“Tsis txhob ua xyem xyav tias ib pawg me me ntawm cov neeg xav txog, cov pej xeem mob siab rau tuaj yeem hloov pauv lub ntiaj teb.Qhov tseeb, nws tsuas yog ib qho nyob ntawd. "
Cureus 'lub hom phiaj yog los hloov tus qauv ntev ntawm kev tshaj tawm kho mob, uas qhov kev tshawb fawb xa tuaj yuav kim, nyuaj, thiab siv sijhawm.
Puv thickness mucoperiosteal nrov plig plawg, mop, piezotomy, corticotomy, lllt, prostaglandin, ceev cov hniav txav, orthodontic, tsis yog phais, phais
Doaa Tahsin Alfaylani, Mohammad Y. Hajir, Ahmad S. Burhan, Luai Mahahini, Khaldun Darwich, Ossama Aljabban
Cite tsab xov xwm no li: Alfailany D, Hajeer MY, Burhan AS, et al.(Tsib Hlis 27, 2022) Kev ntsuas qhov ua tau zoo ntawm kev phais thiab kev phais tsis yog kev phais thaum siv nrog cov neeg tuav pov hwm txhawm rau txhawm rau txhawm rau txhuam hniav: kev tshuaj xyuas zoo.Kho 14(5): e25381.doi: 10.7759/cureus.25381
Lub hom phiaj ntawm qhov kev tshuaj xyuas no yog los soj ntsuam cov pov thawj tam sim no rau kev ua tau zoo ntawm kev phais thiab tsis yog phais acceleration thiab cov kev mob tshwm sim cuam tshuam nrog cov txheej txheem no.Cuaj lub databases tau tshawb nrhiav: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE®, Scopus®, PubMed®, Web of Science™, Google™ Scholar, Trip, OpenGrey thiab PQDT OPEN ntawm pro-Quest®.ClinicalTrials.gov thiab tshawb nrhiav portal ntawm International Clinical Trials Registry Platform (ICTRP) tau raug tshuaj xyuas los tshuaj xyuas cov kev tshawb fawb tam sim no thiab cov ntaub ntawv tsis tau tshaj tawm.Randomized controlled trials (RCTs) thiab tswj kev sim tshuaj ntsuam xyuas (CCTs) ntawm cov neeg mob uas raug kev phais (invasive los yog minimally invasive techniques) ua ke nrog cov tsoos tsau cov cuab yeej thiab piv nrog cov kev pab cuam uas tsis yog phais.Cov cuab yeej Cochrane Risk of Bias (RoB.2) tau siv los ntsuas RCTs, thaum lub cuab yeej ROBINS-I tau siv rau CCT.
Plaub RCTs thiab ob CCTs (154 tus neeg mob) tau suav nrog hauv qhov kev tshuaj xyuas no.Plaub qhov kev sim tau pom tias kev phais thiab kev phais tsis yog kev phais muaj qhov cuam tshuam zoo ib yam rau kev ua kom cov hniav txav ceev (OTM).Hauv qhov sib piv, kev phais tau zoo dua hauv lwm qhov kev tshawb fawb ob.Ib qib siab ntawm heterogeneity ntawm cov kev tshawb fawb suav nrog precluded quantitative synthesis ntawm cov txiaj ntsig.Tshaj tawm cov kev mob tshwm sim cuam tshuam nrog kev phais thiab kev phais uas tsis yog phais tau zoo sib xws.
Muaj 'qis heev' rau 'qis' pov thawj tias kev phais thiab kev phais tsis yog kev phais tau muaj txiaj ntsig zoo sib xws hauv kev ua kom cov hniav txav ntawm cov hniav uas tsis muaj qhov sib txawv ntawm cov kev mob tshwm sim.Ntau qhov kev sim tshuaj zoo tshaj yog xav tau los sib piv cov teebmeem ntawm kev nrawm ntawm ob qho kev hloov hauv ntau hom malocclusion.
Lub sijhawm ntawm kev kho mob rau ib qho kev cuam tshuam orthodontic yog ib qho tseem ceeb uas cov neeg mob xav txog thaum txiav txim siab [1].Piv txwv li, retraction ntawm qhov siab tshaj plaws anchored canines tom qab rho tawm ntawm premolars sab sauv tuaj yeem siv li 7 lub hlis, thaum tus nqi ntawm bioorthodontic hniav txav (OTM) yog kwv yees li 1 hli ib hlis, uas ua rau tag nrho cov sij hawm kho mob ntawm kwv yees li ob xyoos [2, 3. ].Mob, tsis xis nyob, caries, gingival recession thiab hauv paus resorption yog cov kev phiv uas ua rau kom lub sij hawm ntawm orthodontic kho [4].Tsis tas li ntawd, kev zoo nkauj thiab kev sib raug zoo ua rau ntau tus neeg mob xav kom ua tiav kev kho hniav sai sai [5].Yog li ntawd, ob qho tib si orthodontists thiab cov neeg mob nrhiav kom nrawm nrawm ntawm cov hniav thiab txo lub sijhawm kho [6].
Cov txheej txheem los ntawm kev txav ntawm cov hniav kom nrawm yog nyob ntawm kev ua kom cov kab mob lom cov tshuaj tiv thaiv.Raws li qib ntawm invasiveness, cov txheej txheem no tuaj yeem muab faib ua ob pawg: kev saib xyuas (biological, lub cev, thiab biomechanical txoj kev) thiab txoj kev phais [7].
