Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom.
Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, Qassim, Saudi Arabia.
Am J Orthod Dentofacial Orthop. 2023 Sep;164(3):368-376. doi: 10.1016/j.ajodo.2023.02.009. Epub 2023 Mar 24.
The debate about whether malocclusion can or should be treated with or without extraction of premolars continues. This scoping review quantifies the literature, summarizes the outcomes researched and methods, and proposes a way to reduce uncertainty in this area.
Electronic and gray literature searches were undertaken without language restriction, but non-English language titles and abstracts were not translated. A minimum of 2 people independently screened the titles and abstracts.
Searches identified 9010 articles, of which 3851 were duplicates; 5159 were screened, and 4617 were excluded (1092 laboratory or animal studies, 1219 case reports or series, 2306 with no information). By consensus, 399 articles contained information concerning differences between orthodontic patients treated with or without premolar extractions (143 were unclear). The majority (n = 372) reported outcomes in 8 areas. Fifty-seven were review articles (32 systematic reviews and 25 nonsystematic reviews or opinions). The most common research design in the remainder was a cohort (n = 280, 82% of 342 articles reporting primary data), of which a very large majority were considered retrospective (n = 249, 89% of articles reported for subjects over ≥2 time points). Only 28 (8% of articles reporting primary data) were judged to involve prospective data collection (4 randomized controlled trials [RCTs], 23 cohorts, 1 unclear design). Excluding reviews and unclear articles, 99% (332 out of 336) were considered observational research and only 1% were interventional.
There was limited low-quality evidence that extracting premolars in orthodontic patients have a possible negative effect in 2 outcome areas and a positive effect in 1 outcome area. Most study reports were of low methodological quality, and further reviews are unlikely to provide new information. Investigators should concentrate on collecting primary data of outcomes important to patients. A protocol has been made available to help reduce methodological differences, assist future meta-analyses and increase the generalizability of findings: https://doi.org/10.17605/OSF.IO/CQ49Y.
关于错颌畸形是否可以或应该通过不拔除前磨牙或拔牙来治疗的争论仍在继续。本范围综述定量评估了文献，总结了研究和方法的结果，并提出了一种减少该领域不确定性的方法。
电子和灰色文献检索没有语言限制，但未翻译非英语语言的标题和摘要。至少有 2 人独立筛选标题和摘要。
检索共确定了 9010 篇文章，其中 3851 篇是重复的；筛选了 5159 篇文章，排除了 4617 篇（1092 篇为实验室或动物研究，1219 篇为病例报告或系列，2306 篇没有信息）。通过共识，399 篇文章包含了关于正畸患者接受或不接受前磨牙拔牙治疗差异的信息（143 篇信息不明确）。大多数（n=372）报告了 8 个领域的结果。57 篇为综述文章（32 篇系统评价和 25 篇非系统评价或意见）。其余的最常见研究设计是队列（n=280，342 篇报告原始数据的文章中，82%为回顾性），其中绝大多数为回顾性（n=249，89%的文章报告了≥2 个时间点的受试者）。只有 28 篇（8%报告原始数据的文章）被认为涉及前瞻性数据收集（4 项随机对照试验[RCT]，23 项队列研究，1 项设计不明确）。不包括综述和不明确的文章，99%（332 篇中的 336 篇）被认为是观察性研究，只有 1%是干预性研究。
有有限的低质量证据表明，在正畸患者中拔除前磨牙可能对 2 个结果领域有负面影响，对 1 个结果领域有正面影响。大多数研究报告的方法学质量较低，进一步的综述不太可能提供新的信息。研究人员应集中精力收集对患者重要的结果的原始数据。已经制定了一个方案，以帮助减少方法学差异，协助未来的荟萃分析，并提高研究结果的普遍性：https://doi.org/10.17605/OSF.IO/CQ49Y。
