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中华口腔医学研究杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 175 -184. doi: 10.3877/cma.j.issn.1674-1366.2024.03.006

Meta分析

骨皮质切开术对正畸治疗牙根吸收影响的Meta分析
沈皓1, 张驰2, 韩旻轩2, 陆晓庆3, 周愉3, 周莉丽4,()   
  1. 1. 南京医科大学口腔医学院,南京医科大学口腔疾病研究与防治国家级重点实验室培育建设点,江苏省口腔转化医学工程研究中心,南京 210029
    2. 南京医科大学附属口腔医院口腔正畸科,南京医科大学口腔疾病研究与防治国家级重点实验室培育建设点,江苏省口腔转化医学工程研究中心,南京 210029
    3. 南京医科大学附属口腔医院教学办公室,江苏省口腔转化医学工程研究中心,南京 210029
    4. 南京医科大学附属口腔医院牙体牙髓病科,南京医科大学口腔疾病研究与防治国家级重点实验室培育建设点,江苏省口腔转化医学工程研究中心,南京 210029
  • 收稿日期:2024-04-11 出版日期:2024-06-01
  • 通信作者: 周莉丽

The effect of corticotomy on root resorption in orthodontic treatment: A meta analysis

Hao Shen1, Chi Zhang2, Minxuan Han2, Xiaoqing Lu3, Yu Zhou3, Lili Zhou4,()   

  1. 1. School of Stomatology, Nanjing Medical University; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing Medical University; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
    2. Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing Medical University; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
    3. Teaching Office, Affiliated Hospital of Stomatology, Nanjing Medical University; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
    4. Department of Endodontics, Affiliated Hospital of Stomatology, Nanjing Medical University; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing Medical University; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
  • Received:2024-04-11 Published:2024-06-01
  • Corresponding author: Lili Zhou
  • Supported by:
    Education research project of Nanjing Medical University in 2023(2023ZC061)
引用本文:

沈皓, 张驰, 韩旻轩, 陆晓庆, 周愉, 周莉丽. 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析[J]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 175-184.

Hao Shen, Chi Zhang, Minxuan Han, Xiaoqing Lu, Yu Zhou, Lili Zhou. The effect of corticotomy on root resorption in orthodontic treatment: A meta analysis[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2024, 18(03): 175-184.

目的

通过比较现有相关文献中骨皮质切开术辅助正畸治疗后和常规正畸治疗后牙根吸收的差异,分析骨皮质切开术对正畸治疗牙根吸收的影响。

方法

检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据知识服务平台和中国生物医学文献服务系统(检索时间从2000年1月1日至2024年1月27日),查找有关骨皮质切开术对正畸治疗后牙根吸收影响的临床随机对照试验。采用RevMan 5.4.1和Stata 18软件对纳入研究进行质量评估、数据录入和Meta分析。

结果

根据纳入标准,筛选检索文献,最终共纳入12篇文献进行后续的Meta分析。结果显示,采用骨皮质切开术辅助正畸治疗的研究组相比采用常规正畸治疗的对照组,治疗后的牙根吸收量减少[WMD = -0.14,95% CI =(-0.23,-0.04),Z = 2.86,P = 0.004,I2 = 47%],差异具有统计学意义。通过亚组分析探究结果的异质性来源,显示骨皮质切开术是否翻瓣是研究间异质性的主要来源。按照拔牙情况和牙位进行亚组分析显示各亚组间差异无统计学意义。

结论

采用骨皮质切开术辅助正畸治疗能有效减少正畸治疗后的牙根吸收。

Objective

To analyze the effect of corticotomy on root resorption in orthodontic treatment by comparing the differences between corticotomy assisted orthodontic treatment and conventional orthodontic treatment in the existing studies.

Methods

PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang database and SinoMed were searched from January 1st, 2000 to January 27th, 2024 for randomized controlled trials on the effect of corticotomy on root resorption after orthodontic treatment. Quality assessment, data input and meta-analysis of the included studies were performed using RevMan 5.4.1 and Stata 18 software.

Results

According to the inclusion criteria, a total of 12 studies were included for the meta-analysis. The results showed that corticotomy assisted orthodontic treatment manifested the decrease in root resorption [WMD = -0.14, 95% CI = (-0.23, -0.04) , Z = 2.86, P = 0.004, I2 = 47%], compared with the control group receiving conventional orthodontic treatment, and the difference was statistically significant. Subgroup analysis was carried out to explore the source of heterogeneity, indicating that flap surgery was the main source of heterogeneity. There was no statistical difference between subgroups according to tooth extraction condition and tooth position.

Conclusion

Root resorption can be effectively reduced after corticotomy assisted orthodontic treatment.

