Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Central Library of the Health Science Center, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Int J Paediatr Dent. 2020 Nov;30(6):687-712. doi: 10.1111/ipd.12644. Epub 2020 Apr 20.
Information about the functional and morphological consequences that occur following the premature loss of anterior teeth is still insufficient.
To evaluate the consequences in children's speech and arch integrity following premature loss of primary anterior teeth compared to those without premature losses.
Electronic searches were performed based on the PECO criteria. Observational studies in children (P) who suffered premature loss or extraction of primary anterior teeth (E) compared to children presenting normal occlusion development (C) and the consequences to speech and dental arch perimeter (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of premature loss of primary anterior teeth in articulatory speech disorders (distortion, omission, and substitution) and space loss in the dental arches. Random- and fixed-effect models were used, and heterogeneity was tested. The certainty of evidence was estimated using the GRADE approach.
From a total of 2.234 studies, six studies were included in the qualitative synthesis, and four in speech disorders meta-analysis. Despite it was not possible to perform space loss meta-analysis due to the absence of available data, qualitative analysis showed that there was no space loss after premature loss of mandibular primary incisors; a space loss, however, could be observed in children who lost primary canines at an early stage of dental development. For speech disorders results, children who lost anterior tooth presented higher chance of suffering speech distortion, than children without tooth loss (OR 5.466 [1.689, 17.692] P = .005) with low certainty of evidence. On the other hand, there were no statistically differences between premature loss of primary anterior teeth and omission (OR (a) 1.157 [0.439, 3.049] P = .767 and (OR (b) 1.393 [0.434, 4.70] P = .577) or substitution (OR (a) 1.071 [0.581, 1.974] P = .827 and OR (b) 1.218 [0.686, 2.163] P = .5), both with very low certainty of evidence.
Premature loss of primary anterior teeth may affect children phonation causing speech distortion. Consequences of space loss to primary dental arch still need to be further studied. Despite the speech distortion results, included articles present low-level evidence-based quality, thus new studies should be performed.
关于前牙过早缺失后发生的功能和形态后果的信息仍然不足。
评估与未发生过早缺失的儿童相比，前牙过早缺失对儿童语音和牙弓完整性的影响。
根据 PECO 标准进行电子检索。纳入研究对象为（P）患有前牙过早缺失或拔除（E）的儿童，与正常牙合发育的儿童（C）相比，以及对语音和牙弓周长（O）的影响。进行偏倚风险和数据提取。元分析评估了前牙过早缺失对发音语音障碍（变形、遗漏和替代）和牙弓间隙丧失的影响。使用随机效应和固定效应模型，并检验了异质性。使用 GRADE 方法评估证据的确定性。
从总共 2234 篇研究中，有 6 篇研究被纳入定性综合分析，4 篇研究被纳入语音障碍元分析。尽管由于缺乏可用数据，无法进行空间丧失的元分析，但定性分析表明，下颌前牙过早缺失后不会发生空间丧失；然而，在牙齿发育早期失去乳尖牙的儿童中，可以观察到空间丧失。对于语音障碍的结果，与未失去牙齿的儿童相比，失去前牙的儿童发生语音变形的可能性更高（OR 5.466 [1.689, 17.692] P = 0.005），证据确定性低。另一方面，前牙过早缺失与遗漏（OR（a）1.157 [0.439, 3.049] P = 0.767 和 OR（b）1.393 [0.434, 4.70] P = 0.577）或替代（OR（a）1.071 [0.581, 1.974] P = 0.827 和 OR（b）1.218 [0.686, 2.163] P = 0.5）之间无统计学差异，两者的证据确定性均非常低。
前牙过早缺失可能会影响儿童发音，导致语音变形。前牙牙弓空间丧失的后果仍需要进一步研究。尽管语音障碍的结果显示，纳入的文章质量为低水平证据，但仍应开展新的研究。
