目的：主要目的是评估使用临时骨骼锚固装置（TSAD）进行整体回缩与使用常规锚固装置（CA）进行两步回缩在骨骼，牙科,和软组织变量，以及回缩或整体正畸治疗的持续时间。
方法：对PubMed和其他九个主要数据库进行电子搜索，随机对照试验(RCT)和临床对照试验(CCT)于1990年1月至2018年4月期间进行.检查了每篇确定的文章中的参考书目。此外,在五个主要的正畸期刊中，在同一时间范围内进行了手动搜索。接受固定正畸治疗的成年患者，实验组拔除上颌前磨牙，然后进行整体回缩，对照组进行上前牙两步回缩。应用CCT非随机研究的方法学指标和Cochrane的RCT偏倚风险工具。
结果：本综述包括四篇文章（两篇RCT和两篇CCT），所有文章均适用于定量合成。整体回缩组和两步回缩组在SNA方面没有显着差异，SNB,ANB,和MP-SN角度。使用TSAD在后锚固和门牙倾斜方面的效果明显更好，与CA相比，前牙缩回更大（标准化平均差[SMD]=-3.03mm，P<0.001；SMD=0.74°，P=0.003;SMD=-0.46mm,分别为P=0.03)。Masse/TSAD组合导致鼻唇沟角度显著增加，面部凸角减小幅度更大，与两步/CA组合相比，下唇回缩更大（加权平均差=4.73°，P=0.007;P=0.0435;SMD=-0.95mm,分别为P=0.01)。
结论：有轻度到中度的证据表明，使用整体/TSAD组合或两步/CA组合将导致类似的骨骼改善。有一个非常弱到中度的证据表明，使用具有整体回缩的TSAD会导致更好的后锚固和门牙倾斜，与使用两步回缩的CA相比，前牙回缩更大。有弱到中等的证据表明，使用整体/TSAD组合将导致面部轮廓的更好改善。根据证据的质量,我们确认在大规模回缩领域需要更多进行良好的随机对照试验。
OBJECTIVE: The main objective is to evaluate the effectiveness of en masse retraction with temporary skeletal anchorage devices (TSADs) versus two-step retraction with conventional anchorage (CA) in terms of the skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment.
METHODS: An electronic search of PubMed and nine other major databases for prospective, randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was carried out between January 1990 and April 2018. The bibliography in each identified article was checked out. In addition, manual searching was performed in the same time frame in five major orthodontic journals. Adult patients undergoing fixed orthodontic treatment with extraction of maxillary premolars followed by an en masse retraction in the experimental group and two-step retraction of upper anterior teeth in the control group. Methodological index for nonrandomized studies for CCTs and Cochrane\'s risk of bias tool for RCTs were applied.
RESULTS: Four articles (two RCTs and two CCTs) were included in this
review and all articles were appropriate for the quantitative synthesis. There was no significant difference between the en masse retraction and two-step retraction groups in terms of SNA, SNB, ANB, and MP-SN angles. Using TSADs gave significantly better results in terms of posterior anchorage and incisors inclination, and greater anterior teeth retraction in comparison with CA (standardized mean difference [SMD] = -3.03 mm, P < 0.001; SMD = 0.74°, P = 0.003; SMD = -0.46 mm, P = 0.03, respectively). En masse/TSAD combination caused a significantly greater increase in nasolabial angle, higher decrease in facial convexity angle, and greater lower lip retraction in comparison with two-step/CA combination (weighted mean difference = 4.73°, P = 0.007; P = 0.0435; SMD = -0.95 mm, P = 0.01, respectively).
CONCLUSIONS: There is weak-to-moderate evidence that using either en masse/TSAD combination or two-step/CA combination would lead to similar skeletal improvement. There is a very weak-to-moderate evidence that using TSADs with en masse retraction would cause better posterior anchorage and incisors inclination, and greater anterior teeth retraction than using CA with two-step retraction. There is weak-to-moderate evidence that using en masse/TSAD combination would lead to a better improvement in the facial profile. According to the quality of evidence, we confirm the need for more well-conducted RCTs in the en masse retraction field.
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