PhD student, Department of Orthodontics, University of Hama Dental School, Hama, Syria.
Professor of Orthodontics, Department of Orthodontic, University of Hama Dental School, Hama, Syria.
Clin Oral Investig. 2024 May 23;28(6):333. doi: 10.1007/s00784-024-05728-w.
The objective of this review is to assess the effect of total maxillary arch distalization (TMAD) treatment on the dental, skeletal, soft tissues, and airways during non-extraction camouflage treatment of class II division 1 patients.
We performed a systematic review of the published data in four electronic databases up to April 2023. We considered studies for inclusion if they were examining the effects of TMAD during treatment of class II division 1 malocclusion in the permanent dentition. Study selection, data extraction, risk of bias assessment, and assessment of the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool were performed in duplicate.
Out of the 27 articles that met the initial eligibility criteria, 19 studies were finally selected. Fair to relatively good quality evidence was identified after the risk of bias assessment of the included studies. Out of the 19 selected studies, 5 studies used inter-radicular TADs, 10 studies used modified C- palatal plate (MCPP), 3 studies used infra zygomatic crest (IZC) TADs, 1 study compared buccal TADs versus MCPP, and 1 study compared between cervical headgear and MCPP. The maximum amount of maxillary arch distalization using buccal TADs, MCPP, IZC TADs, and headgear was 4.2mm, 5.4mm, 5mm, and 2.5mm respectively. Different results regarding the amount of dental, skeletal, and soft tissue changes were observed.
The current low to very low certainty level of evidence suggests that TMAD is effective in camouflaging class II division 1 malocclusion. Future well-conducted and clearly reported randomized controlled trials that include a control group are needed to make robust recommendations regarding the effect of TMAD with different appliances on dental, skeletal, and soft tissue structures.
TMAD should be given priority with caution in class II patients who refuse the extraction of premolars. TMAD may be considered an adjunctive approach to solve cases associated with high anchorage need or anchorage loss.
本综述旨在评估上颌全弓远移（TMAD）治疗在不拔牙掩饰性治疗安氏Ⅱ类 1 分类错（牙合）患者中对牙齿、骨骼、软组织和气道的影响。
我们对截至 2023 年 4 月发表的文献进行了系统回顾，共在四个电子数据库中检索。我们考虑纳入的研究是检查 TMAD 在治疗恒牙安氏Ⅱ类 1 分类错（牙合）中的作用。研究选择、数据提取、偏倚风险评估以及使用推荐评估、制定与评价（GRADE）工具评估证据强度均由两人进行。
在符合初始纳入标准的 27 篇文章中，最终有 19 篇研究入选。经过对纳入研究的偏倚风险评估，发现了质量为中等或较高的证据。在 19 项入选研究中，有 5 项研究使用了根间 TAD，10 项研究使用了改良 C-腭板（MCPP），3 项研究使用了颧牙槽嵴 TAD，1 项研究比较了颊侧 TAD 与 MCPP，1 项研究比较了颈带与 MCPP。使用颊侧 TAD、MCPP、颧牙槽嵴 TAD 和颈带时，上颌弓最大远移量分别为 4.2mm、5.4mm、5mm 和 2.5mm。观察到牙齿、骨骼和软组织变化的量有不同的结果。
目前证据的确定性水平为低到极低，表明 TMAD 对掩饰安氏Ⅱ类 1 分类错（牙合）有效。需要未来进行良好设计且报告清晰的随机对照试验，纳入对照组，以便就不同矫治器 TMAD 对牙齿、骨骼和软组织结构的影响提出可靠建议。
对于拒绝拔除前磨牙的安氏Ⅱ类患者，应谨慎优先考虑 TMAD。TMAD 可被视为解决高支抗需求或支抗丧失相关病例的辅助方法。
