臺灣博碩士論文加值系統

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。

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.

＊目錄……………………………………………………………………-1-
＊表目錄…………………………………………………………………-2-
＊圖目錄…………………………………………………………………-3-
＊英文摘要………………………………………………………………P1
＊中文摘要………………………………………………………………P3
壹、緒論…………………………………………………………………P5
貳、材料與方法…………………………………………………………P12
叁、結果…………………………………………………………………P20
肆、討論…………………………………………………………………P24
伍、結論…………………………………………………………………P27
陸、參考文獻……………………………………………………………P28
柒、表格及圖片…………………………………………………………P34
捌、附錄…………………………………………………………………P52

Angle E.H. Treatment of malocclusion of the teeth: Angle’s system, SS.
White Dental Manufacturing Co, Philadelphia ,.1907
Andrews L.E. The six keys to normal occlusion, Am J Orthod. 1972;62:
296-309.
Ai H., Lu HF., Liang HY., Wu J., Li RL., Liu GP., Xi Y. Influences of
bracket bonding on mutans streptococcus in plaque detected by real time
fluorescence-quantitative polymerase chain reaction. Chinese Medical
Journal. 2005;118(23):2005-10.
Alexander SA. Effects of orthodontic attachments on the gingival health of
permanent second molars. Am J Orthod Dentofacial
Orthop.1991;100:337-40.
Andre Fournier, Lise Payant, Robert Bouclin. Adherence of Streptococcus
mutans to orthodontic brackets. Am J Orthod Dentofacial
Orthop.1998;114(4):414-417.
Andrea Amezquita Naranjo, Martha Lucia Trivino, Adriana Jaramillo,
Marisol Betancourth, Javier Enrique Botero. Changes in the subgingival
microbiota and periodontal parameters before and 3 months after bracket
placement. American J Orthod Dentofacial Orthop.2006;130(3):275.
Anhoury, Patrick. Nathanson, Dan. Hughes, Christopher V., Socransky,
Sigmund, Feres, Magda, Chou, Laisheng Lee. Microbial profile on metallic
and ceramic bracket materials. Angle Orthodontist. 2002; 72(4):338-43.
Balenseifen JW, Madonia JV. Study of dental plaque in orthodontic patients.
J Dent Res.1970;49:320-324.
Benson PE., Shah AA., Millett DT., Dyer F., Parkin N., Vine RS. Fluorides,
orthodontics and demineralization: a systematic review. J Orthod.
29
2005;32:102-14.
Bloom RH., Brown LR. A study of the effects of orthodontic appliances on
the oral microbial flora. Oral Surg.1964;17:758-767.
Boyd RL., Baumrind S. Periodontal considerations in the use of bonds or
bands on molars in adolescents and adults. Angle Orthod; 1992;62:117-26.
Chatterjee R., Kleinberg I. Effect of orthodontic band placement on the
chemical composition of human incisor tooth plaque. Arch Oral Biol.
1979;24:97-100.
Christersson LA., Fransson CL., Dunford RG., Zambon JJ. Subgingival
distribution of periodontal pathogenic microorganisms in adult periodontitis.
J Periodontol. 1992;63:418-25.
Corbett JA., Brown LR., Keene HJ., Horton IM. Comparison of S mutans
concentrations in non-banded and banded orthodontic patients. J Dent Res.
1981;60:1936-1942.
Dikeman TL. A study of acidogenic and aciduric micro-organisms in
orthodontic and non-orthodontic patients. Am J Orthod; 1962;48:627-628.
Eliades T., Eliades G., Brantley W. Microbial attachment on orthodontic
appliances: Wettability and early pellicle formation on bracket materials. Am
J Orthod Dentofacial Orthop. 1995;108:351-360.
Fournier A., Payant L., Bouclin R. Adherence of Streptococcus mutans to
orthodontic brackets. Am J Orthod Dentofacial Orthop. 1998;114:414-417.
Forsberg CM., Brattstro‥m V., Malmberg E., Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with
microbial colonization of streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13:416-20.
Gong K., Mailloux L., Herzberg M C. Salivary film expresses a complex,
macromolecular binding site for Streptococcus sanguis. J Bio Chem.
30
2000;275(12):8970-4.
Graves DT., Fine D., Teng YT., Van Dyke TE,. Hajishengallis G. The use of
rodent models to investigate host-bacteria interactions related to periodontal
diseases. Journal of Clinical Periodontology. 2008;35(2):89-105.
Gwinnett AJ., Ceen RF. Plaque distribution on bonded brackets: a scanning
microscope study. Am J Orthod.1979;75:667-77.
Hu T., Ge JP., Xu RR., Yue SL., Tan H., Zhou XD. On the relationship
between exopolysaccharides and Actinomyces viscosus in biofilms.Sichuan
da Xue Xue Bao. Yi Xue Ban/Journal of Sichuan University. Medical
Science Edition. 2006;37(2):180-2.
Huser MC., Baehni PC., Lang R. Effects of orthodontic bands on
microbiologic and clinical parameters. Am J Orthod Dentofacial Orthop;
