Department of Pediatric Dentistry and Orthodontics, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Am J Orthod Dentofacial Orthop. 2020 Apr;157(4):454-465.e1. doi: 10.1016/j.ajodo.2019.10.014.
The aim of this systematic review was to identify, evaluate, and provide a synthesis of the available literature on the effects of lip bumper (LB) therapy on the mandibular dental arch of children and adolescents.
MEDLINE, Scopus, Web of Science, Cochrane Library, and Lilacs were systematically searched without restrictions up to May 2019. Risk-of-bias assessment was performed using Cochrane's tool for randomized controlled trials (RCTs) and the Risk of Bias in Nonrandomized Studies of Interventions tool for non-RCTs. The Grading of Recommendations, Assessment, Development and Evaluation tool was used to assess the quality of the evidence.
After examination of the full texts, 6 studies were included. One RCT presented unclear risk of bias, and 5 non-RCTs presented serious to moderate risk of bias. LB therapy resulted in a buccal inclination of the incisors, distalization of the permanent first molars, and distal inclination of the permanent first molars, which increased perimeter and arch length. An increase in the arch width with greater gain in the interpremolar and/or deciduous molar distance and less gain in intercanine and intermolar distances was also reported. LB therapy increased the risk of second molar impaction with inclination >30° and the risk of ectopic eruption when treatment time was >2 years. The level of the evidence was graded as very low for variable arch length and second molar eruption disturbances. All other outcomes were graded as having low level of evidence.
Owing to the low level of certainty identified, the conclusions should be considered cautiously. Increase in arch perimeter and width was attributed to the proclination of the incisors, buccalization of the deciduous molar and premolar areas, and distal inclination of the molars. However, there was an increased chance of impaction and ectopic eruption of permanent second molar after treatment with LB.
本系统评价的目的是识别、评估并综合现有文献，以了解唇挡（LB）治疗对儿童和青少年下颌牙弓的影响。
系统检索了 MEDLINE、Scopus、Web of Science、Cochrane 图书馆和 Lilacs 数据库，检索时间截至 2019 年 5 月，不设任何限制。使用 Cochrane 随机对照试验（RCT）工具和非随机干预研究的偏倚风险工具评估偏倚风险。使用推荐评估、制定与评价工具（GRADE）评估证据质量。
在审查全文后，纳入了 6 项研究。1 项 RCT 存在不明确的偏倚风险，5 项非 RCT 存在严重到中度的偏倚风险。LB 治疗导致切牙颊倾、恒第一磨牙远中移动以及恒第一磨牙远中倾斜，从而增加牙弓周长和长度。也有研究报告称，牙弓宽度增加，双尖牙和/或乳磨牙间隙增加，尖牙和磨牙间隙减少。LB 治疗增加了第二磨牙倾斜>30°和异位萌出的风险，当治疗时间>2 年时。由于证据水平为极低，因此对于可变的牙弓长度和第二磨牙萌出障碍的结论应谨慎考虑。牙弓周长和宽度的增加归因于切牙的前倾、乳磨牙和前磨牙区颊侧移动以及磨牙的远中倾斜。然而，使用 LB 治疗后，第二磨牙发生阻生和异位萌出的几率增加。
