“Ungaze uthandabuze ukuba iqela elincinane labemi abacingayo nabazinikeleyo banokulitshintsha ihlabathi.Enyanisweni, yiyo yodwa ekhoyo.”
Umsebenzi kaCureus kukutshintsha imodeli yexesha elide yokupapashwa kwezonyango, apho ukuhanjiswa kophando kunokubiza kakhulu, kuyinkimbinkimbi, kwaye kuthatha ixesha.
Ukutyeba okupheleleyo kweflap ye-mucoperiosteal, i-mop, i-piezotomy, i-corticotomy, i-lllt, i-prostaglandin, intshukumo yamazinyo ekhawulezileyo, i-orthodontic, engatyandwayo, utyando
Doaa Tahsin Alfaylani, Mohammad Y. Hajir, Ahmad S. Burhan, Luai Mahahini, Khaldun Darwich, Ossama Aljabban
Caphula eli nqaku njenge: Alfailany D, Hajeer MY, Burhan AS, et al.(ngoMeyi 27, 2022) Ukuvavanya ukuphumelela kongenelelo lotyando kunye nokungabikho kotyando xa kusetyenziswa ngokudibeneyo kunye nabagciniyo ukukhawulezisa intshukumo yezinyo le-orthodontic: ukuphononongwa okucwangcisiweyo.Unyango 14(5): e25381.doi:10.7759/cureus.25381
Injongo yolu hlaziyo yayikukuvavanya ubungqina obukhoyo ngoku bokusebenza kweendlela zokukhawulezisa utyando kunye nokungabikho kotyando kunye neziphumo ebezingalindelekanga ezinxulumene nezi ndlela.Kukhangelwe oovimba beenkcukacha ezilithoba: IRejista yeCochrane Central yoLingo oluLawulwayo (CENTRAL), EMBASE®, Scopus®, PubMed®, Web of Science™, Google™ Scholar, Trip, OpenGrey kunye nePQDT OPEN yepro-Quest®.I-ClinicalTrials.gov kunye ne-portal yokukhangela ye-International Clinical Trials Registry Platform (ICTRP) yahlaziywa ukuba ihlolisise uphando lwangoku kunye noncwadi olungapapashwanga.Izilingo ezilawulwa ngokungahleliwe (RCTs) kunye nezilingo zeklinikhi ezilawulwayo (CCTs) zezigulane ezenza utyando (ubuchwephesha obungenabuqhetseba okanye obuncinci) ngokudibanisa nezixhobo ezisisigxina zendabuko kwaye xa kuthelekiswa nokungenelela okungenalo utyando.Isixhobo se-Cochrane Risk of Bias (RoB.2) sisetyenziselwa ukuvavanya ii-RCTs, ngelixa isixhobo se-ROBINS-I sisetyenziselwa iCCT.
Ii-RCT ezine kunye nee-CCT ezimbini (izigulane ze-154) zifakwe kolu hlaziyo olucwangcisiweyo.Izilingo ezine zafumanisa ukuba ungenelelo lotyando kunye nolungekho utyando lube nefuthe elifanayo ekukhawuleziseni intshukumo yamazinyo yamazinyo (OTM).Ngokwahlukileyo koko, utyando lwalusebenza ngakumbi kwezinye izifundo ezibini.Iqondo eliphezulu le-heterogeneity phakathi kwezifundo ezibandakanyiweyo zithintele ukuhlanganiswa kobuninzi beziphumo.Imiphumo emibi echazweyo ehambelana nokungenelela kokuhlinzwa kunye nokungabikho kokuhlinzwa kwakufana.
Bekukho ubungqina 'obuphantsi kakhulu' ukuya 'obuphantsi' bokuba ungenelelo lotyando kunye nolungalulo utyando lusebenze ngokulinganayo ekukhawuleziseni intshukumo yamazinyo amathambo ngaphandle komahluko kwiziphumo ebezingalindelekanga.Izilingo zeklinikhi ezikumgangatho ophezulu ngakumbi ziyafuneka ukuthelekisa imiphumo yokukhawuleza kweendlela ezimbini kwiintlobo ezahlukeneyo ze-malocclusion.
