目的:本系统综述和荟萃分析旨在评估完全引导的牙齿支撑静态手术导向器(FTSG)与部分引导的手术导向器或徒手的深度变形和角度偏差。
方法:本研究遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目,并在开放科学框架(OSF)中注册。制定的人口,干预,比较,结果(PICO)的问题是:“在部分无牙的拱门中,与部分引导手术指南或徒手相比,FTSG的深度失真和角度偏差是什么?“搜索策略涉及四个主要的电子数据库,根据既定的搜索策略,在2023年11月完成了额外的手动搜索。最初的收录是基于标题和摘要,随后对选定的研究进行了详细的回顾,和临床研究,评估部分拱门中FTSG的角度偏差或深度失真,与部分引导的手术指南或徒手相比,包括在内。在FTSG中,比较了两种手术方法:开放皮瓣和无瓣技术,并评估了两种数字方法用于带有基准标记或牙齿表面的手术指南设计。临床研究的定性分析用于评估偏倚的风险。根据建议的等级评估证据的确定性,评估,发展,和评估(等级)系统。此外,进行了单臂比例荟萃分析,以评估徒手和FTSG的角度偏差.
结果:十项研究,在2018年至2023年之间发布,符合资格标准。其中,10项研究报告了FTSG的角度偏差范围为-0.32°至4.96°。关于FTSG手术入路,七项研究检查了FTSG的开放皮瓣技术,报告范围从2.03°到4.23°的平均角度偏差,四项研究评估了无松弛的FTSG,报告角度偏差范围为-0.32°至3.38°。六项研究评估了徒手手术方法,报告范围从1.40°到7.36°的角度偏差。开放皮瓣FTSG的平均深度变形范围为0.19mm至2.05mm,和0.15毫米到0.45毫米之间的无折叠FTSG。对于部分引导的手术导向器,两项研究报告的角度偏差范围为0.59°至3.44°。七项研究符合荟萃分析的条件,重点介绍了FTSG中的开放式襟翼技术,具有高度异质性(I2(95CI)=92.3%(88.7%-96.4%))。相比之下,在开放皮瓣技术中比较徒手与FTSG的研究中,异质性较低(I2(95CI)=21.3%(0.0%-67.8%)),支持FTSG手术方法。
结论:在部分无牙牙弓中,FTSG系统的角度偏差小于徒手和部分引导的手术导向器。无裂口手术入路与减少的角度偏差和深度变形有关。建议在这些程序中对FTSG方法的潜在偏好。
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the depth distortion and angular deviation of fully-guided tooth-supported static surgical guides (FTSG) in partially edentulous arches compared to partially guided surgical guides or freehand.
METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Open Science Framework (OSF). The formulated population, intervention, comparison, and outcome (PICO) question was: \"In partially edentulous arches, what are the depth distortion and angular deviation of FTSG compared to partially guided surgical guides or freehand?\" The search strategy involved four main electronic databases, and an additional manual search was completed in November 2023 by following an established search strategy. Initial inclusion was based on titles and abstracts, followed by a detailed review of selected studies, and clinical studies that evaluated the angular deviations or depth distortion in FTSG in partial arches, compared to partially guided surgical guides or freehand, were included. In FTSG, two surgical approaches were compared: open flap and flapless techniques, and two digital methods were assessed for surgical guide design with fiducial markers or dental surfaces. A qualitative analysis for clinical studies was used to assess the risk of bias. The certainty of the evidence was assessed according to the grading of recommendations, assessment, development, and evaluations (GRADE) system. In addition, a single-arm meta-analysis of proportion was performed to evaluate the angular deviation of freehand and FTSG.
RESULTS: Ten studies, published between 2018 and 2023, met the eligibility criteria. Among them, 10 studies reported angular deviations ranging from -0.32° to 4.96° for FTSG. Regarding FTSG surgical approaches, seven studies examined the open flap technique for FTSG, reporting mean angular deviations ranging from 2.03° to 4.23°, and four studies evaluated flapless FTSG, reporting angular deviations ranging from -0.32° to 3.38°. Six studies assessed the freehand surgical approach, reporting angular deviations ranging from 1.40° to 7.36°. The mean depth distortion ranged between 0.19 mm to 2.05 mm for open flap FTSG, and between 0.15 mm to 0.45 mm for flapless FTSG. For partially guided surgical guides, two studies reported angular deviations ranging from 0.59° to 3.44°. Seven studies were eligible for meta-analysis, focusing on the FTSG in open flap technique, with high heterogeneity (I2 (95%CI) = 92.3% (88.7%-96.4%)). In contrast, heterogeneity was low in studies comparing freehand versus FTSG in open flap techniques (I2 (95%CI) = 21.3% (0.0%-67.8%)), favoring the FTSG surgical approach.
CONCLUSIONS: In partially edentulous arches, FTSG systems exhibited less angular deviation than freehand and partially guided surgical guides. Flapless surgical approaches were associated with reduced angular deviation and depth distortion, suggesting a potential preference for the FTSG method in these procedures.