Kathem Sarah J, Pedersen Thomas K
Department of Oral and Maxillofacial Surgery, University hospital of Zealand, Køge Hospital, Lykkebækvej 1, 4600 Køge, Denmark.
Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000 Aarhus C, Denmark.
Eur J Orthod. 2025 Jun 12;47(4). doi: 10.1093/ejo/cjaf023.
The aim of the systematic review and meta-analysis is to compare the efficacy of 4 different bone-anchored maxillary protraction techniques: 1) bone-anchored maxillary elastics (BAMP), 2) maxillary bone anchors combined with facemask (BAFM), 3) hybrid hyrax combined with facemask (HHFM) and 4) hybrid hyrax combined with mandibular bone anchors (HH-BAMP).
The search was performed in four electronic databases: Pubmed, Embase, Scopus and Web of Science. In addition, the reference lists of eligible articles have been hand-searched.
Study designs included: randomized controlled trials, non-randomized controlled trials, case-control studies including more than 4 patients.
Qualitative and quantitative information were extracted for each study including author, year of publication, study type, sample size, chronological age of patient group pretreatment (years), skeletal maturity stage, gender (female/male), treatment duration (months), treatment type, type of skeletal anchorage, force magnitude (grams), duration of protraction (hours), RME or Alt-RAMEC and cephalometric measurements.Statistical heterogeneity was assessed by a stratified analysis for mean difference (MD) and a graphical display of the estimated treatment effects. A meta-analysis comparing treatment effects for the four groups were only made if two or more outcomes were reported.
653 articles were initially screened, 25 full-text articles satisfied the inclusion criteria including 6 randomized controlled trials. Comparing the four maxillary protraction protocols, SNA improved significantly more in group 4 compared to the other groups including group 1 (mean difference 1.9, 95% confidence interval [CI] 1.6-2.1; p < 0.001).Treatment with facemask (group 2) seemed to increase the lingual inclination of the lower incisors (IMPA) while in the other groups, proclination of the lower incisors were evident.
The level of evidence in the selected articles ranged from low to moderate. The current evidence suggests that skeletally anchored rapid maxillary expansion combined with maxillary protraction with mandibular bone anchors yields the greatest maxillary advancement in cl.III patients.
The study has been registered at PROSPERO with registration number CRD42023380964.
本系统评价和荟萃分析的目的是比较4种不同的骨锚式上颌前牵引技术的疗效：1）骨锚式上颌弹力牵引（BAMP），2）上颌骨锚与面罩联合使用（BAFM），3）混合式Hyrax与面罩联合使用（HHFM），4）混合式Hyrax与下颌骨锚联合使用（HH - BAMP）。
在四个电子数据库中进行检索：PubMed、Embase、Scopus和Web of Science。此外，还手动检索了符合条件的文章的参考文献列表。
研究设计包括：随机对照试验、非随机对照试验、病例对照研究（患者超过4例）。
提取每项研究的定性和定量信息，包括作者、发表年份、研究类型、样本量、治疗前患者组的实际年龄（岁）、骨骼成熟阶段、性别（女性/男性）、治疗持续时间（月）、治疗类型、骨骼锚固类型、力的大小（克）、牵引持续时间（小时）、快速上颌扩弓或交替快速扩弓及头影测量。通过对平均差（MD）的分层分析和估计治疗效果的图形显示来评估统计异质性。只有在报告了两个或更多结果时，才对四组的治疗效果进行荟萃分析。
最初筛选了653篇文章，25篇全文文章符合纳入标准，其中包括6项随机对照试验。比较四种上颌前牵引方案，与其他组（包括第1组）相比，第4组的SNA改善更为显著（平均差1.9，95%置信区间[CI]1.6 - 2.1；p < 0.001）。使用面罩治疗（第2组）似乎会增加下切牙的舌倾度（IMPA），而在其他组中，下切牙前倾明显。
所选文章的证据水平从低到中等。目前的证据表明，在Ⅲ类患者中，骨骼锚固式快速上颌扩弓联合下颌骨锚进行上颌前牵引可实现最大的上颌前移。
该研究已在PROSPERO注册，注册号为CRD42023380964。
