拔牙与非拔牙正畸治疗:一项系统综述和荟萃分析。

Karim Gamal Elias, Gautham Sivamurthy, David R Bearn
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引用次数: 0

摘要

目的:比较四种第一前磨牙拔除和非拔除治疗对牙弓内宽度、外形、治疗时间、咬合效果、微笑美观性和稳定性的影响。材料和方法:使用健康科学数据库对截至2023年6月2日的文献进行电子检索,并对灰色文献、未发表的材料和手工检索进行额外检索,以检索报告使用固定矫治器的非手术患者的16个子结果的研究。数据提取使用定制的表格,使用ROBINS-I(非随机干预研究中的偏倚风险)和Cochrane RoB2(偏倚的风险)工具进行质量评估。GRADE(建议评估、发展和评估分级)评估了证据的确定性。结果:纳入30项研究(29项回顾性研究,1项随机对照试验)。随机效应荟萃分析(95%CI)显示,在四次第一前磨牙拔除后,上颌(MD:2.03 mm;[2.97,-1.09];P<.0001)和下颌第一磨牙间宽度减小(MD:2.00 mm;[2.71,-1.30];P<0.00001);非牵引组的下颌齿间宽度增加(MD:0.68 mm;[0.36,0.99];P<.0001)和治疗时间缩短(MD:0.36年;[0.10,0.62];P=.007)。叙事综合包括三项和五项分别针对上、下lip-E平面的研究。对于美国正畸委员会的客观分级系统和上颌/下颌前对齐(利特尔不规则指数),每项研究都包括两项证据不确定的研究。没有符合英国同行评估评分(标准杆数)的研究。I类亚组/敏感性分析支持相同的结果。预测区间显示所有结果无显著差异。结论:四个第一前磨牙拔除可导致上下颌第一磨牙宽度减小和上下唇退缩。非拔牙治疗可增加下颌关节间隙宽度,缩短治疗时间。两组患者在上颌齿间宽度、US标准杆数评分和治疗后微笑美学方面无显著差异。建议进一步进行高质量的重点研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Extraction vs nonextraction orthodontic treatment: a systematic review and meta-analysis.

Objectives: To compare four first premolar extraction and nonextraction treatment effects on intra-arch width, profile, treatment duration, occlusal outcomes, smile aesthetics and stability.

Materials and methods: An electronic search of the literature to June 2, 2023 was conducted using health science databases, with additional search of gray literature, unpublished material, and hand searching, for studies reporting nonsurgical patients with fixed appliances regarding sixteen sub-outcomes. Data extraction used customized forms, quality assessed with ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) and Cochrane RoB 2 (risk-of-bias) tool. GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessed certainty of evidence.

Results: Thirty (29 retrospective studies, 1 randomized controlled trial) studies were included. Random-effect meta-analysis (95% CI) demonstrated maxillary (MD: -2.03 mm; [-2.97, -1.09]; P < .0001) and mandibular inter-first molar width decrease (MD: -2.00 mm; [-2.71, -1.30]; P < .00001) with four first premolar extraction; mandibular intercanine width increase (MD: 0.68 mm; [0.36, 0.99]; P < .0001) and shorter treatment duration (MD: 0.36 years; [0.10, 0.62]; P = .007) in the nonextraction group. Narrative synthesis included three and five studies for upper and lower lip-E plane, respectively. For American Board of Orthodontics Objective Grading System and maxillary/mandibular anterior alignment (Little's irregularity index), each included two studies with inconclusive evidence. There were no eligible studies for UK Peer Assessment Rating (PAR) score. Class I subgroup/sensitivity analyses favored the same results. Prediction interval indicated no significant difference for all outcomes.

Conclusions: Four first premolar extraction results in maxillary and mandibular inter-first molar width decrease and retraction of upper/lower lips. Nonextraction treatment results in mandibular intercanine width increase and shorter treatment duration. There was no significant difference between the two groups regarding maxillary intercanine width, US PAR score, and posttreatment smile esthetics. Further high-quality focused research is recommended.

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