矯正托架經人工處理及臨床使用後造成腐蝕現象對細菌黏附影響之研究

口腔環境為多樣化的微生物族群提供了繁殖的適當環境。當口腔內環境平衡改變時，可造成細菌之組成改變，可能因此產生疾病。戴固定式矯正裝置後，有可能會造成上述改變，根據之前的研究顯示，固定式矯正裝置的確會引致一些特殊的口腔環境改變，例如增加牙菌斑形成以及增加viridans streptococci 累積。過去有些研究發現，使用金屬矯正托架後會產生菌叢的改變，但是這些研究對於是否因為金屬托架的表面侵蝕而造成加速牙菌斑的生成進而改變菌叢的資料相當缺乏。本研究目的乃探討矯正托架在經電化學腐蝕後細菌附著生長之狀況，與由接受治療之患者口中的矯正托架細菌附著生長之狀況。材料與方法：採用三組矯正托架為實驗組，全新之矯正托架為對照組，第一組的矯正托架在電化學腐蝕後放入人工唾液浸泡，第二組的矯正托架在電化學腐蝕後用漱口水浸泡，第三組則從病人口中取得使用兩年以上的矯正托架。為了要證明哪一組的矯正托架有最高的細菌黏附力、以及所選擇的各種細菌對矯正托架的黏附狀況，以掃描式電子顯微鏡檢測，並選用三種牙齦上菌斑內的細菌，包括 S.sangunis, S.mutans, A.viscosus 和牙周病原菌 P . gingivalis。在實驗組和對照組矯正托架上，黏附單一種或是兩種的細菌做實驗，每一組實驗中都有七顆矯正托架。黏附在矯正托架上細菌的數量則使用菌落形成單位來計算。結果分析以one-way 和two-way ANOVA 統計方法檢驗結果，事後檢定使用 Fisher LSD 檢定比較結果。結果發現在所有組中，菌落形成平均數值最高的是 S.sangunis (4528.7 ± 983)，A.viscosus（3826.4 ± 822.7）， S.mutans（3281.7 ± 1310.9 4 和P.gingivalis（32 ± 8.0）。但是當 P.gingivalis和其他牙齦上牙菌斑內的細菌共同培養的時候P.gingivalis的黏附數量在統計學上有明顯的增加(p ＜0.01)。當牙齦上牙菌斑內細菌和P.gingivalis 依序黏附在矯正托架上時，結果發現細菌黏附數量遞增，依序為：患者口中取出的矯正托架組、浸泡過漱口水的矯正托架組、浸泡過人工唾液組。結論：本實驗證實細菌比較容易黏附在表面有腐蝕之固定式矯正器上。三種齦上菌斑微生物(S.sangunis, S.mutans, A.viscosus) 會造成 P.gingivalis黏附在固定式矯正器的數量增加。患者口中使用過之矯正托架其細菌附著程度較實驗室模擬環境下之矯正托架嚴重。

關鍵字

細菌；矯正托架

並列摘要

Background The oral environment provides the proper conditions for the colonization of a complex microflora. When changes occur in the normal oral environment, diseases may result by the imbalance bacterial composition changes. One of the diseases may cause changes can be brought by the placement of fixed orthodontic appliances, which have been found to induce specific changes in the oral environment such as increased plaque formation, and elevated viridans streptococci accumulation. Although a number of studies have shown a shift in microbial populations in the presence of metallic orthodontic brackets, limited information is available as whether corrosion or erosion of metallic bracket material surface would be prone to the dental plaque adhesion, and the changes of bacterial species during plaque accumulation. The microbiota and food residues cause by the presence of orthodontic appliances, which creates a favorable environment and may cause caries or deteriorate pre-existing periodontal tissue damage. The purpose of the study was to compare the bacterial adhesion present on pre-erosion metallic orthodontic brackets rinsed in artificial saliva, mouthwash and bracket’s debonding after two years from clinical patients. In order to clarify which of the different treated bracket surface has a higher bacteria retaining capacity, and to determine the levels of selected bacterial species adhesion on tested brackets, an in vitro test was performed, with three S.sangunis, S.mutans, A.viscosus supra gingival plaque species and an P.gingivalis important periodontal pathogen were identified by SEM, the single strain cultured and co-cultured with tested brackets under optimal condition were performed, each group contain seven brackets. And non-treated metallic brackets were using as control group. Colony forming 2 unit(CFU) was using for enumerations the brackets adhesion bacterial counts. Results Results were compared statistically by using one- and two-way ANOVA (p<0.01), and further analyzed using Fisher LSD test for comparison. The results showed that the highest values, indicating high adhesion of bacteria, were S.sangunis (4528.7±983)and on the respect of A.viscosus (3826.4±822.7), S.mutans (3281.7±1310.9) and the lowest adhesive was P.gingivalis (32±8.0), but the adhesion was increased significantly (p＜0.01) in P.gingivalis co-cultured with all three selected supragingival bacteria. Which indicated that supragingival plaque formation could aid subgingival bacterial adhesion by cell interaction. By this study we demonstrated that the adherence of supragingival plaque plus P.gingivalis together varied according to the different treated bracket surface descended by clinical debonding brackets, mouthwash soaked pre-corrosion brackets and artificial saliva soaked pre-corrosion brackets. Conclusion Orthodontic appliances serve as different impact zones and modify microbial adherence and colonization, acting as foreign reserves and possible sources of infection. Careful hygiene control around orthodontic brackets is important, but prevention of plaque accumulation by mouthwash will be considered.

並列關鍵字

bateria ； bracket

參考文獻

White Dental Manufacturing Co, Philadelphia ,.1907

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國際替代計量

矯正托架經人工處理及臨床使用後造成腐蝕現象對細菌黏附影響之研究

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