Kev siv tshuaj lom neeg muaj xws li kev siv tshuaj tua kab mob txhawm rau txhawm rau txhim kho hniav hauv kev sim tsiaj thiab hauv tib neeg.Ntau cov kev tshawb fawb tau pom tias muaj txiaj ntsig tiv thaiv feem ntau ntawm cov tshuaj no xws li cytokines, nuclear factor kappa-B ligand receptor activators / nuclear factor-kappa-B protein receptor activators (RANKL / RANK), prostaglandins, vitamin D, cov tshuaj hormones xws li parathyroid hormone (PTH. ).) thiab osteocalcin, nrog rau kev txhaj tshuaj ntawm lwm yam tshuaj xws li relaxin, tsis tau pom muaj kev ua tau zoo sai [8].
Kev siv lub cev yog ua raws li kev siv cov cuab yeej kho mob, suav nrog tam sim no ncaj qha [9], pulsed electromagnetic teb [10], kev vibration [11], thiab kev siv laser siv qis [12], uas tau pom cov txiaj ntsig tau zoo [8].].Cov txheej txheem phais yog suav tias yog siv ntau tshaj plaws thiab cov pov thawj hauv kev kho mob thiab tuaj yeem txo cov sijhawm kho mob [13,14].Txawm li cas los xij, lawv vam khom rau "Regional Acceleration Phenomenon (RAP)" txij li thaum qhov tshwm sim ntawm kev phais mob rau cov pob txha alveolar tuaj yeem ua kom nrawm OTM ib ntus [15].Cov kev phais mob no suav nrog cov tshuaj corticotomy [16,17], interstitial alveolar pob txha phais [18], ceev osteogenic orthodontics [19], alveolar traction [13] thiab periodontal traction [20], compression electrotomy [14,21], cortical resection 19] ib.22] thiab microperforation [23].
Ntau qhov kev tshuaj xyuas (SR) ntawm randomized tswj kev sim (RCTs) tau tshaj tawm txog qhov ua tau zoo ntawm kev phais thiab tsis yog phais hauv kev ua kom nrawm OTM [24,25].Txawm li cas los xij, qhov zoo tshaj ntawm kev phais dua li cov txheej txheem tsis phais tsis tau muaj pov thawj.Yog li ntawd, qhov kev tshuaj xyuas qhov systematic (SR) no yog los teb cov lus nug tseem ceeb hauv qab no: Qhov twg yog qhov zoo dua rau kev ua kom cov hniav txhuam hniav kom nrawm dua thaum siv cov cuab yeej kho hniav: kev phais lossis tsis yog phais?
Ua ntej, kev tshawb nrhiav kev sim tau ua nyob rau hauv PubMed kom ntseeg tau tias tsis muaj SRs zoo sib xws thiab txhawm rau txheeb xyuas tag nrho cov ntawv cuam tshuam ua ntej sau cov lus pom zoo SR kawg.Tom qab ntawd, ob qhov kev sim ua tau zoo tau raug txheeb xyuas thiab tshuaj xyuas.Kev tso npe ntawm SR raws tu qauv hauv PROSPERO database tau ua tiav (tus lej cim: CRD42021274312).Qhov SR no tau muab tso ua ke raws li Cochrane Phau Ntawv Qhia Txog Kev Tshawb Fawb Txog Kev Ua Haujlwm [26] thiab Cov Lus Qhia Tshaj Lij Tshaj Lij Tshaj Lij ntawm Cov Lus Qhia rau Kev Ntsuam Xyuas Txheej Txheem thiab Meta-analysis (PRISMA) [27,28].
Txoj kev tshawb no suav nrog cov txiv neej thiab poj niam noj qab haus huv cov neeg mob uas tau txais kev kho mob kho hniav, tsis hais hnub nyoog li cas, hom malocclusion, lossis haiv neeg, raws li Kev Koom Tes Koom Tes, Sib piv, Cov txiaj ntsig, thiab Kev Kawm Tsim (PICOS) qauv.Kev phais ntxiv (invasive lossis minimally invasive) rau kev kho hniav kho hniav yog txiav txim siab.Txoj kev tshawb no suav nrog cov neeg mob uas tau txais kev kho hniav kho hniav (OT) ua ke nrog cov kev pabcuam uas tsis yog phais.Cov kev cuam tshuam no yuav suav nrog kev siv tshuaj (hauv zos lossis hauv cheeb tsam) thiab kev siv lub cev (laser irradiation, hluav taws xob tam sim no, pulsed electromagnetic teb (PEMF) thiab kev co).
Cov txiaj ntsig tseem ceeb ntawm qhov kev ntsuas no yog tus nqi ntawm cov hniav txav (RTM) lossis ib qho kev qhia zoo sib xws uas tuaj yeem qhia peb txog kev ua haujlwm ntawm kev phais thiab tsis yog phais.Cov txiaj ntsig thib ob suav nrog cov txiaj ntsig tsis zoo xws li cov txiaj ntsig tau tshaj tawm ntawm tus neeg mob (mob, tsis xis nyob, txaus siab, qhov ncauj noj qab haus huv ntawm lub neej, kev zom zaub mov nyuaj, thiab lwm yam kev paub), cov txiaj ntsig ntawm cov ntaub so ntswg ntsig txog lub cev raws li ntsuas los ntawm lub sijhawm ntsuas (PI), cov teeb meem. , Gingival Index (GI), poob kev txuas (AT), gingival recession (GR), periodontal tob (PD), poob kev txhawb nqa thiab tsis xav tau cov hniav txav (tilting, twisting, rotation) los yog iatrogenic hniav raug mob xws li cov hniav poob hniav Vitality , Hauv paus Resorption.Tsuas yog ob txoj kev kawm tsim tau raug lees txais - Randomized Controlled Trials (RCTs) thiab Tswj Kev Ntsuam Xyuas Kev Ntsuam Xyuas (CCTs), sau ua lus Askiv nkaus xwb, tsis muaj kev txwv rau xyoo ntawm kev tshaj tawm.
