Omidkhoda Maryam, Bardideh Erfan, Jahanbin Arezoo, Zarei Milad
Department of Orthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
J Dent Res Dent Clin Dent Prospects. 2023 Fall;17(4):196-210. doi: 10.34172/joddd.2023.40754. Epub 2023 Dec 30.
Posterior intrusion with skeletal anchorage is one of the effective methods in the treatment of anterior open bite. Knowing the effects of posterior intrusion, the amount of possible molar intrusion using skeletal anchorage, and its impact on clinical and cephalometric indicators can help the clinician choose the optimal treatment method, especially in borderline surgical cases.
In this systematic review, a series of articles were collected through a systematic search in databases, and the titles and summaries of all these articles were reviewed. After removing the irrelevant articles, the full texts of the related articles were read carefully, and their validity was evaluated. Only RCTs and observational studies that complied with PICO questions were included. The Cochrane Risk of Bias 2.0 (RoB 2), ROBINS-I, and GRADE were used to assess the risk of bias in the included studies. The relevant information on selected articles was extracted, and a meta-analysis was performed with Review Manager 5.4 software.
The meta-analysis revealed a significant average molar intrusion of 2.89 mm using temporary anchorage devices (TADs). A subgroup analysis showed that miniplates achieved greater intrusion (3.29 mm) compared to miniscrews (2.25 mm) (=0.03). The level of applied force did not significantly affect the degree of intrusion. Dental parameters such as overbite and overjet were notably altered, with overbite increasing by 4.81 mm and overjet decreasing by 2.06 mm on average. As for the skeletal cephalometric characteristics, SNB, ANB, and SN-Pog increased while mandibular plane angle and lower anterior facial height (LAFH) decreased, and these changes were significant. Meanwhile, SNA and palatal angle changes were not significant.
TADs have proved effective in achieving significant intrusion of maxillary molars, leading to marked improvements in dental and skeletal characteristics in patients with open bite malocclusion. Miniplates proved more effective in achieving greater intrusion.
利用骨支抗进行后牙压低是治疗前牙开（牙合）的有效方法之一。了解后牙压低的效果、使用骨支抗可能实现的磨牙压低量及其对临床和头影测量指标的影响，有助于临床医生选择最佳治疗方法，尤其是在临界手术病例中。
在本系统评价中，通过在数据库中进行系统检索收集了一系列文章，并对所有这些文章的标题和摘要进行了审查。去除无关文章后，仔细阅读相关文章的全文，并对其有效性进行评估。仅纳入符合PICO问题的随机对照试验（RCT）和观察性研究。使用Cochrane偏倚风险2.0（RoB 2）、ROBINS - I和GRADE来评估纳入研究中的偏倚风险。提取所选文章的相关信息，并使用Review Manager 5.4软件进行荟萃分析。
荟萃分析显示，使用临时支抗装置（TADs）平均磨牙压低量显著为2.89 mm。亚组分析表明，与微型螺钉（2.25 mm）相比，微型钛板实现了更大的压低量（3.29 mm）（P = 0.03）。施加力的水平对压低程度没有显著影响。覆（牙合）和覆盖等牙齿参数有明显改变，覆（牙合）平均增加4.81 mm，覆盖平均减少2.06 mm。至于骨骼头影测量特征，SNB、ANB和SN - Pog增加，而下颌平面角和下前牙面部高度（LAFH）降低，且这些变化具有显著性。同时，SNA和腭平面角变化不显著。
已证明TADs在实现上颌磨牙显著压低方面有效，可使开（牙合）错（牙合）患者的牙齿和骨骼特征得到显著改善。微型钛板在实现更大压低量方面被证明更有效。
