背景:随着清晰对准器的普及,序贯远距方案更常用于磨牙远距.然而,可以实现的磨牙远距的量,以及伴随的矢状尺寸的副作用,不清楚。
方法:已在PROSPERO注册(CRD42023447211),从七个数据库中筛选了相关的原始研究(MEDLINE[PubMed],EBSCOhost,WebofScience,Elsevier[SCOPUS],科克伦,LILACS[拉丁美洲和加勒比健康科学文献],和GoogleScholar),并由两名调查员独立手动搜索全读手稿的参考文献。进行了偏见风险评估,提取了相关数据,使用RStudio进行荟萃分析。
结果:筛选后,13篇(11篇涉及上颌骨扩张,两个涉及下颌骨扩张)符合纳入标准。所有研究都有高或中等偏倚风险。荟萃分析显示,上颌第一磨牙(U6)近颊尖扩张2.07mm[1.38mm,2.77毫米]基于扩张后牙科模型叠加,U6表冠远离2.00毫米[0.77毫米,3.24mm]基于治疗后侧位头颅测量评估。然而,U6中颊根显示1.13毫米[-1.34毫米,3.60mm],指示冠部远端倾斜,经荟萃分析验证(U6-PP角度:2.19°[1.06°,3.33°])。此外,在扩张后时间点观察到足弓内锚固损失(U1突出:0.39mm[0.27mm,0.51mm]),在治疗后的时间点校正(切缘-PTV距离:-1.50mm[-2.61mm,-0.39mm])。
结论:通过序贯扩张方案可以实现约2mm的上颌磨牙扩张,伴有轻微的磨牙冠远端倾斜。由于目前可用的研究存在较高的偏倚风险,因此需要对该主题进行其他研究。
BACKGROUND: With the popularity of clear aligners, the sequential distalization protocol has been more commonly used for molar distalization. However, the amount of molar distalization that can be achieved, as well as the accompanying side effects on the sagittal dimension, are unclear.
METHODS: Registered with PROSPERO (CRD42023447211), relevant original studies were screened from seven databases (MEDLINE [PubMed], EBSCOhost, Web of Science, Elsevier [SCOPUS], Cochrane, LILACS [Latin American and Caribbean Health Sciences Literature], and Google Scholar) supplemented by a manual search of the references of the full-reading manuscripts by two investigators independently. A risk of bias assessment was conducted, relevant data were extracted, and meta-analysis was performed using RStudio.
RESULTS: After the screening, 13 articles (11 involving maxillary distalization, two involving mandibular distalization) met the inclusion criteria. All studies had a high or medium risk of bias. The meta-analysis revealed that the maxillary first molar (U6) mesiobuccal cusp was distalized 2.07 mm [1.38 mm, 2.77 mm] based on the post-distalization dental model superimposition, and the U6 crown was distalized 2.00 mm [0.77 mm, 3.24 mm] based on the post-treatment lateral cephalometric evaluation. However, the U6 mesiobuccal root showed less distalization of 1.13 mm [-1.34 mm, 3.60 mm], indicating crown distal tipping, which was validated by meta-analysis (U6-PP angle: 2.19° [1.06°, 3.33°]). In addition, intra-arch anchorage loss was observed at the post-distalization time point (U1 protrusion: 0.39 mm [0.27 mm, 0.51 mm]), which was corrected at the post-treatment time point (incisal edge-PTV distance: -1.50 mm [-2.61 mm, -0.39 mm]).
CONCLUSIONS: About 2 mm maxillary molar distalization can be achieved with the sequential distalization protocol, accompanied by slight molar crown distal tipping. Additional studies on this topic are needed due to the high risk of bias in currently available studies.