Lentini-Oliveira D, Carvalho F R, Qingsong Y, Junjie L, Saconato H, Machado M A C, Prado L B F, Prado G F
Universidade Federal de São Paulo, Internal Medicine Department, Tuiuti -22, Sorocaba, Vergueiro, Brazil, 18035-340.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD005515. doi: 10.1002/14651858.CD005515.pub2.
Anterior open bite occurs when there is a lack of vertical overlap of the upper and lower incisors. The aetiology is multifactorial including: oral habits, unfavourable growth patterns, enlarged lymphatic tissue with mouth breathing. Several treatments have been proposed to correct this malocclusion, but interventions are not supported by strong scientific evidence.
The aim of this systematic review was to evaluate orthodontic and orthopaedic treatments to correct anterior open bite in children.
Search strategies were developed for MEDLINE and revised appropriately for the following databases: Cochrane Oral Health Group Trials Register; CENTRAL (The Cochrane Library 2005, Issue 4); PubMed (1966 to December 2005); EMBASE (1980 to February 2006); Lilacs (1982 to December 2005); Brazilian Bibliography of Odontology (BBO) (1986 to December 2005); and SciELO (1997 to December 2005). Chinese journals were handsearched and the bibliographies of papers were retrieved.
All randomised or quasi-randomised controlled trials of orthodontic or orthopaedic treatments or both to correct anterior open bite in children.
Two review authors independently assessed the eligibility of all reports identified. Risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated for dichotomous data. The continuous data were expressed as described by the author.
Twenty-eight trials were potentially eligible, but only three randomised controlled trials were included comparing: effects of Frankel's function regulator-4 (FR-4) with lip-seal training versus no treatment; repelling-magnet splints versus bite-blocks; and palatal crib associated with high-pull chincup versus no treatment. The study comparing repelling-magnet splints versus bite-blocks could not be analysed because the authors interrupted the treatment earlier than planned due to side effects in four of ten patients.FR-4 associated with lip-seal training (RR = 0.02 (95% CI 0.00 to 0.38)) and removable palatal crib associated with high-pull chincup (RR = 0.23 (95% CI 0.11 to 0.48)) were able to correct anterior open bite.No study described: randomisation process, sample size calculation, there was not blinding in the cephalometric analysis and the two studies evaluated two interventions at the same time. These results should be therefore viewed with caution.
AUTHORS' CONCLUSIONS: :There is weak evidence that the interventions FR-4 with lip-seal training and palatal crib associated with high-pull chincup are able to correct anterior open bite. Given that the trials included have potential bias, these results must be viewed with caution. Recommendations for clinical practice cannot be made based only on the results of these trials. More randomised controlled trials are needed to elucidate the interventions for treating anterior open bite.
当上、下切牙缺乏垂直覆盖时会出现前牙开颌。其病因是多因素的，包括：口腔习惯、不良生长模式、因口呼吸导致的淋巴组织增生。已经提出了几种治疗方法来纠正这种错颌畸形，但这些干预措施缺乏有力的科学证据支持。
本系统评价的目的是评估正畸和矫形治疗对纠正儿童前牙开颌的效果。
针对MEDLINE制定了检索策略，并针对以下数据库进行了适当修订：Cochrane口腔健康组试验注册库；CENTRAL（Cochrane图书馆2005年第4期）；PubMed（1966年至2005年12月）；EMBASE（1980年至2006年2月）；Lilacs（1982年至2005年12月）；巴西牙科学文献目录（BBO）（1986年至2005年12月）；以及SciELO（1997年至2005年12月）。对手检中文期刊并检索了论文的参考文献。
所有关于正畸或矫形治疗或两者结合以纠正儿童前牙开颌的随机或半随机对照试验。
两位综述作者独立评估所有识别出的报告的合格性。对二分数据计算风险比（RRs）和相应的95%置信区间（CIs）。连续数据按作者描述的方式表示。
28项试验可能符合条件，但仅纳入了3项随机对照试验，比较了：Frankel功能调节器-4（FR-4）联合唇封闭训练与不治疗的效果；斥力磁夹板与咬合板；以及腭托联合高位牵引颏兜与不治疗。比较斥力磁夹板与咬合板的研究无法进行分析，因为作者因10名患者中有4名出现副作用而比计划提前中断了治疗。FR-4联合唇封闭训练（RR = 0.02（95%CI 0.00至0.38））和可摘腭托联合高位牵引颏兜（RR = 0.23（95%CI 0.11至0.48））能够纠正前牙开颌。没有研究描述随机化过程、样本量计算，头影测量分析中未采用盲法，且两项研究同时评估了两种干预措施。因此，应谨慎看待这些结果。
有微弱证据表明，FR-4联合唇封闭训练和腭托联合高位牵引颏兜的干预措施能够纠正前牙开颌。鉴于纳入的试验存在潜在偏倚，必须谨慎看待这些结果。不能仅基于这些试验的结果给出临床实践建议。需要更多的随机对照试验来阐明治疗前牙开颌的干预措施。
