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補牙補的東西掉了怎麼辦？｜證據鏈

km 編輯部2026-08-13閱讀約 57 分鐘
#證據鏈#牙醫KM#台灣#補牙

本頁是〈補牙補的東西掉了怎麼辦？〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

補牙補的東西掉了怎麼辦？｜證據鏈

F-Units（事實單元帳）

  • F1｜confidence: verified｜basis: internal_dataset｜period: 2025-03 至 2026-08 GSC｜geo: TW｜span: backlog #46「補牙掉了」（81,369）與「補牙的地方掉了」（7,567）2 詞項合計曝光 88,936，單站｜caveat: 曝光為資產級數字、非去重流量；發布轉檔時本條整條不輸出（內部數據不進可見層）
  • F2｜confidence: 結構性整理（編輯框架，非外部事實宣稱）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 四路分流（正式填補物／療程中暫時封填／間接修復體／牙冠與牙橋）、「掉下來是結果不是原因」的提問框架、當下五件事的清單編排、紅旗清單的排序、以及第七節判斷面向的整理，皆為本站依 F3 至 F24 各來源整理的溝通用架構｜caveat: 非診斷工具、非分級判準、非決策流程圖，不取代牙醫師檢查
  • F3｜confidence: verified｜basis: peer_reviewed（PMID 26091581，統合分析）｜period: 檢索涵蓋 1996 至 2015，2015 刊出；版本時效已查（2026-08-06 以 posterior composite survival/longevity/failure 併 meta-analysis[pt] 限 2018 年後檢索，回傳之近期統合分析主題為銀汞與樹脂之失敗風險比較、大塊填充與分層堆疊之比較等，未見取代本篇「依失敗原因排序」之更新版；修復體存活率之現行 canonical 在本站 KM-DENTAL-16 卡）｜geo: universal｜span: 「In this study only prospective, clinical trials with specification of the failure rate according to Class I/II composite fillings were included.」「A total of 88 studies were included for statistical analysis.」「Fracture of the restorations, secondary caries and marginal gap are the main causes for failure in the first 5 years (in descending order), while fracture and secondary caries are similarly distributed in long-term studies.」｜caveat: 族群層級之失敗型態組成，非個別修復體之原因判定；納入限第一類與第二類複合樹脂充填之前瞻試驗，不含第五類與嵌體；本卡未引用其年失敗率數值，該面向 canonical 在 KM-DENTAL-16
  • F4｜confidence: verified｜basis: peer_reviewed（PMID 34481667，系統性回顧與統合分析）｜period: 2021 刊出；版本時效已查（2026-08-06 以 non-carious cervical 併 universal adhesive 限 systematic review/meta-analysis[pt]、2022 年後檢索，回傳筆數 0，本篇為現行可引用版本；同團隊 2022 年另篇 PMID 35151466 為不同 PICO，本卡未引用）｜geo: universal｜span: 「After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis.」「At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups」「Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.」｜caveat: 族群限定為非齲性頸部病灶之複合樹脂修復，不可外推至所有補牙；原文對各時間點之確定性評為中等或更低；本卡未引用其風險比數值，亦不作任何黏著程序之優劣建議或對任何一次治療之評價
  • F5｜confidence: verified｜basis: peer_reviewed（PMID 39547467，系統性回顧與統合分析）｜period: 檢索至 2024-05，2025 刊出｜geo: universal｜span: 「Studies were identified through searches in six databases (PubMed, Scopus, Cochrane, Embase, Scielo, Web of Science) up to May 2024.」「Of 1,565 articles identified, 10 met the inclusion criteria. These studies, conducted in five countries, included 411 participants with follow-up periods ranging from 1 to 8 years.」「Meta-analysis found no statistically significant differences between bioactive and conventional resin composites in preventing secondary caries or reducing retention loss (p > 0.05), the two primary outcomes considered in this review for assessing restoration longevity.」｜caveat: 「無統計顯著差異」不等於「等效」；納入試驗僅十篇、材料品項有限，本卡不引用亦不評價其中任何商品名
  • F6｜confidence: verified｜basis: peer_reviewed（PMID 2639947，體外力學研究）｜period: 1989 刊出｜geo: universal｜span: 「This study was designed to compare the contributions of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on extracted intact, maxillary, second bicuspids.」「Results on 42 teeth indicate that endodontic procedures have only a small effect on the tooth, reducing the relative stiffness by 5%. This was less than that of an occlusal cavity preparation (20%). The largest losses in stiffness were related to the loss of marginal ridge integrity. MOD cavity preparation resulted in an average of a 63% loss in relative cuspal stiffness.」｜caveat: 體外實驗、離體上顎第二小臼齒四十二顆、1989 年；測的是窩洞製備後的相對剛性，不是「填補物掉落後的牙齒」，不可換算為個別牙齒的斷裂風險；本卡以此說明窩洞形態是變因，未作任何斷裂機率陳述
