背景:本系统综述旨在分析使用不同扩张方案获得的成长患者上颌扩张后下颌弓的自发性牙槽变化:快速上颌扩张(RME),缓慢的上颌扩张(SME),和叶扩张器。
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。资格标准以PICO格式建立,涉及接受缓慢治疗的患者,快速,或在混合或早期恒牙期间的叶片上颌扩张。截至2023年12月,对电子数据库和手动搜索进行了全面搜索。结果测量包括下颌间第一恒磨牙宽度,乳牙间磨牙和犬齿宽度,拱形周长,和足弓长度;考虑了短期和长期结果。符合纳入标准的文章被纳入本系统评价,并使用13分量表的方法学质量评分系统进行定性评估。评估关于文章选择和纳入研究的定性评估的相互审查协议,计算Kappa统计量。
结果:通过电子和人工检索共识别出1184篇文章。删除副本并对标题和摘要进行初步审查后,对57篇文章进行了全文分析,根据资格和排除标准,最终选择了22项研究,由8项随机对照试验(RCTs)和14项回顾性/病例对照研究组成。对纳入研究的定性评价显示以下得分:6篇论文具有较高的研究质量,5质量适中,11质量低。SME表现出微不足道的下颌变化,在选定的参数中平均变化小于1毫米(范围0.46-2.00毫米),并且长期观察到复发。RME诱导更显著的增加,特别是磨牙间宽度大于1毫米,范围在0.93到3.3毫米之间,和良好的长期稳定性。扩叶器显示出有希望的短期较低的磨牙间宽度增加大于1毫米,范围为0.5至1.69毫米,但长期稳定性未得到彻底评估.
结论:中小企业的短期和长期影响微不足道,而RME,尤其是哈斯型电器,表现出显著的磨牙间宽度增加,多年来保持稳定。扩叶显示短期较低的磨牙间宽度增加,需要进一步调查长期稳定性。
BACKGROUND: This systematic review aims to analyze the spontaneous dentoalveolar changes in the mandibular arch after maxillary expansion in growing patients obtained with different expansion protocols: Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander.
METHODS: The study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria were established in the PICO format, involving patients who underwent slow, rapid, or leaf maxillary expansion during the mixed or early permanent dentitions. A comprehensive search of electronic databases and manual searches was conducted up to December 2023. The outcome measures included inter-mandibular first permanent molar width, inter-deciduous molar and canine width, arch perimeter, and arch length; both short- and long-term results were considered. The articles that met the inclusion criteria were included in this systematic review and were qualitatively evaluated using a methodological quality scoring system with a 13-point scale. To assess the inter-examiner agreement concerning the article selection and the qualitative assessment of the included studies, Kappa statistics were computed.
RESULTS: A total of 1184 articles were identified through electronic and manual searches. After the removal of duplicates and the initial examination of the titles and abstracts, 57 articles were considered for the full text analysis, and according to the eligibility and exclusion criteria, 22 studies were finally selected, composed of 8 randomized controlled trials (RCTs) and 14 retrospective/case-control studies. The qualitative assessment of the included studies showed the following scores: 6 papers have high research quality, 5 have moderate quality, and 11 have low quality. SME demonstrated negligible mandibular changes, with less than 1 mm variation on average (range 0.46-2.00 mm) in the selected parameters and relapses observed in the long term. RME induced more significant increases, particularly in intermolar width greater than 1 mm, which ranged between 0.93 and 3.3 mm, and good stability over the long term. Leaf Expander exhibited promising short-term lower intermolar width increases greater than 1 mm and ranged from 0.5 to 1.69 mm, but long-term stability was not thoroughly evaluated.
CONCLUSIONS: SME results in negligible short- and long-term effects, while RME, especially with Haas-type appliances, exhibits significant intermolar width increases that remain stable over the years. Leaf Expander shows short-term lower intermolar width increases, requiring further investigation into long-term stability.