与固定正畸治疗相比，透明牙套中的白色斑点病变、菌斑堆积和与唾液相关的龋齿细菌。系统评价和荟萃分析。
White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta- analysis.
机构信息
College of Dental Medicine, QU Health, Qatar University, Doha, P.O. Box: 2713, Qatar.
Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar.
出版信息
BMC Oral Health. 2023 Aug 27;23(1):599. doi: 10.1186/s12903-023-03257-8.
OBJECTIVE
To analyse the available evidence regarding the incidence and severity of white spot lesions (WSLs), plaque accumulation and salivary caries-associated bacteria(SCB) in clear aligners (CA) verses conventional fixed (CF) orthodontic appliances.
METHODS
Electronic searches of MEDLINE, Scopus, Embase, Google Scholar, Clinical trial registry, OpenGrey and ProQuest were done for all relevant studies. Eligibility criteria were; Randomized Controlled Trials and Non-Randomized Studies that compared the incidence and severity of WSLs, plaque accumulation and SCB between CA and CF appliances in patients undergoing orthodontic treatment. The risk of bias(ROB) and certainty of evidence was assessed independently by two reviewers using Cochrane's ROB and GRADEpro, respectively. Standardized mean difference (SMD) was used to estimate the effect size using STATA 17 software.
RESULTS
A total of 14 studies met the eligibility criteria, and eight were suitable for meta-analysis. The qualitative results showed lower incidence and severity of WSLs, plaque accumulation, and SCB in CA group compared to CF appliances. The pooled results showed significantly lower plaque accumulation(SMD - 1.58;95%CI:-2.57,0.58;p = 0.002) in CA compared to CF appliances.
CONCLUSIONS
A moderate-quality evidence reveals less plaque accumulation and less SCB in CA, which might be related to the reduced incidence and severity of WSLs associated with CA when compared with CF appliances. However, the results of the present study should be interpreted with caution given the high ROB among some of the included studies as well as the marked heterogeneity across the studies.
CLINICAL RELEVANCE
For patients who can be treated with either CA or CF appliances, CA may be a better choice concerning oral health.
REGISTRATION
Open Science Framework (DOI: https://doi.org/10.17605/osf.io/kcpvb ).
目的
分析有关隐形矫治器（CA）与传统固定矫治器（CF）相比，在白斑病（WSL）的发生率和严重程度、菌斑积聚和与唾液龋相关的细菌（SCB）方面的证据。
方法
对 MEDLINE、Scopus、Embase、Google Scholar、临床试验注册处、OpenGrey 和 ProQuest 进行电子检索，以查找所有相关研究。纳入标准为：比较 CA 和 CF 矫治器在接受正畸治疗的患者中 WSL 发生率和严重程度、菌斑积聚和 SCB 的随机对照试验和非随机研究。使用 Cochrane 的 ROB 和 GRADEpro 分别由两名评审员独立评估偏倚风险（ROB）和证据确定性。使用 STATA 17 软件，使用标准化均数差（SMD）来估计效应量。
结果
共有 14 项研究符合纳入标准，其中 8 项适合进行荟萃分析。定性结果表明，CA 组的 WSL 发生率和严重程度、菌斑积聚和 SCB 较低。汇总结果显示，CA 组的菌斑积聚明显低于 CF 组（SMD-1.58；95%CI：-2.57，0.58；p=0.002）。
结论
中等质量证据表明 CA 组的菌斑积聚和 SCB 较少，这可能与 CA 组与 CF 组相比，WSL 的发生率和严重程度降低有关。然而，鉴于一些纳入研究的 ROB 较高，以及研究之间的显著异质性，本研究的结果应谨慎解释。
临床相关性
对于可以用 CA 或 CF 矫治器治疗的患者，CA 可能是一个更好的选择，因为它对口腔健康有益。
注册
开放科学框架（DOI：https://doi.org/10.17605/osf.io/kcpvb）。
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