  • F7｜confidence: verified｜basis: peer_reviewed（PMID 37345582，文獻回顧）｜period: 檢索 1947 至 2023-03-28，2023 刊出｜geo: universal｜span: 「A search was conducted in PubMed from 1947 to March 28, 2023.」「A total of 72 articles were included in the review, which revealed the variety and complexity of aetiological factors and treatment of food impaction in dentistry, as well as the heterogeneity of previous studies.」「Considering the causal factors of food impaction - including proximal contact loss, occlusal disharmony, morphological deformity, positional abnormality, and interdental papillae loss - different management approaches such as restoration, occlusal adjustment, orthodontic, nonsurgical or surgical treatment could be applied.」｜caveat: 敘述性回顧、非系統性回顧；成因清單為文獻整理而非因果證明；本卡未引用其任何處置方法作為建議
  • F8｜confidence: verified｜basis: peer_reviewed（PMID 34956432，文獻回顧）｜period: 2021 刊出｜geo: universal｜span: 「Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth.」「While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome.」｜caveat: 敘述性回顧、無統合數據；本卡僅引其「牙裂為獨立臨床問題且病因討論含修復處置面」之定位，未引用任何比例，亦不提供辨識牙裂的自我判斷方法
  • F9｜confidence: verified｜basis: peer_reviewed（PMID 21689541，系統性回顧與統合分析）｜period: 2011 刊出；版本時效已查（2026-08-06 以 coronal restoration 併 root canal treatment/root filling 與 outcome/success/apical periodontitis、限 systematic review/meta-analysis[pt] 檢索，回傳 7 筆，主題較接近之新近者為 PMID 41651276 之孔口封填屏障系統性回顧與 PMID 40851324 之修復體類型系統性回顧，兩者 PICO 皆不同；未見本篇之更新版）｜geo: universal｜span: 「Nine articles were identified and were reviewed by 3 investigators.」「After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE (OR = 2.734; 95% confidence interval [CI], 2.61-2.88; P < .001) and AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64-2.97; P < .001).」「On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these 2 combinations.」｜caveat: 原文比較的是「修復體品質適當 vs 不適當」，不是「有修復體 vs 完全沒有修復體」，更不是「填補物掉落若干天」；本卡已於正文明寫此界線；納入研究為觀察性設計，勝算比為族群層級估計
  • F10｜confidence: verified｜basis: peer_reviewed（PMID 24392750，十年追蹤觀察性世代研究）｜period: 1997／2003／2008 三次檢查，2014 刊出｜geo: universal（丹麥一般成人族群）｜span: 「The study provides longitudinal, observational information on endodontic status for 327 randomly selected individuals from a general Danish population receiving three consecutive full-mouth radiographic examinations.」「Overall 13% of the root filled teeth had been extracted, 12% had received a revision of the root filling and 42% of root filled teeth present in 2008 had apical periodontitis (AP) after the 10-year follow-up period.」「The probability of persistent AP was higher if the root filling was either short or long (P = 0.001), if there were voids (P < 0.001), or if there were radiographic signs of overhang or open margin of the restoration (P = 0.01). Further, the probability of extraction was high if there were radiographic signs of overhang or open margin of the restoration (P = 0.008)」｜caveat: 觀察性研究，顯示相關而非因果；族群限定為根管治療過的牙齒、單一國家；影像上的「懸突或邊緣開放」與「填補物整個掉了」不是同一件事，本卡未將兩者等同
