国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (1): 91-98.doi: 10.7518/gjkq.2024003

• 综述 • 上一篇    下一篇

正畸相关釉质脱矿危险因素的研究进展

王楠楠1(),贺红1,花放1,2,3()   

  1. 1.口颌系统重建与再生全国重点实验室;口腔生物医学教育部重点实验室;口腔医学湖北省重点实验室 武汉大学口腔医（学）院 武汉 430079
    2.武汉大学口腔医院光谷分院正畸与儿童口腔中心 武汉 430079
    3.武汉大学口腔医院循证口腔医学中心 武汉 430079
  • 收稿日期:2023-03-01 修回日期:2023-07-21 出版日期:2024-01-01 发布日期:2024-01-10
  • 通讯作者: 花放
  • 作者简介:王楠楠，硕士，Email：nannanwang@whu.edu.cn
  • 基金资助:
    国家自然科学基金(81901044);中华口腔医学会口腔正畸专业委员会青年人才科研基金(COS-B2021-08)

Research progress on the risk factors of orthodontically induced enamel demineralization

Wang Nannan1(),He Hong1,Hua Fang1,2,3()   

  1. 1.State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
    2.Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
    3.Center for Evidence-based Stomatology, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2023-03-01 Revised:2023-07-21 Online:2024-01-01 Published:2024-01-10
  • Contact: Fang Hua
  • Supported by:
    National Natural Science Foundation of China(81901044);Chinese Stomatological Association COS Basic Research Fund(COS-B2021-08)

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摘要：

在正畸治疗过程中，由于矫治装置及多余粘接剂的存在使得牙面不易清洁，菌斑堆积产酸造成正畸治疗最常见的不良反应——釉质脱矿。正畸釉质脱矿常表现为牙齿唇面的白垩色斑，不仅影响牙齿美观、降低正畸患者满意度，严重者还可形成龋洞，危害口腔健康。不断完善对相关危险因素及表型特征的理解是促进正畸釉质脱矿精准防控的关键。本文旨在对近年来与正畸釉质脱矿相关危险因素有关的文献进行总结，重点介绍牙位、口腔卫生、饮食习惯、治疗时间、矫治器类型、微生物菌群变化以及6-n-丙基硫氧嘧啶个体味觉敏感性等因素与正畸釉质脱矿之间的关联。

关键词: 口腔正畸, 釉质脱矿, 危险因素, 精准医学

Abstract:

During orthodontic treatment, the existence of orthodontic appliances and residual adhesives, as well as the resultant difficulty in oral hygiene, can lead to enamel demineralization, which is one of the most common side effects of orthodontics. Orthodontic enamel demineralization is often manifested as chalky spots on the labial surface of teeth, which can not only negatively affect dental appearance and reduce orthodontic patients’ satisfaction but also result in ca-ries and jeopardize oral health in severe cases. Improving our understanding of enamel demineralization’s risk factors and phenotypic characteristics is crucial to promote precise prevention and control of orthodontic enamel demineralization. This review aims to summarize the recent literature regarding risk factors of orthodontic enamel demineralization. It focuses on the association between orthodontic enamel demineralization and tooth position, oral hygiene, dietary habits, treatment time, type of appliances, changes in microflora, and 6-n-propylthiouracil individual taste sensitivity.

Key words: orthodontic treatment, enamel demine-ralization, risk factor, precision medicine

中图分类号: 

  • R783.5

表 1

正畸相关釉质脱矿的危险因素"

危险因素临床意义/影响研究类型及参考文献样本量
个体系统因素年龄呈正相关，釉质脱矿风险↑前瞻性观察研究[9]74
横断面研究[11]350
横断面研究[10]202
性别无明显相关横断面研究[12]45
横断面研究[13]885
横断面研究[14]191
体重呈正相关，釉质脱矿风险↑回顾性队列研究[16]175
回顾性队列研究[15]77
饮食习惯糖摄入频率↑，釉质脱矿风险↑前瞻性队列研究[19]50
病例-对照研究[20]50
PROP个体表征PROP非敏感者釉质脱矿风险高病例-对照研究[21]44
唾液相关性质流速↓，釉质脱矿风险↑；pH↓，釉质脱矿风险↑随机临床试验[26]70
前瞻性观察研究[22]60
前瞻性观察研究[28]35
前瞻性观察研究[25]30
前瞻性观察研究[27]27
口腔因素牙位上颌前牙（侧切牙和尖牙）及下颌后牙（前磨牙和第一磨牙）釉质脱矿风险高前瞻性观察研究[9]74
病例-对照研究[20]50
横断面研究[13]885
横断面研究[12]45
横断面研究[29]121
口腔卫生口腔卫生状况差，釉质脱矿风险高前瞻性队列研究[19]50
回顾性队列研究[30]450
病例-对照研究[31138
横断面研究[13]885
基线WSL无明显相关病例-对照研究[20]885
横断面研究[13]50
微生物因素相关致龋菌及牙周致病菌水平变化，提示釉质脱矿风险可能增高系统评价[35]464
随机临床试验[32]60
随机临床试验[36]42
随机临床试验[33]20
前瞻性队列研究[38]75
前瞻性观察研究[40]72
前瞻性观察研究[37]25
前瞻性观察研究[41]18
前瞻性观察研究[43]17
治疗因素治疗时长呈正相关，治疗时长↑，釉质脱矿风险↑横断面研究[11]350
横断面研究[44]158
横断面研究[4]72
酸蚀时间酸蚀时间≥15 s，釉质脱矿风险↑病例-对照研究[31]138
病例-对照研究[46]100
矫治器类型固定矫治较隐形矫治、陶瓷托槽较金属托槽、镍钛弓丝较含铜镍钛弓丝釉质脱矿风险高；结扎方式对釉质脱矿的影响存在争议随机临床试验[47]60
随机临床试验[48]24
回顾性队列研究[30]450
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