影響Dental Prescale II 測量值之因子探討

Investigation of factors affecting Dental Prescale II measurements

張詠翔(Yung-Hsiang Chang)

指導教授 ： 王東美

國立臺灣大學/醫學院/臨床牙醫學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202102098

摘要

實驗目的：
本研究的目的在於了解Dental Prescale II (DPS II, GC Corp., Tokyo, Japan)於不同狀況下，記錄所受力量之數值變化，並且觀察其所呈現數值與實際受力大小之相關性。
材料與方法：
體外測試：
使用萬能試驗機(Instron 5566, Instron Corp., Canton, MA, USA)對DPS II以一12mm2圓形平面進行三項壓縮試驗，再以EPSON Perfection V600 Photo掃描機，搭配Bite Force Analyzer (GC Corp., Tokyo, Japan)進行力量(N)、面積(mm2)、平均壓力(MPa)及最大壓力(MPa)數值分析。三項試驗分別為：
1. 以Instron對DPS II以300 N進行壓縮，包含兩組，樣本數均為10張：(1) 壓縮第1次後立即掃描，並間隔1分鐘後進行第2次壓縮及掃描，重複進行至第11次壓縮及掃描後結束，其第1壓縮點與第11壓縮點間隔10分鐘；(2) 壓縮第1次後置於原包裝袋中避免光照，並間隔1分鐘後進行第2次壓縮，重複進行至第11次壓縮後立即掃描，其第1壓縮點與第11壓縮點間隔10分鐘。
2. 以Instron對DPS II以100 N ~ 800 N (中間間隔100N) 進行壓縮，三組測試狀況分別為: (1) 施壓時間3秒；(2) 施壓時間5秒；(3) 施壓時間5秒，並以樹脂板與橡皮障模擬自然牙硬度與牙周韌帶。每組均壓縮第1次後立即掃描，並間隔1分鐘後進行第2次壓縮及掃描，重複進行至第11次壓縮及掃描後結束，其第1壓縮點與第11壓縮點間隔10分鐘，樣本數均為10張：
3. 以Instron對DPS II以1Hz的頻率在300 N ~ 500 N之間模擬施力過程中力量大小無法維持恆定而有高低變化，壓縮時間5秒，壓縮第一次後立即掃描，並間隔1分鐘後進行第2次壓縮及掃描，重複進行至第11次壓縮及掃描後結束，其第1點與第11點間隔10分鐘，樣本數為1張。
體內測試：
實驗包含10位20歲以上健康受試者(男女比1:1)，以主觀感覺咬牛排之力量咬住DPS II三秒鐘後進行掃描，掃描時機點為立即(設為0分鐘)至10分鐘(間隔1分鐘)、15分鐘、20分鐘、25分鐘、30分鐘、60分鐘、90分鐘、120分鐘。
統計分析：
實驗數據資料以 Excel 分類建檔後，使用統計軟體(IBM SPSS Statistics Version 27, USA)做分析，顯著值定在 p＜0.05。若各組間有顯著差異，以Scheffé 法進行事後檢定。
體外測試：
1. 使用變異數分析，觀察不同光照次數、時間對DPS II的數值的影響
2. 使用變異數分析，觀察不同壓縮時間或是否模擬牙周韌帶，對DPS II數值的影響
3. 使用簡單線性回歸，觀察試驗機實際施力大小以及DPS II顯示數值之關係
體內測試：
使用變異數分析，觀察時間對DPS II數值的影響
實驗結果：
體外測試1：
1. 光照次數(1次與11次)不影響DPS II呈現之力量(p=0.939)、面積(p=0.785)、平均壓力(p=0.481)及最大壓力(p=0.900)四項數值。
2. 掃描延遲時間(0至10分鐘)對DPS II呈現之面積無顯著差異(p=1.000)，力量、平均壓力、最大壓力則有顯著差異(p<0.05)
3. 對DPS II光照11次後之力量標準化，以0分鐘標準化後，增加1分上升9.7%，2分上升13.2%，至10分上升23.7%；以2分鐘標準化後，增加1分上升1.7%，2分上升3.2%，至8分增加9.6%。
體外測試2：
1. 施壓3秒與施壓5秒組別之間(p<0.001) 於力量數值有顯著差異，於面積、平均壓力與最大壓力數值無顯著差異、施壓5秒與施壓5秒並模擬自然牙組別之間(p<0.001)於四項數值有顯著差異。
2. 施壓3秒組別力量數值約為Instron數值之0.652倍(R2=0.981)，去除最大壓力120MPa的資料後為0.693倍(R2=0.987)；施壓5秒組別力量數值約為Instron數值之0.638倍(R2=0.966)，去除最大壓力120MPa的資料後為0.655倍(R2=0.977)；施壓5秒並模擬自然牙組別力量數值約為Instron數值之0.794倍(R2=0.991)。
體外測試3：
以300N~500N力量模擬施力過程中力量大小無法維持恆定而有高低變化之組別，與300N(p=0.000)、400N(p=0.000)、500N(p=0.024)組別均有顯著差異。
體內測試：
1. 力量以0分鐘數值標準化後，0分至60分組內無顯著差異，1分至120分組內無顯著差異。觀察上升比例時，0分至2分的變化量約為6%，至10分鐘時約13%，至120分鐘時約27%。
2. 面積以0分鐘數值標準化後，0分至120分組內無顯著差異。
3. 平均壓力以0分鐘數值標準化後，0分至90分組內無顯著差異，1分至120分組內無顯著差異。
4. 最大壓力以0分鐘數值標準化後，0分至15分組內無顯著差異，1分至60分組內無顯著差異，2分至120分組內無顯著差異。
結論：
1. 光照次數在11次以內不會對DPS II顯示之力量、面積、平均壓力及最大壓力有影響。
2. 掃描延遲時間對於DPS II顯示力量、平均壓力及最大壓力有影響，對面積則無影響。
3. 掃描延遲時間以2分鐘後的力量變化較0~2分鐘的數值穩定。
4. DPS II顯示力量數值與受壓時間有關。
5. DPS II顯示力量與實際力量相比，需一係數轉換，此係數視情況可能介於0.6至0.8之間。
6. DPS II顯示力量，若在最大壓力120MPa的狀況下，會有低估實際力量的情形。
7. 不論施力期間是否永遠保持最大力量，DPS II顯示力量仍會是最大力量。
8. 臨床或研究上使用，以測試後放置10分鐘的數值會比較穩定。

