Reynders Reint Meursinge
Private Practice, Milan, Italy.
Evid Based Dent. 2013 Sep;14(3):78-80. doi: 10.1038/sj.ebd.6400950.
Medline, Embase, LILACS, Cochrane Library, Google Scholar, Web of Science, African Journals Online, Digital Dissertations.
Randomised controlled trials (RCTs), prospective controlled clinical trials(CCTs) and prospective cohort studies were included. Studies on implants with a diameter greater than 2 mm were excluded.
Data were extracted independently by two authors. Bias in RCTs was assessed using the Cochrane risk of bias tool, with non-randomised studies being assessed using the Newcastle-Ottawa Scale. Failures of mini-screw implants were expressed as event rates with 95% confidence intervals. Risk factors were assessed using random effects model and sub-group and meta-regression analyses were also conducted.
Fifty-two studies; five RCTs, eight CCTs, twenty-seven prospective cohort studies and twelve studies with unclear designs that were assessed to be prospective cohort studies were included. A funnel plot suggested there may be publication bias. Analysis of 4987 miniscrew implants used in 2281 patients indicated an overall failure rate of 13.5% (95% confidence interval, 11.5%-15.8%). Failures were not associated with patient sex or age and mini-screw implant insertion side, whereas they were significantly associated with jaw of insertion. Some trends were identified through exploratory analysis but no definite conclusions could be drawn.
Orthodontic miniscrew implants have a modest small mean failure rate, indicating their usefulness in clinical practice. Although many factors seem to affect their failure rates, the majority of them still need additional evidence to support any possible associations.
医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）、拉丁美洲及加勒比地区卫生科学数据库（LILACS）、考克兰图书馆、谷歌学术、科学网、非洲在线期刊、数字论文数据库。
纳入随机对照试验（RCT）、前瞻性对照临床试验（CCT）和前瞻性队列研究。排除直径大于2mm的种植体相关研究。
由两位作者独立提取数据。使用考克兰偏倚风险工具评估RCT中的偏倚，使用纽卡斯尔-渥太华量表评估非随机研究中的偏倚。微型螺钉种植体的失败率以事件发生率及95%置信区间表示。使用随机效应模型评估风险因素，并进行亚组分析和Meta回归分析。
共纳入52项研究；5项RCT、8项CCT、27项前瞻性队列研究以及12项设计不明确但经评估为前瞻性队列研究的研究。漏斗图提示可能存在发表偏倚。对2281例患者使用的4987枚微型螺钉种植体的分析表明，总体失败率为13.5%（95%置信区间为11.5%-15.8%）。失败与患者性别、年龄以及微型螺钉种植体植入侧无关，而与植入颌骨显著相关。通过探索性分析确定了一些趋势，但无法得出明确结论。
正畸微型螺钉种植体的平均失败率适中且较低，表明其在临床实践中的实用性。尽管许多因素似乎会影响其失败率，但其中大多数仍需要更多证据来支持任何可能的关联。