1990;97:213-8.
Knoernschild KL., Rogers HM., Lefebvre CA., Fortson WM., Schuster GS.
Endotoxin affinity for orthodontic brackets. Am J Orthod Dentofacial
Orthop.1999;115:634-639.
Liljemark W F., Bloomquist C. Human oral microbial ecology and dental
caries and periodontal diseases. Critical Reviews in Oral Biology &
Medicine. 1996;7(2):180-98.
Maeda Kazuhiko, Nagata Hideki, Nonaka Aya, Kataoka Kosuke, Tanaka
Muneo, Shizukuishi Satoshi. Oral streptococcal glyceraldehyde-3-phosphate
dehydrogenase mediates interaction with Porphyromonas gingivalis fimbriae.
Microbes & Infection. 2004;6(13):1163-70.
Maiden MF., Macuch PJ., Murray L., Tanner A. ‘‘Checkerboard’
DNA-probe analysis and anaerobic culture of initial periodontal lesions. Clin
Infect Dis.1997;25(2):230–232.
Marsh PD. Dental plaque as a biofilm: the significance of pH in health and
31
caries. Compendium of Continuing Education in Dentistry. 2009;30(2): 76-8,
80, 83-7; quiz 88, 90.
Matsumoto N., Salam MA., Watanabe H., Amagasa T., Senpuku H. Role of
gene E2f1 in susceptibility to bacterial adherence of oral streptococci to tooth
surfaces in mice. Oral Microbio & Immuno. 2004;19(4):270-6.
Menzaghi N., Saletta M., Garattini G., Brambilla E., Strohmenger L.
Changes in the yeast oral flora in patients in orthodontic treatment. Prev
Assist Dent. 1991;17:26-30.
Mitchell L. An investigation into the effect of a fluoride releasing adhesive
on the prevalence of enamel surface changes associated with directly bonded
orthodontic attachments. Br J Orthod. 1992;19:207-14.
Mizrahi E. Enamel demineralization following orthodontic treatment. Am J
Orthod. 1982;82:62-7.
Ogaard B. Prevalence of white spot lesions in 19-year-olds: a study on
untreated and orthodontically treated persons 5 years after treatment. Am J
Orthod Dentofacial Orthop; 1989;96:423-7.
O’Reilly MM., Featherstone JD. Demineralization and remineralization
around orthodontic appliances: an in vivo study. Am J Orthod Dentofacial
Orthop. 1987;92:33-40.
Owen OW. A study of bacterial counts (lactobacilli) in saliva related to
orthodontic appliances. Am J Orthod. 1994;35:672-678.
Papapanou PN., Madianos PN., Dahlen G., Sandros J.
‘‘Checkerboard’’versus culture: a comparison between two methods for
identification of subgingival microbiota. Eur J Oral Sci. 1997;105:389-396.
Ristic M., Vlahovic Svabic M. , Sasic M. , Zelic O. Clinical and
microbiological effects of fixed orthodontic appliances on periodontal tissues
in adolescents. Orthodontics & Craniofacial Research. 2007;10(4):187-95.
32
Rosenbloom RG., Tinanoff N. Salivary S. mutans levels in patients before,
during, and after orthodontic treatment. Am J Orthod Dentofacial Orthop.
1991;100:35-37.
Scheie AA., Arnesberg P., Krogstad O. Effects of orthodontic treatment on
prevalence of Streptococcus mutans in plaque and saliva. Scand J Dent Res.
1984;92:211-217.
Slot J., Taubman MA., characteristic of oral gram negative species. In
“Contemporary oral microbiology and immunology” Mosby year book Co.
1992;19:307.
Sug-Joon Ahn, Bum-Soon Lim, Shin-Jae Lee. Prevalence of cariogenic
streptococci on incisor brackets detected by polymerase chain reaction. Am J
Orthod Dentofacial Orthop. 2007;131(6):736-741.
Sukontapatipark W., el-Agroudi MA., Selliseth NJ., Thunold K., Selvig KA.
Bacterial colonization associated with fixed orthodontic appliances. A
scanning electron microscopy study. Eur J Orthod. 2001;23:475-84.
Turkkahraman H., Sayin MO., Bozkurt FY., Yetkin Z., Kaya S., Onal S.
Archwire ligation techniques, microbial colonization, and periodontal status
in orthodontically treated patients. Angle Orthod. 2005;75:231-6.
van der Mei HC., Rustema-Abbing M., de Vries J., Busscher HJ. Bond
strengthening in oral bacterial adhesion to salivary conditioning films.
Applied & Environmental Microbiology. 2008;74(17):5511-5.
van der Mei H C., Rustema-Abbing M., Bruinsma G M. , Gottenbos B.,
Busscher H J., Sequence of oral bacterial co-adhesion and non-contact
brushing. Journal of Dental Research. 2007;86(5):421-5.
Wahl, Norman. Orthodontics in 3 millennia. Chapter 16: Late 20th-century
fixed appliances. Am.J Ortho & Dentofacial Orthopedics.
2008;134(6):827-30.
33
Zimmer B. Systematic decalcification prophylaxis during treatment with
fixed appliances. J Orofacial Orthopedics. 1999;60(3):205-14.