在不同模片與附件下於口腔外之犬齒移動分析

Canine Distalization on Typodont under Different Aligner Materials and Attachements Design

黃芸婷(Yun-Ting Huang)

指導教授 ： 高嘉澤

中山醫學大學/口腔醫學院/牙醫學系/碩士(2020年)

https://doi.org/10.6834/csmu202000159

摘要

矯正的方法主要分成傳統矯正與隱形矯正，隨著隱形矯正蓬勃的發展，對於牙齒的移動更能預測，過去使用隱形矯正裝置治療牙齒，以牙齒的傾斜移動為主，但對於拔牙的病例，讓牙根一起移動的效果較不理想，經過改良，加入附件(attachment)於矯正器上，牙齒的移動變成可以改變牙根的位置之後，隱形矯正能夠有更好的應用，因此多不同種類的附件(attachment)陸續被不同公司開發出，與隱形矯正器結合使用達成牙根之移動。

本研究採用三種不同的模片與三種不同的附件，對於右下顎第一小臼齒拔牙後，對犬齒遠心移動中牙冠與牙根的移動量以及牙齒軸度來做比較。實驗所使用的三種模片分別為SCHEU的DURAN®T(簡稱Biostar)、BENQ的easyDU、MaxflexTM的TPU coping sheet。第一、二種附件分別為半月斜邊型(ellipsoid attachment)，分別用thick attachment跟thin attachment表示，第三種為長立方型(rectangular attachment)，用bar attachment表示。使用FORM 2 SLA 3D雷射光固化印表機將下顎右側側門齒、下顎右側第二小臼齒、下顎右側第一大臼齒的樹脂塊印出，其中下顎右側犬齒及下顎右側第一小臼齒的位置使用typodont wax來做包埋，並且將下顎右側犬齒的金屬牙埋入蠟體中。

使用3Shape Ortho Analyzer來將下顎右側犬齒往遠心直線移動，每次移動量為0.25 mm，下顎右側第一小臼齒的近遠心徑為7 mm，因此有28組的移動，在使用FORM 2 SLA 3D雷射光固化印表機將上述28副印出後使用Biostar所出的高效率氣壓熱塑成型機將三種不同附件的使用Biostar及TPU coping sheet兩種模片壓製，沒有加附件的使用BENQ、Biostar及TPU coping sheet三種模片壓製。本研究探討不同的附件裝置與不同種類的模片對於牙齒牙冠與牙根移動之效應。

實驗的結果顯示，DURAN®T biostar模片在無附件及三種不同附件的比較，在牙冠的移動上有相似的結果，但在牙根的移動上thin attachment往近心的改變量最小，牙齒軸度上的改變量也最小。TPU coping sheet的結果顯示在牙冠的移動上有相似的結果，但在牙根的移動上thin attachment往近心的改變量最小而bar attachment往近心的移動量改變最大，牙齒軸度上的改變量以thin attachment最小而bar attachment最大。而在三種模片的比較中，BENQ在牙齒軸度的改變量最小。綜合以上之結果，BENQ的模片可以達到最好的整體移動(bodily movement)，附件則是以thin attachment有比較好的表現。

關鍵字

附件設計 ； 犬齒移動 ； 隱形矯正模片材料

並列摘要

Orthodontic treatment can be performed by brackets and aligners. With the development of aligners, the movement of teeth is more predictable. In the past, aligners mainly movement were tipping. The effect of crown and root to move together is less than ideal. After adding attachments on the aligners, the movement of the teeth can change the position of the roots. However, there are more different types of attachments that have been developed by different companies in combination with aligners to achieve root movement of teeth.

The purpose of this experiment is to compare the movement of the crown and root and inclination of the canine during the distalized movement of the canine after the extraction of the lower right first permolar in three different sheets. The three sheets used in the experiment are SCHEU's DURAN®T referred to as Biostar, BENQ's easyDU, and MaxflexTM's TPU coping sheet. The first and second of the three different attachments are half-moon beveled type ellipsoid attachments, which are represented by thick attachment and thin attachment respectively, and the third type is a long cubic type rectangular attachment, which is represented by bar attachment (3,4). Use the FORM 2 SLA 3D laser curing printer to print the resin block of the lower right lateral incisor, the lower right second premolar, and the lower right first molar. Typodont wax is used for embedding the metal teeth of the lower right canine.

Use the 3Shape Ortho Analyzer to distalize the lower right canine to the lower right second premolar, each time the amount of movement is 0.25mm, and the mesial distal distance of the lower right first premolar is 7mm, so there are 28 groups of movements. Using FORM 2 SLA 3D laser printer to printed above 28 sets. Thermoforming machine produced by BIOSTAR to press the three different attachments using Biostar and TPU coping sheet. Without using attachments, BENQ, Biostar and TPU are used. This study aims to understand how different attachment devices and different types of sheets affect the movement of tooth crown and root.

The results of the experiment show that the comparison of the DURAN® T biostar without attachments and with three different attachments has similar results in the movement of the crown, but the minimum change of the thin attachment on the root, and the tooth inclination. The degree of change is also minimal. The results of the TPU coping sheet show similar results in the movement of the crown, but the smallest change in the attachment of the thin attachment to the root and the largest change in the movement of the bar attachment. The amount of movement in thin attachment is the smallest and bar attachment is the largest. In the comparison of the three molds, BENQ has the smallest change in tooth inclination. Based on the above results, the BENQ template can achieve the best overall movement (bodily movement), and the attachment is thin attachment with better performance.

並列關鍵字

attachment design ； canine distalization ； aligner material

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