Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland.
Department of Paediatric Oral Heath and Orthodontics, University Centre for Dental Medicine UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland.
Eur J Orthod. 2024 Dec 1;46(6). doi: 10.1093/ejo/cjae060.
Several appliances or treatment protocols are marketed to either patients or orthodontists as being associated with improved orthodontic outcomes. However, clinical decision-making should be based on robust scientific evidence and not marketing claims or anecdotal evidence.
To identify appliances/protocols being associated with improved outcomes of fixed appliance treatment.
Unrestricted literature searches in seven databases/registers for human studies until March 2024.
Randomized or quasi-randomized clinical trials on human patients of any age, sex, or ethnicity receiving comprehensive orthodontic treatment with fixed appliances and assessing occlusal outcome with either the Peer Assessment Rating (PAR) or the American Board of Orthodontics-Objective Grading System (ABO-OGS) index.
Duplicate/independent study selection, data extraction, and risk of bias assessment with the Cochrane RoB 2 tool. Random-effects meta-analyses of averages or mean differences with their 95% Confidence Intervals (CI), followed by meta-regression/subgroup/sensitivity analyses and assessment of the quality of clinical recommendations with the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Data from 20 small- to moderately-sized trials covering 1470 patients indicated that orthodontic treatment with fixed appliances is effective and results on average in a final PAR score of 6.0 points (95% CI 3.9-8.2 points), an absolute PAR reduction of 23.0 points (95% CI 15.6-30.4 points), a % PAR reduction of 82.6% (95% CI 70.8%-94.4%), and an absolute ABO-OGS score of 18.9 points (95% CI 11.7-26.2 points). However, very high between-study heterogeneity (I2 > 75%) was seen for both PAR and ABO-OGS. Extraction treatment was associated with significantly better occlusal outcome than non-extraction treatment with ABO-OGS (12.9 versus 16.6 points; P = .02). There was no statistically significant difference in occlusal outcome with (i) 0.018″-slot or 0.022″-slot brackets; (ii) customized or prefabricated brackets; (iii) anchorage reinforcement with temporary anchorage devices; (iv) use of vibrational adjuncts; and (v) aligners or fixed appliances (P > .05 in all instances), while small benefits were seen with indirectly bonded brackets.
Considerable between-study heterogeneity exists in the reported occlusal outcome of fixed appliance treatment, and different appliances or adjuncts have little effect on this. Standardization and/or automatization of the scoring procedures for PAR and ABO-OGS might help to improve consistency and reliability of outcome measurement in orthodontic trials.
PROSPERO (CRD42024525088).
有几种器械或治疗方案被宣传为可以改善正畸治疗效果，无论是针对患者还是正畸医生。然而，临床决策应该基于可靠的科学证据，而不是营销宣传或轶事证据。
确定与固定矫治器治疗结果改善相关的器械/方案。
截至 2024 年 3 月，在七个数据库/注册中心对人类研究进行无限制的文献检索。
年龄、性别或种族不限的接受全面正畸治疗的固定矫治器治疗的人类患者的随机或准随机临床试验，使用同伴评估等级（PAR）或美国正畸医师协会-客观分级系统（ABO-OGS）指数评估咬合结果。
使用 Cochrane RoB 2 工具进行重复/独立的研究选择、数据提取和偏倚风险评估。使用随机效应荟萃分析平均值或均值差异及其 95%置信区间（CI），然后进行荟萃回归/亚组/敏感性分析，并使用推荐分级、评估、开发和评估（GRADE）方法评估临床推荐的质量。
来自 20 项小型到中等规模试验的数据涵盖了 1470 名患者，表明固定矫治器治疗是有效的，平均最终 PAR 评分为 6.0 分（95%CI 3.9-8.2 分），PAR 绝对减少 23.0 分（95%CI 15.6-30.4 分），PAR 减少百分比为 82.6%（95%CI 70.8%-94.4%），ABO-OGS 绝对评分 18.9 分（95%CI 11.7-26.2 分）。然而，PAR 和 ABO-OGS 的异质性都非常高（I2>75%）。与非拔牙治疗相比，拔牙治疗与更好的咬合结果相关（ABO-OGS 为 12.9 分比 16.6 分；P=0.02）。在（i）0.018″-槽或 0.022″-槽托槽；（ii）定制或预制托槽；（iii）使用临时锚固装置增强锚固；（iv）使用振动辅助装置；以及（v）直丝弓矫治器或固定矫治器（所有情况下 P>.05）方面，没有观察到咬合结果有统计学意义上的差异，而间接粘接托槽则显示出较小的益处。
固定矫治器治疗的报告咬合结果存在相当大的研究间异质性，并且不同的器械或辅助物对其影响很小。PAR 和 ABO-OGS 的评分程序的标准化和/或自动化可能有助于提高正畸试验中结果测量的一致性和可靠性。
PROSPERO（CRD42024525088）。
