青少年正畸患者釉質脫礦的發生與口腔菌群及分泌型免疫球蛋白A的關系

[中圖分類號]R781.5[文獻標志碼]A[doi] 10.7518/gjkq.2025066

Relationship betweenenameldemineralizationandoral microbiota with secretory immunoglobulinAinadolescent orthodontic patients

HuKai，Znio，oing，nin，Wenue，ing， 1.SchoolofenedonUeityuiia;etoo matologicallililali Supportedby：NationalNaturalScienceFoundationofChina（3237230o）;YoungandMiddle-agedResearchersProject ofOrthodonticialtyeeguotloicalsoiionJ-3）;suoinialKey ryofOralDiseasesResearchProject（JSKLOD-KF-2108）；Wuxi Municipal HealthCommision GeneralProgram （M202338）

Correspondence：ZhangQiuxiang，Email：zhangqx@jiangnan.edu.cn

[Abstract]ObjectiveThis study aimed to elucidate the key factors contributing to enamel demineralization inorthodonticpatientsdentifyomarkersassociatedwithitsocurrence，andexplore theelationshipetweenenameldemineralization and oralmicrobiotain adolescent orthodontic patients.MethodsTwo groups of patients were selected，one group with self-ligating brackets （Group S） and the other with traditional metal brackets （Group M）， with22 participantsin each group.Subgingival plaque wascollected formicrobiome analysisatthe baselineof orthodontictreatmentandafter3months.Simultaneously，salivawascollected to measure the levels of secretoryimmunoglobulinA（sIgA）.Clinicalindicessuchas theenameldemineralizationindex，plaqueindex （PLI），gingival index，and periodontalindexwerestatisticallanalyzedduring monthlyrecallvisits.ResultsAfter3monthsofrthodontic treatment，the incidenceofenamel demineralizationamongpatients significantly inreased，withanaverage increase of over 20% indemineralizationrates.InGroupS，theabundanceofFusobacterium，Campylobacter，Neisseria，andPrevotella significantly increased after 3 months of orthodontics （Plt;0.05） . In Group M，the abundance of Rothia significantly increased （Plt;0.05） .Theabundanceortroacter，cillusAcintobcterrevotellandmyloacteriie lycorrelatedwith enamel demineralizationandPLIscores.The levels of sIgA insaliva were negativelycorelated with theoccurrenceofenameldemineralization，withasignificantdecreaseinsIgAlevelsinGroupSafterorthodontictreatment （Plt;0.01） .ConclusionOrthodontic patients with self-ligating brackets are more prone to enamel demineralization， and Campylobacterand Prevotella maybe key bacterial species that exacerbate enameldemineralization in adolescent orthodontic patients.Adecrease insalivary sIgAlevels mayindicatean increasedriskofenamel demineralization northodontic patients.

[KeyWords] orthodontics； enamel demineralization； oral microbiota;secretory immunoglobulinA

口腔正畸是牙科治療中的一項關鍵技術，它通過在牙齒上的托槽施加連續的彈性力，利用穿過托槽的弓絲來逐步移動牙齒，從而達到矯正牙齒和頜骨排列的目的。這種方法能夠有效地改善牙齒的異常排列，幫助患者改善口腔咀嚼功能和面部美學。然而，托槽在一定程度上會妨礙患者的口腔清潔2，而不良的口腔衛生狀況則會造成釉質脫礦[3。釉質脫礦是指釉質區域礦物質喪失，表現為牙齒表面出現白色斑點或斑塊（white spot le-sion，WSL）[4]。WSL通常是齲病進展的早期指標，如果不及時干預，可能會演變成齲洞[3，進而影響牙齒美學和治療滿意度。

托槽結構和材料的不同已被發現會影響牙面的菌群組成5。Bergamo等研究表明，自鎖托槽在黏合60d后，患者口腔中橙色和紅色復合物的豐度更高。Lim等研究指出，變異鏈球菌對不同托槽的黏附能力的不同可能會進一步影響口腔內的菌群平衡。除了托槽材料對菌群的影響，個體對釉質脫礦的易感性也是一個關鍵因素。免疫應答的水平和特異性被認為可能會影響變異鏈球菌在乳牙和恒牙上的定植能力。Huang等研究表明，提高唾液中分泌型免疫球蛋白A（secretoryimmunoglobulinA，sIgA）的表達可顯著抑制變異鏈球菌在口腔中的黏附，預防齲齒的發生。

鑒于這些發現，本研究旨在探討青少年正畸患者釉質脫礦的發生與口腔菌群組成及唾液中sIgA水平之間的關系。通過記錄研究對象在正畸治療前后釉質脫礦的變化情況，并分析這些變化與佩戴的托槽類型、口腔菌群組成以及唾液中sIgA水平的相關性，本研究期望從口腔微生態和機體免疫學的角度預測青少年正畸患者的釉質脫礦風險。……