  • F11｜confidence: verified｜basis: peer_reviewed（PMID 29201596，流行病學綜述）｜period: 2017 刊出｜geo: universal｜span: 「Twenty-nine articles reporting data on the prevalence of primary or posttreatment apical periodontitis from all over the world were included.」「The quality of the coronal restoration and the root filling appears to be the major predictors of apical periodontitis.」｜caveat: 敘述性綜述、非統合分析；「預測因子」為相關性描述，非因果；本卡未引用其盛行率區間
  • F12｜confidence: verified｜basis: peer_reviewed（PMID 36375647，長期回溯臨床研究）｜period: 單一術者十五年間治療，追蹤 1 至 35 年以上，2023 刊出｜geo: universal｜span: 「Treatments were conducted over a period of 15 years by a single operator.」「In general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods.」「The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P < .001).」｜caveat: 族群限定為因深齲導致牙髓暴露、臨床診斷為可逆性牙髓炎而接受直接蓋髓的成熟恆牙，且為單一術者之回溯資料，不可外推至所有補牙；本卡未引用其成功率數值
  • F13｜confidence: verified｜basis: peer_reviewed（PMID 33378579，系統性回顧與統合分析；同錨＝本站 KM-DENTAL-15 卡 F17）｜period: 檢索至 2019-09，2021 刊出｜geo: universal｜span: 「Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease」「The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth.」「The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2 = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2 = 99.5%)」｜caveat: 作者明載臨床異質性高（I² 逾 97%）與偏差風險高，結果須謹慎解讀；根尖牙周炎之成因不限於掉落的填補物，本卡未作歸因
  • F14｜confidence: verified｜basis: peer_reviewed（PMID 28174365，體外微滲漏研究）｜period: 2017 刊出｜geo: universal｜span: 「Biomechanical preparation of the root canals of 204 fresh mandibular first premolar teeth was done using endodontic files with intermittent irrigation of sodium hypochlorite solution and ethylenediaminetetraacetic acid.」「Permanent restorations should be given as soon as possible after the completion of root canal therapy.」「All the temporary restorative materials were not able to prevent microleakage after 1 week's time」｜caveat: 體外實驗；且「永久性修復體應儘早施作」一句出自該文導言，屬作者之背景陳述而非其實驗結果，本卡已於正文標明；本卡未引用其各材料間的優劣比較，亦不作任何材料推薦
  • F15｜confidence: verified｜basis: peer_reviewed（PMID 34777500，問卷調查研究）｜period: 2021 刊出｜geo: universal（沙烏地阿拉伯）｜span: 「An online questionnaire was distributed among general dentists, dental specialists, and clinical trainees in undergraduate and postgraduate dental programs.」「The total number of participants who met the inclusion criteria was 525.」「Temporary restoration breakdown or complete loss was a common observation.」「Although the duration between the two RCT visits was 2 weeks or less for 83.6% of participants, only 19.6% of participants claimed that they rarely observed temporization breakdown.」｜caveat: 牙醫師自陳臨床觀察之問卷、單一國家，不能作為病人層級的發生率；本卡未引用其各材料使用比例作為任何建議
  • F16｜confidence: verified｜basis: peer_reviewed（PMID 14719578，個案報告；同錨＝本站 KM-DENTAL-38 卡 F12）｜period: 2003 刊出｜geo: universal｜span: 「This article describes how a man attempted to repair damage to his maxillary teeth with super glue. Such action is discouraged, however, because of possible adverse reactions in the hard and soft tissues.」｜caveat: 單一個案報告、證據等級低，該摘要未載明具體不良反應之型態與嚴重度；本卡引用其結論句之立場（不建議），未推論任何損傷發生率
