Kamber Rita, Papageorgiou Spyridon N, Eliades Theodore
Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland.
J Orofac Orthop. 2018 Mar;79(2):73-82. doi: 10.1007/s00056-018-0123-7. Epub 2018 Feb 20.
Aim of this systematic review was to assess the effect of orthodontic treatment with fixed appliances on the tooth color of patients.
Nine databases were searched up to May 2017 for clinical cohort studies on the effect of fixed appliance treatment on tooth color. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses of mean differences (MD) or means and their 95% confidence intervals (CIs) were performed, followed by GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the quality of evidence.
Three nonrandomized and one randomized study with a total of 138 patients (46% male, 54% female) with average age of 15.7 years were included. Tooth color of treated patients was significantly altered during or after orthodontic treatment (4 studies; average of 3.2 ∆E units; 95% CI = 2.0-4.4 ∆E units), which was more than the variation among controls (1 study; MD = 1.9 ∆E units; 95% CI = 1.7-2.2 ∆E units). However, the quality of evidence was very low, due to the inclusion of nonrandomized studies, bias, and imprecision. Re-analysis of raw study data indicated that significant differences in clinically discernable treatment-induced color changes were seen between chemically and light-cured adhesives and among the various tooth categories.
Existing evidence of very low quality indicates that orthodontic treatment might be associated with alterations of tooth color, which are however not consistently clinically discernible. Treatment-induced color alterations might be dependent on bonding material and tooth type, but evidence supporting this is weak.
本系统评价旨在评估固定矫治器正畸治疗对患者牙齿颜色的影响。
检索了9个数据库，截至2017年5月，查找关于固定矫治器治疗对牙齿颜色影响的临床队列研究。在剔除重复研究、进行数据提取并根据Cochrane指南进行偏倚风险评估后，对平均差（MD）或均值及其95%置信区间（CI）进行随机效应荟萃分析，随后对证据质量进行GRADE（推荐分级评估、制定与评价）评估。
纳入了3项非随机研究和1项随机研究，共138例患者（男性46%，女性54%），平均年龄15.7岁。正畸治疗期间或之后，治疗患者的牙齿颜色发生了显著改变（4项研究；平均3.2 ∆E单位；95% CI = 2.0 - 4.4 ∆E单位），这超过了对照组的变化（1项研究；MD = 1.9 ∆E单位；95% CI = 1.7 - 2.2 ∆E单位）。然而，由于纳入了非随机研究、存在偏倚和不精确性，证据质量非常低。对原始研究数据的重新分析表明，化学固化和光固化粘结剂之间以及不同牙齿类别之间在临床上可察觉的治疗引起的颜色变化存在显著差异。
现有质量极低的证据表明，正畸治疗可能与牙齿颜色改变有关，但在临床上并非始终可察觉。治疗引起的颜色改变可能取决于粘结材料和牙齿类型，但支持这一点的证据很薄弱。
