國內學童齲齒率之高是眾所皆知，尤其是國內口腔衛生教育做的尚不 確實，一般人的觀念認為乳齒會換，蛀掉無所謂，甚至約在六歲左右即萌 出的恆牙第一大臼齒，也被誤以為是乳牙而不予重視 o 其實牙齒具有咀嚼 食物﹑幫助消化﹑發音正確等重要功能，尤其是恆牙第一大臼齒在維持顏 面咬合垂直高度上具有相當重要的地位 o 預防齲 齒的方法有很多，但針對臼齒咬合面特有的溝裂，窩隙封劑是相當有效的 利器 o
窩隙封劑的優點在於治療時不須除去過多的齒質，就可以將齒 面上所有的溝裂加以填補，治療所需的時間很短，操作時也不會引發疼痛
，是引介兒童病患熟悉牙科環境及治療的優良起步方法 o 臨床上窩隙封劑 填補後是否能夠持久，和防溼有絕對的關係，因而減少酸蝕時間以降低口 水汙染的機會，也成為研究上的方向之一 o 本研究的目的就是利用左右對稱 成對之恆牙第一大臼齒做窩隙封劑的填 補，以及利用攝影技術記錄治療結果，用來比較 20 秒與 60 秒不同酸蝕時間 對恆牙第一大臼齒窩隙封劑保固效果之影響 o
本研究是選取臺北市某國小二﹑三年級的學童，其恆牙第一大臼齒沒有齲 蝕或僅有琺瑯質之輕微齲蝕，且必須為左右二側對稱之恆牙第一大臼齒均 可進行窩隙封劑填補者，作為本研究之對象 o
利用該國小健康中既有之 基本設備，使用 3M Concise White Sealant 及鹵素光機，術前﹑術後用相 同的相機，相同的放大倍率，拍照存證，繼而每個月回診照相一次 o 最後利用相片進行評估，比較不同酸蝕條件下窩隙封劑之保固結果 o 總計收集了 260 對案例，二年級 160 對－男生 91 對；女生 69 對，三 年級 100 對－男生 60 對；女生 40 對 o
使用 Macintosh 中 Statview 軟體的 Contingency Table 及 Chi-square 進行統 計分析 o 結果發現
一﹑ 20 秒的酸蝕與 60 秒的酸蝕對保固率而言，無統 計學上的差異（ｐ >0.005 ） o 二﹑二﹑三年級的保固率除九個月
外，無統計學上之差異 o 三﹑性別並不影響 保固結果 o 四
﹑以一年的追蹤結果來說，上顎完全沒有脫落之比例比下顎大，具有統計 學上之差異 o 五﹑全部資料合併時，左右側臼齒在 3 個月﹑ 9 個月﹑ 12 個月 的保固結果具統計學上之差異 ，右側保固結果優於左側 o
六﹑輕微之琺瑯質齲蝕與無 齲蝕之琺瑯質其保固率無統計學上之差異 o 七﹑操作者 的年資對保固率有影響 o
八﹑本研究為期一年的保固結果：完整沒有脫落者佔 44.9 ％，只有副 溝脫落者佔 27.2 ％， 咬合面主要溝裂有脫落者佔 27.9 ％ o
酸蝕時間對恆牙第一大臼齒窩隙封劑保固效果之影 響
It is known that myofascial pain syndrome （ MPS ） shares the same neural pathway with sympathetic nerve system, but the mechanisms is not clea r. Sympathetic nerve system control the microcirculation of the skin. The change of the microcirculation below the skin will reflect on the temperature of the skin. Infrared thermogram can detect the changing. Abnormal infrared thermogram always match the dermotomes including upper back, lower b ack or extremities. Someone who suffered from MPS will be noted the sign. However, the relationship between skin temperature regulation over the ar ea with trigger points and referred pain is still unknown. Therefore, to implement the use of infrared thermogram as a plausible tool for the clinical ass essment of referred pain in MPS and treatment assessment, current study will propose a human experiment based on the thermo-changes in skin tempe rature for patient with MPS.
The study first compares the differences of patients with MPS and normal adult in changes respects to skin temperature, visual analog scale （ VAS ） , cervical range of motion （ ROM ） , and pain threshold on trigger point over upper trapezius muscle before and after cervical spinal mobilization. T hen investigate the relation between data from skin temperature of bilateral trigger point over upper trapezius muscles and its referred pain area. Finall y we analyze the correlation between the detected change of skin temperature and visual analog scale, cervical ROM and pain threshold on trigger poi nt. We found that: 1) The control group who had different temperature on bilateral trigger point and referred pain area before and after treatment are signi ficantly noted by using T-test. Significant changes are also noted in temperature on bilateral trigger point and right side referred pain area before and a fter treatment with experimental group. Bilateral pain threshold are found differently before and after treatment. No difference found on VAS and cerv ical ROM between two groups. 2) High degree of positive correlation found between change of skin temperature on trigger point and its referred pain area with experimental group, but no significant finding on control group. 3) There is no significant relation on cervical ROM changes with the temper ature change on bilateral trigger points in both experimental and control groups. 4) There is also no significant relation on VAS change with the tempe rature change on bilateral trigger points in both experimental and control groups. 5) Negative correlation was noted between change of pain threshold on right trigger point and change of skin temperature on bilateral trigger point and its referred pain area with experimental group, but no significant fin ding on control group. Negative relation were found between change of pain threshold on left trigger point and change of skin temperature on bilateral trigger point and only right referred pain area with experimental group, but no significant finding on control group. There is no significant relation on change of pain threshold on left trigger point with change of skin temperature on left trigger point ( p>0.05 ). But negative correlation was noted betwe en change of pain threshold on right trigger point and change of skin temperature on bilateral trigger point and its referred pain area with control group . According these results, we can provide a new clinical evaluative tool for MPS for comparing the differences after treatment or therapy.
Key words ： Myofascial pain syndrome, Infrared thermogram, Cervical spinal mobilization, Visual analog scale, Cervical range of motion, Trigger p oint, Pain threshold
Influence of different etching time on the retention of pit and
