目的:使用文献系统回顾和荟萃分析比较计算机辅助设计和计算机辅助制造(CAD/CAM)固定固位体和常规固定固位体在正畸患者中的有效性。
方法:在MEDLINE中进行了全面搜索,WebofScience,EMBASE,Scopus,科克伦中心,谷歌学者,奥维德,和LILACS截至2023年5月,没有语言或日期限制。
方法:仅纳入符合PICO问题的随机临床试验(RCT),在纳入的研究中,使用Cochrane偏差风险2.0(RoB2)工具评估偏倚风险.
方法:使用自定义试点表格,从纳入的研究中检索相关数据.然后使用随机效应逆方差荟萃分析来汇集结果。主要结果是通过牙模测量和牙周状态测量的治疗结果的稳定性,而次要结局是失败率和患者报告的结局.
结果:共有601名参与者的7个随机对照试验被纳入综述。短期内(≤6个月),荟萃分析显示CAD/CAM与下颌固位体中常规固定固位体在犬间距离或足弓长度上无显著差异.然而,对于Little\的不规则指数,在3个月和6个月时,单链不锈钢固位体明显比Ni-TiCAD/CAM固位体差,虽然多股不锈钢保持器在6个月的里程碑时仅与CAD/CAM分开,尽管这些变化的总体临床后果。CAD/CAM固位体的菌斑指数低于传统固位体,但牙龈指数无显着差异。CAD/CAM与下颌固位体中其他类型的固位体的故障率没有显着差异。尽管如此,一项研究出现大量CAD/CAM保持器失效,导致研究停止.
结论:在短期内,CAD/CAM固定固位器有望替代传统固位器。它们可以增强牙周健康,菌斑指数评分低于常规固位体。然而,需要广泛的研究来确定CAD/CAM保持器在正畸治疗中的长期耐久性和有效性,尤其是他们的失败率。在获得全面证据之前,CAD/CAM固定器的使用应针对每种情况进行定制。
背景:本系统评价的方案在PROSPERO注册,ID为CRD42023412741。
Comparing computer-aided design and computer-aided manufacturing (CAD/CAM) fixed retainers and conventional fixed retainers for their effectiveness in orthodontic patients using systematic
review and meta-analysis of literature.
A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus, Cochrane\'s CENTRAL, Google Scholar, Ovid, and LILACS up to May 2023, with no language or date restrictions.
Only randomized clinical trials (RCTs) that complied with PICO questions were included, and the Cochrane Risk of Bias 2.0 (RoB 2) tool was used to assess the risk of bias in the included studies.
Using custom-piloted forms, relevant data were retrieved from the included studies. Then a random-effects inverse variance meta-analysis was used to pool the results. Primary outcomes were stability of treatment results measured through dental cast measurements and periodontal status, while secondary outcomes were failure rates and patient-reported outcomes.
Seven RCTs with 601 participants were included in the
review. In the short term (≤6 months), the meta-analysis showed no significant differences in inter-canine distance or arch length between CAD/CAM and conventional fixed retainers in mandibular retainers. However, for Little\'s irregularity index, single-stranded stainless-steel retainers were notably worse than Ni-Ti CAD/CAM retainers at 3 and 6 months, while multi-stranded stainless-steel retainers only diverged from CAD/CAM at the 6-month milestone, despite the overall clinical inconsequence of these changes. CAD/CAM retainers were associated with a lower plaque index than traditional retainers but no significant difference in gingival index. Failure rates did not differ significantly between CAD/CAM and other types of retainers in mandibular retainers. Nonetheless, one study had a high amount of CAD/CAM retainer failures leading to the study being stopped.
In the short term, CAD/CAM fixed retainers show promise as an alternative to traditional retainers. They may enhance periodontal health, as indicated by lower plaque index scores than conventional retainers. However, extensive research is needed to determine the long-term durability and effectiveness of CAD/CAM retainers in orthodontic treatment, particularly regarding their failure rate. Until comprehensive evidence is available, the use of CAD/CAM retainers should be tailored for each case.
The protocol for this systematic
review was registered at PROSPERO with the ID CRD42023412741.