无托槽隐形矫治器与固定矫治器对口腔正畸治疗患者口腔微生物菌群和龈沟液sICAM-1、MMP-8水平的影响

Effects of invisible orthodontic appliance without brackets and fixed orthodontic appliance on the oral microbial flora and the levels of sICAM-1 and MMP-8 in gingival crevicular fluid of patients with orthodontic treatment

目的探究无托槽隐形矫治器与固定矫治器对口腔正畸治疗患者口腔微生物菌群和龈沟液可溶性细胞间黏附分子-1(sICAM-1)、基质金属蛋白酶-8(MMP-8)水平的影响。方法前瞻性纳入2020年2月至2023年3月在山西省儿童医院接受正畸治疗的106例患者为研究对象,按照随机数字表法对患者分为对照组和研究组,每组各53例。对照组采用固定矫治器,研究组采用无托槽隐形矫治器。比较两组患者矫正前和矫正后3个月口腔微生物菌群情况(卟啉单胞菌、具核梭杆菌、福塞斯坦氏菌和中间型普里沃菌)、牙周健康情况(牙龈指数、龈沟出血指数、菌斑指数及龈沟探诊深度)、龈沟液sICAM-1和MMP-8水平、患者满意度及并发症情况。结果矫正后3个月,两组各菌群水平均较矫正前升高,但研究组卟啉单胞菌、具核梭杆菌、福塞斯坦氏菌、中间型普里沃菌水平分别为0.29±0.06、0.33±0.06、0.33±0.08、0.27±0.06,均低于对照组(0.35±0.07、0.44±0.08、0.45±0.09、0.37±0.09),差异均有统计学意义(P<0.05)。两组组内矫正后3个月的牙龈指数和龈沟探诊深度与矫正前比较,以及组间矫正后3个月的牙龈指数和龈沟探诊深度比较,差异均无统计学意义(P>0.05);两组矫正后3个月的龈沟出血指数及菌斑指数均较矫正前升高,且研究组出血指数及菌斑指数分别为(0.65±0.06)、(0.99±0.12)分,均低于对照组[(0.72±0.08)、(1.23±0.15)分],差异均有统计学意义(P<0.05)。矫正后3个月,两组龈沟液sICAM-1水平均较矫正前升高,MMP-8水平均较矫正前降低,研究组龈沟液sICAM-1、MMP-8水平分别为(166.26±21.02)、(22.12±3.39)ng/mL,均低于对照组[(178.52±23.05)、(26.77±4.12)ng/mL],差异均有统计学意义(P<0.05)。研究组患者矫正后3个月的咀嚼、固定、美观、舒适性、方便程度、言语功能的满意度均高于对照组,差异均有统计学意义(P<0.05)。研究组患者牙龈红肿、牙龈萎缩、局部拥挤等总并发症发生率为7.55%,低于对照组(22.64%),差异有统计学意义(P<0.05)。结论相比固定矫治器矫正,采用无托槽隐形矫治器矫正对口腔微生物菌群和龈沟液中sICAM-1、MMP-8水平具有积极影响,能够提高患者的满意度,降低牙周疾病的发生。

Objective To explore the effects of invisible orthodontic appliance without brackets and fixed orthodontic appliance on the oral microbial flora and soluble intercellular adhesion molecule-1(sICAM-1)and matrix metalloproteinase-8(MMP-8)in gingival crevicular fluid of patients with orthodontic treatment.Methods A total of 106 patients who underwent orthodontic treatment in Shanxi Children's Hospital from February 2020 to March 2023 were prospectively included in the study.The patients were divided into control group and study group according to the random number table method,with 53 cases in each group.The control group used fixed orthodontic appliance,and the study group used invisible orthodontic appliance without brackets.The oral microbial flora(Porphyromonas,Fusobacterium nucleatum,Forsythia and Prevotella intermedia),periodontal health(gingival index,gingival sulcus bleeding index,plaque index and gingival sulcus probing depth),levels of sICAM-1 and MMP-8 in gingival crevicular fluid before and 3 months after correction,satisfaction and complications were compared between the two groups.Results At three months after orthodontic correction,the levels of each flora in the two groups were higher than those before correction,but the levels of Porphyromonas,Fusobacterium nucleatum,Forsythia and Privulococcus intermedius in the study group were 0.29±0.06,0.33±0.06,0.33±0.08 and 0.27±0.06,respectively,which were lower than those in the control group(0.35±0.07,0.44±0.08,0.45±0.09 and 0.37±0.09),and the differences were statistically significant(P<0.05).There was no significant difference in gingival index and gingival sulcus probing depth between the two groups at 3 months after correction and before correction(P>0.05),and there was no significant difference in gingival index and gingival sulcus probing depth between the two groups at 3 months after correction(P>0.05).At three months after orthodontic correction,the gingival sulcus bleeding index and plaque index of the two groups were higher than those before correction,and the bleeding index and plaque index of the study group were(0.65±0.06)and(0.99±0.12)points,respectively,which were lower than those of the control group[(0.72±0.08),(1.23±0.15)points],the differences were statistically significant(P<0.05).At three months after orthodontic correction,the levels of sICAM-1 in gingival crevicular fluid of the two groups were higher than those before correction,and the levels of MMP-8 were lower than those before correction,the levels of sICAM-1 and MMP-8 in gingival crevicular fluid of the study group were(166.26±21.02)and(22.12±3.39)ng/mL,respectively,which were lower than those of the control group[(178.52±23.05)and(26.77±4.12)ng/mL],the differences were statistically significant(P<0.05).The satisfaction of chewing,fixation,beauty,comfort,convenience and speech function in the study group at three months after orthodontic correction were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of total complications such as gingival swelling,gingival atrophy and local congestion in the study group was 7.55%,which was lower than that in the control group(22.64%),and the difference was statistically significant(P<0.05).Conclusion Compared with fixed orthodontic appliance,using invisible orthodontic appliance without brackets has a positive impact on sICAM-1 and MMP-8 levels in oral microbial flora and gingival crevicular fluid,which can improve patient satisfaction and reduce the occurrence of periodontal disease.