微种植支抗与口外支抗对上颌或双颌前突患者的疗效评价

发布时间：2018-03-10 10:50

本文选题：微种植体　切入点：口外弓　出处：《重庆医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：对微种植体支抗与口外弓支抗对上颌或双颌前突患者正畸治疗前后的牙齿指标及侧貌变化进行系统评价。评价利用微种植体和传统口外支抗对前突患者的临床治疗效果，为治疗安氏Ⅰ类上颌前突或安氏Ⅱ类双颌前突的错合畸形提供决策依据。方法：全面检索相关中英文文献（包括随机/半随机对照试验和前后对照试验），检索相关数据库包括：Cochrane library(2009Issue4)、MEDLINE、EMBASE、ISI Webof science、Science Direct、CBM、VIP、CNKI和Wangfang,同时手动检索Campbell Library、NLM、WHOLIS及循证医学及口腔正畸学杂志,检索截止2011年12月30日,并追踪参考文献,利用Google等搜索引擎进行检索,收集国内外关于微种植体支抗与传统口外支抗治疗安氏Ⅰ类上颌前突或安氏Ⅱ类双颌前突的错合畸形进行对比研究的相关文献。文献的筛选，数据的提取，以及方法学质量评估均由2位研究人员分别进行，对实验设计，干预措施和结局指标采用RevMan5.1.2软件进行meta分析。结果：根据纳入排除标准，本研究最终纳入13篇文献，其中有8篇随机对照试验，5篇前后对照试验。参考“Jadad量表”及“非随机对照试验的质量评价表”对纳入文献进行进一步的方法学质量评价，其中随机对照试验中有3篇为高质量，5篇为低质量；前后对照试验中有1篇为C级，4篇为B级。纳入3篇高质量随机对照试验及4篇B及以上前后对照试验分别进行meta分析，共包括209例患者，其中随机对照试验共72例，包括微种植体支抗36例，口外支抗36例；前后对照试验共137例，包括微种植支抗70例，口外弓支抗67例。微种植支抗为实验组，传统口外支抗组为对照组，两组在SNA°方面，随机对照试验结果为两组差异没有统计学意义（P=0.085），4篇前后对照试验Meta分析结果显示纳入文献的同质性较好（P=0.23,I2=31%），两组差别具有统计学意义，其WMD及其95%CI为：0.32[0.07,0.56]（P=0.01），提示：传统口外支抗比微种植支抗对上颌基骨相对于颅骨的前后向位置有更多的向后移动。在SN-MP°方面，3篇前后对照试验进行Meta分析后结果显示文献异质性较大（P=0.003,I2=83%），进行敏感性分析和亚组分析结果：其中1人研究较其余2人研究异质性较大；高角亚组和低角/均角亚组纳入文献同质性均好，对高角组Meta分析结果显示，微种植支抗比口外支抗可以更好的使下颌逆时针旋转，且两组差异具有高度统计学意义（P=0.002）；低角/均角亚组中，两组对下颌平面角的改变差异没有统计学意义（P=0.18）。在U1-SN°方面，，纳入3篇随机对照试验和3篇前后对照试验，分别进行Meta分析结果为：随机对照试验中于世德等人的研究较其他2人研究的异质性较大（P0.0001,I2=90%），其他2人研究结果为口外弓支抗比微种植支抗对U1-SN°的改变更大，且差异具有显著统计学意义（P=0.0008）；前后对照实验纳入的3篇文献同质性较好（P=0.17,I2=43%）,其WMD及其95%CI为：-2.61[-5.05,-0.17],两组差异具有统计学意义（P=0.04），进行年龄亚组分析显示，微种植支抗组纳入的研究对象年龄要大于口外支抗的研究对象年龄，且差异具有高度统计学意义（P=0.004）。而在NLA°,UL-E Line(mm)和G-Sn-Pg°方面的结果仅有1篇前后对照实验提及，结果为两组在UL-E Line(mm)方面差异具有统计学意义（P=0.028），提示：微种植支抗可以更好的内收上唇；在NLA°和G-Sn-Pg°方面两组差别则没有统计学差别（P=0.123，P=0.818），提示：在鼻唇角和面突角方面，微种植支抗和口外支抗均能达到良好的治疗效果。结论:微种植体支抗和传统口外弓支抗对于上颌或双颌前突患者均可达到良好的治疗效果，但相对于传统口外强支抗而言，微种植体支抗可以更好的改善患者前突的上唇，特别是对于高角病例，微种植支抗可以使下颌平面角逆时针旋转，跟有利于高角患者的治疗。而在上颌基骨相对于颅骨前后向位置及鼻唇角，上中切牙倾斜度以及面突角方面，由于本系统评价纳入的文献数量和质量有限，还需国内外有关微种植支抗的临床研究质量有待提高，开展更多高质量的随机对照研究以提供更好的评价依据。
[Abstract]:Objective: the micro implant anchorage and anchorage of maxillary or bimaxillary teeth index and profile changes before and after the process of orthodontic treatment were evaluated. The evaluation of Micro Implant and traditional extraoral anchorage clinical effect in the treatment of patients with protrusion, for the treatment of skeletal class on maxillary protrusion or class II bimaxillary protrusion malocclusion to provide decision-making basis. Methods: a comprehensive search for relevant documents in English (including randomized or quasi randomized controlled trials and controlled trials), we searched relevant databases including: Cochrane Library (2009Issue4), MEDLINE, EMBASE, ISI Webof science, Science Direct, CBM, VIP, CNKI at the same time, Campbell and Wangfang, Library NLM, manual retrieval, WHOLIS and evidence-based medicine and Journal of Orthodontics and retrieval, as of December 30, 2011, and track the reference, using Google and other search engines for retrieval, collection of domestic and international. In the literature of Micro Implant Anchorage and traditional extraoral anchorage in the treatment of class I malocclusion with maxillary protrusion or bimaxillary protrusion malocclusion were studied. The literature screening, data extraction and assessment of methodological quality by 2 researchers respectively, the experimental design. Interventions and outcomes of using RevMan5.1.2 software for meta analysis. Results: according to the inclusion and exclusion criteria, this study included 13 papers, including 8 RCTs, 5 case control study. Reference "Jadad scale" and "non randomized controlled trial quality evaluation test table for further methods included in the literature quality evaluation, including randomized controlled trials in 3 to 5 for high quality, low quality; control before and after 1 articles for class C test, 4 B. The 3 included high quality randomized controlled trials and 4 B and above before and after The control experiments were