Abstract：
The aim of this systematic review (SR) was to assess whether tooth mobility (TM) increases the risk of tooth extraction/loss. The protocol was registered in PROSPERO database (CRD42023485425). The focused PECO questions were as follows: (1) \"In patients with periodontitis, undergoing periodontal treatment, are teeth affected by mobility at higher risk of being extracted/lost compared to non-mobile teeth, with a minimum follow-up of 10 years?\" and (2) \"In these patients, does varying degrees of tooth mobility increase the risk of tooth extraction/loss, with a minimum follow-up of 10 years?\". Results were reported according to PRISMA statement. Electronic and manual searches were conducted to identify longitudinal studies. The different assessments of tooth mobility were pooled into three groups: TM0: Undetectable tooth mobility, TM1: Horizontal/Mesio-distal mobility ≤1 mm, TM2: Horizontal/Mesio-distal mobility >1 mm or vertical tooth mobility. Tooth loss was the primary outcome. Various meta-analyses were conducted, including subgroup analyses considering different follow-up lengths and the timing of TM assessment, along with sensitivity analyses. A trial sequential analysis was also performed. Eleven studies were included (1883 patients). The mean follow-up range was 10-25 years. The weighted total of included teeth, based on the sample size, was 18 918, with a total of 1604 (8.47%) extracted/lost teeth. The overall rate of tooth extraction/loss increased with increasing mobility: TM0 was associated with a 5.85% rate (866/14822), TM1 with the 11.8% (384/3255), TM2 with the 40.3% (339/841). Mobile teeth (TM1/TM2) were at an increased risk for tooth extraction/loss, compared to TM0 (HR: 2.85; [95% CI 1.88-4.32]; p < .00001). TM1 had a higher risk than TM0 (HR: 1.96; [95% CI 1.09-3.53]; p < .00001). TM2 had a higher risk than TM1 (HR: 2.85; [95% CI 2.19-3.70]; p < .00001) and TM0 (HR: 7.12; [95% CI 3.27-15.51]; p < .00001). The results of the tests for subgroup differences were not significant. Sensitivity meta-analyses yielded consistent results with other meta-analyses. Within the limits of the quality of the studies included in the meta-analyses, mobile teeth were at higher risk of being extracted/lost in the long-term and higher degrees of TM significantly influenced clinicians\' decision to extract a tooth. However, most teeth can be retained in the long-term and thus TM should not be considered a reason for extraction or a risk factor for tooth loss, regardless of the degree of TM.
摘要：
这项系统评价（SR）的目的是评估牙齿活动度（TM）是否会增加拔牙/脱落的风险。该协议在PROSPERO数据库(CRD42023485425)中注册。重点关注的PECO问题如下：（1）“在牙周炎患者中，正在接受牙周治疗，与不可移动的牙齿相比，受移动性影响的牙齿被拔除/丢失的风险更高，至少随访10年？“和（2）”在这些患者中，不同程度的牙齿活动性是否会增加拔牙/脱落的风险，至少随访10年？\"根据PRISMA声明报告结果。进行电子和手动搜索以确定纵向研究。对牙齿活动度的不同评估分为三组：TM0：无法检测到的牙齿活动度，TM1:水平/Mesio-远端移动性≤1mm,TM2:水平/中远端活动度>1mm或垂直牙齿活动度。牙齿脱落是主要结果。进行了各种荟萃分析，包括考虑不同随访时间和TM评估时机的亚组分析，以及敏感性分析。还进行了试验顺序分析。纳入11项研究（1883例患者）。平均随访时间为10-25年。包括牙齿的加权总数，根据样本量，为18918颗，总计1604颗（8.47%）拔牙/脱落。总的拔牙率/脱落率随着活动度的增加而增加：TM0与5.85%的比率相关（866/14822），TM1为11.8%（384/3255），TM2占40.3%（339/841）。移动牙齿（TM1/TM2）拔牙/脱落的风险增加，与TM0相比（HR：2.85；[95%CI1.88-4.32]；p<.00001）。TM1的风险高于TM0（HR：1.96；[95%CI1.09-3.53]；p<.00001）。TM2的风险高于TM1（HR：2.85；[95%CI2.19-3.70]；p<.00001）和TM0（HR：7.12；[95%CI3.27-15.51]；p<.00001）。亚组差异测试结果不显著。敏感性荟萃分析与其他荟萃分析结果一致。在荟萃分析中纳入的研究质量范围内，可移动牙齿在长期内被拔除/丢失的风险较高,且更高程度的TM显著影响临床医生拔牙的决定.然而,大多数牙齿可以长期保留，因此TM不应被视为拔牙的原因或牙齿脱落的风险因素，无论TM的程度如何。
