正畸治疗中牙龈指数及龈沟液细菌的变化研究

目的探讨正畸治疗中牙龈指数及龈沟液细菌的变化.方法记录牙龈指数并采集龈沟液进行厌氧菌培养.结果矫治初两个月牙龈指数GI明显升高,牙龈卟啉单胞菌、伴放线放线杆菌和核梭杆菌的检出率明显升高,三种细菌培养的阳性率水平与GI呈正相关关系.结论固定矫治器对牙龈组织的健康有一定的影响,上述细菌与牙龈指数有密切的正相关关系;矫治过程中需要采取必要的措施,尽量减少其对龈组织健康造成的影响.     

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目的探讨具核梭杆菌(Fusobacterium nucleatum,Fn)在正畸牙龈炎性反应发生发展中的作用。方法收集2011年8月至2012年2月在济南市口腔医院正畸科接受固定矫治并伴有不同程度牙龈炎性反应的牙颌畸形患者63例组成正畸治疗组;正畸治疗前未戴用矫治器的牙周健康者30例组成正常对照组;牙周科就诊的慢性牙周炎患者35例组成牙周炎组。记录患者牙龈指数(GI),分别采集牙周袋最深处或龈沟液标本,采用16SrDNAPCR技术对Fn进行检测,分析Fn的检出率与GI之间的关系。结果 128例患者临床标本中,共扩增出Fn87例,检出率67.97%。其中正畸治疗组检出率为69.84%(44/63);正常对照组检出率为46.67%(14/30);牙周炎组检出率为82.86%(29/35)。正畸治疗组的Fn检出率明显高于正常对照组,牙周炎组高于正畸治疗组和正常对照组,三者之间差异有统计学意义(χ2=9.843,P<0.05)。Spearman等级相关分析显示,Fn的检出率与牙龈指数之间存在明显的正相关关系(rs=1.000,P<0.01)。结论 Fn与正畸治疗中牙龈炎性反应的发生发展密切相关,正畸医生应高度重视正畸治疗前与治疗过程中的口腔卫生指导和监督。     

正畸治疗中牙龈增生的致病因素分析

目的 探讨正畸治疗中牙龈增生的相关致病因素.方法 12例因接受固定正畸治疗而出现牙龈增生的患者纳入牙龈增生组,对照组为12例牙龈健康者.分别于基线时采集两组研究对象的牙周检查指标、龈下菌斑标本和龈沟液标本,采用实时PCR技术对龈下菌斑内的牙龈卟啉单孢菌（Pg）、伴放线放线杆菌（Aa）、中间普氏菌（Pi）、齿密螺旋体（Td）和福赛氏类杆菌（Tf）进行定量检测,使用ELISA法测量龈沟液中白介素-1β的含量,比较牙龈增生组和对照组各项指标间的差异.对牙龈增生组患者实施牙周基础治疗,并于4周后重新采样比较牙周治疗前后上述指标间的差异.结果 基线时,牙龈增生组中龈下菌斑内五种牙周可疑微生物的检出率均显著高于对照组（P＜0.05）,龈沟液内白介素-1β的含量显著高于对照组（P＜0.05）.牙周基础治疗后4周时,牙龈增生患者的各项牙周检查指标均明显下降,同时Pg、Aa和Td的检出率、细菌数量以及龈沟液内白介素-1β的含量均显著减少（P＜0.05）.结论 Pg、Aa和Td等牙周病原菌和白介素-1β与正畸治疗中牙龈增生的发生和发展密切相关.     

正畸对龈沟液中细菌微生态及碱性磷酸酶活性影响的研究

目的　探讨采用直丝弓技术正畸过程中龈沟液碱性磷酸酶活性及其细菌的变化。方法　随机选择口腔正畸科门诊患者100例,测定矫治前、1个月、2个月、3个月时龈沟液中碱性磷酸酶的活性,并对龈沟液中的细菌进行厌氧菌培养,探讨其变化规律。结果　矫治期间牙龈卟啉单胞菌、伴放线放线杆菌和核酸杆菌的检出率明显,矫治开始时与3个月时ALP的活性差别有统计学意义（P<0.05）;1个月与3个月时ALP的活性差别有统计学意义（P<0.01）。结论　矫治初期碱性磷酸酶的活性逐渐增高,易引起牙龈的局部炎症,上述3种细菌可能是正畸中引起牙龈炎性反应的主要致病菌,需要引起足够的重视。     