  • F17｜confidence: verified｜basis: peer_reviewed（PMID 20689240，單一機構回溯調查；同錨＝本站 KM-DENTAL-38 卡 F5）｜period: 2008 會計年度資料，2010 刊出｜geo: universal（日本單一牙科醫院）｜span: 「Accidental ingestion accounted for about 30% of accidents that occurred at our hospital in fiscal 2008, but all ingested items were naturally excreted, and no accidental aspiration occurred. Accidental ingestion most frequently occurred when dental restorations were removed. Inlays and crowns were most frequently ingested」｜caveat: 單一機構、單一年度之院內事故調查，不可外推為一般發生率；情境為診間內由專業人員拆除修復體時，與病人在家中口內留有鬆動碎片不是同一個場景，本卡未以本條把居家碎片說成誤吞的典型情境（2026-08-06 CX 對抗審指出原稿此處歸屬過度，已改寫）；誤吞誤吸之完整分流 canonical 在 KM-DENTAL-38
  • F18｜confidence: verified｜basis: peer_reviewed（PMID 31145805，Cochrane 系統性回顧 pub5；同錨＝本站 KM-DENTAL-15 卡 F19）｜period: 檢索至 2019-02-18，2019 刊出｜geo: universal｜span: 「Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care」「there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics」｜caveat: 僅一項小樣本試驗、證據確定性低；該回顧檢定的對象只有抗生素，本卡不得把它擴大讀成「所有藥物都沒有證據」；本條不構成任何用藥或停藥指示
  • F19｜confidence: verified｜basis: textbook（PMID 30020634，StatPearls 深頸部感染條目；同錨＝本站 KM-DENTAL-15 卡 F21 與 KM-DENTAL-33 卡）｜period: 現行版｜geo: universal｜span: 「Symptoms often result from local pressure effects on the respiratory, nervous, or gastrointestinal tracts, including neck swelling, dysphagia, dysphonia, and trismus」「often involving fever, neck pain, and respiratory distress」｜caveat: 教科書層級（basis 階梯之下層），非系統性回顧；深頸部感染之來源不限牙源性；本卡僅引其症狀清單作為紅旗依據，未引任何發生率或預後數字
  • F20｜confidence: verified｜basis: peer_reviewed（PMID 38777729，敘述性綜述；同錨＝本站 KM-DENTAL-15 卡 F22）｜period: 2024 刊出｜geo: universal｜span: 「Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth」｜caveat: 該綜述以兒童族群為主題，本卡引其為機轉層級之一般陳述，未引任何發生率；敘述性綜述非系統性回顧
  • F21｜confidence: verified｜basis: peer_reviewed（PMID 40851324，系統性回顧與統合分析）｜period: 2025 刊出（PROSPERO CRD42024594890）｜geo: universal｜span: 「A total of 2063 articles were screened; eventually, 11 studies were included (Ten cohort studies and one RCT).」「Overall, RFT restored with indirect coronal restorations survived significantly better compared to directly restored RFT (p = 0.01), whereas no statistical difference in periapical healing was demonstrated (p = 0.72).」「Indirect restorations appear to be associated with improved survival in RFT, but this finding should be interpreted cautiously.」｜caveat: 納入十一項研究中僅一項為隨機對照試驗、其餘為世代研究；作者自載此發現應謹慎解讀，本卡照錄該限制；族群限定為根管治療後牙齒，不可讀為「填補物掉了就該做間接修復」
  • F22｜confidence: verified（2026-08-06 以 ego-browser 實載醫療器材分類分級查詢資料庫，簡易查詢輸入關鍵字「暫時性填補」送出，回傳一筆、分類類別欄顯示 F-牙科學，逐欄讀取代碼、中英文名稱、鑑別範圍與等級；同錨＝本站 KM-DENTAL-38 卡 F24，本卡以不同關鍵字獨立複驗命中同一品項）｜basis: official_statement（衛生福利部食品藥物管理署委託建置之醫療器材分類分級查詢資料庫）｜period: 2026-08-06 查詢現況｜geo: TW｜span: 代碼 F.3275「牙科用水泥(士敏汀)」（Dental cement），鑑別範圍逐字：「牙科用水泥(士敏汀)用於作為牙齒的暫時性填補；或作為黏附暫時性牙科補綴物及牙冠或牙橋等牙科器材的基底層；或塗於牙齒上用來保護牙髓。此器材一般是由氧化鋅－丁香酚(zinc oxide-eugenol)組成。(1)第一等級: 主要作用成分為氧化鋅－丁香酚；(2)第二等級: 主要作用成分非為氧化鋅－丁香酚。」等級欄「1,2」，特定的管理規定欄「簡化審查(符合性聲明書), 製造廠精要模式」｜caveat: 該資料庫頁面自載「本網站為衛生福利部食品藥物管理署委託建置維護，內容僅供參考，如有差異以衛生福利部食品藥物管理署公告為準」；分類品項之鑑別範圍是器材的用途描述，不是臨床適應症判定，亦非個別商品之合法性判定，本卡不作法規適用判斷
  • F23｜confidence: verified（2026-08-06 以 curl 取回全國法規資料庫該條頁面，HTTP 200，抽取條文區塊逐字比對；同錨＝本站 KM-DENTAL-38 卡 F27）｜basis: law｜period: 現行條文｜geo: TW｜span: 《醫療器材管理法》第 25 條第 1 項「製造、輸入醫療器材，應向中央主管機關申請查驗登記，經核准發給醫療器材許可證後，始得為之。但經中央主管機關公告之品項，其製造、輸入應以登錄方式為之。」｜caveat: 條文引述，非法律意見；個別產品之管理方式以主管機關公告為準