Cov kab lus hauv qab no tsis suav nrog: kev tshawb fawb rov qab, kev tshawb fawb hauv hom lus uas tsis yog lus Askiv, kev sim tsiaj, kev tshawb fawb hauv vitro, cov ntaub ntawv xov xwm lossis cov ntaub ntawv xov xwm, cov ntawv sau, cov ntawv sau nrog cov tshuaj xyuas thiab cov ntawv dawb, cov kev xav ntawm tus kheej, kev sim tsis muaj cov qauv qhia, tsis muaj pab pawg tswj, lossis muaj cov pab pawg tswj tsis tau kho thiab ib pab pawg sim nrog tsawg dua 10 tus neeg mob tau kawm los ntawm cov txheej txheem finite element.
Kev tshawb nrhiav hluav taws xob tau tsim los ntawm cov ntaub ntawv hauv qab no (Lub Yim Hli 2021, tsis muaj sijhawm txwv, Askiv nkaus xwb): Cochrane Central Register of Controlled Trials, PubMed®, Scopus®, Web of Science™, EMBASE®, Google™ Scholar, Trip, OpenGrey (rau kev txheeb xyuas cov ntaub ntawv grey) thiab PQDT OPEN los ntawm pro-Quest® (rau kev txheeb xyuas cov ntaub ntawv thiab cov ntawv tshaj tawm).Cov ntaub ntawv cov npe ntawm cov ntawv xaiv tau raug kuaj xyuas rau ib qho kev sim uas muaj feem cuam tshuam uas tej zaum yuav tsis pom los ntawm kev tshawb nrhiav hluav taws xob hauv Is Taws Nem.Nyob rau tib lub sijhawm, kev tshawb nrhiav phau ntawv tau ua nyob rau hauv Phau Ntawv Xov Xwm ntawm Lub Cev Orthodontics, American Journal of Orthodontics thiab Dentofacial Orthopedics ™, European Journal of Orthodontics thiab Orthodontics thiab Craniofacial Research.ClinicalTrials.gov thiab World Health Organization's International Clinical Trials Registry Platform (ICTRP) tshawb nrhiav portal tau tshawb xyuas hluav taws xob los nrhiav cov kev sim uas tsis tau tshaj tawm lossis tam sim no ua tiav cov kev tshawb fawb.Cov ntsiab lus ntxiv ntawm e-search lub tswv yim muaj nyob rau hauv Table 1.
RANKL: nuclear factor kappa-beta ligand receptor activator;RANK: Nuclear factor kappa-beta ligand receptor activator
Ob tus kws tshuaj xyuas (DTA thiab MYH) ntawm nws tus kheej tau soj ntsuam qhov tsim nyog ntawm txoj kev tshawb no, thiab yog tias muaj qhov tsis sib xws, tus kws sau ntawv thib peb (LM) tau raug caw los txiav txim siab.Thawj kauj ruam tsuas yog kuaj xyuas lub npe thiab cov lus piav qhia.Cov kauj ruam thib ob rau txhua qhov kev tshawb fawb yog ntsuas cov ntawv tag nrho raws li qhov cuam tshuam thiab lim rau kev suav nrog lossis thaum lub npe lossis cov ntsiab lus tsis meej los pab txiav txim kom meej.Cov khoom raug tshem tawm yog tias lawv tsis ua raws li ib lossis ntau dua ntawm cov txheej txheem suav nrog.Yog xav tau kev piav qhia ntxiv lossis cov ntaub ntawv ntxiv, thov sau rau tus kws sau ntawv.Tib cov kws sau ntawv (DTA thiab MYH) ntawm nws tus kheej tau muab cov ntaub ntawv rho tawm los ntawm cov kws tsav dav hlau thiab cov lus teev tseg ua ntej rho tawm cov ntaub ntawv.Thaum ob tus thawj coj saib xyuas tsis pom zoo, tus kws sau ntawv thib peb (LM) tau thov kom pab daws lawv.Cov lus qhia cov ntsiab lus suav nrog cov hauv qab no: cov ntaub ntawv dav dav txog tsab xov xwm (lub npe ntawm tus sau, xyoo ntawm kev tshaj tawm thiab keeb kwm ntawm kev kawm);txoj kev (kev kawm tsim, pab pawg neeg soj ntsuam);cov neeg koom nrog (tus naj npawb ntawm cov neeg mob raug xaiv, hnub nyoog nruab nrab thiab hnub nyoog ntau yam)., pem teb);Kev cuam tshuam (hom txheej txheem, qhov chaw ntawm cov txheej txheem, kev ua haujlwm ntawm tus txheej txheem);Orthodontic yam ntxwv (degree ntawm malocclusion, hom orthodontic hniav txav, zaus ntawm orthodontic kho, lub sij hawm ntawm kev soj ntsuam);thiab Cov txiaj ntsig tau los ntsuas (cov txiaj ntsig tseem ceeb thiab theem nrab tau hais tseg, cov txheej txheem ntawm kev ntsuas, thiab qhia txog qhov sib txawv tseem ceeb ntawm cov lej).