正畸过程中伴放线菌聚集杆菌的检测及其毒力因子细胞致死性膨胀毒素的研究

目的建立PCR方法对正畸治疗患者口腔中的伴放线菌聚集杆菌（Aa）及毒力因子细胞致死性膨胀毒素进行检测,并与牙龈指数进行相关性分析。方法 选择55例戴入矫治器后产生牙龈炎性反应患者为矫治组,34例未带矫治器的牙周健康者为对照组,49例口腔内科就诊的成人牙周炎患者为成人牙周炎组。记录牙龈炎症指数,用无菌纸尖法分别采集牙周袋最深处及龈沟内液标本进行细菌DNA提取及PCR反应。结果以16S rDNA引物PCR扩增138例患者临床标本,共扩增出Aa 44株;其中正畸治疗组29株;对照组5株;成人牙周炎组10株。用Spearm an等级相关分析矫治组Aa检出率与牙龈指数G I之间存在明显的正相关关系（P〈0.01）。矫治组Aa的检出率明显高于牙周炎组和对照组（P〈0.01）;而牙周炎组与对照组之间的Aa检出率无明显差异（P〉0.05）。44例PCR扩增阳性的患者平均年龄为16.23岁,而Aa阴性的患者年龄平均为38.73岁,二者具有明显差异（t=3.598,P〈0.01）。以CDT引物直接扩增44例Aa16S rDNA阳性的临床标本中的CDT基因片段,13例为阳性,其阳性率为29.54%,其中扩增出667bp的CDT1型3例,扩增出1893bp的CDT2型10例。结论 Aa在青少年患者尤其在带矫治器的青少年患者发病中起到重要的作用,但对成人牙周炎的致病不起主要作用。CDT扩增产物有两种,但检出数量较少,还有待于进一步研究。     

正畸牙龈炎患者龈沟液中牙龈卟啉单胞菌及致病岛rag基因的研究

目的探讨正畸过程中牙龈卟啉单胞菌及致病岛rag基因与牙龈炎症程度的相关关系,分析其在正畸牙龈炎发生发展中的作用。方法收集102例来自济南市口腔医院正畸科和口腔内科患者组成正畸牙龈炎组（57例）、对照组（20例）、牙周炎组（25例）,并记录其各临床指标,分别采集牙周袋最深处或龈沟液标本,采用16SrDNAPCR和多重PCR对牙龈卟啉单胞菌及致病岛rag基因进行检测,分析其与临床指标的关系。结果102例患者临床标本,共扩增出牙龈卟啉单胞菌65株,其中正畸牙龈炎组35株;对照组7株;牙周炎组23株,经Spearman等级相关分析,牙龈卟啉单胞菌检出率与牙龈指数之间存在明显的正相关关系（P〈0．01）。正畸牙龈炎组检出率明显高于对照组,牙周炎组高于正畸牙龈炎组和对照组,三者之间有显著性差异（X2=15．918,P〈0．001）,65例牙龈卟啉单胞菌阳性患者临床标本,扩增出rag基因的有52例,其中正畸牙龈炎组29例;对照组1例;牙周炎组22例,正畸牙龈炎组明显高于对照组,牙周炎组高于正畸牙龈炎组和对照组,三者之间有显著性差异（X2=22．593,P〈0．001）。结论牙龈卟啉单胞菌致病岛rag基因与正畸治疗中牙龈炎性反应密切相关。     

