Angle Orthod. 2018 Sep;88(5):638-648. doi: 10.2319/110217-749.1. Epub 2018 May 22.
To elucidate the positional and dimensional temporomandibular joint (TMJ) changes after correction of posterior crossbite in growing patients.
A systematic unrestricted search was done in six databases until June 27, 2017. A manual search in the reference lists of the included studies and gray literature was also performed. The eligibility criteria included randomized controlled trials and prospective nonrandomized controlled clinical trials and a sample of growing subjects with posterior crossbite that required maxillary expansion. Risk of bias assessment was performed using Cochrane's Risk of Bias Tool. The literature search, study inclusion, risk of bias assessment, evaluation of quality of evidence (GRADE), and data extraction were performed by two reviewers independently.
Only two articles were finally eligible to be included in the qualitative analysis. Both studies were RCTs and were assessed as having unclear risk of bias. Meta-analysis was not possible since one study used cone-beam computed tomography as an assessment tool while the other used ultrasonography. One study reported significant reduction in the condylar positional difference between centric and habitual occlusion in the treatment group, while no spontaneous correction of condylar asymmetric position occurred in the control group. The other study reported minor changes of condylar position in both treatment and control groups.
The current available data provide insufficient and weak evidence to form a solid and firm conclusion. There is poor, very low-quality evidence regarding the positional and dimensional effects of posterior crossbite correction on the TMJs.
阐明生长患者在矫正后牙反 后颞下颌关节(TMJ)的位置和大小变化。
直到 2017 年 6 月 27 日,我们在六个数据库中进行了系统的无限制搜索。还对纳入研究的参考文献和灰色文献进行了手动搜索。纳入标准包括随机对照试验和前瞻性非随机对照临床试验,以及需要上颌扩展的后牙反患者的生长样本。使用 Cochrane 的偏倚风险工具进行偏倚风险评估。文献检索、研究纳入、偏倚风险评估、证据质量评估(GRADE)和数据提取由两名独立的审查员进行。
只有两篇文章最终有资格进行定性分析。这两项研究均为 RCT,并被评估为偏倚风险不明确。由于一项研究使用锥形束计算机断层扫描作为评估工具,而另一项研究使用超声检查,因此无法进行荟萃分析。一项研究报告称,治疗组在正中咬合和习惯性咬合之间的髁突位置差异有显著减少,而对照组无髁突不对称位置的自发矫正。另一项研究报告称,治疗组和对照组的髁突位置都有轻微变化。
目前可用的数据提供的证据不足且薄弱,无法得出确凿的结论。关于后牙反矫正对 TMJ 的位置和大小影响的证据质量较差,非常低。