Kuc Anna Ewa, Kotuła Jacek, Nahajowski Marek, Warnecki Maciej, Lis Joanna, Amm Ellie, Kawala Beata, Sarul Michał
Dental Star Specjalistyczne Centrum Stomatologii Estetycznej, 15-215 Bialystok, Poland.
Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland.
Diagnostics (Basel). 2022 Jul 1;12(7):1611. doi: 10.3390/diagnostics12071611.
There are various methods of controlling the inclination of the incisors during retraction, but there is no evidence as to the advantages of some methods over others. The purpose of this systematic review and meta-analysis was to determine the effectiveness of the methods used to control torque during anterior teeth retraction.
In accordance with the PRISMA guidelines, the main research question was defined in the PICO format [P: patients with complete permanent dentition; I: the maxillary incisor torque after (I) and before I retraction with straight-wire appliance and different modes of torque control; O: statistically significant differences in torque values of the upper incisors after orthodontic treatment]. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for keywords combining: retraction orthodontics, torque control orthodontics, torque orthodontics, inclination orthodontics, torque control retraction. The articles were subjected to risk of bias and quality analyses with the ROBINS-I protocol and the modified Newcastle-Ottawa QAS, respectively. Meta-analyses were performed with both fixed- and random-effects models.
13 articles were selected in which total number of 580 subjects took part. In all studies, incisors were retroclined during retraction by 2.46° (mean difference), which was statistically significant. Considering the articles separately, the differences in torque between the study group and the control group were statistically significant in six articles. The Q statistic was 36.25 with = 0.0003 and I = 66.9%, which indicated a high level of study heterogeneity.
Both properly performed corticotomy and en-masse retraction using orthodontic microimplants seem to be the most effective and scientifically validated methods of torque control. Further high-quality research is needed to perform better quality analyses and draw more reliable conclusions.
在牙齿后移过程中，有多种控制切牙倾斜度的方法，但尚无证据表明某些方法优于其他方法。本系统评价和荟萃分析的目的是确定在前牙后移过程中用于控制扭矩的方法的有效性。
按照PRISMA指南，主要研究问题采用PICO格式定义[P：恒牙列完整的患者；I：使用直丝弓矫治器及不同扭矩控制模式进行切牙后移前后的上颌切牙扭矩；O：正畸治疗后上切牙扭矩值的统计学显著差异]。在MEDLINE、EMBASE和Cochrane对照试验中央注册库数据库中搜索组合关键词：正畸后移、扭矩控制正畸、扭矩正畸、倾斜正畸、扭矩控制后移。分别采用ROBINS-I方案和改良的纽卡斯尔-渥太华质量评估量表对文章进行偏倚风险和质量分析。采用固定效应模型和随机效应模型进行荟萃分析。
共纳入13篇文章，580名受试者参与。在所有研究中，切牙在向后移动过程中平均后倾2.46°（平均差异），具有统计学意义。单独考虑这些文章，6篇文章中研究组与对照组之间的扭矩差异具有统计学意义。Q统计量为36.25，P = 0.0003，I² = 66.9%，表明研究异质性较高。
正确实施的皮质切开术和使用正畸微种植体的整体后移似乎是最有效且经过科学验证的扭矩控制方法。需要进一步开展高质量研究，以进行更好的质量分析并得出更可靠的结论。
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