牙龈卟啉单胞菌对正畸治疗病人牙周状况影响的研究

目的:观察牙龈卟啉单胞菌对正畸治疗病人牙周状况的影响,以便有效地控制正畸过程中牙龈炎性反应的发生发展,避免不可逆性的牙周损害。方法:收集41例正畸治疗中发生牙龈炎性反应的病人、20例正畸治疗前牙周健康者和35例慢性牙周炎病人的龈沟液标本,应用16SrDNA PCR技术检测各样本中的牙龈卟啉单胞菌,并分析其与临床指标(GI)之间的关系。结果:牙龈卟啉单胞菌的检出率分别为:正畸治疗组70.73%、正常对照组35.00%、牙周炎组85.71%;正畸治疗组的检出率明显高于正常对照组;牙周炎组显著高于正畸治疗组和正常对照组,三者之间有显著性差异(P<0.05);牙龈卟啉单胞菌的检出率随着牙周病变程度的增加而升高,与牙龈指数呈正相关关系(P<0.05)。结论:牙龈卟啉单胞菌与正畸治疗中的牙龈炎性反应和发展密切相关。     

舌侧矫治器对牙周致病菌的影响

目的研究舌侧矫治器对患者牙周临床指标和牙周致病菌的影响。方法收集成年正畸治疗患者55例资料,28例使用颊侧矫治器作为对照组,27例使用舌侧矫治器作为试验组,于治疗前和治疗6个月后,分别记录菌斑指数、龈沟出血指数、探诊深度,PCR检测龈下菌斑中牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、伴放线放线杆菌(Actinobacillus actinomycetemcomtans,Aa)、福赛斯坦氏菌(Tannerella forsythensis,Tf)3种牙周致病菌的检出率。结果治疗6个月试验组菌斑指数、龈沟出血指数、探诊深度分别为2.36±0.71、2.05±0.49、(3.43±0.56)mm,对照组分别为1.86±0.44、1.67±0.25、(2.87±0.74)mm,2组间差异均有统计学意义(P<0.05);试验组Pg、Aa检出率分别为37.0%和22.2%,对照组的Pg、Aa检出率分别为14.3%和10.7%,试验组高于对照组(P<0.05)。结论舌侧矫治器,较颊侧矫治器,对牙周临床指标影响更大,可造成更多的牙周致病菌聚集。     

慢性牙周炎患者牙周袋内硫化物水平与厌氧细菌分布的相关性研究

目的:探讨慢性牙周炎患者牙周袋内硫化物水平(sulfide levels in periodontal pockets,SUL)与牙龈卟啉单胞菌、中间普氏菌、伴放线放线杆菌分布的相关性.方法:用perio2000 system金刚探针牙周诊断仪测定慢性牙周炎患者SUL,采用PCR方法检测龈下菌斑中牙龈卟啉单胞菌、中间普氏菌和伴放线放线杆菌.结果:慢性牙周炎患者随着牙周袋内SUL浓度的增加牙龈卟啉单胞菌、中间普氏菌的检出率逐渐增加,相关系数分别为0.812和0.651(P<0.05);SUL阳性位点与阴性位点中牙龈卟啉单胞菌的检出率分别是为85.6%、26.7%,中间普氏菌的检出率分别为95.2%、53.3%.SUL阳性位点中牙龈卟啉单胞菌和中间普氏菌的检出率明显高于SUL阴性位点;在80.9%的SUL阳性位点中牙龈卟啉单胞菌与中间普氏菌共存.SUL阳性位点与阴性位点均未检出伴放线放线杆菌.结论:慢性牙周炎患者SUL与牙龈卟啉单胞菌和中间普氏菌分布关系较为密切.     

冲牙器辅助对口腔正畸患者牙龈龈沟液炎性因子及牙周健康状况的影响

目的 观察冲牙器辅助对口腔正畸患者牙龈龈沟液炎性因子及牙周健康状况的影响。方法选取2020年01月至2021年12月于我院口腔科就诊的口腔正畸患者80例。随机数字表法分为对照组和观察组，每组40例；对照组采用声波震动牙刷早、中、晚饭后清洁口腔3 min，观察组采用声波震动牙刷联合冲牙器清洁口腔，冲牙器使用时间3 min；分别于清洁前后检测两组牙周情况[出血指数（BI）、菌斑指数（PLI）、牙龈指数（GI）、菌斑百分率、探诊深度（PD）]和龈沟液炎性因子[检测龈沟液中白细胞介素-6(IL-6)、高敏C反应蛋白（hs-CRP）、白细胞介素-1β(IL-1β)及肿瘤坏死因子-α(TNF-α)]。结果 清洁后观察组BI、PLI、GI、菌斑百分率低于对照组（P<0.05），观察组牙齿邻面（颊侧近中、颊侧远中、舌侧近中、舌侧远中）和光滑面（颊侧正中、舌侧正中）的BI低于对照组（P<0.05），观察组IL-6、hs-CRP、IL-1β及TNF-α均低于对照组（P<0.05）。结论 冲牙器辅助能有效减少口腔正畸患者的牙龈龈沟液炎性因子水平，改善牙周健康状况。     

Site-specific subgingival colonization by Actinobacillus actinomycetemcomitans in orthodontic patients.

