Starch-Jensen Thomas, Blæhr Tue Lindberg
Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg Denmark.
J Oral Maxillofac Res. 2016 Dec 28;7(4):e1. doi: 10.5037/jomr.2016.7401. eCollection 2016 Oct-Dec.
The objective of the present systematic review was to test the hypothesis of no difference in transverse skeletal and dental arch expansion and relapse after segmental Le Fort I osteotomy versus surgically assisted rapid maxillary expansion.
A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted by including human studies published in English from January 1, 2000 to June 1, 2016.
The search provided 130 titles and four studies fulfilled the inclusion criteria. All the included studies were characterized by high risk of bias and meta-analysis was not possible due to considerable variation. Both treatment modalities significantly increase the transverse maxillary skeletal and dental arch width. The transverse dental arch expansion and relapse seems to be substantial higher with tooth-borne surgically assisted rapid maxillary expansion compared to segmental Le Fort I osteotomy. The ratio of dental to skeletal relapse was significantly higher in the posterior maxilla with tooth-borne surgically assisted rapid maxillary expansion. Moreover, a parallel opening without segment tilting was observed after segmental Le Fort I osteotomy.
Maxillary transverse deficiency in adults can be treated successfully with both treatment modalities, although surgically assisted rapid maxillary expansion seems more effective when large transverse maxillary skeletal and dental arch expansion is required. However, considering the methodological limitations of the included studies, long-term randomized studies assessing transverse skeletal and dental expansion and relapse with the two treatment modalities are needed before definite conclusions can be provided.
本系统评价的目的是检验以下假设，即节段性Le Fort I截骨术与外科辅助快速上颌扩弓术后，横向骨骼和牙弓扩展及复发情况无差异。
通过检索MEDLINE（PubMed）、Embase和Cochrane图书馆，并手工检索相关期刊，纳入2000年1月1日至2016年6月1日以英文发表的人体研究。
检索得到130篇文献标题，4项研究符合纳入标准。所有纳入研究均存在高偏倚风险，由于存在显著差异，无法进行荟萃分析。两种治疗方式均能显著增加上颌横向骨骼和牙弓宽度。与节段性Le Fort I截骨术相比，牙支持式外科辅助快速上颌扩弓术后横向牙弓扩展及复发似乎明显更高。在牙支持式外科辅助快速上颌扩弓术后，上颌后部牙复发相对于骨骼复发的比例显著更高。此外，节段性Le Fort I截骨术后观察到无节段倾斜的平行开口。
两种治疗方式均可成功治疗成人上颌横向发育不足，尽管在需要大幅扩大上颌横向骨骼和牙弓时，外科辅助快速上颌扩弓似乎更有效。然而，考虑到纳入研究的方法学局限性，在得出明确结论之前，需要进行长期随机研究，评估两种治疗方式对上颌横向骨骼和牙弓扩展及复发的影响。
