PDF(Pubmed)
Abstract：
BACKGROUND: Metallic and elastomeric ligatures are widely used in orthodontics to secure the archwire within the bracket slots, but elastomeric ligatures have traditionally been associated with increased microbial colonization, which could adversely affect periodontal health.
OBJECTIVE: This systematic review compares the periodontal effects of elastomeric and steel ligatures used for orthodontic fixed appliances.
METHODS: Unrestricted literature search of 7 databases (MEDLINE, Scopus, Web of Science, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Virtual Health Library) up to July 2023 were performed for randomized / non-randomized clinical studies on humans comparing the two ligation methods during fixed-appliance therapy. After duplicate study selection, data extraction, and risk-of-bias assessment with the Risk of Bias (RoB) 2 or the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool, random-effects meta-analyses of Mean Differences (MD) or Standardized Mean Differences (SMD) and their 95% confidence intervals (CIs) were carried out, followed by assessment of certainty of existing evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS: A total of 11 studies (3 randomized / 8 non-randomized) with 354 patients (mean age 14.7 years and 42% male) were included. No statistically significant differences were seen for plaque index (5 studies; SMD = 0.48; 95% CI = -0.03 to 1.00; P = 0.07), gingival index (2 studies; MD = 0.01; 95% CI = -0.14 to 0.16; P = 0.89), probing pocket depth (2 studies; MD = 0; 95% CI = -0.17 to 0.16; P = 0.97), or Streptococcus mutans counts (4 studies; SMD = 0.40; 95% CI=-0.41 to 1.20; P = 0.21). Elastomeric ligatures were associated with moderately increased total bacterial load (3 studies; SMD = 0.43; 95% CI = 0.10 to 0.76; P = 0.03). Confidence in these estimates was low in all instances due to the inclusion of non-randomized studies with high risk of bias.
CONCLUSIONS: Existing low quality evidence indicates that ligature method does not seem to influence the periodontal health during fixed treatment, even if elastomeric ligatures are associated with a moderate increase of bacterial load.
BACKGROUND: PROSPERO (CRD42023444383).
OBJECTIVE: This systematic review compares the periodontal effects of elastomeric and steel ligatures used for orthodontic fixed appliances.
METHODS: Unrestricted literature search of 7 databases (MEDLINE, Scopus, Web of Science, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Virtual Health Library) up to July 2023 were performed for randomized / non-randomized clinical studies on humans comparing the two ligation methods during fixed-appliance therapy. After duplicate study selection, data extraction, and risk-of-bias assessment with the Risk of Bias (RoB) 2 or the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool, random-effects meta-analyses of Mean Differences (MD) or Standardized Mean Differences (SMD) and their 95% confidence intervals (CIs) were carried out, followed by assessment of certainty of existing evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS: A total of 11 studies (3 randomized / 8 non-randomized) with 354 patients (mean age 14.7 years and 42% male) were included. No statistically significant differences were seen for plaque index (5 studies; SMD = 0.48; 95% CI = -0.03 to 1.00; P = 0.07), gingival index (2 studies; MD = 0.01; 95% CI = -0.14 to 0.16; P = 0.89), probing pocket depth (2 studies; MD = 0; 95% CI = -0.17 to 0.16; P = 0.97), or Streptococcus mutans counts (4 studies; SMD = 0.40; 95% CI=-0.41 to 1.20; P = 0.21). Elastomeric ligatures were associated with moderately increased total bacterial load (3 studies; SMD = 0.43; 95% CI = 0.10 to 0.76; P = 0.03). Confidence in these estimates was low in all instances due to the inclusion of non-randomized studies with high risk of bias.
CONCLUSIONS: Existing low quality evidence indicates that ligature method does not seem to influence the periodontal health during fixed treatment, even if elastomeric ligatures are associated with a moderate increase of bacterial load.
BACKGROUND: PROSPERO (CRD42023444383).
摘要：
背景：金属和弹性体结扎线广泛用于正畸学以将弓丝固定在托槽槽内，但是传统上，弹性结扎线与微生物定植增加有关，这可能会对牙周健康产生不利影响。
目的：本系统综述比较了用于正畸固定矫治器的弹性体结扎线和钢结扎线对牙周的影响。
方法：7个数据库的无限制文献检索(MEDLINE，Scopus,WebofScience,Embase,Cochrane系统评价数据库，Cochrane中央控制试验登记册,和虚拟健康图书馆），直到2023年7月，对人类进行了随机/非随机临床研究，比较了固定矫治器治疗期间的两种结扎方法。重复研究选择后，数据提取,和偏倚风险评估与风险偏倚（RoB）2或非随机研究中的偏倚风险-干预（ROBINS-I）工具，进行了平均差异（MD）或标准化平均差异（SMD）及其95％置信区间（CI）的随机效应荟萃分析，然后用建议等级评估现有证据的确定性，评估,发展,和评估(等级)方法。
结果：共纳入11项研究（3项随机/8项非随机），其中354例患者（平均年龄14.7岁，42%为男性）。菌斑指数无统计学差异（5项研究；SMD=0.48；95％CI=-0.03至1.00；P=0.07），牙龈指数（2项研究；MD=0.01；95％CI=-0.14至0.16；P=0.89），探测口袋深度(2项研究；MD=0；95%CI=-0.17至0.16；P=0.97)，或变形链球菌计数（4项研究；SMD=0.40；95％CI=-0.41至1.20；P=0.21）。弹性结扎线与细菌总负荷适度增加相关（3项研究；SMD=0.43；95％CI=0.10至0.76；P=0.03）。在所有情况下，由于纳入了具有高偏倚风险的非随机研究，对这些估计的信心都很低。
结论：现有的低质量证据表明，在固定治疗期间，结扎方法似乎不会影响牙周健康，即使弹性结扎线与细菌负荷的适度增加有关。
背景：PROSPERO（CRD42023444383）。
目的：本系统综述比较了用于正畸固定矫治器的弹性体结扎线和钢结扎线对牙周的影响。
方法：7个数据库的无限制文献检索(MEDLINE，Scopus,WebofScience,Embase,Cochrane系统评价数据库，Cochrane中央控制试验登记册,和虚拟健康图书馆），直到2023年7月，对人类进行了随机/非随机临床研究，比较了固定矫治器治疗期间的两种结扎方法。重复研究选择后，数据提取,和偏倚风险评估与风险偏倚（RoB）2或非随机研究中的偏倚风险-干预（ROBINS-I）工具，进行了平均差异（MD）或标准化平均差异（SMD）及其95％置信区间（CI）的随机效应荟萃分析，然后用建议等级评估现有证据的确定性，评估,发展,和评估(等级)方法。
结果：共纳入11项研究（3项随机/8项非随机），其中354例患者（平均年龄14.7岁，42%为男性）。菌斑指数无统计学差异（5项研究；SMD=0.48；95％CI=-0.03至1.00；P=0.07），牙龈指数（2项研究；MD=0.01；95％CI=-0.14至0.16；P=0.89），探测口袋深度(2项研究；MD=0；95%CI=-0.17至0.16；P=0.97)，或变形链球菌计数（4项研究；SMD=0.40；95％CI=-0.41至1.20；P=0.21）。弹性结扎线与细菌总负荷适度增加相关（3项研究；SMD=0.43；95％CI=0.10至0.76；P=0.03）。在所有情况下，由于纳入了具有高偏倚风险的非随机研究，对这些估计的信心都很低。
结论：现有的低质量证据表明，在固定治疗期间，结扎方法似乎不会影响牙周健康，即使弹性结扎线与细菌负荷的适度增加有关。
背景：PROSPERO（CRD42023444383）。