A high prevalence of Actinobacillus actinomycetemcomitans (Aa) in subgingival plaque in patients for orthodontia already has been observed. The present study had the following aims: 1) to ascertain a direct relationship between the orthodontic appliance placement and the subgingival colonization by Aa, and 2) to determine whether the Aa growth specifically occurred on teeth with braces attached or whether the presence of orthodontic appliances could also cause the isolation of Aa in teeth free from therapeutic appliances. Twenty-four young systemically and periodontally healthy subjects with malaligned and crowded teeth in the anterior sextants of both dental arches participated in this study. After 1 session of ultrasonic scaling with oral hygiene instructions during the first experimental session, the mesiobuccal sites of the first molars and the distobuccal sites of the lateral incisors in both dental arches in each participant were subjected to clinical and microbiologic examination for the recovery of Aa. Clinical examination consisted of recording the presence of plaque and the examination of gingival bleeding on probing and probing depth. Microbiologic sampling was obtained with the insertion of 3 sterile paper points at the deepest part of each gingival sulcus. Altogether, 192 periodontal sites were examined. After the examinations, the patients received fixed orthodontic appliances in only 1 dental arch (test sites) and the other one was left free from appliances (control sites). Clinical examination and microbiologic sampling were repeated in the same experimental test and control sites after 4, 8, and 12 weeks. At the 12-week session, the orthodontic appliance was removed from the test arch, and, 4 weeks later, a further clinical and microbiologic examination was performed. The results showed that, during the period with orthodontic appliances, the presence of plaque scores and the gingival bleeding on probing scores were increased significantly and that Aa, initially absent from all but 1 subject, was isolated in 19 and 20 subjects after 4 and 8 weeks, respectively. Furthermore, no gingival sites from the control teeth (free from Aa colonization at baseline) showed positive results for the sought-after bacterium throughout the entire length of the study. It was concluded that the placement of orthodontic appliances promotes the subgingival growth of Aa; this specific microbial change is specifically restricted to subgingival plaque from orthodontic appliance-bearing teeth. The presence of orthodontic bands and brackets therefore cannot affect the microbiologic condition of the whole mouth.     

Toothbrushing and transient bacteremia in patients undergoing orthodontic treatment

A study was made to determine the extent of bacteremia experienced by patients undergoing orthodontic treatment with fixed appliances during periods of routine oral hygiene--namely, brushing the teeth. Sixteen orthodontic patients made up the population--11 who practiced good oral hygiene and five who demonstrated poor oral hygiene. Blood was drawn aseptically from the median cubital vein of the subjects before and 15 minutes after brushing the teeth. An aliquot of each blood specimen was added to separate blood culture bottles and incubated at 37 degrees C for a period of up to 5 days. Blood was also used to determine the immune status of the subjects. Anaerobic bacteria were recovered from the blood of nine of the 16 patients studied; aerobic bacteria were not recovered. A negative blood culture before brushing and positive blood culture after brushing were expected but did not occur. Some subjects showed bacteremia before brushing and a negative blood culture after brushing. Others showed bacteremia before and after brushing. The unexpected results could be attributed to the patients eating and/or brushing before starting the test. The study showed the capacity of specific anaerobic bacteria to remain in the bloodstream for a 15-minute period. It also demonstrated a presence of bacteria in the bloodstream before the test began.     

