第四章 討論
4.7 研究設計討論
4.7.4 硬體及軟體的限制性
本研究採用 i-CAT 機型照射 cone-beam CT，雖然照射時間已比傳統 CT 來得短，但仍需要 40 秒的時間，受試者仍有可能因為呼吸、眨眼、吞嚥…
等生理動作而使得影像有所變化，但由於此機型可照射涵蓋範圍較廣、費 用較低，同時又可提供解析度高的影像，因此選擇之，但若未來研究只需 要看到顳顎關節局部資料的話，便可選擇照射時間較短的機型，例如:CB MercuRayTM、3D Accuitomo XYZ…等機型。
本研究中所採用的軟體為 Mimics 及 Implant Max4.0，此兩套軟體都無 法直接將顳顎關節做矯正治療前後影像重疊，直接觀測顳顎關節的變化，
即使使用 Rapidform 此套軟體嘗試做影像重疊比較，依然有因顳顎關節周圍 軟組織影響判讀結果，此為軟體的限制性，期望未來能發展更好的軟體來 做觀測，以降低人為誤差。
4.8 研究的限制性
4.8.1 生理構造的影響
本研究中無法得知顳顎關節 remodeling 的情形,也無法得知在矯正治療 中顳顎關節周圍軟組織(ex:肌肉、韌帶….等)對 condyle 位置移動的影響。
本研究中亦無法得知受試者中不同的咀嚼模式是否會對顳顎關節位置
移動的影響。
4.8.2 受試者的選擇
本研究中所選擇的受試者主要是 Class I malooclusion，mild crowding，
實驗是 pure leveling，所以 condyle 在經過矯正 leveling 治療後較不能有大輻 度的移動。同時受試者數目不夠多，可能也會無法完全表現出真正全面的 改變。
第五章結論
1. 本研究成功利用 CBCT 建立髁狀突 3 維空間中髁狀突形態及位置的方 法，以供未來臨床醫師能利用 3D 影像來評估矯正治療或其他治療對顳 顎關節所造成的影響。
2. 從沒有拔牙，Class I 咬合不正的病人在經過七個月純 leveling 後的矯正 治療後，顳顎關節透過 cone-beam CT 影像觀察到 :
(1) 在 2D 及 3D 觀測下髁狀突形態變化量沒有差異。
(2) 在 2D 觀測下髁狀突位置變化量沒有差異。
(3) 在 3D 觀測中發現右側髁狀突有往前方方向移動，而左側髁狀突有往下 方方向移動的趨勢(p value: 0.0625~0.125)。
第六章未來展望
矯正牽引力量的加入
在本研究中尚未加入牙齒外的矯正牽引力量進行主動調整咬合，在矯 正過程當中時常會使用顎間橡皮筋 IME(intermaxillary elastics)來調整顎位 或使得牙齒上下垂直關係更好，在本研究中尚未取得受試者在經過主動積 極矯正治療後的資料，因此期望在取得資料後可針對矯正治療對顳顎關節 的影響能有更深入的了解。
受試者的選擇
本研究中的受試者主要是選擇輕微擁擠安格氐一級不正咬合的病人，
僅觀察 pure leveling 前後的變化，因此 condyle 在經過純 leveling 的矯正治 療後較不易有大輻度的移動，因此建議未來研究可以找尋一些經過矯正治 療後預期 condyle 會有較多移動的受試者來做進一步的研究，例如: Class II division 2、facial asymmetry、functional crossbite、有進行 functional appliance 治療的….等.。
本研究中的受試者數目僅有六位,可能會使得呈現出的資料會有不足的 狀況，建議未來研究可以找尋更多的受試者同意來進行研究。
軟組織變化觀測的加入
本研究中無法得知在矯正治療中顳顎關節周圍軟組織(ex:肌肉、韌帶….
等)對 condyle 位置移動的影響，因此在未來的研究中建議亦可使用 MRI 或 其它影像資料在矯正前後加入軟組織的觀測，如此一來便可更加地了解矯 正治療對顳顎關節的影響。
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作 者 簡 歷
1.姓名：董冠綾 2.性別：女
3.生日：民國 71年 01 月 27 日
4.學歷：中國醫藥大學牙醫學系第 21 屆 (89.9-95.6)
中國醫藥大學醫學研究所臨床牙醫學組 (96.9-99.7) 5.經歷：台大醫院牙科實習醫師 (94.6-95.6)
台北長庚醫院牙科住院醫師 (95.7-96.7)
6. 現職：中國醫藥大學齒顎矯正專科訓練醫師 (96.8-99.8)