Ob tus neeg saib xyuas (DTA thiab MYH) tau soj ntsuam qhov kev pheej hmoo ntawm kev tsis ncaj ncees siv RoB-2 ntsuas rau RCTs tau txais [29] thiab ROBINS-I ntsuas rau CCTs [30].Yog tias tsis pom zoo, thov sab laj nrog ib tus kws sau ntawv (ASB) kom ncav cuag qhov kev daws teeb meem.Rau kev sim randomized, peb ntsuas cov cheeb tsam hauv qab no raws li "kev pheej hmoo tsawg", "muaj kev pheej hmoo siab" lossis "qee qhov teeb meem ntawm kev tsis ncaj ncees": kev tsis ncaj ncees tshwm sim los ntawm cov txheej txheem randomization, kev tsis ncaj ncees vim qhov sib txawv ntawm qhov kev cuam tshuam uas xav tau (tshuaj cuam tshuam los ntawm kev cuam tshuam; cuam tshuam ntawm kev ua raws li kev cuam tshuam), kev tsis ncaj ncees vim tsis muaj cov ntaub ntawv tau txais txiaj ntsig, kev ntsuas kev tsis ncaj ncees, kev xaiv tsis ncaj ncees hauv kev tshaj tawm cov txiaj ntsig.Tag nrho cov kev pheej hmoo ntawm kev tsis ncaj ncees rau cov kev tshawb fawb xaiv tau raug ntsuas raws li hauv qab no: "Kev pheej hmoo tsawg ntawm kev tsis ncaj ncees" yog tias txhua tus thawj tswj hwm raug ntsuas "tsis tshua muaj kev tsis ncaj ncees";"Ib txhia Kev txhawj xeeb" yog tias tsawg kawg ib cheeb tsam tau ntsuas raws li "Qee Kev txhawj xeeb" tab sis tsis yog "High Risk of Bias nyob rau hauv ib cheeb tsam, High Risk of Bias: yog tias tsawg kawg ib lossis ntau lub chaw raug ntsuas raws li Kev Nyuaj Siab Siab" lossis qee qhov kev txhawj xeeb hla ntau lub npe, uas txo qis kev ntseeg siab hauv cov txiaj ntsig.Txawm li cas los xij, rau qhov kev sim tsis sib xws, peb ntsuas cov cheeb tsam hauv qab no kom tsawg, nruab nrab, thiab muaj kev pheej hmoo siab: thaum muaj kev cuam tshuam (kev cuam tshuam kev faib tawm tsis ncaj ncees);tom qab kev cuam tshuam (kev tsis ncaj ncees vim qhov sib txawv ntawm qhov xav tau kev cuam tshuam; kev tsis ncaj ncees vim tsis muaj ntaub ntawv; qhov tshwm sim) ntsuas kev tsis ncaj ncees;qhia txog kev tsis ncaj ncees hauv kev xaiv cov txiaj ntsig).Tag nrho cov kev pheej hmoo ntawm kev tsis ncaj ncees rau cov kev tshawb fawb xaiv tau raug ntsuas raws li hauv qab no: "Kev pheej hmoo tsawg ntawm kev tsis ncaj ncees" yog tias txhua tus thawj tswj hwm raug ntsuas "tsis tshua muaj kev tsis ncaj ncees";"kev pheej hmoo nruab nrab ntawm kev tsis ncaj ncees" yog tias txhua tus thawj tswj hwm raug ntsuas raws li "kev pheej hmoo tsawg lossis nruab nrab ntawm kev tsis ncaj ncees".kev tsis ncaj ncees" "Kev pheej hmoo loj ntawm kev tsis ncaj ncees";"Severe Risk of Bias" yog tias tsawg kawg yog ib lub npe tau ntsuas "Severe Risk of Bias" tab sis tsis muaj Kev pheej hmoo loj ntawm kev tsis ncaj ncees hauv ib qho kev sau npe, "Severe Risk of Bias" yog tias tsawg kawg ib tus sau tau ntsuas "Kev pheej hmoo loj ntawm kev ua yuam kev";ib qho kev tshawb fawb tau suav tias yog "cov ntaub ntawv ploj lawm" yog tias tsis muaj qhov qhia meej tias txoj kev tshawb fawb yog "tseem ceeb lossis muaj kev pheej hmoo loj ntawm kev tsis ncaj ncees" thiab nws tau ploj cov ntaub ntawv hauv ib lossis ntau qhov tseem ceeb ntawm kev tsis ncaj ncees.Qhov kev ntseeg siab ntawm cov pov thawj tau raug soj ntsuam raws li Cov Txheej Txheem Kev Ntsuam Xyuas, Kev Txhim Kho thiab Kev Ntsuas (GRADE) cov txheej txheem, nrog cov txiaj ntsig tau muab faib ua siab, nruab nrab, qis, lossis qis heev [31].
Tom qab kev tshawb fawb hauv hluav taws xob, tag nrho ntawm 1972 cov khoom raug txheeb xyuas thiab tsuas yog ib qho kev hais los ntawm lwm qhov chaw.Tom qab tshem cov duplicates, 873 cov ntawv sau tau raug tshuaj xyuas.Cov npe thiab cov ntawv nyeem tau raug kuaj xyuas kom tsim nyog thiab txhua qhov kev tshawb fawb uas tsis ua raws li kev tsim nyog tau raug tsis lees paub.Raws li qhov tshwm sim, kev tshawb fawb tob ntawm 11 cov ntaub ntawv muaj feem cuam tshuam tau ua tiav.Tsib qhov kev sim ua tiav thiab tsib qhov kev tshawb fawb tsis tu ncua tsis ua raws li cov txheej txheem suav nrog.Cov ntsiab lus tsis suav nrog tom qab kev ntsuam xyuas tag nrho cov ntawv nyeem thiab cov laj thawj rau kev cais tawm yog muab rau hauv cov lus hauv cov ntawv ntxiv.Thaum kawg, rau qhov kev tshawb fawb (plaub RCTs thiab ob CCTs) tau suav nrog hauv SR [23,32–36].Daim duab thaiv ntawm PRISMA tau pom hauv daim duab 1.