Changes in salivary periodontal pathogens after orthodontic treatment: An in vivo prospective study

Objective:To analyze the initial changes in salivary levels of periodontal pathogens after orthodontic treatment with fixed appliances.Materials and Methods:The subjects consisted of 54 adult patients. The Simplified Oral Hygiene Index, Plaque Index, and Gingival Index were measured as periodontal parameters. Both the plaque and gingival indexes were obtained from the central and lateral incisors and first molars of both arches. Whole saliva and periodontal parameters were obtained at the following four time points: immediately before debonding (T1), 1 week after debonding (T2), 5 weeks after debonding (T3), and 13 weeks after debonding (T4). Repeated measures analysis of variance was used to determine salivary bacterial levels and periodontal parameters among the four time points after quantifying salivary levels of Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf), and total bacteria using the real-time polymerase chain reaction.Results:All periodontal parameters were significantly decreased immediately after debonding (T2). The salivary levels of total bacteria and Pg were decreased at T3, while Pi and Tf levels were decreased at T4. However, the amount of Aa and Fn remained at similar levels in saliva during the experimental period. Interestingly, Aa and Fn were present in saliva at higher levels than were Pg, Pi, and Tf.Conclusion:The higher salivary levels of Aa and Fn after debonding suggests that the risk of periodontal problems cannot be completely eliminated by the removal of fixed orthodontic appliances during the initial retention period, despite improved oral hygiene.     

Salivary nickel and chromium in patients with fixed orthodontic appliances

The purpose of this study was to determine the alterations in the chromium and nickel concentrations in the saliva of orthodontic patients treated with fixed orthodontic appliances. Forty-five orthodontic patients were included in this study. The first group consisted of 15 patients (7 female, 8 male) with fixed appliances placed in their upper and lower arches. The second group consisted of 15 patients (8 female, 7 male) with a fixed appliance placed only in the upper arch. The control group consisted of 15 patients (7 female, 8 male) who were not undergoing orthodontic treatment. Four samples of stimulated saliva were collected from each patient before insertion of the fixed appliance, 1 week after insertion of the appliance, 1 month after insertion of the appliance, and 2 months after insertion of the appliance. The same 4 samples of saliva were collected from each control patient at the same time intervals as for the fixed-appliance groups. The chemical analyses were done with an electrothermal atomic absorption spectrophotometer (Perkin Elmer 2380, Perkin Elmer Corp, Baden Seewerk, Germany). The Wilcoxon matched-pairs signed ranks test was used to test differences between samples before and after insertion of orthodontic appliances. A Kruskal Wallis 1-way analysis of variance was used to test differences in nickel and chromium concentration among the 3 test groups. It was observed that there was a large variation in the concentrations of both nickel and chromium in saliva. No significant differences were found between the no-appliance group and the samples obtained after insertion of the appliances. The results of the study suggest that fixed orthodontic appliances do not significantly affect nickel and chromium concentrations of saliva during the first 2 months of treatment.     

Monitoring the caries risk of orthodontic patients.

Several caries activity tests were used to investigate the caries risk of patients with fixed orthodontic appliances. Twenty young individuals, with a mean age of 11 years, participated in this study. Ten subjects were free of any orthodontic appliances and formed the control group. The other 10 individuals had been wearing fixed orthodontic appliances for at least 4 months. Stimulated saliva samples were obtained from all patients. Saliva samples were used to investigate the salivary flow rate, the salivary buffer capacity, and mutans streptococci and lactobacilli counts. The orthodontic patients exhibited a significant increase in salivary flow rate. Results of statistical analyses were nonsignificant in all other tests, suggesting that fixed orthodontic appliances are not the sole factor increasing the patient's caries risk during orthodontic treatment.     

Clinical and microbiological effects of fixed orthodontic appliances on periodontal tissues in adolescents

OBJECTIVE: To determine the effects of fixed orthodontic appliances on periodontal health and microbiological composition of subgingival dental plaque. MATERIAL AND METHODS: This prospective longitudinal self-controlled study was conducted on 32 adolescents (13 males, 19 females), who were scheduled for fixed orthodontic treatment between 2002 and 2005. Dental plaque accumulation, gingival inflammation and pocket probing depth were measured at the mesio-vestibular angle of the examined group of teeth followed by collection of subgingival dental plaque samples in the same points. These periodontal indices and microbiological parameters were determined prior to the placement of fixed appliances and 1, 3 and 6 months after the beginning of orthodontic treatment. RESULTS: All values of both clinical and microbiological parameters started to increase after the placement of fixed appliances. Maximum values were reached 3 months after fixed appliance placement followed by their decrease in the last registration period of 6 months after the placement of fixed appliances. CONCLUSIONS: Treatment with fixed appliances in adolescents may transitionally increase the values of all periodontal indices and stimulate the growth of periodontopathogenic bacteria, but without destructive effects on deep periodontal tissues.     

