这项系统评价的目的是评估有关用于治疗II类错牙合畸形患者的上颌双骨锚固装置(BMSAD)的骨骼和牙槽骨作用的现有证据。
在PubMed上进行了全面搜索,Scopus,科学直接,WebofScience,科克伦,和LILACS直到2021年11月,通过手动搜索得到了增强。纳入的研究为临床试验(RCTs)和/或随访观察性研究(回顾性和前瞻性)。感兴趣的结果是骨骼,齿状肺泡,以及从头颅测量前后测量获得的咬合治疗引起的变化。使用以前出版物的评估工具评估了纳入研究的偏倚风险。
在742篇筛选文章中,只有4人符合资格,因此被纳入定性综合.他们显示出适度的总体偏倚风险。结果显示为研究组和对照组的平均变化。所有研究都报告了上颌基部的缩进和下颌骨的前移(意味着ANB角减小)。纳入的三项研究报告了垂直颌骨关系的增加,这与第四项研究的报道相反。三项研究报告上颌切牙的倾斜度或位置增加,而一项研究报告了他们的逆行。下颌切牙的前倾发生在两项研究中,而其他两项研究报道了逆行。在所有纳入的研究中,过度喷射都减少了。
除了对下颌骨的突出作用,对上颌骨的影响,以及随之而来的过度喷射的减少,BMSAD导致不一致的骨骼和牙槽效应。然而,目前的证据是有限的,由于在颌间组件的生物力学的变化,锚固类型,和纳入研究中的可比组。高度鼓励采用更标准化方法的进一步RCT。
BMSAD(在两个颌骨上使用微型或微型板)诱导的骨骼效应比牙槽效应更多。然而,必须谨慎行事,基于获益与风险(手术插入)的比率,以及到目前为止掌握的有限证据。注册本系统审查的方案已在国际系统审查前瞻性登记册(PROSPERO,不。:CRD42020199601)。
The goal of this systematic
review was to assess the available evidence regarding the skeletal and dentoalveolar effects of bi-maxillary skeletal anchorage devices (BMSADs) used in treating growing class II malocclusion patients.
A comprehensive search was conducted on PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS up to November 2021, which was augmented by a manual search. The studies included were clinical trials (RCTs) and/or follow-up observational studies (retrospective and prospective). The outcomes of interest were the skeletal, dentoalveolar, and occlusal treatment-induced changes obtained from pre- and post-cephalometric measurements. The risks of bias of the included studies were assessed using an assessment tool from previous publications.
Out of 742 screened articles, only 4 were eligible and thus included in the qualitative synthesis. They showed a moderate overall risk of bias. The results are presented as mean changes in both the study and control groups. All studies reported retrusion of the maxillary base and advancement of the mandible (meaning reduced ANB angle). Three of the included studies reported an increase in the vertical jaw relation, which was contrary to what the fourth study reported. Three studies reported an increase in the maxillary incisors\' inclination or position, while one study reported their retroclination. Proclination of the mandibular incisors happened in two studies, whereas the other two studies reported retroclination. The overjet was reduced in all included studies.
Apart from the protrusive effects on the mandible, retrusive effects on the maxilla, and the consequent reduction of the overjet, BMSADs results in inconsistent skeletal and dentoalveolar effects. However, the current evidence is limited due to the variability in the biomechanics of the intermaxillary components, type of anchorage, and comparable groups in the included studies. Further RCTs with more standardized methodologies are highly encouraged.
BMSADs (using miniscrews or miniplates on both jaws) induces more skeletal than dentoalveolar effects. However, this must be practiced with caution, based on the benefit to risk (surgical insertion) ratio, and the limited evidence available in hand so far. Registration The protocol for this systematic
review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199601).