Cov yam ntxwv ntawm rau qhov kev sim no muaj nyob hauv Cov Lus 2 thiab 3 [23,32-36].Tsuas yog ib qho kev sim ntawm cov txheej txheem raug txheeb xyuas;saib Tables 4 thiab 5 yog xav paub ntxiv txog qhov kev tshawb fawb txuas ntxiv no.
RCT: randomized soj ntsuam kuaj;NAC: kev tswj tsis tau nrawm;SMD: cais lub qhov ncauj tsim;MOPs: microosseous perforation;LLLT: Tsawg siv laser kho;CFO: orthodontics nrog corticotomy;FTMPF: tag nrho tuab mucoeriosteal nrov plig plawg;Exp: kev sim;txiv neej: txiv neej;F: poj niam;U3: tus menyuam dev;ED: zog ceev;RTM: cov hniav txav ceev;TTM: lub sij hawm txav hniav;CTM: cov hniav sib txuas;PICOS: cov neeg koom, kev cuam tshuam, kev sib piv, cov txiaj ntsig thiab kev tsim qauv
TADs: ib ntus thauj tog rau nkoj;RTM: cov hniav txav ceev;TTM: lub sij hawm txav hniav;CTM: cov hniav sib txuas;EXP: kev sim;NR: tsis qhia;U3: tus menyuam dev;U6: sab sauv thawj molar;SS: stainless hlau;NiTi: npib tsib xee-titanium;MOPs: microbial pob txha perforation;LLLT: Tsawg siv laser kho;CFO: orthodontics nrog corticotomy;FTMPF: tag nrho thickness mucoeriosteal nrov plig plawg
NR: Tsis qhia;LEEJ TWG ICTRP: Nrhiav Portal ntawm WHO International Clinical Trials Registry Platform
Qhov kev tshuaj xyuas no suav nrog plaub qhov ua tiav RCTs23,32–34 thiab ob CCTs35,36 suav nrog 154 tus neeg mob.Muaj hnub nyoog li ntawm 15 mus rau 29 xyoo.Ib txoj kev tshawb fawb suav nrog cov poj niam nkaus xwb [32], thaum lwm txoj kev tshawb fawb suav nrog cov poj niam tsawg dua li txiv neej [35].Muaj cov poj niam ntau dua li cov txiv neej hauv peb txoj kev tshawb fawb [33,34,36].Tsuas yog ib qho kev tshawb fawb tsis tau muab kev faib ua poj niam txiv neej [23].
Plaub ntawm cov kev tshawb fawb suav nrog yog kev sib cais-chaw nres nkoj (SMD) tsim [33–36] thiab ob yog kev sib xyaw (COMP) tsim (kab ib sab thiab cais cov chaw nres nkoj) [23,32].Nyob rau hauv ib txoj kev tshawb fawb tsim, sab kev ua haujlwm ntawm pawg sim tau muab piv nrog rau sab tsis ua haujlwm ntawm lwm pab pawg sim, vim tias sab tsis sib haum ntawm cov pab pawg no tsis tau muaj kev nrawm (tsuas yog kev kho mob orthodontic nkaus xwb) [23,32].Hauv lwm qhov kev tshawb fawb plaub, qhov kev sib piv no tau ua ncaj qha yam tsis muaj pawg tswj hwm tsis nrawm [33-36].
Tsib txoj kev tshawb fawb piv rau kev phais nrog kev cuam tshuam lub cev (piv txwv li, kev siv lub tshuab laser qis qis {LILT}), thiab kev tshawb fawb thib rau piv rau kev phais nrog kev kho mob (piv txwv li, prostaglandin E1).Cov kev cuam tshuam kev phais muaj xws li los ntawm overtly invasive (ib txwm corticotomy [33–35], FTMPF tag nrho tuab mucoperiosteal nrov plig plawg [32]) rau cov kev cuam tshuam tsawg heev (cov txheej txheem tsawg heev {MOPs} [23] thiab flapless piezotomy cov txheej txheem [36]).
Tag nrho cov kev tshawb fawb pom muaj cov neeg mob xav tau kev tshem tawm ntawm canine tom qab kev rho tawm ua ntej [23,32–36].Txhua tus neeg mob suav nrog tau txais kev kho raws li kev tshem tawm.Cov canines raug tshem tawm tom qab rho tawm ntawm thawj premolars ntawm lub puab tsaig sab sauv.Kev rho tawm tau ua thaum pib kho kom txog thaum ua tiav ntawm qib thiab qib hauv peb qhov kev tshawb fawb [23, 35, 36] thiab peb lwm tus [32–34].Kev soj ntsuam tom qab tau muaj txij li ob lub lis piam [34], peb lub hlis [23,36], thiab plaub lub hlis [33] kom ua tiav cov canine retraction [32,35].Hauv plaub txoj kev tshawb fawb [23, 33, 35, 36], qhov ntsuas ntawm cov hniav txav tau qhia tias "tus hniav txav tus nqi" (RTM), thiab hauv ib txoj kev tshawb fawb, "hnub txav hniav" (CTM) tau hais tias "cov hniav txav" ."Lub Sijhawm" (TTM).) ntawm ob txoj kev tshawb fawb [32,35], ib qho tshuaj xyuas sRANKL concentrations [34].Tsib qhov kev tshawb fawb siv TAD thauj tog rau nkoj ib ntus [23,32–34,36], thaum txoj kev tshawb fawb thib rau siv rov qab khoov khoov rau kev kho [35].Nyob rau hauv cov nqe lus ntawm txoj kev siv los ntsuas cov hniav tshaj tawm, ib txoj kev tshawb fawb tau siv digital intraoral calipers [23], ib txoj kev tshawb fawb siv ELISA thev naus laus zis los kuaj cov kua dej gingival sulcus (GCF) cov qauv [34], thiab ob txoj kev tshawb fawb tau soj ntsuam kev siv hluav taws xob digital cam khwb cia..pov lub caliper [33,35], thaum ob txoj kev tshawb fawb siv 3D scanned kawm qauv kom tau txais kev ntsuas [32,36].
