Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, and Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Sydney, Australia.
Division of Orthodontics, University Clinics of Medicine and Dentistry, University of Geneva, Geneva, Switzerland.
Am J Orthod Dentofacial Orthop. 2022 Jan;161(1):7-19.e2. doi: 10.1016/j.ajodo.2021.06.015. Epub 2021 Oct 13.
The aim of this 2-arm-parallel, split-mouth trial was to investigate the effects of piezocision compared with no piezocision on maxillary canine distalization and to evaluate patient perceptions on the surgical procedure.
Twenty-two participants requiring extractions of maxillary first premolars were recruited from the Department of Orthodontics (Sydney Dental Hospital) waiting list. After leveling and alignment, a minimum of 3 mm space was required for canine retraction. Piezocision cuts distal to the canines were 4 mm long and 3 mm deep into the buccal cortical plate. The canine retraction was initiated on both sides immediately after surgery, with coil springs delivering 150 g of force per side. Random assignment of piezocision or control intervention on the patient's right side was performed (www.randomisation.com) for the random number generation, and allocation concealment was accomplished with opaque, sealed envelopes. Patients were assessed every 6 weeks for coil activation and alginate impressions over 18 weeks. The primary outcome was the amount of tooth movement in mm. Secondary outcomes were canine rotation, anchorage loss measured on scanned dental models, and patient pain levels and perception on piezocision using visual analog scale questionnaires. Blinding was feasible for the dental model measurements.
Twenty patients completed the trial. The treatment × time interaction showed no statistically or clinically significant differences in maxillary extraction space closure (b = -0.02; 95% confidence interval [CI], -0.29 to 0.25; P = 0.89) canine rotation (b = -1.45; 95% CI, -4 to 1.09; P = 0.26) and anchorage loss (b = -0.02; 95% CI, -0.38 to 0.34; P = 0.92). All patients except for one had minimal pain associated with the piezocision surgery but found the procedure tolerable and would recommend it. No harm occurred during the trial.
Piezocision-assisted maxillary canine distalization was similar to distalization with conventional orthodontics with patients tolerating the procedure.
本研究采用双臂平行、分组对照的方法，旨在比较与不进行超声骨刀法（piezocision）相比，超声骨刀法辅助上颌尖牙远移的效果，并评估患者对手术过程的感知。
本研究从悉尼牙科医院正畸科的等候名单中招募了 22 名需要拔除上颌第一前磨牙的患者。在整平排齐后，需要至少 3mm 的间隙来实现尖牙远移。在尖牙远中进行的超声骨刀法切口长 4mm，深 3mm 切入颊侧皮质骨板。手术完成后，两侧立即开始使用螺旋弹簧施加每侧 150g 的力进行尖牙远移。在患者右侧随机分配超声骨刀法或对照组（www.randomisation.com）进行随机数生成，并使用不透明、密封的信封实现分配隐藏。患者在 18 周的时间内，每 6 周评估一次螺旋弹簧的激活情况和藻酸盐印模。主要结局为牙齿移动的毫米数。次要结局为尖牙旋转、扫描牙模上的支抗丧失以及使用视觉模拟量表问卷调查评估患者对超声骨刀法的疼痛水平和感知。对牙模测量结果进行了盲法评估。
20 名患者完成了试验。治疗×时间的交互作用在关闭上颌拔牙间隙（b=-0.02；95%置信区间[CI]，-0.29 至 0.25；P=0.89）、尖牙旋转（b=-1.45；95% CI，-4 至 1.09；P=0.26）和支抗丧失（b=-0.02；95% CI，-0.38 至 0.34；P=0.92）方面均无统计学或临床显著差异。除 1 名患者外，所有患者均有轻微的疼痛与超声骨刀法手术相关，但发现该手术可耐受，并会推荐该手术。试验过程中未发生任何不良事件。
超声骨刀法辅助上颌尖牙远移与传统正畸方法相似，患者可耐受该手术。
