Kalluf Gabriel Haddad, Tatim Thiago, Sell Priscila, Takeshita Karolina, Romanini Érika, Granjeiro José Mauro, Andrighetto Augusto Ricardo
Regional University of Blumenau, SC, Brazil; Faculdade Ilapeo, Curitiba, PR, Brazil.
Faculdade Ilapeo, Curitiba, PR, Brazil.
Br J Oral Maxillofac Surg. 2024 Dec;62(10):909-916. doi: 10.1016/j.bjoms.2024.09.001. Epub 2024 Sep 11.
This systematic review aimed to evaluate the available evidence on the incidence and quantification of 3-dimensional changes in mandibular condyles after orthognathic surgery by bilateral sagittal split osteotomy (BSSO), with or without maxillary surgery, in class III symmetrical or asymmetrical individuals. The databases PubMed, Lilacs, Web of Science, Embase, SciELO, Scopus, EBSCO, Cochrane, and Google Scholar were surveyed and the study was registered on the PROSPERO (CRD42022383594). The selected studies met the criteria established by the PICO model: 1: Population - individuals over 18 years of age with class III dentofacial skeletal deformities; 2: Intervention - orthognathic surgery using BSSO; 3: Comparison - condylar tomographic measurements (volume, thickness, height, and width) prior to the surgical procedure; and 4: Results - condylar tomographic measurements (volume, thickness, height, and width) at least 12 months after surgery. Initially, 800 articles were identified. After excluding 694 duplicates and screening 153, nine studies met the inclusion criteria for data extraction and analysis. Six evaluated class III symmetrical individuals, and three assessed those with mandibular asymmetry. A total of 233 patients (92 males and 141 females) were studied. Analysis of 466 condyles revealed minimal bone remodelling, with resorption averaging from -0.03 to -0.94 mm and apposition from 0.01 to 0.34 mm. Data analysis showed minimal changes in condylar morphology post BSSO with or without maxillary surgery, indicating predictable skeletal stability. Bias (ACROBAT-NRSI guidelines) did not affect data reliability, and no occlusal changes were observed. The main limitations of the study were heterogeneous imaging techniques, varied study designs, diverse populations, and inconsistent protocols. Further trials with standardised cone-beam computed tomography are needed to enhance remodelling and volume measurement reliability. This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
本系统评价旨在评估关于正颌手术（采用双侧矢状劈开截骨术[BSSO]，无论是否联合上颌手术）后，III类对称或不对称个体下颌髁突三维变化的发生率及量化的现有证据。对PubMed、Lilacs、科学网、Embase、SciELO、Scopus、EBSCO、Cochrane和谷歌学术等数据库进行了检索，该研究已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42022383594）登记。所选研究符合PICO模型制定的标准：1. 研究对象——18岁以上患有III类牙颌面骨骼畸形的个体；2. 干预措施——采用BSSO的正颌手术；3. 对照——手术前髁突断层测量（体积、厚度、高度和宽度）；4. 结果——手术后至少12个月的髁突断层测量（体积、厚度、高度和宽度）。最初，共识别出800篇文章。排除694篇重复文章并筛选153篇后，有9项研究符合数据提取和分析的纳入标准。其中6项评估III类对称个体，3项评估下颌不对称个体。共研究了233例患者（92例男性和141例女性）。对466个髁突的分析显示，骨重塑程度极小，吸收平均为-0.03至-0.94毫米，增生为0.01至0.34毫米。数据分析表明，无论是否联合上颌手术，BSSO术后髁突形态变化极小，表明骨骼稳定性可预测。偏倚（采用ACROBAT-NRSI指南评估）未影响数据可靠性，且未观察到咬合变化。本研究的主要局限性在于成像技术异质性、研究设计多样、研究人群不同以及方案不一致。需要进一步开展采用标准化锥形束计算机断层扫描技术的试验，以提高重塑和体积测量的可靠性。本研究未获得公共、商业或非营利部门资助机构的特定资助。
