Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, 74800 Karachi, Pakistan.
Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, 74800 Karachi, Pakistan.
Int Orthod. 2021 Dec;19(4):539-547. doi: 10.1016/j.ortho.2021.09.004. Epub 2021 Oct 7.
Fixed retainer failure is a common cause of relapse and may require additional orthodontic treatment. The two main methods for bonding the mandibular fixed retainer include direct and indirect techniques. This topic has not been explored previously in a systematic review. Therefore, the objective of this systematic review was to evaluate the effect of direct versus indirect bonding technique on the failure rate of mandibular fixed retainer.
Online databases (PubMed, Dental and Oral Science, CINAHL, and Cochrane Central Register of Controlled Trials, Scopus) were systematically searched electronically for articles up until April 2021. Google Scholar and clinicaltrials.gov databases were utilized for hand searching. Randomized, non-randomized clinical trials and cohort studies on human subjects were considered regardless of language or year of publication. Orthodontic patients in their retention phase (mandibular 3×3 fixed retainer), in which the retainer was bonded using direct bonding technique as control and indirect as intervention were included. The outcome assessed was retainer failure rate. Two authors independently examined and extracted the data from the studies that satisfied the inclusion criteria. Risk of bias in clinical trials was assessed using the Cochrane Collaboration's tool, whereas risk of bias in cohort studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis was conducted using the RevMan software V.5.3.5.22. The outcome was estimated using weighted average difference and 95% confidence intervals (CIs). The studies' heterogeneity was assessed using Cochrane's heterogeneity test (I2 Test).
Four articles fulfilling the inclusion criteria were included in qualitative and quantitative synthesis. Retainer failure rates were analysed in a total number of 266 patients bonded with mandibular 3×3 retainers after orthodontic therapy. Direct bonding technique of fixed retainer on 131 patients was compared with indirect technique on 135 patients. There was no statistically significant difference in the rate of retainer failure between the two methods (95% CI, 0.67, 1.40).
Within the limitations of insufficient evidence this systematic review and meta-analysis concluded that there is no difference in the failure rate of mandibular fixed retainers between direct and indirect bonding techniques. Due to the scarcity of available data, further studies are needed to establish definitively one's clinical benefit over the other.
固定保持器的失败是复发的常见原因，可能需要额外的正畸治疗。粘接下颌固定保持器的两种主要方法包括直接和间接技术。这个主题以前没有在系统评价中探讨过。因此，本系统评价的目的是评估直接与间接粘接技术对下颌固定保持器失败率的影响。
在线数据库（PubMed、Dental and Oral Science、CINAHL 和 Cochrane Central Register of Controlled Trials、Scopus）系统地检索了截至 2021 年 4 月的文章。利用 Google Scholar 和 clinicaltrials.gov 数据库进行手工检索。纳入了无论语言或出版年份如何，针对人类受试者的随机、非随机临床试验和队列研究。纳入了处于保持期（下颌 3x3 固定保持器）的正畸患者，其中以直接粘接技术作为对照，间接粘接技术作为干预措施。评估的结果是保持器失败率。两名作者独立检查并从符合纳入标准的研究中提取数据。使用 Cochrane 协作工具评估临床试验的偏倚风险，使用 Newcastle-Ottawa 量表评估队列研究的偏倚风险。使用 RevMan 软件 V.5.3.5.22 进行荟萃分析。使用加权平均差异和 95%置信区间（CI）估计结果。使用 Cochrane 异质性检验（I2 检验）评估研究的异质性。
纳入了四项符合纳入标准的文章，进行了定性和定量综合分析。共分析了 266 名接受正畸治疗后用下颌 3x3 保持器粘接的患者的保持器失败率。在 131 名患者中使用直接粘接技术固定保持器，在 135 名患者中使用间接技术。两种方法的保持器失败率无统计学差异（95%CI，0.67，1.40）。
在证据不足的限制下，本系统评价和荟萃分析得出结论，直接和间接粘接技术对下颌固定保持器的失败率没有差异。由于可用数据的稀缺性，需要进一步的研究来确定一种方法相对于另一种方法的临床优势。
