背景:初始弓丝是在正畸治疗开始时插入固定矫治器的第一弓丝。有许多不同类型的正畸弓丝可用于初始牙齿对齐,重要的是要了解哪些是最有效的,并且在治疗的初始对齐阶段引起的牙根吸收和疼痛最少。这是Cochrane评论于2010年首次发布的第三次更新。
目的:为了评估初始弓丝对牙齿与固定正畸牙套对齐的影响,就牙齿对齐的速度而言,伴随牙齿移动的牙根吸收量,以及患者在治疗初始对齐阶段所经历的疼痛强度。
方法:我们搜索了Cochrane口腔健康试验注册,中部,MEDLINE,Embase,以及2022年7月4日两个正在进行的试验登记册。
方法:我们纳入了随机对照试验(RCT),这些试验涉及不同的初始弓丝用于将牙齿与固定的正畸牙套对齐。我们包括在上弓使用全弓固定正畸矫治器的人,下拱,或者两个拱门。
方法:两名独立的综述作者负责研究选择,数据提取,并评估纳入研究的偏倚风险。我们联系了纳入研究的相应作者,以获取缺失的信息。我们通过评论作者之间的讨论解决了分歧。我们的主要结果是对齐率(牙齿的移动以毫米为单位),根吸收,对齐时间,和疼痛强度以100-mm视觉模拟评分(VAS)测量。我们使用随机效应模型汇集了具有类似干预措施和结果的研究数据。我们报告了连续数据的平均差异(MD)和95%置信区间(CI),二分数据具有95%CI的风险比(RRs),和与95%CI的时间到事件数据的对齐率比率。两名独立评论作者评估了证据的确定性。我们通过评论作者之间的讨论解决了分歧。
结果:在本综述中,我们纳入了29个RCT,其中1915名参与者(2581个拱门)。研究通常规模较小(样本量为14至200名参与者)。随访时间在3天至6个月之间变化。11项研究获得资助,六个没有得到资助,和12没有提供有关资金来源的信息。我们判断有8项研究存在高偏倚风险,九个处于低风险的人,12个风险不明。我们将这些研究分为六个主要比较。多股不锈钢丝与由其他材料组成的钢丝的六项研究有409名参与者(545个拱形)评估了多股不锈钢丝(StSt)与由其他材料组成的钢丝。我们非常不确定多股StSt线与其他线对对准率的影响(4项研究,281名参与者,417个拱门;非常低的确定性证据)。在疼痛强度方面,多股StSt线与其他线之间可能几乎没有差异(MD-2.68mm,95%CI-6.75至1.38;2项研究,127名与会者127个拱门;低确定性证据)。常规镍钛丝与超弹性镍钛丝的四项研究有266名参与者(274个拱门)评估了常规镍钛(NiTi)丝与超弹性NiTi丝。在对准率方面,不同的导线类型之间可能几乎没有差异(124名参与者,124个拱门,2项研究;低确定性证据)和疼痛强度(MD-0.29mm,95%CI-1.10至0.52;2项研究,142名与会者150个拱门;低确定性证据)。常规镍钛线与热弹性铜镍钛线的比较有210名参与者(210个拱门)的三项研究评估了常规Ni-Ti与热弹性铜镍钛(CuNiTi)线的关系。我们非常不确定不同弓丝对对准率的影响(1项研究,66人66个拱门;非常低的确定性证据)。在对准时间方面,常规NiTi丝和热弹性CuNiTi丝之间可能几乎没有差异(对准率1.30,95%CI0.68至2.50;1项研究,60名学员,60个拱门;低确定性证据)。超弹性镍钛丝与热弹性镍钛丝的十二项研究,有703名参与者(936个拱形)评估了超弹性NiTi与热弹性NiTi丝的关系。在四周时,超弹性NiTi丝和热弹性NiTi丝的对准率可能几乎没有差异(MD-0.28mm,95%CI0.62至0.06;5项研究,183名与会者,183拱门;低确定性证据)。我们非常不确定不同的电线对根部吸收的影响(2项研究,52名学员,312颗牙齿;非常低的确定性证据)。与热弹性NiTi丝相比,超弹性NiTi丝可能会导致对准时间略有增加(MD0.5个月,95%CI0.21至0.79;1项研究,32名与会者,32个拱门;低确定性证据),但可能与疼痛强度的轻微增加有关(MD6.96mm,95%CI1.82至12.10;3项研究,94名参与者,138个拱门,中度确定性证据)。单股超弹性镍钛丝与同轴超弹性镍钛丝三项有104名参与者(104个拱门)的研究评估了单股超弹性NiTi与同轴超弹性NiTi丝。与同轴超弹性NiTi丝相比,使用单股超弹性NiTi丝可能会导致四周的对准率略有降低(MD-2.64mm,95%CI-4.61至-0.67;2项研究,64名参与者,64个拱门,中度确定性证据)。不同尺寸的镍钛丝有149名参与者(232个拱门)的两项研究比较了不同类型的NiTi丝。就疼痛而言,不同尺寸的NiTi线之间可能几乎没有差异(低确定性证据)。