Qhov kev pheej hmoo ntawm kev tsis ncaj ncees rau kev suav nrog hauv RCTs yog qhia hauv daim duab 2, thiab tag nrho cov kev pheej hmoo ntawm kev tsis ncaj ncees rau txhua tus thawj coj tau qhia hauv daim duab 3. Txhua RCTs tau raug ntsuas raws li muaj "qee qhov kev txhawj xeeb rau kev tsis ncaj ncees" [23,32-35]."Qee qhov kev txhawj xeeb txog kev tsis ncaj ncees" yog qhov tseem ceeb ntawm RCTs.Kev tsis ncaj ncees vim yog kev sib txawv ntawm qhov kev xav tau (kev cuam tshuam txog kev cuam tshuam; cuam tshuam kev cuam tshuam) yog qhov feem ntau xav tias thaj chaw (piv txwv li, "qee qhov kev txhawj xeeb" muaj nyob hauv 100% ntawm plaub qhov kev tshawb fawb).Qhov kev pheej hmoo ntawm kev tsis ncaj ncees rau qhov kev tshawb fawb CCT tau pom nyob rau hauv daim duab 4. Cov kev tshawb fawb no muaj "kev pheej hmoo tsawg ntawm kev tsis ncaj ncees".
Daim duab raws li cov ntaub ntawv los ntawm Abdelhameed thiab Refai, 2018 [23], El-Ashmawi li al., 2018 [33], Sedky et al., 2019 [34], thiab Abdarazik et al., 2020 [32].
Kev phais thiab kev cuam tshuam lub cev: Tsib qhov kev tshawb fawb piv rau ntau hom kev phais nrog kev siv laser qis (LILT) txhawm rau txhawm rau tshem tawm canine [23,32–34].El-Ashmawy et al.Cov teebmeem ntawm "kev lig kev cai corticotomy" piv rau "LLT" tau raug soj ntsuam hauv RCT cleft [33].Hais txog canine retraction ceev, tsis muaj statisticically sib txawv ntawm corticotomy thiab LILI sab ntawm ib tug taw tes nyob rau hauv qhov kev ntsuam xyuas (txhais tau tias 0.23 hli, 95% CI: -0.7 rau 1.2, p = 0.64).
Turker et al.soj ntsuam cov nyhuv ntawm piezocision thiab LILT ntawm RTM hauv cleft TBI [36].Nyob rau hauv thawj lub hlis, qhov zaus ntawm sab sauv canine retraction nyob rau sab LILI yog statistically siab dua nyob rau sab piezocision (p = 0.002).Txawm li cas los xij, tsis muaj qhov sib txawv ntawm qhov sib txawv ntawm ob sab ntawm lub hlis thib ob thiab thib peb ntawm sab sauv canine retraction, ntsig txog (p = 0.377, p = 0.667).Xav txog tag nrho lub sij hawm ntsuam xyuas, qhov cuam tshuam ntawm LILI thiab Piezocisia ntawm OTM tau zoo sib xws (p = 0.124), txawm hais tias LILI tau zoo dua li cov txheej txheem Piezocisia hauv thawj lub hlis.
Abdelhameed thiab Refai tau kawm txog cov txiaj ntsig ntawm "MOPs" piv rau "LLLT" thiab "MOPs + LLLT" ntawm RTM hauv cov qauv tsim RCT [23]. Lawv pom qhov nce ntawm tus nqi ntawm sab sauv canine retraction nyob rau sab nrawm ("MOPs" thiab "LLLT") thaum piv nrog rau sab tsis nrawm, nrog rau qhov sib txawv tseem ceeb ntawm txhua lub sijhawm ntsuas (p<0.05). Lawv pom qhov nce ntawm tus nqi ntawm sab sauv canine retraction nyob rau sab nrawm ("MOPs" thiab "LLLT") thaum piv nrog rau sab tsis nrawm, nrog rau qhov sib txawv tseem ceeb ntawm txhua lub sijhawm ntsuas (p<0.05). Они обнаружили ускоренное увеличение скорости ретракции верхних клыков в боковых сторонах («MOPs», а растина та скоренными боковыми ретракциями со статистически значимыми различиями во все времена оценки (p<0,0,0). Lawv pom qhov nce nrawm nrawm ntawm kev thim rov qab ntawm cov canines sab sauv ("MOPs" nrog rau "LLLT") piv rau qhov tsis nrawm ntawm kev thim rov qab nrog qhov sib txawv tseem ceeb ntawm txhua lub sijhawm ntsuas (p <0.05).他们发现，与非加速侧相比，加速侧（“MOPs” 和“LLLT”）的上犬齿回缩率增加，在牀有评伦微闶闶闶。