關鍵字

Dental Prescale II (DPS II) ； 咬合力 ； 掃描延遲時間 ； 咬合指示工具 ； 咬合調整 ； 自然牙與植體贋復物

並列摘要

Purpose:
This study was conducted to investigate the data measured by Dental Prescale II (DPS II, GC Corp., Tokyo, Japan) under different conditions, and the correlation between the measured loads and the actual loads.
Materials and Methods:
In vitro studies:
Three experiments used a 12mm2 flat and circular platform attached on the universal testing machine (Instron 5566, Instron Corp., Canton, MA, USA) to deliver compressive forces on DPS II sheets. The DPS II sheets were then scanned with the recommended scanner (EPSON Perfection V600 Photo). The scanned images were analysed by Bite Force Analyzer (GC Corp., Tokyo, Japan) and the measurements including force (N), area (mm2), average pressure (MPa), and maximal pressure (MPa) were obtained. The three experiments were:
1. A compression force 300 N was applied on each DPS II sheet. Two scan protocols were tested (n = 10 for each protocol): (1) The DPS II was scanned immediately after the 1st compression, then the compression and scanning procedures were repeated with a 1-minute interval until the 11th compression was performed; (2) The DPS II was compressed with a 1-minute interval and was placed in the original package to avoid light after each compression procedure. Scanning was performed after the 11th compression.
2. The different compression forces from100 N to 800 N (with 100 N interval) were applied on DPS II sheets. The scan protocol was scanning DPS II immediately after the 1st compression, then the compression and scanning procedures were repeated with a 1-minute interval until the 11th compression was performed. There were 3 groups (n = 10 for each) in this experiment: (1) The compression time was 3 seconds; (2) The compression time was 5 seconds; (3) The compression time was 5 seconds, and there were a resin plate and a rubber dam beneath the DPS II sheet to simulate the hardness of nature tooth and the periodontal ligament.
3. A dynamic compression force with a 1Hz oscillation between 300 N to 500N for 5 seconds were applied. The scanning protocol was same as experiment 2. Sample size was one.
In vivo study:
Ten healthy participants (> 20 years old, male:female = 1:1) were asked to bite a DPS II sheet with a subjective force similar to biting a steak for 3 seconds. The DPS II sheet was scanned immediately after removal from the mouth (set as 0 minute) and repeatly scanned with a 1-minute interval for 10 times, and then scanned at 15, 20, 25, 30, 60, 90 and 120 minutes after the 1st scan.
Statisticcal Analysis:
The data was categoried with Excel (Microsoft) and then analyzed with IBM SPSS Statistics Version 27, USA. The level of significance was set at p < 0.05. Post hoc test was performed by the Scheffé method if there was significant different between groups.
In vitro study:
1. One-way ANOVA was performed to evaluate the influence of the numbers of scanning and the duration of scanning delay on the measurements.
2. One-way ANOVA was performed to evaluate the influence of compression time and the simulation of periodontal ligament.
3. Simple linear regression was performed to evaluate the real load applied by Instron and the load measured by DPS II.
In vitro study:
One-way ANOVA was performed to evaluate the influence of scanning delay.
Results:
In vitro experiment 1:
1. There was no significant difference between 2 scanning protocols (once and 11 times) for the force (p = 0.939), area (p = 0.785), average pressure (p=0.481) and maximal pressure (p=0.900) measured by DPS II.
2. There was no significant difference among scan delay duration (0~10 minutes) for the area (p = 1.000) but for the force, average pressure and maximal pressure (p<0.05) measured by DPS II.