In vivo study of metal content of oral mucosa cells in patients with and without fixed orthodontic appliances

OBJECTIVE: To compare the concentration of nickel, chromium and cobalt in oral mucosa cells of patients with and without fixed orthodontic appliances. MATERIALS AND METHODS: A total of 60 patients were included in this study. The control group consisted of 30 patients without any type of fixed orthodontic appliances or metal restoration in the mouth (20 females and 10 males from 16 to 20 years with a mean age of 18 years). The test group consisted of 30 patients who had fixed orthodontic appliance in their upper and lower arches (20 females and 10 male from 16 to 20 years with a mean age of 18.2 years). The metal content determinations were carried out using atomic absorption spectrophotometry with a graphite furnace. RESULTS: According to spectrophotometric analysis, no significant differences in chromium (p = 0.09) and cobalt (p = 0.10) content of oral mucosa cells were found between the test and control samples. The nickel content in mucosa samples was significantly higher (p = 0.003) in orthodontic patients compared with the controls. The mean levels of nickel in control and orthodontic patient group were 12.26 and 21.74 ng / ml, respectively. CONCLUSION: Our findings indicate that there was no difference in the concentration of chromium and cobalt in oral mucosa cells of patients with or without fixed appliances. However, a significantly higher concentration of nickel can be found in oral mucosa cells of patients wearing fixed orthodontic appliances. Continued follow-up is needed to determine the long-term significance of nickel release.     

Clinical significance of Actinobacillus actinomycetemcomitans in young individuals during orthodontic treatment

Abstract The aim of the present study was: (I) to assess longitudinally the occurrence of Actinobacillus actinomycetemcomitans (Aa) in young subjects wearing fixed orthodontic appliances compared to matched appliance-free controls: (2) to determine whether the presence of the micro-organism at baseline could influence the periodontal status assessed 3 years later. 70 subjects. 27 male and 43 female. aged between 12 and 20 years participated in the study: 35 subjects under orthodontic treatment with fixed appliances for at least 6 months, and 35 appliance-free individuals matched for age and gender. All subjects were free of clinically demonstrable loss of attachment. They all received oral hygiene instructions 2× during the 2 months preceding the first clinical and microbiological examination. No subgingival instrumentation was performed between baseline and the 3-year examination. Clinical parameters included gingival bleeding index (GBI). pocket probing depth (PPD) and measurements of attachment level (AL). Statistically significant differences were reported regarding frequency of detection of Aa between both groups at each examination. The %s of orthodontic subjects infected with Aa at the baseline and at the 3-year examination were 86% and 80%, respectively, while the corresponding figures for control subjects were 16.6% and 26.6%. The frequency distribution of %s of Aa in the total anaerobic subgingival flora among control subjects remained fairly stable, whereas the proportion of orthodontic subjects yielding Aa at a concentration 1.0% dropped significantly from 32% at baseline to 19% at the 3-year visit. Calculations of the relative risk for increasing GBI and PPD in both groups when Aa was present at baseline, revealed that the orthodontic subjects positive for Aa had a negligible relative risk of experiencing worse periodontal conditions compared to orthodontic patients where Aa was not detected at baseline. In contrast, control subjects initially infected with Aa presented with a risk for increased GBI 6.6×higher than that for subjects without Aa. In conclusion, the present study confirmed previous cross-sectional findings reporting that young individuals with an integer periodontium wearing fixed orthodontic appliances harbor Aa with a statistically significant greater frequency than appliance-free matched controls. However, although orthodontic patients exhibited more inflammation, their deteriorated clinical conditions could not be accounted for by the sole presence of Aa in their sulci. In contrast, appliance-free young subjects initially infected with Aa had a higher risk of experiencing more gingival inflammation than subjects without the bacterium during a 3-year observation period.