  • F24｜confidence: verified（2026-08-06 自政府資料開放平臺該資料集所列之健保署介接端點以 curl 取回 CSV，HTTP 200、1,692,784 bytes、6,098 行含表頭，表頭逐字為「診療項目代碼,健保支付點數,生效起日,生效迄日,英文項目名稱,中文項目名稱,備註」，以 Python csv 逐列解析、命中含「充填」之中文項目名稱四十三筆並逐筆讀取備註欄；同錨＝本站 KM-DENTAL-36 卡 F26，本卡獨立重跑）｜basis: official_statement（衛生福利部中央健康保險署「醫療服務給付項目及支付標準」開放資料）｜period: 2026-08-06 取回之現行清單｜geo: TW｜span: 診療項目代碼 89008C「後牙複合樹脂充填-單面」之備註欄逐字：「1.同顆牙申報複合樹脂充填，乳牙一年、恆牙一年半內，不論任何原因，所做任何形式（窩洞及材質）之再填補，皆不得再申報充填(89001C～89005C，89008C～89012C，89014C～89015C，89204C~89205C，89208C~89210C，89212C，89214C~89215C）費用，以同一院所為限。2.應於病歷詳列充填牙面部位。3.申報面數最高以三面為限。」｜caveat: 本卡不引用任何支付點數；該備註規範的是保險醫事服務機構的申報規則，不等於病人端的付費結論，也不是個案給付判定；同類項目各自成文、條件並不完全相同（例如 89013C「複合體充填」之備註為限恆牙牙根齲齒申報、每顆牙一年半內不得重複申報）；清單每日更新，引用時請註明查證日期；費用組成 canonical 在 KM-DENTAL-36
  • F25｜confidence: verified（2026-08-06 以 curl 取回全國法規資料庫該條頁面，HTTP 200，抽取條文區塊逐字比對；同錨＝本站多卡）｜basis: law｜period: 現行條文｜geo: TW｜span: 《醫療法》第 81 條「醫療機構診治病人時，應向病人或其法定代理人、配偶、親屬或關係人告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應。」｜caveat: 條文引述，非法律意見
  • F26｜confidence: verified（2026-08-06 以 curl 取回全國法規資料庫該條頁面，HTTP 200，抽取條文區塊逐字比對；同錨＝本站多卡）｜basis: law｜period: 現行條文｜geo: TW｜span: 《醫療法》第 87 條「廣告內容暗示或影射醫療業務者，視為醫療廣告。醫學新知或研究報告之發表、病人衛生教育、學術性刊物，未涉及招徠醫療業務者，不視為醫療廣告。」｜caveat: 條文引述，非法律意見；本卡之衛教定位依此條
  • F27｜confidence: verified（2026-08-05 由 OP 以 ego-browser 親驗，下拉選單類別逐項讀取；本卡未重複實測，沿用 km-compliance/VERIFIED-FACTS.md 之跨卡已驗事實）｜basis: official_statement｜period: 2026-08-05 查證現況｜geo: TW｜span: 衛生福利部中央健康保險署「醫材比價網」之兩個查詢軌（自付差額醫材比價、醫材收費比價）品項分類皆不含牙科，頁面全文無「牙」字｜caveat: 本卡未重複實測；官方資料庫可能更新，引用時請註明查證日期。牙科自費費用之查證管道為各縣市衛生局核定之牙科收費標準與院所書面報價
  • F28｜confidence: n/a｜basis: 證據缺口聲明（editorial，非待驗）｜period: 2026-08-06｜geo: universal｜span: 本次檢索未取得可引用證據、故本卡不寫的項目：①任何金額、區間或行情 ②「補牙掉了幾天內必須回診」之時效數字（以 emergency dental 併 lost restoration/lost filling 檢索 PubMed，回傳筆數 0）③填補物掉落後放置若干天之後果研究 ④重新填補後之存活率或使用年限 ⑤「自行填補」與「不填補」之頭對頭比較研究 ⑥填補物脫落在台灣的發生率統計 ⑦「自行填補會把蛀牙封起來繼續惡化」之直接證據｜caveat: 本條為證據缺口之誠實揭露，非待驗 claim；檢索侷限於 PubMed 與上列檢索式，未取得不等於已被推翻；日後若取得可引用來源，須完成三件齊查證後才可補寫
  • F29｜confidence: 結構性整理（編輯框架，非外部事實宣稱）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 同族卡分工聲明——KM-DENTAL-02 負責補牙後的進食與清潔時機；KM-DENTAL-16 負責修復體存活率、年失敗率、材質選擇與「修補 vs 重做」的證據比較；KM-DENTAL-12 負責「要不要補、怎麼補」的決策；KM-DENTAL-36 負責費用組成與報價讀法；KM-DENTAL-38 負責假牙、牙冠與牙橋脫落及誤吞誤吸的完整分流；KM-DENTAL-15 與 KM-DENTAL-33 負責蛀牙拖延與牙痛的完整紅旗分級。本卡（KM-DENTAL-46）只處理「填補物已脫落之後的處置、成因型態、後果關聯與回診判斷面向」，重疊處只引用結論、不重寫｜caveat: 編輯性分工聲明，非醫學宣稱，不得標為待驗
  • F30｜confidence: verified｜basis: textbook（PMID 29493976，StatPearls "Ludwig Angina" 條目；PubMed pubtype 為 Study Guide，非同儕審查研究。本卡不代為中譯病名，避免以記憶寫專有名詞——事故簿第 1 條）｜period: 現行版（條目最後更新 2025-06-22）｜geo: universal｜span: 「Ludwig angina is a rare, life-threatening condition characterized by diffuse cellulitis that involves the soft tissues of the floor of the mouth and neck.」「True Ludwig angina originates from an infection of a lower molar tooth.」「Early recognition and treatment are critical, including emergent airway management, intravenous antibiotic therapy, and surgical drainage if an abscess is present.」｜caveat: 教科書層級（basis 階梯之下層），非系統性回顧；本條在本卡的用途只有一個——為紅旗清單中的「口底腫脹」提供可核對的來源；原文未提供任何發生率，本卡亦不作機率陳述；口底腫脹的來源不限於牙源性，鑑別須由醫療端為之
