Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111, Szczecin, Poland.
Department of Dental and Maxillofacial Sciences, Sapienza University of Rome, 00161, Rome, Italy.
Head Face Med. 2021 Jul 24;17(1):32. doi: 10.1186/s13005-021-00281-3.
Orthodontic retention aims to maintain optimal teeth positions after active treatment. The stability is affected by numerous factors, including patients' individual features, thus retention should be adjusted in the most optimal way. Bonding a retainer makes retention less dependent on patient's compliance.
What wire or fiber splint type provides the best treatment stability? What materials should be used to bond the wire or fiber splint? Should be the bonding procedure be direct or indirect? The aim of the study is to assess and synthesize available controlled trials investigating failures of fixed retainers.
Literature searches of free text and MeSH terms were performed in Scopus, Web of Science, Embase and PubMed Central in order to find studies, referring to failures of fixed retention (12th February 2021). The keywords were: ("orthodontic retainers AND failure AND wire"). The framework of this systematic review according to PICO was: Population: orthodontic patients; Intervention: fixed orthodontic retainer bonding; Comparison: Different protocols of fixed orthodontic retention applied; Outcomes: failure rate, survival rate. Three different specific scales from the Cochrane Collaboration Handbook were used, according to each study type. Additionally, a meta-analysis was conducted to compare the effectiveness of retention using fiber reinforced composite and multistranded steel wire.
The search identified 177 potential articles: 114 from PubMed, 41 from Scopus, 20 from Web of Science and 2 from Embase. After excluding studies inconsistent with selection criteria, 21 studies were included and subjected to qualitative analysis. The main outcome investigated was failure rate. This systematic review has some potential limitations due to the heterogeneity of design between included studies.
No retainer is proved to guarantee a perfect stability of dental alignment. The retainer should be bonded to all adherent teeth, preferably with additional use of bonding resin. No wire or fiber splint present superior characteristics concerning failure rate. Fiber reinforced composite retention is more sensitive to operator skills, and with imperfect bonding technique, failure rate is much higher. During the first 6 months after bonding retainer the patient should be under frequent control. The study protocol was registered in PROSPERO database with the number CRD42021233406.
正畸保持的目的是在主动治疗后维持牙齿的最佳位置。稳定性受到许多因素的影响，包括患者的个体特征，因此保持器的选择应尽可能最佳。粘结保持器可减少对患者依从性的依赖。
哪种线或纤维夹板类型提供最佳的治疗稳定性？应使用什么材料来粘结线或纤维夹板？粘结程序应该是直接的还是间接的？本研究旨在评估和综合现有研究，以调查固定保持器的失败情况。
在 Scopus、Web of Science、Embase 和 PubMed Central 中进行自由文本和 MeSH 术语的文献检索，以查找提到固定保持器失败的研究（2021 年 2 月 12 日）。关键词为：“orthodontic retainers AND failure AND wire”。本系统评价的 PICO 框架为：人群：正畸患者；干预：固定正畸保持器粘结；比较：应用不同的固定正畸保持方案；结局：失败率、存活率。根据每种研究类型，使用 Cochrane 协作手册的三种不同的特定量表进行评估。此外，还进行了荟萃分析，以比较使用纤维增强复合材料和多股钢丝的保持效果。
搜索共确定了 177 篇潜在文章：来自 PubMed 的 114 篇、Scopus 的 41 篇、Web of Science 的 20 篇和 Embase 的 2 篇。在排除与选择标准不一致的研究后，纳入了 21 项研究并进行了定性分析。主要观察结果是失败率。由于纳入研究设计的异质性，本系统评价存在一定的局限性。
没有一种保持器能保证牙齿排列的完美稳定性。保持器应粘结到所有附着的牙齿上，最好使用额外的粘结树脂。没有哪种线或纤维夹板在失败率方面表现出更好的特性。纤维增强复合材料保持器对操作人员的技能要求更高，而且如果粘结技术不完美，失败率会更高。在粘结保持器后的头 6 个月内，患者应接受频繁的控制。本研究方案已在 PROSPERO 数据库中注册，编号为 CRD42021233406。