3. After the forces measured by scanning DPS II 11 times were normalized by 0 minute, the data increased 9.7% after 1 minute, 13.2% after 2 minutes, and 23.7% after 10 minutes; when normalized by 2 minutes, the data increased 1.7% after 1 minute, 3.2% after 2 minutes, and 9.6% after 8 minutes.
In vitro experiment 2:
1. There was significant difference for DPS II force between 3-second compression and 5-second compression (p < 0.001), but no difference for DPS II area, average pressure and mamimal pressure. There was significant difference for 4 DPS II data between 5-second compression and 5-second compression with simulation of nature tooth (p < 0.001).
2. The force measured by DPS II for 3-second compression group was about 0.652 time (R2 = 0.981) of the force applied by Instron; and 0.693 time (R2 = 0.987) after the data with 120 MPa maximal pressure was excluded. The force measured by DPS for 5-second compression group was about 0.638 time (R2 = 0.966) of the force applied by Instron; and 0.655 time (R2 = 0.977) after the data with 120 MPa maximal pressure was excluded. The force measured by DPS for 5-second compression with simulation of nature tooth group was about 0.794 time (R2 = 0.991) of the force appliede by Instron.
In vitro experiment 3:
There were significant differences between the dynamic loading group with the 300 N group (p = 0.000), 400 N group (p = 0.000) and 500 N group (p = 0.024)
In vivo experiment:
1. After the force measured was normalized by 0 minute, there was no significant difference among 0- to 60-minute group and 1- to 120-minute group. And there were 6% increasment from 0 to 2 minutes, 13% from 0 to 10 minutes, and 27% from 0 to 120 minutes.
2. After the area measured was normalized by 0 minute, there was no significant difference among 0- to 120-minute group.
3. After the average pressure measured was normalized by 0 minute, there was no significant difference among 0- to 90-minute group and 1- to 120-minute group.
4. After the maximal pressure measured was normalized by 0 minute, there was no significant difference among 0- to 15-minute group, 1- to 60-minute group and 2- to 120-minute group.
Conclusions:
1. There will be no influence for the data measured by DPS II within 11 times of light exposure.
2. Scan delay will influence the data measured by DPS II except the area measured.
3. The change of force measured from 2-minute scan delay is more stable than the data from 0-minute scan delay.
4. The force measured was correlated to the compression time.
5. The forced measured by DPS II may be 0.6-time ~ 0.8-time to the actual force, depending on different condition
6. If there was a maximal pressure of 120MPa, the force measured may be much lower than the actual force.
7. The force measured by DPS II will be the maximal force during each bite, whether the bite force was maintained at maximum or not.
8. For clinical or experimental application, the data measured after 10 minutes scan delay will be more stable.

並列關鍵字

Dental Prescale II (DPS II) ； bite force ； scan delay ； occlusal indicator ； occlusal adjustment ； nature tooth and implant prostheses

參考文獻

1. Laird MF, Vogel ER, Pontzer H. Chewing efficiency and occlusal functional morphology in modern humans. J Hum Evol. 2016;93:1-11.

2. Fan J, Caton JG. Occlusal trauma and excessive occlusal forces: Narrative review, case definitions, and diagnostic considerations. Journal of Periodontology. 2018;89:S214-S22.

3. Misch CE, Suzuki JB, Misch-Dietsh FM, Bidez MW. A positive correlation between occlusal trauma and peri-implant bone loss: literature support. Implant Dent. 2005;14:108-16.

4. Pjetursson BE, Brägger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clin Oral Implants Res. 2007;18 Suppl 3:97-113.

5. Dawson PE. Functional occlusion: from TMJ to smile design. 2007.