  • F31｜confidence: verified｜basis: peer_reviewed（PMID 40533920，系統性回顧與統合分析；PubMed pubtype 標示 Systematic Review／Meta-Analysis）｜period: 檢索至 2024-06，2025-05 刊出｜geo: universal｜span: 「Teeth exhibiting symptomatic irreversible pulpitis (SIP) were defined as exhibiting spontaneous unprovoked pain, lingering thermal pain, or referred pain, and may have periapical pathosis/involvement or not.」｜caveat: 本卡只引用該文對「症狀性不可逆性牙髓炎」的操作型定義句，未引用其任何成功率數值、材料比較或治療方式建議；該回顧的主題為恆牙活髓治療、刊於兒童牙科期刊，其定義句為診斷分類之界定，不是病人可自我對照的診斷清單；牙痛的來源不只牙髓一種
  • F32｜confidence: verified｜basis: peer_reviewed（PMID 29735507，個案報告）｜period: 2018 刊出｜geo: universal｜span: 「A 62-year-old man with a background of type 2 diabetes mellitus presented to the emergency department (ED) with a 5-day history of dental pain, progressive right facial swelling, trismus, dysphagia and voice changes.」「The patient had a National Early Warning Score of 0 and so was triaged into the 'minors' section of ED.」「Following assessment by the on-call oral and maxillofacial surgeon, an urgent contrast-enhanced CT demonstrated a large parapharyngeal collection, which required urgent anaesthetic and surgical intervention.」｜caveat: 單一個案報告、證據等級低，不能用於估計發生率或個人風險；該病人另有第二型糖尿病病史，本卡未將其結果歸因於單一因素；本卡引用它的用途限於兩點——顏面腫脹與張口受限、吞嚥困難、聲音改變同時出現的這一組症狀被記錄過，以及早期預警評分正常仍需緊急處置，未推論任何比例

來源清單

取用日期均為 2026-08-06。PubMed 條目以 E-utilities efetch（rettype=abstract）取得摘要原文逐字對照，並以 esummary 之 pubtype 逐筆檢查撤回狀態（22 筆全數無 Retracted Publication 標記、無 WITHDRAWN 標題）；醫療器材分類分級查詢資料庫以 ego-browser 實載並執行關鍵字查詢、逐欄讀取；法規條文以 curl 取回全國法規資料庫頁面（HTTP 200）後抽取條文區塊逐字比對；健保給付項目清單以 curl 自資料集所列端點取回 CSV（HTTP 200、1,692,784 bytes）後以 Python csv 逐列解析比對 [F24]。

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  2. Josic U, et al. Is clinical behavior of composite restorations placed in non-carious cervical lesions influenced by the application mode of universal adhesives? A systematic review and meta-analysis. Dent Mater. 2021;37(11):e503-e521. PMID 34481667
  3. de Carvalho LF, et al. Effectiveness of bioactive resin materials in preventing secondary caries and retention loss in direct posterior restorations: A systematic review and meta-analysis. J Dent. 2025;152:105460. PMID 39547467
  4. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15(11):512-6. PMID 2639947
  5. Truong VM, Kim S, Yi YJ, Park YS. Food Impaction in Dentistry: Revisited. Oral Health Prev Dent. 2023;21:229-242. PMID 37345582
  6. Li F, et al. Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention. Pain Res Manag. 2021;2021:3788660. PMID 34956432
  7. Gillen BM, et al. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod. 2011;37(7):895-902. PMID 21689541
  8. Kirkevang LL, Vaeth M, Wenzel A. Ten-year follow-up of root filled teeth: a radiographic study of a Danish population. Int Endod J. 2014;47(10):980-8. PMID 24392750
  9. Persoon IF, Ozok AR. Definitions and Epidemiology of Endodontic Infections. Curr Oral Health Rep. 2017;4(4):278-285. PMID 29201596
  10. Ricucci D, et al. Outcome of Direct Pulp Capping Using Calcium Hydroxide: A Long-term Retrospective Study. J Endod. 2023;49(1):45-54. PMID 36375647
  11. Tiburcio-Machado CS, et al. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J. 2021;54(5):712-735. PMID 33378579
  12. Srivastava PK, et al. Assessment of Coronal Leakage of Temporary Restorations in Root Canal-treated Teeth: An in vitro Study. J Contemp Dent Pract. 2017;18(2):126-130. PMID 28174365
