Reynders Reint, Ronchi Laura, Bipat Shandra
Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Am J Orthod Dentofacial Orthop. 2009 May;135(5):564.e1-19; discussion 564-5. doi: 10.1016/j.ajodo.2008.09.026.
In this article, we systematically reviewed the literature to quantify success and complications encountered with the use of mini-implants for orthodontic anchorage, and to analyze factors associated with success or failure.
Computerized and manual searches were conducted up to March 31, 2008, for clinical studies that addressed these objectives. The selection criteria required that these studies (1) reported the success rates of mini-implants on samples sizes of 10 implants or more, (2) gave a definition of success, (3) used implants with a diameter smaller than 2.5 mm, and (4) applied forces for a minimum duration of 3 months. Factors associated with implant success were accepted only if potentially influencing variables were controlled. The Cochrane Handbook for Systematic Reviews of Interventions was used as the guideline for this article.
Nineteen reports met the inclusion criteria, but definitions of success, duration of force application, and quality of the methodology of these studies varied widely. Rates of primary outcomes ranged from 0% to 100%, but most articles reported success rates greater than 80% if mobile and displaced implants were included as successful. Adverse effects of miniscrews included biologic damage, inflammation, and pain and discomfort. Only a few articles reported negative outcomes. All proposed correlations between clinical success and specific variables such as implant, patient, location, surgery, orthodontic, and implant-maintenance factors were rejected because they did not meet the selection criteria for controlling those variables.
Mini-implants can be used as temporary anchorage devices, but research in this field is still in its infancy. Interpretation of findings was conditioned by lack of clarity and poor methodology of most studies. Questions concerning patient acceptability, rate and severity of adverse effects of miniscrews, and variables that influenced success remain unanswered. This article includes a guideline for future studies of these issues, based on specific definitions of primary and secondary outcomes correlated with specific operational variables.
在本文中，我们系统地回顾了文献，以量化使用微型种植体进行正畸支抗时的成功率和并发症，并分析与成功或失败相关的因素。
截至2008年3月31日，进行了计算机化和人工检索，以查找涉及这些目标的临床研究。选择标准要求这些研究：（1）报告样本量为至少10枚种植体的微型种植体成功率；（2）给出成功的定义；（3）使用直径小于2.5毫米的种植体；（4）施加力的最短持续时间为3个月。仅当潜在影响变量得到控制时，与种植体成功相关的因素才被接受。《Cochrane干预措施系统评价手册》用作本文的指南。
19篇报告符合纳入标准，但这些研究的成功定义、力施加持续时间和方法学质量差异很大。主要结局的发生率从0%到100%不等，但如果将可移动和移位的种植体视为成功，则大多数文章报告的成功率高于80%。微型螺钉的不良反应包括生物损伤、炎症、疼痛和不适。只有少数文章报告了负面结果。所有关于临床成功与特定变量（如种植体、患者、位置、手术、正畸和种植体维护因素）之间的相关性提议均被拒绝，因为它们不符合控制这些变量的选择标准。
微型种植体可作为临时支抗装置使用，但该领域的研究仍处于起步阶段。大多数研究缺乏清晰度和方法学欠佳，这限制了研究结果的解读。关于患者可接受性、微型螺钉不良反应的发生率和严重程度以及影响成功的变量等问题仍未得到解答。本文基于与特定操作变量相关的主要和次要结局的具体定义，为这些问题的未来研究提供了指南。