结论:超弹性NiTi丝一天后可能比热弹性NiTi丝产生更多的疼痛,与同轴超弹性NiTi丝相比,单股超弹性NiTi丝在四周内的对准率可能较低。所有其他关于对准率的证据,根吸收,对齐时间,在所有比较中,疼痛的确定性很低或很低。因此,没有足够的证据来确定任何特定的弓丝材料或尺寸是否优于任何其他弓丝。这项审查的结果是不精确和不可靠的;需要精心设计的大型研究来更好地估计不同弓丝的益处和危害。正畸医生在解释本评论的发现时应谨慎行事,并准备根据个人患者的需求调整其治疗计划。
Initial arch wires are the first arch wires inserted into fixed appliance at the beginning of orthodontic treatment. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which are most efficient and which cause the least amount of root resorption and pain during the initial aligning stage of treatment. This is the third update of a Cochrane review first published in 2010.
To assess the effects of initial arch wires for the alignment of teeth with fixed orthodontic braces, in terms of the rate of tooth alignment, amount of root resorption accompanying tooth movement, and intensity of pain experienced by patients during the initial alignment stage of treatment.
We searched Cochrane Oral Health\'s Trials Register, CENTRAL, MEDLINE, Embase, and two ongoing trials registries on 4 July 2022.
We included randomised controlled trials (RCTs) of different initial arch wires used to align teeth with fixed orthodontic braces. We included people with full-arch fixed orthodontic appliances on the upper arch, lower arch, or both arches.
Two independent review authors were responsible for study selection, data extraction, and assessment of risk of bias in included studies. We contacted corresponding authors of included studies to obtain missing information. We resolved disagreements by discussion between the review authors. Our main outcomes were alignment rate (movement of teeth in mm), root resorption, time to alignment, and intensity of pain measured on a 100-mm visual analogue scale (VAS). We pooled data from studies with similar interventions and outcomes using random-effects models. We reported mean differences (MDs) with 95% confidence intervals (CIs) for continuous data, risk ratios (RRs) with 95% CIs for dichotomous data, and alignment rate ratios with 95% CIs for time-to-event data. Two independent review authors assessed the certainty of evidence. We resolved disagreements by discussion between the review authors.
