比較諧振響應法與激振衝擊法分析牙科植體穩固度之研究

Assessment of dental implant stability detection methods: Comparisons between harmonic response method and impulse force method

吳成哲(Wu Chen-Che)

指導教授 ： 林哲堂 ； 李勝揚 ； 黃豪銘

臺北醫學大學/口腔學院/牙醫學系碩博士班/碩士(2006年)

摘要

目前臨床應用檢測植體與齒槽骨間之癒合程度與穩固程度的共振頻率原理有以諧振響應法HRM的Osstell? (Integration Diagnostics, Sweden)系統以及以激振衝擊法IFM的Implomates? (BioTech One, Inc., Taipei, Taiwan）系統兩者。但是尚未有關於兩者量測結果之間差異性探討以及相關性的研究。本研究即以激振衝擊法Implomates?系統與諧振響應法Osstell?系統植體穩固度監測儀器進行一系列的試驗。體外的模擬試驗在改變各種可能影響植體穩固度的參數條件下，探討此兩種系統儀器其所得到結果的操作差異與相關性。此外本研究以動物模型進行牙科植體治療，並且於12週的骨癒合期間進行量測，同時以放射線X光進行骨-植體邊界的觀察。另外收集臨床上接受牙科植體（3i,Inc. FL, USA）治療的患者臨床診斷資料，在其植入牙科植體時，以及之後的第2、4、8、12週接受IFM量測植體穩固度的量值進行分析。在體外實驗結果發現，隨著穩固度增加，兩系統量測到的穩固度數值均同樣增加，結果也存在一線性關係趨勢以及高度正相關(y = 0.31x -11.62，R = 0.98，p<0.05)。以動物模型進行兩者線性轉換方程式的校正，我們可以訂出兩系統量測值ISQ與kHz轉換方程式為kHz = 0.3 ISQ - 8.0。而分析臨床植體穩固度資訊，可以依照植體初始穩固度區分為三種癒合型態：RF值大於10.0kHz則可以接受立即負載，RF值介於4.0至10.0kHz之間者則需要等待骨整合完成，低於4.0kHz者建議需要更保守的治療。此結果表現出IFM法的確可以用來表現植體穩固度，而其量測數值與HRM之ISQ值間具有相關性及可轉換性。而且依照初始穩固度的量測可以提供臨床醫師進行後續治療的資訊，值得再進一步探討研究穩固度量值與植體骨整合的變化。

關鍵字

共振頻率 ； 牙科植體 ； 穩固度檢測裝置

並列摘要

Implant stability is necessary for long-term success in implant treatment. However, there are few scientific methods for implant stability detection. In this study, implant stability was evaluated by the resonance frequency analysis (RFA). Both Osstell? system (based on harmonic response method, HRM.) and Implomates? system (based on impulse force method, IFM.) were used in vivo and in vitro RFA. To test the differences in measured data and accuracy between the two systems, a series of in vitro experiments were carried out under various stability parameters. On the other hand, to find the mathematical relationship between ISQ values and RF values in kHz, in vivo studies were performed using animal model. Boundary conditions of the tested implants placed in the animals were monitored by both RFA and radiographic images after 12weeks of healing. Furthermore, in this study, implant study in kHz were also collected clinically and immediately after surgery and at 2, 4, 8, 12weeks. In the in vitro study, our results indicated that measured data of tested implants increased when their simulated boundaries were set with a higher rigidity in the both system. A positive relationship is exist between the boundary condition and RFA values (y = 0.31x -11.62，R = 0.98，p<0.05). From the animal study, we found the transfer function of ISQ and RFA in kHz is kHz=0.3ISQ-8.0. In the clinical data, measured initial resonance frequency of implants can be divided into three groups. When measured initial RF value larger than 10.0 kHz, the implants can immediately accept functional loading. When the initial RF of tested implants falls into the range from 4.0 to 10.0 kHz, a period waiting for osseointegration is suggested. It should be noted, implants with initial RF lower than 4.0 kHz have higher risk of failure. It can be an alarm for dentist. In conclusion, IFM can be used for the detection of implant stability clinically. There is a relationship between ISQ and RFA in kHz. The initial RF value of an implant can be served as a useful predictor for clinicians to evaluate the healing situation of placed implant.

並列關鍵字

resonance frequency analysis ； dental implant ； stability detector

參考文獻

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