analyzed by meta, including 209 patients, including randomized controlled trials involving 72 cases, including 36 cases of Micro Implant Anchorage and extraoral anchorage in 36 cases; 137 cases of control before and after the test, including the micro implant anchorage in 70 cases, 67 cases of micro implant anchorage for the experiment. Group, traditional extraoral anchorage group for the control group, two groups in SNA degrees, results of randomized controlled trials for the difference between the two groups was not statistically significant (P=0.085), 4 articles were compared before and after in the homogeneity test of Meta display analysis results (P=0.23, I2=31%), statistically significant difference between the two groups, the WMD and 95%CI: 0.32[0.07,0.56] (P=0.01), suggested that traditional extraoral anchorage micro implant anchorage for maxillary than the skull base bone relative to the position before and after to move back more. In SN-MP degrees, 3 articles before and after controlled test Meta analysis showed greater heterogeneity of literature (P=0.003, I2=83%), sensitivity analysis and subgroup analysis results: 1 of them on the remaining 2 people of great heterogeneity; high angle group and low angle / angle sub group included in the literature on the homogeneity was good, the high angle group, Meta analysis showed that the micro implant anchorage than extraoral anchorage can better the mandibular clockwise rotation, and the difference between the two groups has statistical significance (P=0.002); low angle / angle subgroup, two groups of mandibular plane angle change was not statistically significant difference (P=0.18). At U1-SN, a total of 3 randomized controlled trials and 3 articles before and after control. The results of Meta analysis were as follows: in the randomized controlled trials, Shide compared to the other 2 people on the heterogeneity (P0.0001, I2=90%), the other 2 Results for anchorage Micro Implant Anchorage ratio on U1-SN degrees greater change, and the difference was statistically significant. Yi (P=0.0008) before and after the experiment; 3 articles included homogeneity (P=0.17, I2=43%), WMD and 95%CI: -2.61[-5.05, -0.17], with significant difference between two groups (P=0.04), subgroup analysis showed age, micro implant group into the research object to study the age of age. Anchorage is greater than, and the difference was highly statistically significant (P=0.004). At NLA degrees, UL-E Line (mm) and G-Sn-Pg ~ the result of only 1 pieces before and after the experiment mentioned, the results for the two groups in UL-E Line (mm) difference was statistically significant (P=0.028), tip: Micro implants anti can better adduction of upper lip; at NLA DEG and G-Sn-Pg DEG on the difference between the two groups was not statistically significant difference (P=0.123, P=0.818), tip: in the nasolabial angle and face angle, micro implant anchorage and extraoral anchorage can achieve a good therapeutic effect. Conclusion: the micro implant Anchorage and traditional anchorage for the maxillary or bimaxillary protrusion patients can achieve good treatment effect, but compared with the traditional extraoral anchorage, micro implant anchorage can improve patients with upper lip protrusion, especially for high angle cases, micro implant anchorage can make mandibular plane angle counter clockwise rotation, and is conducive to the treatment of patients with high angle. In the maxilla relative to the skull anteroposterior position and nasolabial angle, upper incisor inclination and face angle, because the system evaluation in the literature is limited in quantity and quality, the domestic and foreign related micro implant anchorage to the quality of clinical research improve, carry out more high quality randomized controlled study to provide the basis for a better evaluation.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R783.5

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