Wang Jiangwei, Yang Yingying, Wang Yingxue, Zhang Lu, Ji Wei, Hong Zheng, Zhang Linkun
School of Clinical Stomatology, Tianjin Medical University, Tianjin, China.
Department of Orthodontic, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin, China.
Korean J Orthod. 2022 Jul 18;52(5):313-323. doi: 10.4041/kjod21.264.
This study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices by using a network meta-analysis.
We searched seven databases for randomized and controlled clinical trials that compared bone-anchored maxillary protraction with tooth-anchored maxillary protraction interventions or untreated groups up to May 2021. After literature selection, data extraction, and quality assessment, we calculated the mean differences, 95% confidence intervals, and surface under the cumulative ranking scores of eleven indicators. Statistical analysis was performed using R statistical software with the GeMTC package based on the Bayesian framework.
Six interventions and 667 patients were involved in 18 studies. In comparison with the tooth-anchored groups, the bone-anchored groups showed significantly more increases in Sella-Nasion-Subspinale (°), Subspinale-Nasion-Supramentale(°) and significantly fewer increases in mandibular plane angle and the labial proclination angle of upper incisors. In comparison with the control group, Sella-Nasion-Supramentale(°) decreased without any statistical significance in all treated groups. IMPA (angle of lower incisors and mandibular plane) decreased in groups with facemasks and increased in other groups.
Bone-anchored maxillary protraction can promote greater maxillary forward movement and correct the Class III intermaxillary relationship better, in addition to showing less clockwise rotation of mandible and labial proclination of upper incisors. However, strengthening anchorage could not inhibit mandibular growth better and the lingual inclination of lower incisors caused by the treatment is related to the use of a facemask.
本研究旨在通过网络荟萃分析评估不同类型骨锚式上颌前牵引装置的临床效果。
我们检索了七个数据库，以查找截至2021年5月比较骨锚式上颌前牵引与牙锚式上颌前牵引干预措施或未治疗组的随机对照临床试验。经过文献筛选、数据提取和质量评估后，我们计算了11项指标的平均差异、95%置信区间和累积排序曲线下面积。使用基于贝叶斯框架的R统计软件和GeMTC包进行统计分析。
18项研究涉及6种干预措施和667例患者。与牙锚式组相比，骨锚式组在蝶鞍-鼻根-前鼻棘（°）、前鼻棘-鼻根-上唇沟（°）方面的增加显著更多，而下颌平面角和上切牙唇倾度的增加显著更少。与对照组相比，所有治疗组的蝶鞍-鼻根-上唇沟（°）均有下降，但无统计学意义。戴面罩组的IMPA（下切牙与下颌平面夹角）下降，其他组则上升。
骨锚式上颌前牵引除了能减少下颌顺时针旋转和上切牙唇倾外，还能促进上颌更大程度地向前移动，并更好地纠正III类颌间关系。然而，增强支抗并不能更好地抑制下颌生长，且治疗引起的下切牙舌倾与面罩的使用有关。
