固定和可摘正畸保持器的效果：一项系统评价
The effects of fixed and removable orthodontic retainers: a systematic review.
作者信息
Al-Moghrabi Dalya, Pandis Nikolaos, Fleming Padhraig S
机构信息
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AD, UK.
Dental School, Medical Faculty, University of Bern, Bern, Switzerland.
出版信息
Prog Orthod. 2016 Dec;17(1):24. doi: 10.1186/s40510-016-0137-x. Epub 2016 Jul 26.
OBJECTIVE
In the view of the widespread acceptance of indefinite retention, it is important to determine the effects of fixed and removable orthodontic retainers on periodontal health, survival and failure rates of retainers, cost-effectiveness, and impact of orthodontic retainers on patient-reported outcomes.
METHODS
A comprehensive literature search was undertaken based on a defined electronic and gray literature search strategy (
PROSPERO
CRD42015029169). The following databases were searched (up to October 2015); MEDLINE via OVID, PubMed, the Cochrane Central Register of Controlled Trials, LILACS, BBO, ClinicalTrials.gov, the National Research Register, and ProQuest Dissertation and Thesis database. Randomized and non-randomized controlled clinical trials, prospective cohort studies, and case series (minimum sample size of 20) with minimum follow-up periods of 6 months reporting periodontal health, survival and failure rates of retainers, cost-effectiveness, and impact of orthodontic retainers on patient-reported outcomes were identified. The Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa Scale were used to assess the quality of included trials.
RESULTS
Twenty-four studies were identified, 18 randomized controlled trials and 6 prospective cohort studies. Of these, only 16 were deemed to be of high quality. Meta-analysis was unfeasible due to considerable clinical heterogeneity and variations in outcome measures. The mean failure risk for mandibular stainless steel fixed retainers bonded from canine to canine was 0.29 (95 % confidence interval [CI] 0.26, 0.33) and for those bonded to canines only was 0.25 (95 % CI: 0.16, 0.33). A meta-regression suggested that failure of fixed stainless steel mandibular retainers was not directly related to the period elapsed since placement (P = 0.938).
CONCLUSION
Further well-designed prospective studies are needed to elucidate the benefits and potential harms associated with orthodontic retainers.
目的
鉴于不定时保持器已被广泛接受，确定固定和可摘正畸保持器对牙周健康、保持器的存留率和失败率、成本效益以及正畸保持器对患者报告结局的影响具有重要意义。
方法
根据既定的电子和灰色文献检索策略（PROSPERO：CRD42015029169）进行全面的文献检索。检索了以下数据库（截至2015年10月）；通过OVID检索MEDLINE、PubMed、Cochrane对照试验中央注册库、LILACS、BBO、ClinicalTrials.gov、国家研究注册库以及ProQuest学位论文数据库。纳入报告牙周健康、保持器的存留率和失败率、成本效益以及正畸保持器对患者报告结局的随机和非随机对照临床试验、前瞻性队列研究以及病例系列（最小样本量为20），最小随访期为6个月。使用Cochrane协作网的偏倚风险工具和纽卡斯尔-渥太华量表评估纳入试验的质量。
结果
共识别出24项研究，18项随机对照试验和6项前瞻性队列研究。其中，仅有16项被认为质量较高。由于存在相当大的临床异质性和结局指标的差异，无法进行荟萃分析。下颌从尖牙到尖牙粘结的不锈钢固定保持器的平均失败风险为0.29（95%置信区间[CI]0.26，0.33），仅粘结到尖牙的保持器的平均失败风险为0.25（95%CI：0.16，0.33）。一项荟萃回归分析表明，下颌固定不锈钢保持器的失败与放置后经过的时间无直接关系（P = 0.938）。
结论
需要进一步开展设计良好的前瞻性研究，以阐明正畸保持器的益处和潜在危害。
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