Kalemaj Zamira, DebernardI Cesare Lorenzo, Buti Jacopo
Eur J Oral Implantol. 2015 Spring;8(1):9-24.
To conduct a systematic review of randomised controlled trials (RCTs) evaluating the effect of surgical and non-surgical procedures on the acceleration of orthodontic tooth movement (OTM) as an adjunct to orthodontic therapy (OT) in order to estimate the efficacy of these procedures and the benefit of their use in everyday orthodontic practice.
Literature search was performed on PubMed, Scopus, Web of Science and Cochrane databases up to July 2014. Inclusion criteria were: (1) RCTs; (2) orthodontic therapy on permanent dentition; (3) application of adjunctive surgical or non-surgical procedures for accelerating OTM; (4) measurement of tooth movement. The primary outcome measure was tooth movement expressed as cumulative tooth movement (CTM), rate of tooth movement (RTM) or time of tooth movement (TTM). Pain and discomfort, periodontal health, anchorage loss, bone and root changes, and undesired tooth movement were evaluated as secondary outcomes.
Literature research identified 184 studies. After screening of titles, abstracts and full-text studies, fifteen fulfilled the inclusion criteria and were included in this review. Six of the included studies investigated the effect of corticotomies, one of interseptal bone reduction, four of lowlevel laser therapy (LLLT), three of intraoral/extraoral devices releasing extracorporeal shock waves (ESWT), pulsed electromagnetic field (PEMF) and electrical current, respectively, and one of injected substances (relaxin) as an adjunct to OT. Three studies resulted of high methodological quality, six of medium, and six of low quality. Interseptal bone reduction was reported to increase RTM during the first 2 months (P = 0.002) and CTM at 3 months (P = 0.003). Studies investigating corticotomy reported significantly increased RTM (up to 2.3 times) during the first months after intervention, whereas results on TTM and CTM were quite controversial ranging from non-significant to highly significant (up to three times of TTM increase). The heterogeneity between studies investigating corticotomy could not allow for quantitative synthesis of the findings. Out of four studies investigating LLLT three reported positive effect on OT. Due to inadequate statistical analysis of data from original articles, results could not be summarised in meta-analyses. Effects of both electrical current devices and PEMF devices on CTM were reported to be larger on the experimental sides than on the control sides (P < 0.001). The other interventions were reported to be of no statistical or clinical relevance.
In the short term, corticotomy can accelerate OTM whereas long-term effects are questionable, thus no firm conclusions can be made on its efficacy and benefit of clinical use. There is some evidence that LLLT can slightly accelerate OTM but this result is not significant and the effect estimated is not clinically relevant. The very limited research-based evidence suggesting beneficial effects of interseptal bone reduction, electrical current and PEMF on OTM does not allow for solid conclusions. More high quality clinical research is required in order to estimate the efficacy of adjunctive interventions on accelerating OTM and their potential clinical use.
对随机对照试验（RCT）进行系统评价，评估手术和非手术方法作为正畸治疗（OT）辅助手段对加速正畸牙齿移动（OTM）的效果，以估计这些方法的疗效及其在日常正畸实践中的应用价值。
截至2014年7月，在PubMed、Scopus、科学引文索引和考克兰数据库进行文献检索。纳入标准为：（1）RCT；（2）恒牙列正畸治疗；（3）应用辅助手术或非手术方法加速OTM；（4）测量牙齿移动。主要观察指标为牙齿移动，以累积牙齿移动（CTM）、牙齿移动速率（RTM）或牙齿移动时间（TTM）表示。疼痛与不适、牙周健康、支抗丧失、骨与牙根变化以及不期望的牙齿移动作为次要观察指标进行评估。
文献检索确定了184项研究。经标题、摘要和全文研究筛选，15项符合纳入标准并纳入本评价。纳入研究中6项调查了皮质骨切开术的效果，1项调查了牙间隔骨减少术的效果，4项调查了低强度激光治疗（LLLT）的效果，3项分别调查了口内/口外释放体外冲击波（ESWT）、脉冲电磁场（PEMF）和电流装置的效果，1项调查了注射物质（松弛素）作为OT辅助手段的效果。3项研究方法学质量高，6项中等，6项低。据报道，牙间隔骨减少术在最初2个月可增加RTM（P = 0.002），在3个月时增加CTM（P = 0.003）。调查皮质骨切开术的研究报告称，干预后最初几个月RTM显著增加（高达2.3倍），而TTM和CTM的结果存在较大争议，从无显著性差异到高度显著性差异（TTM增加高达3倍）。调查皮质骨切开术的研究之间的异质性使得无法对结果进行定量综合分析。在调查LLLT的4项研究中，3项报告对OT有积极作用。由于原始文章数据的统计分析不足，结果无法在荟萃分析中进行总结。据报道，电流装置和PEMF装置对CTM的影响在试验侧均大于对照侧（P < 0.001）。据报道，其他干预措施无统计学或临床相关性。
短期内，皮质骨切开术可加速OTM，但长期效果存疑，因此无法就其临床应用的疗效和价值得出确切结论。有证据表明LLLT可轻微加速OTM，但这一结果不显著，估计的效果与临床无关。关于牙间隔骨减少术、电流和PEMF对OTM有益作用的基于研究的证据非常有限，无法得出确凿结论。需要更多高质量的临床研究来评估辅助干预措施对加速OTM的疗效及其潜在的临床应用。