异 (p <0.05). Lawv pom tias, piv rau sab tsis nrawm, cov hniav sab sauv ntawm sab nrawm ("MOPs" thiab "LLLT") nce qhov txo qis, thiab muaj qhov sib txawv tseem ceeb (p<0.05) ntawm txhua lub sijhawm ntsuas. . Они обнаружили, что ретракция верхнего клыка была выше на стороне акселерации («MOPs» и «LLLT») по сравоне по сравоне ации со статистически значимой разницей (p<0,05) во все оцениваемые моменты времени. Nws pom tias kev tshem tawm sab sauv sab sauv siab dua ntawm sab nrog kev nrawm ("MOPs" thiab "LLLT") piv rau sab tsis muaj kev nrawm nrog qhov sib txawv tseem ceeb (p<0.05) txhua lub sijhawm ntsuas.Piv nrog rau sab tsis nrawm, qhov thim rov qab ntawm lub clavicle tau nrawm los ntawm 1.6 thiab 1.3 zaug ntawm "SS" thiab "NILT" sab, feem.Tsis tas li ntawd, lawv kuj tau pom tias cov txheej txheem MOPs tau ua haujlwm zoo dua li cov txheej txheem LLLT hauv kev ua kom nrawm ntawm kev thim rov qab ntawm cov clavicles sab saud, txawm hais tias qhov sib txawv tsis yog qhov tseem ceeb.Qhov siab heterogeneity thiab qhov sib txawv hauv kev siv cov kev cuam tshuam ntawm cov kev tshawb fawb yav dhau los tau txwv tsis pub muaj kev sib txuas ntawm cov ntaub ntawv [23,33,36].Abdalazik et al.Ib ob sab caj npab RCI nrog cov qauv tsim [32] tau soj ntsuam cov txiaj ntsig ntawm qhov puv-thickness mucoperiosteal nrov plig plawg (FTMPF qhov siab tsuas yog nrog LLLT) ntawm cov hniav txav (CTM) thiab cov hniav txav sij hawm (TTM)."Lub Sijhawm Hniav txav" thaum muab piv rau sab nrawm thiab tsis nrawm, qhov txo qis hauv tag nrho lub sijhawm ntawm cov hniav retraction tau pom.Hauv tag nrho txoj kev tshawb fawb, tsis muaj qhov sib txawv tseem ceeb ntawm "FTMPF" thiab "LLLT" nyob rau hauv cov nqe lus ntawm "cov hniav txav" (p = 0.728) thiab "lub sij hawm cov hniav" (p = 0.298).Tsis tas li ntawd, "FTMPF" thiab "LLLT" » tuaj yeem ua tiav 25% thiab 20% acceleration OTM feem.
Seki et al.Cov txiaj ntsig ntawm "kev coj ua corticotomy" piv rau "LLT" ntawm RANKL tso tawm thaum OTM hauv RCT nrog orotomy tau soj ntsuam thiab muab piv [34].Txoj kev tshawb no tau tshaj tawm tias ob qho tib si corticotomy thiab LILI nce RANKL tso tawm thaum OTM, uas cuam tshuam ncaj qha rau kev kho pob txha thiab OTM tus nqi.Qhov sib txawv ntawm ob sab tsis yog qhov tseem ceeb ntawm 3 thiab 15 hnub tom qab kev cuam tshuam (p = 0.685 thiab p = 0.400, feem).Qhov sib txawv ntawm lub sijhawm lossis txoj hauv kev ntsuas cov txiaj ntsig tau txwv tsis pub suav nrog ob qhov kev tshawb fawb yav dhau los hauv kev tshuaj ntsuam meta [32,34].
Kev phais thiab tshuaj kho mob: Rajasekaran thiab Nayak tau soj ntsuam cov txiaj ntsig ntawm corticotomy piv rau prostaglandin E1 txhaj ntawm RTM thiab cov hniav txav sijhawm (TTM) hauv qhov ncauj sib cais CCT [35].Lawv tau pom tias corticotomy txhim kho RTM zoo dua li prostaglandins, nrog qhov sib txawv tseem ceeb (p = 0.003), vim qhov nruab nrab RTM ntawm sab prostaglandin yog 0.36 ± 0.05 hli / lub lis piam, thaum corticotomy yog 0.40 ± 0.04mm / perimeter.Kuj tseem muaj qhov sib txawv ntawm cov hniav txav ntawm ob qho kev cuam tshuam.Pab pawg corticotomy (13 lub lis piam) muaj luv luv "hnub txav hniav" dua li pawg prostaglandin (15 lub lis piam).Yog xav paub ntxiv, cov ntsiab lus ntawm cov kev tshawb pom ntau los ntawm cov kev tshawb pom tseem ceeb ntawm txhua qhov kev tshawb fawb tau nthuav tawm hauv Table 6.
RTM: cov hniav txav ceev;TTM: lub sij hawm txav hniav;CTM: cov hniav sib txuas;NAC: kev tswj tsis tau nrawm;MOPs: microbial pob txha perforation;LLLT: Tsawg siv laser kho;CFO: orthodontics nrog corticotomy;FTMPF: tag nrho tuab mucoeriosteal nrov plig plawg;NR: not report
Plaub qhov kev tshawb fawb tau soj ntsuam cov txiaj ntsig thib ob [32,33,35,36].Peb qhov kev tshawb fawb tau soj ntsuam qhov poob ntawm molar txhawb [32,33,35].Rajasekaran thiab Nayak pom tsis muaj qhov sib txawv tseem ceeb ntawm corticotomy thiab prostaglandin pawg (p = 0.67) [35].El-Ashmawi et al.Tsis muaj qhov sib txawv tseem ceeb ntawm corticotomy thiab LLLT sab hauv txhua lub sijhawm ntawm kev soj ntsuam (MD 0.33 mm, 95% CI: -1.22-0.55, p = 0.45) [33] .Xwb, Abdarazik et al.Ib qho kev sib txawv tseem ceeb tau tshaj tawm ntawm pawg FTMPF thiab LLLT, nrog rau pawg LLLT loj dua [32].
