Former instructor in Orthodontic Department, Syrian Ministry of Health, Private Practice, Damascus, Syria.
CMH Institute of Dentistry Lahore, National University of Medical Sciences, Lahore, Pakistan.
J Orthod. 2021 Jun;48(2):156-171. doi: 10.1177/1465312520988735. Epub 2021 Feb 5.
To identify and evaluate the body of the evidence regarding the effectiveness of surgical adjunctive procedures (SAPs) in accelerating orthodontic tooth movement (OTM).
Unrestricted search of three electronic databases and manual search up to 12 June 2020 were undertaken.
All systematic reviews of randomised and non-randomised controlled trials that investigate the effectiveness of the SAPs in accelerating OTM were included.
Study selection and data extraction were undertaken independently and in duplicate by two reviewers. A random-effects model with a 95% confidence interval (CI) was generated for comparable outcomes. Two reviewers assessed the quality of the included studies using AMSTAR2 and GRADE.
Fourteen systematic reviews were included; however, four systematic reviews were assessed quantitatively. Meta-analysis showed that mean difference (MD) of canine retraction rate, for the first month after SAPs, was mild (MD = 0.65 mm/month). Compared to control, micro-osteoperforations (MOPs) statistically but temporally accelerate lower canine retraction and en masse retraction by 0.25 mm/month and 0.31 mm/month, respectively. There was no significant effect (>0.05) in terms of molar anchorage loss (MAL) between control and MOP groups. Piezocision non-significantly shortens the duration of en masse retraction (4.30 months, >0.05), but significantly shortens incisors retraction (101.64 days, <0.001). MAL is mild but significantly less in the piezocision group compared to the control group (MD = 0.53 mm, =0.03). Low-level evidence showed that SAPs have no significant effect on root resorption or periodontal health; however, piezocision is associated with transient acute inflammation and noticeable scars.
Low-level evidence concludes that SAPs accelerate OTMs and reduce treatment duration, but the acceleration is minor and transient. The effect on anchorage loss is variable and technique related. Side effects of SAPs are transient, but some might be aesthetically noticeable. A cost-benefit analysis of SAPs should be considered while making the treatment decision.
确定和评估外科辅助治疗（SAP）加速正畸牙齿移动（OTM）的证据体。
对三个电子数据库进行无限制搜索，并于 2020 年 6 月 12 日之前进行手动搜索。
所有纳入的 SAP 加速 OTM 有效性的随机和非随机对照试验的系统评价。
研究选择和数据提取由两位评审员独立进行，重复两次。对于可比较的结果，生成了具有 95%置信区间（CI）的随机效应模型。两位评审员使用 AMSTAR2 和 GRADE 评估纳入研究的质量。
共纳入 14 项系统评价，其中 4 项系统评价进行了定量分析。荟萃分析显示，SAP 后第一个月犬齿回收速度的平均值差异（MD）为轻度（MD=0.65mm/月）。与对照组相比，微骨切开术（MOPs）在统计学上但在时间上分别以 0.25mm/月和 0.31mm/月加速下犬齿回收和整体回收。在磨牙支抗丢失（MAL）方面，对照组和 MOP 组之间没有显著差异（>0.05）。Piezo 非显著性缩短整体回收的持续时间（4.30 个月，>0.05），但显著缩短切牙回收时间（101.64 天，<0.001）。与对照组相比，MAL 明显减轻（MD=0.53mm，=0.03），但仍为轻度。低水平证据表明，SAPs 对根吸收或牙周健康没有显著影响；然而，Piezo 与短暂的急性炎症和明显的疤痕有关。
低水平证据表明，SAP 加速 OTMs 并缩短治疗时间，但加速程度较小且短暂。对支抗丢失的影响是可变的，与技术有关。SAP 的副作用是短暂的，但有些可能在美学上是明显的。在做出治疗决策时，应考虑 SAP 的成本效益分析。
