- 學位論文
引導式根管治療技術運用於前牙與後牙根管定位準確性的比較：體外實驗
Comparison of Accuracy for Root Canal Location between Anterior and Posterior Tooth Using Guided Endodontic Technique – in Vitro Study
摘要
前言: 根管治療是臨床上用來治療牙髓病的技術，而其中的根管定位在臨床上是相當困難的。目前開始有應用類似植牙導板的方式在臨床上進行根管定位的技術，本研究欲驗證此方式在臨床上的可行性。 研究目的: 本研究欲使用引導式根管治療技術，配合三維列印導板進行根管定位，確認其精準程度，並比較在前牙、小臼齒及大臼齒的使用上是否會有所差異。 材料與方法: 本研究共收集84顆口外牙，使用石膏固定於模型上，牙齒分為前牙、小臼齒、大臼齒三類。進行錐狀斷層掃描以及口內掃描。於軟體中進行影像疊合，並規劃鑽針於根管內的位置。將設計的導板使用三維列印製出並與鑽針進行根管定位，操作後再進行術後錐狀斷層掃描，並於軟體中疊合。測量鑽針規畫位置及實際位置的差異，測量的分別為鑽針冠部偏移量、根尖部偏移量、鑽針角度偏移量。並使用無母數分析其組間差異。並使用ROC曲線 (Receiver operating characteristic curve)驗證鑽針冠部偏移量、根尖部偏移量、鑽針角度三者與鑽針根尖部偏移量是否可以銼針到達根管內的關係。 結果: 所有的組別的平均冠部偏移量為0.13 ± 0.21 mm，在根尖部偏移量為0.46 ± 0.4 mm，角度偏移量為2.80 ± 2.57°。在冠部位置有顯著差異的組別為前牙與大臼齒、小臼齒與大臼齒，前牙與小臼齒間無顯著差異。而在根尖部偏移量有顯著差異的組別亦為前牙與大臼齒、小臼齒與大臼齒，前牙與小臼齒間無顯著差異。角度偏移量的統計結果亦然。ROC曲線計算曲線下面積(Area Under Curve; AUC)顯示，鑽針冠部偏移量為0.562、根尖部偏移量0.786、角度偏移量為0.975，有統計顯著意義的為根尖部偏移量及角度偏移量，冠部偏移量則無顯著意義。 結論： 本篇研究顯示引導式根管治療技術於前牙與小臼齒的使用上無顯著差異，但在大臼齒不論是冠部偏移量、根尖偏移量、鑽針角度皆與前牙與小臼齒有顯著差異。可能由於大臼齒需到達規畫位置中所需經過的齒質干擾比較多，所以造成如此結果。而ROC曲線顯示出根尖部偏移量及角度偏移量較能預測銼針是否能到達根管內，顯示出在使用導板治療時，這兩者越大，越難有機會讓銼針能到達根管內。
並列摘要
Abstract Purpose: The purpose of this study was to evaluate the application of guided endodontics technique in non-surgical endodontic treatment, and compare the accuracy of root canal location between anterior teeth, premolar and molar. Materials and Methods: 84 teeth were collected, and mounted in plaster model. Teeth was devided into three group: anterior tooth(A), premolar(P), and molar(M). Cone beam computerized tomography(CBCT) was taken and oral scan was performed. Superimposition was done in software and endodontic drill position was planned. After 3D printed endodontic stent was used with the drill. Post-operative CBCT was taken. Planed position and post-operative position was compared in software. Measurement about coronal position deviation, apex position deviation, and angle deviation was made, and nonparametric statistics was performed. Receiver operating characteristic(ROC) curve was used to evaluate the possibility for endodontic file to achieve the root canal in coronal position deviation, apex position deviation, and angle deviation. Results: The average deviation for all groups was 0.13 ± 0.21 mm at the coronal position, 0.46 ± 0.4 mm at the apex position and 2.8 ± 2.6° in angulation respectively. In coronal position, there was significant differences between A and M group, also between P and M group, but not between A and P. The same result was found in apex position and angle deviation. The area under curve of ROC curve are 0.562 in coronal position, 0.786 in apex position, 0.975 in angle deviation. Statistical significance was noted in apex position and angle deviation. Conclusion: This study shows that application of 3 guided endodontics technique for non-surgical endodontic treatment on anterior tooth and premolar was no significant difference. In M group, the deviation either coronal position or apex position are significant higher than A and P group. Possibly because the interference within drill pathway in M group was more than the other two. This study shows that the accuracy of the three-dimensional printing stent is acceptable, but the application on molar still needs to be modified and improved to increase its accuracy.