拔牙与非拔牙矫治对牙弓宽度影响的系统评价

发布时间：2018-10-29 16:33

【摘要】：目的系统分析比较拔牙与非拔牙矫治对牙弓宽度的影响，为口腔正畸临床工作者制定正畸矫治方案提供决策依据。方法计算机检索PubMed、Embase、Cochrane library、Web ofScience, CENTRAL, SIGLE，中文科技期刊数据库(VIP)、万方数据库、相关期刊论文(CNKI)、中国生物医学文献数据库(CBM)。同时手动检索中国循证医学、中华口腔正畸学及NLM、Campbell Library、WHOLIS杂志，检索时间截止至2012年12月30日，并查找已检索文献的参考文献，利用搜索引擎如Google等进行查漏，全面收集通过模型测量拔牙与非拔牙矫治对牙弓宽度影响的所有文献。由两名研究人员独立完成文献筛选、资料提取和方法学质量评价，，并交叉核对；然后通过讨论或征求第三方意见来解决分歧，统一意见。对纳入文献采用RevMan5.2软件进行Meta分析。结果共纳入文献12篇，其中有2篇随机对照试验，10篇前后对照试验，共包括846例患者。分别比较分析了上颌尖牙间的宽度变化（12个试验），下颌尖牙间的宽度变化（12个试验），上颌磨牙间的宽度变化（10个试验），下颌磨牙间宽度的变化（10个试验）。另外，其中有一篇试验将研究对象分为男性组和女性组分别进行统计分析，因此在Meta分析前采用统计学公式将两组数据合并后再进行数据输入。通过对纳入研究进行方法学质量评价，2篇随机对照试验评价结果均为高质量，10篇临床对照试验评价结果均为B级。Meta分析结果： ①上颌尖牙间宽度的变化拔牙组与非拔牙组相比，Meta分析结果显示上颌尖牙间宽度的变化差异有统计学意义（WMD=0.55mm，95%CI[0.31,0.79]），异质性检验结果显示有轻度异质性(I2=21%, p=0.24)。 ②下颌尖牙间宽度的变化 Meta分析结果显示下颌尖牙间宽度的变化差异有统计学意义（WMD=0.62mm，95%CI[0.43,0.81]），异质性检验结果显示各研究间有轻度异质性(I2=1%, p=0.43)。 ③上颌磨牙间宽度的变化 Meta分析结果显示上颌磨牙间宽度的变化差异有统计学意义（WMD=-2.24mm，95%CI [-2.72,-1.76]）异质性检验结果显示有明显异质性(I2=58%, p=0.01)。 ④下颌磨牙间宽度的变化 Meta分析结果显示下颌磨牙间宽度的变化差异有统计学意义（WMD=-1.91mm，95%CI [-2.13,-1.68]）异质性检验结果显示各研究间同质性好(I2=0%, p=0.69)。结论 ①与非拔牙矫治相比，拔牙矫治不会导致上颌尖牙间的宽度缩小； ②与非拔牙矫治相比，拔牙矫治下颌尖牙间的宽度增大，差异有统计学意义，但临床差异不明显； ③与非拔牙矫治相比，拔牙矫治上下颌磨牙间的宽度均明显缩小。
[Abstract]:Objective to analyze and compare the effects of extraction and non-extraction on the width of dental arch, and to provide decision basis for orthodontic clinical workers to formulate orthodontic treatment. Methods PubMed,Embase,Cochrane library,Web ofScience, CENTRAL, SIGLE, Chinese scientific and technological journal database (VIP), Wanfang database, Chinese journal full text database (CNKI), Chinese biomedical literature database (CBM). At the same time, the Chinese Evidence-based Medicine, Chinese Orthodontics and NLM,Campbell Library,WHOLIS Journal were searched manually until December 30, 2012. All literatures were collected to measure the effect of tooth extraction and non-extraction on the width of dental arch. Two researchers independently completed the literature screening, data extraction and methodological quality evaluation, and cross-check, and then through discussion or soliciting the views of third parties to resolve differences, unified opinions. RevMan5.2 software was used for Meta analysis. Results A total of 12 articles were included, including 2 randomized controlled trials and 10 pre and post controlled trials, including 846 patients. The width changes of maxillary canines (12 experiments), mandibular canines (12 experiments), maxillary molars (10 experiments) and mandibular molars (10 experiments) were compared and analyzed. In addition, one of the subjects was divided into male group and female group for statistical analysis, so statistical formula was used to combine the two groups of data before Meta analysis and then input the data. The results of two randomized controlled trials were of high quality. The results of 10 clinical controlled trials were all B grade. The results of Meta analysis were as follows: 1 the changes of maxillary canine width in the extraction group were compared with those in the non-extraction group. Meta analysis showed that there was significant difference in the width of maxillary canine teeth (WMD=0.55mm,95%CI [0.31 卤0.79]), and the heterogeneity test showed slight heterogeneity (I _ 2i _ (21), p ~ (0.24). 2the change of the width of mandibular canine teeth by Meta analysis showed that there was significant difference in the width of mandibular canine teeth (WMD=0.62mm,95%CI [0.43 卤0.81]). The results of heterogeneity test showed that there was slight heterogeneity among the studies (I _ 2 ~ (1), p ~ (0.43). (3) Meta analysis showed that there was significant difference in the width of maxillary molars (WMD=-2.24mm,95%CI [-2.72], P < 0.05). The results of heterogeneity test showed obvious heterogeneity (I _ (2) N _ (58), p ~ (0.01). (4) the change of the width of mandibular molars by Meta analysis showed that there was a significant difference in the width of mandibular molars (WMD=-1.91mm,95%CI [-2.13, -2.13], P < 0.05). The results of heterogeneity test showed that there was good homogeneity among the studies (I _ 2 / 0, p _ (0.69). Conclusion (1) the width of maxillary canine teeth will not be reduced after extraction compared with non-extraction orthodontics. 2Compared with non-extraction correction, the width of mandibular canine was larger and the difference was statistically significant, but the clinical difference was not obvious. 3Compared with the non-extraction correction, the width of the upper and lower molars was significantly reduced.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R783.5

【参考文献】