Bins Arjan, Oomens Marjolijn A E, Boffano Paolo, Forouzanfar Tymour
Ph.D. Student, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands.
Resident, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), The Netherlands.
J Oral Maxillofac Surg. 2015 Oct;73(10):1963-9. doi: 10.1016/j.joms.2015.03.072. Epub 2015 Apr 11.
Intermaxillary fixation (IMF) is traditionally achieved with arch bars; however, this method has several well-known disadvantages and other techniques, such as bone screws, are available. This study evaluated current evidence regarding these IMF screws (IMFSs) for mandibular trauma and to assess whether this allows a change of treatment protocol for IMF.
A systematic electronic literature search was conducted in the PubMed, Embase, and Cochrane databases. Titles and abstracts retrieved from the search were screened and evaluated for inclusion and exclusion criteria. The full text of all relevant articles was read and citation lists were checked for any missing references. All randomized controlled trials (RCTs) were subjected to a quality assessment. Included articles were checked for outcome measurements concerning occlusion, operative time, oral hygiene, root trauma, wire-stick injuries, and mucosa overgrowth.
Twenty-two articles (17 case series, 4 RCTs, and 1 cohort study) were included. None of the RCTs scored high methodologic results in the quality assessment. The results suggest IMFSs have similar malocclusion rates as arch bars, fewer wire-stick injuries, improved oral hygiene, and shorter operative time. Root damage is less likely to occur with self-drilling screws and seldom requires treatment.
Although the methodologic quality of the included studies is poor, self-drilling IMFSs are recommended for temporary per-operative IMF of noncomminuted mandibular fractures. More high-quality studies are required to allow an evidence-based change of protocol.
传统上采用牙弓夹板实现颌间固定（IMF）；然而，这种方法存在一些众所周知的缺点，并且有其他技术可供使用，例如骨螺钉。本研究评估了关于这些用于下颌骨创伤的颌间固定螺钉（IMFS）的现有证据，并评估这是否允许改变IMF的治疗方案。
在PubMed、Embase和Cochrane数据库中进行了系统的电子文献检索。对检索到的标题和摘要进行筛选，并根据纳入和排除标准进行评估。阅读所有相关文章的全文，并检查参考文献列表以查找任何遗漏的参考文献。对所有随机对照试验（RCT）进行质量评估。检查纳入文章中有关咬合、手术时间、口腔卫生、牙根创伤、钢丝黏附损伤和黏膜过度生长的结局测量。
纳入了22篇文章（17个病例系列、4个RCT和1个队列研究）。在质量评估中，没有一个RCT获得高方法学结果。结果表明，IMFS的错牙合率与牙弓夹板相似，钢丝黏附损伤较少，口腔卫生改善，手术时间较短。自攻螺钉导致牙根损伤的可能性较小，很少需要治疗。
尽管纳入研究的方法学质量较差，但对于非粉碎性下颌骨骨折的临时术中IMF，建议使用自攻IMFS。需要更多高质量的研究来实现基于证据的方案改变。