  13. Algahtani FN, et al. Common Temporization Techniques Practiced in Saudi Arabia and Stability of Temporary Restoration. Int J Dent. 2021;2021:4965500. PMID 34777500
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  15. Hisanaga R, et al. Survey of accidental ingestion and aspiration at Tokyo Dental College Chiba Hospital. Bull Tokyo Dent Coll. 2010;51(2):95-101. PMID 20689240
  16. Agnihotry A, et al. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev. 2019;5(5):CD004969. PMID 31145805
  17. Almuhaiza M, et al. Deep Neck Infections. StatPearls. PMID 30020634
  18. Cachovan G, et al. Odontogenic Infections in Children. Review. 2024. PMID 38777729
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  20. AL Ghabra Y, Brizuela M, Winters R, Singhal M. Ludwig Angina. StatPearls. 2025 Jun 22. PMID 29493976
  21. Coll JA, et al. Vital Pulp Therapy in Permanent Teeth: A Systematic Review and Meta-Analyses. Pediatr Dent. 2025;47(3):137-150. PMID 40533920
  22. Wates E, Higginson J, Kichenaradjou A, McVeigh K. A severe deep neck odontogenic infection not prioritised by the emergency department triage system and National Early Warning Score. BMJ Case Rep. 2018;2018:bcr2018224634. PMID 29735507
  23. 醫療器材分類分級查詢資料庫（衛生福利部食品藥物管理署委託建置維護）
  24. 醫療器材管理法 第 25 條（全國法規資料庫）
  25. 醫療法 第 81 條（全國法規資料庫）
  26. 醫療法 第 87 條（全國法規資料庫）
  27. 政府資料開放平臺 資料集「醫療服務給付項目及支付標準(csv檔)」（提供機關：衛生福利部中央健康保險署）
  28. 跨卡已驗事實：`km-compliance/VERIFIED-FACTS.md`（健保署醫材比價網不含牙科，2026-08-05 OP 親驗）
  29. 內部數據：`analysis/reports/km-dental-backlog.md` #46 附錄（詞×站×曝光逐筆可對帳）
  30. 編輯框架與證據缺口：本站四路分流、當下處置清單編排、紅旗排序與不寫清單（無外部來源，標示為結構性整理）

內部引用鏈

  • 補完牙多久可以吃東西、多久可以刷牙：補牙後多久可以吃東西、多久可以刷牙？（KM-DENTAL-02）——分工聲明：術後進食與清潔的時機、術後敏感的判讀屬該卡的 canonical 範圍，本卡只在「掉落後仍要繼續清潔」這一點上引用，不重寫。
  • 補牙能撐幾年、材質怎麼選、修補還是重做：樹脂補牙可以撐幾年？材質怎麼選？（KM-DENTAL-16）——分工聲明：修復體存活率、年失敗率、材料比較、以及「修補 vs 整個置換」的證據比較屬該卡的 canonical 範圍，本卡不重寫、亦不轉載其存活率數值。
  • 要不要補、補牙那一次在做什麼：蛀牙了一定要補嗎？補牙怎麼補？（KM-DENTAL-12）——分工聲明：修復適應症與去齲策略屬該卡的 canonical 範圍，本卡不重寫。
  • 費用怎麼組成、報價怎麼讀：補牙要多少錢？補牙縫、補缺角各多少？（KM-DENTAL-36）
  • 假牙、牙冠、牙橋掉了（含誤吞誤吸的完整分流）：假牙／牙套掉了，可以自己黏回去嗎？（KM-DENTAL-38）——分工聲明：修復體脫落後的黏著問題、誤吞誤吸的紅旗與影像判讀屬該卡的 canonical 範圍，本卡處理的是直接填補物。
  • 拖延的後果與紅旗分級：蛀牙可以拖多久？會自己好嗎？（KM-DENTAL-15）
  • 牙痛怎麼分辨、什麼時候該立刻就醫：牙齒痛怎麼辦？蛀牙痛是什麼感覺？（KM-DENTAL-33）
發布閘門提醒：本卡為 draft。四語（zh-Hans／en／ja）未產前不得進 km_entries；F27 為沿用之跨卡已驗事實（本卡未重複實測），發布前若制度頁面有更新須重驗；F24 之健保清單每日更新，發布前須重跑取回並確認備註未變。

FAQ

什麼情況要立刻就醫、不能等？
口底或臉部腫脹、發燒、頸部腫脹、頸部疼痛、吞嚥困難、聲音改變、張口困難或呼吸窘迫時，不要等牙科門診排程，請立即尋求醫療協助 [F19][F30][F32]。若碎片找不到，而且開始咳嗽或呼吸不順，這也是急症；嗆咳、講不出話或胸痛亦同。請立即就醫，不要等到回診日 [F2][F29]。
どのような場合に直ちに受診し、待ってはいけませんか？ — 口腔底又は顔面の腫れ、発熱、頸部腫脹、頸部痛、嚥下困難、声の変化、開口困難又は呼吸窮迫がある場合は、歯科外来の予約を待たず、直ちに医療の助けを求めてください [F19][F30][F32]。破片が見つからず、せき又は息苦しさが始まった場合も救急です。むせ、話せない、胸痛でも同じく、直ちに受診し、予約日を待たないでください [F2][F29]。
When should I seek immediate medical care rather than wait? — For swelling of the floor of the mouth or face, fever, neck swelling, neck pain, difficulty swallowing, voice change, difficulty opening the mouth, or respiratory distress, do not wait for a dental appointment; seek medical help immediately [F19][F30][F32]. If the fragment cannot be found and you begin coughing or having trouble breathing, this is also an emergency; the same applies to choking or coughing, inability to speak, or chest pain. Seek medical care immediately; do not wait for the appointment date [F2][F29].
