulative radiographic periodontal attachment loss (CRPAL); yearly radiographic periodontal attachment loss (YRPAL)
參考文獻
延伸閱讀
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