We included 29 RCTs with 1915 participants (2581 arches) in this review. Studies were generally small (sample sizes ranged from 14 to 200 participants). Duration of follow-up varied between three days and six months. Eleven studies received funding, six received no funding, and 12 provided no information about funding sources. We judged eight studies at high risk of bias, nine at low risk, and 12 at unclear risk. We grouped the studies into six main comparisons. Multistrand stainless steel wires versus wires composed of other materials Six studies with 409 participants (545 arches) evaluated multistrand stainless steel (StSt) wires versus wires composed of other materials. We are very uncertain about the effect of multistrand StSt wires versus other wires on alignment rate (4 studies, 281 participants, 417 arches; very low-certainty evidence). There may be little to no difference between multistrand StSt wires and other wires in terms of intensity of pain (MD -2.68 mm, 95% CI -6.75 to 1.38; 2 studies, 127 participants, 127 arches; low-certainty evidence). Conventional nickel-titanium wires versus superelastic nickel-titanium wires Four studies with 266 participants (274 arches) evaluated conventional nickel-titanium (NiTi) wires versus superelastic NiTi wires. There may be little to no difference between the different wire types in terms of alignment rate (124 participants, 124 arches, 2 studies; low-certainty evidence) and intensity of pain (MD -0.29 mm, 95% CI -1.10 to 0.52; 2 studies, 142 participants, 150 arches; low-certainty evidence). Conventional nickel-titanium wires versus thermoelastic copper-nickel-titanium wires Three studies with 210 participants (210 arches) evaluated conventional Ni-Ti versus thermoelastic copper-nickel-titanium (CuNiTi) wires. We are very uncertain about the effects of the different arch wires on alignment rate (1 study, 66 participants, 66 arches; very low-certainty evidence). There may be little to no difference between conventional NiTi wires and thermoelastic CuNiTi wires in terms of time to alignment (alignment rate ratio 1.30, 95% CI 0.68 to 2.50; 1 study, 60 participants, 60 arches; low-certainty evidence). Superelastic nickel-titanium wires versus thermoelastic nickel-titanium wires Twelve studies with 703 participants (936 arches) evaluated superelastic NiTi versus thermoelastic NiTi wires. There may be little to no difference between superelastic NiTi wires and thermoelastic NiTi wires in alignment rate at four weeks (MD -0.28 mm, 95% CI 0.62 to 0.06; 5 studies, 183 participants, 183 arches; low-certainty evidence). We are very uncertain about the effects of the different wires on root resorption (2 studies, 52 participants, 312 teeth; very low-certainty evidence). Superelastic NiTi wires compared with thermoelastic NiTi wires may result in a slight increase in time to alignment (MD 0.5 months, 95% CI 0.21 to 0.79; 1 study, 32 participants, 32 arches; low-certainty evidence) but are probably associated with a slight increase in intensity of pain (MD 6.96 mm, 95% CI 1.82 to 12.10; 3 studies, 94 participants, 138 arches, moderate-certainty evidence). Single-strand superelastic nickel-titanium wires versus coaxial superelastic nickel-titanium wires Three studies with 104 participants (104 arches) evaluated single-strand superelastic NiTi versus coaxial superelastic NiTi wires. Use of single-strand superelastic NiTi wires compared with coaxial superelastic NiTi wires probably results in a slight reduction in alignment rate at four weeks (MD -2.64 mm, 95% CI -4.61 to -0.67; 2 studies, 64 participants, 64 arches, moderate-certainty evidence). Different sizes of nickel-titanium wires Two studies with 149 participants (232 arches) compared different types of NiTi wires. There may be little to no difference between different sizes of NiTi wires in terms of pain (low-certainty evidence).
Superelastic NiTi wires probably produce slightly more pain after one day than thermoelastic NiTi wires, and single-strand superelastic NiTi wires probably have a lower alignment rate over four weeks compared with coaxial superelastic NiTi wires. All other evidence on alignment rate, root resorption, time to alignment, and pain is of low or very low certainty in all comparisons. Therefore, there is insufficient evidence to determine whether any particular arch wire material or size is superior to any other. The findings of this review are imprecise and unreliable; well-designed larger studies are needed to give better estimates of the benefits and harms of different arch wires. Orthodontists should exercise caution when interpreting the findings of this review and be prepared to adapt their treatment plans based on individual patient needs.