本综述的目的是评估传统方法和加速方法在治疗持续时间方面的疗效,速度,牙周,和患者报告的变量。在9个数据库中对1990年1月至2021年10月之间发表的随机对照试验(RCT)和对照临床试验(CCT)进行了电子搜索。手工搜索了五个主要的正畸期刊以进行其他研究。参与者是单侧或双侧PICs患者,他们接受了固定矫治器的常规或加速正畸治疗。使用Cochrane的RCT偏倚风险工具(RoB2工具)和CCT的ROBINS-I工具评估偏倚风险。建议评估的分级,发展,和评估(GRADE)指南用于评估证据的总体质量。本综述包括9篇文章(8篇RCT和1篇CCT)(371例患者)。在大多数研究中,机械牵引方法对治疗结果的可能影响尚不清楚。当使用传统技术进行开放手术时,治疗时间缩短(约3至6个月),而使用加速方法时,牵引速度显着增加(约1-1.5mm/月)。常规干预组之间无显著差异,以及传统和加速群体之间,就大多数牙周变量而言(p>0.005)。在短期随访(1-10天)中比较不同的暴露方法时,与传统PICs牵引相关的疼痛水平没有显着差异,而在这些方法之间的疼痛发生率中发现了矛盾的结果。未评估疼痛/不适水平与机械牵引方法类型之间的关系。根据等级,支持这些发现的证据质量从低到极低不等.开放式手术技术与超弹性丝或弹性牵引装置的各种设计的组合可以导致PIC的正畸治疗持续时间的减少。通过微型支架使用直接锚固将PIC从相邻的牙齿根部移开可以导致根部吸收的减少并缩短治疗时间。支持这些发现的证据从低到非常低。使用不同类型的机械装置进行常规PIC牵引,使用开放式或封闭式牵引技术,并不会导致干预组之间牙周结局的显着差异。关于感知疼痛的严重程度与手术暴露类型存在矛盾的结果,该变量与机械牵引方式的关系尚不清楚。在PIC牵引中使用加速方法可导致牵引运动速度的增加,而加速方法与常规方法之间的牙周结局没有显着差异。支持这些发现的证据从低到非常低。需要更多高质量的随机CCT来建立该领域的良好证据。在本审查的第一阶段,本系统审查的方案已在国际前瞻性系统审查登记册(PROSPERO;CRD42021274476)中注册。
The objective of the current
review was to evaluate the effectiveness of traditional and accelerated methods of palatally impacted canine\'s (PIC) traction in terms of treatment duration, velocity, periodontal, and patient-reported variables. An electronic search for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) published between January 1990 and October 2021 was conducted in nine databases. Five major orthodontic journals were hand searched for additional studies. The participants were patients with unilateral or bilateral PICs who received conventional or accelerated orthodontic treatment with fixed appliances. Cochrane\'s risk of bias tool (RoB 2 tool) for RCTs and ROBINS-I tool for CCTs were used to assess the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence. Nine articles (eight RCTs and one CCT) were included in this
review (371 patients). There was no clarity in most studies about the possible effect of the mechanical traction method on treatment outcomes. The treatment duration decreased (about three to six months) when the open surgical method was used with traditional techniques and the traction velocity increased significantly (about 1-1.5 mm/month) when acceleration methods were used. No significant differences were found between the conventional intervention groups, as well as between the traditional and accelerated groups, in terms of most periodontal variables (p > 0.005). No significant differences were found in the pain levels associated with traditional PICs\' traction when comparing different exposure methods in the short-term follow-up (1-10 days), while contradictory results were found in the pain incidence between these methods. The relationship between the pain/discomfort levels and the type of mechanical traction method was not evaluated. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low. The combination of the open surgical technique with various designs of either superelastic wires or elastic traction means can lead to a reduction in the orthodontic treatment duration of PICs. The use of direct anchorage by miniscrews to move the PICs away from the adjacent teeth roots can lead to a reduction in root resorption and shorten the treatment duration. The evidence supporting these findings ranged from low to very low. The use of different types of mechanical means for conventional PICs\' traction, with the use of open or closed traction techniques, does not lead to significant differences in periodontal outcomes between intervention groups. Contradictory results exist regarding the severity of the perceived pain in relation to the surgical exposure type, and the relationship between this variable and the mechanical traction method is still unclear. The use of accelerated methods for PICs\' traction can lead to an increase in the velocity of traction movement with no significant differences in periodontal outcomes between accelerated and conventional methods. The evidence supporting these findings ranged from low to very low. More high-quality randomized CCTs are needed to establish good evidence in this field. The protocol of this systematic
review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021274476) during the first stages of this
review.