先進牙髓病根管治療專用精密機器人之發展

Abstract

牙髓病科(Endodontics)為牙醫學系的一門專科，俗稱根管治療，其程序為移 除牙腔內部受感染的壞死神經組織後予以封閉，以根除病患的牙齒劇痛，每年造 福了上千萬的病患。然而進行此耗時的手術仰賴執業牙醫經多年培訓的豐富經驗 與靈巧手藝，不只診斷時即須破壞部分牙冠、牙質，也容易產生人為失誤。據美 國牙髓專科醫生協會的統計，一般牙醫的手術成功率只有60-65%，而牙髓專科 醫生的手術成功率也只有90%。台灣受過專業訓練的牙髓病專科醫生卻少得屈指 可數，一般牙醫常過度挖除牙質或失敗後拔除那根牙齒，是台灣牙科病患的悲哀。 本研究計畫結合交通大學工學院、哥倫比亞大學牙醫學院、及辛辛那提大學 應用科學院共同努力，進行跨國、跨校、跨領域的研究，以期開發出世界最先進 的牙髓科治療新技術，從依賴人工技藝的傳統作法，改進成以科技為基礎的自動 療程。在前幾年的努力下，我們已完成的技術創新包括:（1）非破壞性的診斷， 智慧庫輔助的二維X 光影像處理及牙齒根管三維電腦建模型；（2）以醫學及工程 規則主導的電腦輔助根管治療程序安排，自動優化成最小侵入的治療，以保留牙 齒的強度健康。這兩項經電腦軟體的發展已初步實現證明可行，並經牙醫實驗室 的牙齒切片量測比較，誤差範圍在容許範圍內，成果已有多篇期刊及會議論文的 發表。 為期三年的本研究計畫書將進行第三階段的技術發展:根管治療專用智慧型 微型機器人之研發，以機器的精準代替人手的誤差，配以電子根管探測及?銼全 程偵測監控，保證治療手術品質。在國科會的補助下，台灣的團隊自95 年8 月 開始進行在第一年微型機器人的機械設計，包含五個運動軸的液壓製動器系統、 具速換功能的高速動力工具卡匣式組合、及定位裝置機器底座。我們已克服主要 的技術瓶頸，完成細部設計，在96 年6 月前將可順利完成製造組裝及測試。 本計畫書著重在第2 年及第3 年的研發工作，將繼續改良機器人的設計，發 展感測回朔系統，完成電腦CNC 控制，以及根管探測系統及線上監控等人工智慧。 完成後期能提供病人高效、安全、準確、可靠、廉價的先進牙髓病治療技術，又 能縮短牙髓病專科醫師的養成教育、減少牙醫受服務年齡及體能限制。

Endodontic therapy, also called root canal treatment, is a procedure performed to remove damaged tissue from the inner canal of a tooth and seal the canal to prevent the tooth from being a source of infection. Each year more than 24 million teeth receive endodontic treatment in the USA alone. A typical procedure includes access preparation, root canal preparation and root canal filling. The treatment process is expensive, time-consuming and prone to human error. Destructive removal of crown is needed before the clinician can diagnose the root canal, and excessive tooth structure removal weakens the tooth』s strength. Furthermore, the outcome relies on the clinician』s master skills that can be gained only through years of training and practice. No wonder the treatment successful rate is only 60-65% for general dentists and 90% by specialists. Through the international and inter-institutional collaborative efforts, among Columbia University, University of Cincinnati, and National Chiao Tung University, of endodontics research, engineering development and computer application, laboratory and clinical trial, this integrated project is designed to modernize the traditional way endodontists treat root canal, moving from manual 「art」 to science-based automation. In the past years, we have two major achievements: (1)developed a non-destructive precision technique for assessing the teeth』s root canal geometry, built a computer 3-D tooth model from 2-D x-ray and endoscope images and displayed in state-of-the-art computer graphic; (2) developed a minimum invasive, rule-based system for computer-aided treatment procedure planning , which convert the 3-D model to CNC (Computer Numerical Control) program including tool selection and tool path control. The software was developed and its accuracy was experimentally verified by comparing with real tooth measurement. Several Journal and proceeding papers have been published as the result of previous research effort. Since August, 2006, we in Taiwan have begun the effort for the third stage of the advanced endodontic technology development: to design and build a smart multi-purpose precision micro robotic drilling machine that can position and orient itself to perform the root canal treatment procedures with intelligent control and on-line monitoring for quality assurance. As the first year of this three-year project, we has concentrated on creation of the mechanical design of the micro machine, including designing (1) the 5 axis hydraulic drive system, (2) the high speed power tool cartridge with quick change mechanism, (3) the registration fixture for dental imaging and machine base mounting. We have overcome major technical challenges and expect to complete the design, fabrication and test of this machine by June 2007. This proposal is for the second year and the third year research and development work. We will continue the refinement of the mechanical design and control system, and start the development of sensor and intelligent control for this multi-functional machine in the second year. And in the third year, we will develop additional root canal probing technique and on-line monitoring of the root canal shaping process. Once completed, the results will provide advanced endodontic technologies for safe, accurate, efficient, reliable, and low-cost root canal treatment that will directly benefit the dentist and patients.