補牙掉了，可以先用市售的暫時填補材料自己補起來嗎？
**不建議，請把它當成「回診之前的問題」而不是「自己解決的問題」。** 在台灣制度上，用於作為牙齒暫時性填補的材料屬醫療器材分類分級資料庫代碼 F.3275「牙科用水泥(士敏汀)」的鑑別範圍 [F22]，而依《醫療器材管理法》第 25 條，醫療器材之製造、輸入應經查驗登記或依公告以登錄方式為之 [F23]。**本卡不判定任何個別產品的合法性，也不推薦任何商品** [F26]。更根本的理由是：即使是牙科場合使用的暫時性修復材料，一項體外研究記錄所有受測材料在一週之後都無法阻止微滲漏 [F14]；把洞蓋起來並不能處理掉落的原因，而原因需要檢查才分得開 [F3][F8][F2]。
詰め物が取れた時、市販の暫時充填材料を自分で使ってよい？ — **勧めません。「自分で解決する問題」ではなく、「受診前に持ち込む問題」と考えてください。** 台湾制度上、歯の暫時的充填に用いる材料は、医療機器分類・等級データベースの F.3275「牙科用水泥(士敏汀)」（Dental cement）の識別範囲に入ります [F22]。台湾医療機器管理法第 25 条は、医療機器の製造・輸入には査験登録又は公告に基づく登録を求めます [F23]。**本カードは個別製品の適法性を判定せず、いかなる商品も推奨しません** [F26]。さらに根本的には、歯科で使う暫間修復材料でも、in vitro 研究で全材料が一週間後の微小漏洩を防げませんでした [F14]。穴を覆っても脱落の原因は処理できず、その原因は診察でなければ分かりません [F3][F8][F2]。
My filling fell out. Can I use a store-bought temporary filling material myself first? — **It is not advised. Treat it as a matter for before the dental review, not a problem to solve by yourself.** In Taiwan's system, material for temporary tooth filling is within the identifying scope of code F.3275 “Dental cement” in the medical-device classification and grading database [F22]. Article 25 of Taiwan's Medical Devices Management Act requires medical-device manufacture and import to undergo inspection and registration or registration under an announced route [F23]. **This card does not determine the legality of any individual product and recommends no product** [F26]. More fundamentally, even temporary restorative materials used in dental settings all failed to prevent microleakage after one week in one in-vitro study [F14]. Covering the hole does not address why it came out, and that cause needs examination to be distinguished [F3][F8][F2].
那三秒膠（強力膠）呢？我只是先黏一下。
**文獻裡的紀錄是不建議。** 一篇個案報告描述一位男性以強力膠自行修補上顎牙齒的損壞，該文結論句寫明不建議這樣做，因為可能對硬組織與軟組織造成不良反應 [F16]。**這是單一個案報告、證據等級低，摘要未載明不良反應的型態與嚴重度**；本卡引用它的立場，不推論任何損傷發生率 [F16][F28]。如果你已經黏過了，回診時請主動說明用了什麼、黏了幾次 [F2]。
瞬間接着剤（強力接着剤）は？ ひとまず少し接着したいだけです。 — **文献で記録された結論は、勧めない、です。** 症例報告は、男性が上顎歯の損傷を強力接着剤で自ら修理しようとしたことを記録し、硬組織と軟組織に有害反応を起こす可能性があるため勧めないと結論しました [F16]。**単一症例で根拠水準は低く、抄録は有害反応の種類と重症度を示していません。** 本カードはその立場を引用するだけで、障害の発生率を推定しません [F16][F28]。すでに使った場合は、受診時に何を何回使ったかを自ら伝えてください [F2]。
What about superglue? I only want to stick it for now. — **The recorded literature position is that it is discouraged.** A case report describes a man attempting to repair maxillary-tooth damage himself with superglue and concludes that this is discouraged because it may cause adverse reactions in hard and soft tissues [F16]. **It is one low-level case report and the abstract does not state the type or severity of adverse reactions.** This card follows its position but does not infer any rate of injury [F16][F28]. If you have already used it, tell the dentist what you used and how many times when you attend [F2].

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km 編輯部・《補牙補的東西掉了怎麼辦？｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/post/reports/dental-filling-fell-out-evidence

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更新 2026-08-13T14:17:17.984Z · server-rendered · four-language · IDAEO 知識庫