Mousa Mudar Mohammad, Hajeer Mohammad Y, Burhan Ahmad S, Almahdi Wael H
Department of Orthodontics, University of Damascus Dental School, Damascus, Syria.
Department of Periodontics, University of Damascus Dental School, Damascus, Syria.
Eur J Orthod. 2022 Dec 1;44(6):622-635. doi: 10.1093/ejo/cjac038.
With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure.
This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment.
Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken.
Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure.
Cochrane's risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence.
Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low.
All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field.
The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.
随着手术辅助正畸加速技术的广泛应用，在采用任何加速程序之前，分析患者报告的结局指标（PROMs）对于确保患者的接受度和满意度变得非常重要。
本综述旨在严格评估与传统非加速治疗相比，手术辅助正畸治疗加速过程中疼痛、不适、功能障碍及其他患者报告结局指标的现有证据。
检索了1990年1月至2022年5月的八个电子文献数据库。还对手选的正畸期刊进行了手工检索。
本系统综述纳入了随机对照试验（RCTs），研究对象为接受正畸治疗的患者，其中一组接受加速程序。
采用Cochrane偏倚风险工具（RoB2工具）评估纳入RCTs的偏倚风险。使用推荐分级评估、制定和评价（GRADE）指南评估证据的总体质量。
本综述纳入了13项RCTs（333例患者），仅纳入了微创性手术辅助加速研究。两项RCTs纳入了数据的定量综合分析。手术干预第一天后，手术组的疼痛和不适程度为轻度至中度（平均值为0.8至6.8），而对照组为轻度。然而，手术干预第七天后，两组之间的疼痛、不适、肿胀和功能障碍程度几乎相似。根据GRADE，支持这些发现的证据质量从低到极低。
所有手术干预均为微创。有极低到低的证据表明，加速在手术干预后第一天引起轻度至中度疼痛和不适，并在术后一周完全消失。在即刻和短期随访中，功能障碍在可接受范围内。需要更多高质量的随机对照临床试验来在该领域建立充分的证据。
本系统综述的方案在本综述的第一阶段在PROSPERO数据库（CRD42021274481）中注册。