图1 骨皮质切开术对正畸治疗牙根吸收影响Meta分析的文献筛选流程图
表1 12篇骨皮质切开术对正畸治疗牙根吸收影响相关研究的基本特征
表2 12篇骨皮质切开术对正畸治疗牙根吸收影响相关研究亚组分类的依据指标
作者 发表年份 干预措施 拔牙情况 研究牙齿类型
研究组 对照组
Alkasaby等[8] 2022年 MOP(不翻瓣,上颌第一磨牙远中垂直排列制造3个微骨穿孔,深度为5 mm,孔间距约3 mm) 常规正畸治疗 未拔牙 上颌第一磨牙
Alkebsi等[9] 2018年 MOP(不翻瓣,上颌尖牙远中垂直排列制造3个微骨穿孔,孔直径为1.5 mm,深度为3 ~ 4 mm,孔间距约5 mm) 常规正畸治疗 上颌第一前磨牙拔除 上颌尖牙
Bakr等[10] 2023年 激光微创骨皮质切开术(不翻瓣,使用激光在尖牙近中和远中分别切割出3个圆孔,深度为3 mm,孔间距为2 mm) 常规正畸治疗 上下颌第一前磨牙拔除 上下颌尖牙
Chandorikar[11] 2023年 MOP(不翻瓣,上下颌所有前牙间及尖牙远中打孔,每个部位垂直排列制造3个微骨穿孔,孔直径为1.6 mm,深度为5 mm) 常规正畸治疗 上下颌第一前磨牙拔除 上下颌前牙
Hatrom等[12] 2020年 Piezocision(不翻瓣,在尖牙唇侧近中和远中切开骨皮质) 常规正畸治疗 上颌第一前磨牙拔除 上颌前牙
Joseph等[13] 2022年 MOP(不翻瓣,在第一前磨牙的拔牙间隙中距尖牙和第二前磨牙等距离处制造3个微骨穿孔,孔直径为1.5 mm,深2 ~ 3 mm) 常规正畸治疗 上下颌第一前磨牙拔除 上下颌前牙
Mousa等[14] 2023年 MOP+Piezocision(不翻瓣,第一次手术时在皮质骨上制造一系列微骨穿孔,直径为1 mm,深度1 ~ 2 mm,孔间距约为1.5 mm。2个月后采用超声骨刀在颊侧进行第二次骨皮质切开术,切口高度为8 mm,宽1 mm,深2 ~ 3 mm,切口间距为2 mm) 常规正畸治疗 未拔牙 上颌侧切牙
Ravi等[15] 2021年 Piezocision(不翻瓣,在尖牙的近中和远中作小切口后,使用超声骨刀透过切口进行骨皮质切开) 常规正畸治疗 上颌第一前磨牙拔除 上颌尖牙
Raza等[16] 2021年 翻瓣后作骨皮质垂直切开或穿孔(上颌侧切牙近中至上颌第二前磨牙近中全层切开翻瓣,在牙槽嵴下方2 mm垂直切开骨皮质或穿孔) 常规正畸治疗 上颌第一前磨牙拔除 上颌尖牙
Sirri等[17] 2021年 Corticision(不翻瓣,在两侧下颌侧切牙和尖牙之间以及下颌中切牙之间,通过锤击刀柄使刀片穿透牙龈直达皮质骨,作3个垂直微创切口,高度为4 ~ 5 mm,深度为3 ~ 4 mm) 常规正畸治疗 未拔牙 下颌前牙
Thomas[18] 2021年 MOP(不翻瓣,在上颌尖牙的近中和远中制造3个垂直排列的微骨穿孔,孔间距为3 mm) 常规正畸治疗 上颌第一前磨牙拔除 上颌尖牙
付腾飞等[19] 2019年 MOP(不翻瓣,在下颌第一磨牙缺牙区近第二磨牙处制造3个垂直排列的微骨穿孔,深度为2 mm) 常规正畸治疗 下颌第一磨牙拔除 下颌第二磨牙
图2 12篇骨皮质切开术对正畸治疗牙根吸收影响相关研究的质量评价图 A:偏倚风险汇总评价;B:偏倚风险比例分布。
图3 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析森林图
图4 骨皮质切开术对正畸治疗牙根吸收影响基于手术是否翻瓣的亚组分析森林图
图5 骨皮质切开术对正畸治疗牙根吸收影响基于拔牙情况的亚组分析森林图
图6 骨皮质切开术对正畸治疗牙根吸收影响基于牙齿类型的亚组分析森林图
图7 12篇骨皮质切开术对正畸治疗牙根吸收影响相关研究的敏感性分析图
图8 12篇骨皮质切开术对正畸治疗牙根吸收影响相关研究的发表偏倚漏斗图
表3 12篇骨皮质切开术对正畸治疗牙根吸收影响相关研究的发表偏倚Egger′s检验
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