Mob thiab o tau raug soj ntsuam hauv ob qhov kev sim [33,35].Raws li Rajasekaran thiab Nayak, cov neeg mob tau qhia qhov mob me me thiab mob thaum thawj lub lim tiam ntawm sab corticotomy [35].Hauv cov xwm txheej ntawm prostaglandins, txhua tus neeg mob tau ntsib kev mob hnyav thaum txhaj tshuaj.Hauv cov neeg mob feem ntau, qhov kev siv zog yog siab thiab kav ntev txog peb hnub txij li hnub txhaj tshuaj.Txawm li cas los xij, El-Ashmawi et al.[33] qhia tias 70% ntawm cov neeg mob yws yws ntawm qhov o ntawm sab corticotomy, thaum 10% tau o ntawm ob sab corticotomy thiab sab LILI.Kev mob tom qab phais tau sau tseg los ntawm 85% ntawm cov neeg mob.Sab ntawm corticotomy yog qhov hnyav dua.
Rajasekaran thiab Nayak tau soj ntsuam qhov kev hloov pauv ntawm qhov siab thiab lub hauv paus ntev thiab pom tsis muaj qhov sib txawv ntawm cov corticotomy thiab prostaglandin pawg (p = 0.08) [35].Qhov tob ntawm kev kuaj mob ib txwm raug soj ntsuam hauv ib qho kev tshawb fawb thiab pom tsis muaj qhov sib txawv ntawm FTMPF thiab LLLT [32].
Türker thiab al tshuaj xyuas cov kev hloov pauv hauv canine thiab thawj molar cov ces kaum thiab pom tsis muaj qhov sib txawv tseem ceeb hauv canine thiab thawj molar ces kaum ntawm sab piezotomy thiab LLLT sab thaum lub sij hawm peb lub hlis tom qab [36].
Lub zog ntawm cov pov thawj rau orthodontic misalignment thiab cov kev phiv los ntawm "tsawg heev" mus rau "qis" raws li GRADE cov lus qhia (Table 7).Txo lub zog ntawm cov pov thawj yog txuam nrog kev pheej hmoo ntawm kev tsis ncaj ncees [23,32,33,35,36], indirectness [23,32] thiab imprecision [23,32,33,35,36].
a, g Txo qhov kev pheej hmoo ntawm kev tsis ncaj ncees los ntawm ib qib (kev tsis ncaj ncees vim qhov sib txawv ntawm qhov xav tau kev cuam tshuam, poob loj rau kev soj ntsuam) thiab txo qhov tsis ncaj ncees los ntawm ib qib * [33].
c, f, i, j Kev pheej hmoo ntawm kev tsis ncaj ncees txo qis los ntawm ib theem (tsis yog kev tshawb fawb randomized) thiab cov npoo ntawm kev ua yuam kev poob los ntawm ib theem * [35].
d Txo qhov kev pheej hmoo ntawm kev tsis ncaj ncees (vim qhov sib txawv ntawm qhov kev cuam tshuam uas xav tau) los ntawm ib theem, indirectness los ntawm ib theem **, thiab imprecision los ntawm ib theem * [23].
e, h, k Txo qhov kev pheej hmoo ntawm kev tsis ncaj ncees (kev tsis ncaj ncees cuam tshuam nrog cov txheej txheem randomization, kev tsis ncaj ncees vim kev sib txawv ntawm qhov kev cuam tshuam) los ntawm ib theem, indirectness los ntawm ib theem **, thiab imprecision los ntawm ib theem * [32] .
CI: kev ntseeg siab luv;SMD: cais chaw nres nkoj tsim;COMP: sib xyaw tsim;MD: txhais tau tias sib txawv;LLLT: Tsawg siv laser kho;FTMPF: tag nrho thickness mucoeriosteal nrov plig plawg
Muaj kev nce ntxiv hauv kev tshawb fawb txog kev nrawm ntawm orthodontic txav siv ntau txoj hauv kev nrawm.Txawm hais tias txoj kev phais mob nrawm tau kawm dav, txoj kev tsis yog phais kuj pom lawv txoj hauv kev mus rau kev tshawb fawb dav dav.Cov ntaub ntawv thiab pov thawj tias ib txoj hauv kev nrawm yog zoo dua li lwm qhov tseem sib xyaw.
Raws li qhov SR no, tsis muaj kev pom zoo ntawm cov kev tshawb fawb txog qhov tseem ceeb ntawm kev phais lossis tsis phais txoj hauv kev nrawm OTM.Abdelhameed thiab Refai, Rajasekaran thiab Nayak pom tias hauv OTM, kev phais tau zoo dua li kev cuam tshuam tsis yog phais [23,35].Xwb, Türker et al.Kev cuam tshuam tsis yog kev phais tau ua pov thawj tias muaj txiaj ntsig zoo dua li kev cuam tshuam kev phais thaum thawj lub hlis ntawm kev tshem tawm sab saud [36].Txawm li cas los xij, xav txog tag nrho lub sijhawm sim, lawv pom tias qhov cuam tshuam ntawm kev phais thiab tsis yog phais ntawm OTM yog qhov zoo sib xws.Tsis tas li ntawd, Abdarazik et al., El-Ashmawi et al., thiab Sedki et al.tau sau tseg tias tsis muaj qhov sib txawv ntawm kev phais thiab tsis yog phais kev cuam tshuam ntawm OTM acceleration [32-34].