Ubude bexesha lokunyanga naluphi na ukungenelela kwe-orthodontic yenye yezinto ezibalulekileyo eziqwalaselwa zizigulane xa zenza isigqibo [1].Ngokomzekelo, ukuhoxiswa kwee-canine ezigxininiswe kakhulu emva kokutsalwa kwee-premolars eziphezulu kunokuthatha malunga neenyanga ezi-7, ngelixa izinga le-bioorthodontic tooth movement (OTM) limalunga ne-1 mm ngenyanga, okukhokelela kwixesha elipheleleyo lonyango malunga neminyaka emibini [2, 3 ] .Ubuhlungu, ukungonwabi, i-caries, i-gingival recession kunye ne-root resorption yimiphumo emibi eyandisa ixesha lonyango lwe-orthodontic [4].Ukongeza, izizathu zobuhle kunye nezentlalo zibangela ukuba izigulana ezininzi zifune ukugqitywa ngokukhawuleza konyango lwamathambo [5].Ngoko ke, zombini i-orthodontists kunye nezigulane zifuna ukukhawuleza ukuhamba kwamazinyo kunye nokunciphisa ixesha lonyango [6].
Indlela yokuhamba kwamazinyo ngokukhawuleza ixhomekeke ekusebenzeni kwe-biological tissue reaction.Ngokomlinganiselo wokuhlaselwa, ezi ndlela zinokwahlulwa zibe ngamaqela amabini: i-conservative (i-biological, physical, kunye ne-biomechanical method) kunye neendlela zotyando [7].
Iindlela zebhayoloji ziquka ukusetyenziswa kwee-agent ze-pharmacological ukunyusa ukuhamba kwamazinyo kwiimvavanyo zezilwanyana kunye nakubantu.Izifundo ezininzi zibonise ukusebenza ngokuchasene uninzi lwezi zinto ezifana ne-cytokines, i-nuclear factor kappa-B ligand receptor activators/nuclear factor-kappa-B protein receptor activators (RANKL/RANK), prostaglandins, vitamin D, hormones ezifana parathyroid hormone (PTH) ).) kunye ne-osteocalcin, kunye neenaliti zezinye izinto ezifana ne-relaxin, azizange zibonise nayiphi na i-accurated efficacy [8].
Iindlela zokwenyama zisekwe kusetyenziso lwezixhobo zonyango, kubandakanywa ngqo okwangoku [9], ipulsed electromagnetic fields [10], vibration [11], kunye ne-low-intensity laser therapy [12], ebonise iziphumo ezithembisayo [8].].Iindlela zokuhlinzwa zibhekwa njengezona zisetyenziswa kakhulu kwaye zibonakaliswe ngokweklinikhi kwaye zinokunciphisa kakhulu ixesha lonyango [13,14].Nangona kunjalo, bathembele kwi-"Regional Acceleration Phenomenon (RAP)" ekubeni ukuvela komonakalo wotyando kwithambo le-alveolar kunokukhawuleza okwethutyana i-OTM [15].Olu ngenelelo lotyando lubandakanya i-corticotomy yendabuko [16,17], i-interstitial alveolar bone surgery [18], i-accelerated osteogenic orthodontics [19], i-alveolar traction [13] kunye ne-periodontal traction [20], i-compression electrotomy [14,21], i-cortical resection [ 19].I-22] kunye ne-microperforation [23].
Uphononongo oluninzi olucwangcisiweyo (SR) lwezilingo ezilawulwa ngokungahleliwe (RCTs) zipapashwe ngokusebenza kokungenelela kokuhlinzwa kunye nokungabikho kokuhlinzwa ekukhawuleziseni i-OTM [24,25].Nangona kunjalo, ukugqwesa kotyando kwiindlela ezingezizo utyando abukabonakaliswa.Ngoko ke, olu hlaziyo olucwangcisiweyo (SR) lujolise ekuphenduleni lo mbuzo ulandelayo wokuphonononga obalulekileyo: Yiyiphi eyona nto isebenzayo ekukhawuleziseni ukunyakaza kwamazinyo e-orthodontic xa usebenzisa izixhobo ezisisigxina ze-orthodontic: iindlela zokuhlinzwa okanye ezingezizo zokuhlinzwa?
Okokuqala, uphando lokulinga lwenziwe kwi-PubMed ukuqinisekisa ukuba akukho zi-SRs ezifanayo kunye nokujonga onke amanqaku ahambelanayo ngaphambi kokubhala isiphakamiso sokugqibela se-SR.Emva kwexesha, izilingo ezimbini ezinokuthi zisebenze zichongiwe kwaye zavavanywa.Ukubhaliswa kwale protocol ye-SR kwisiseko sedatha sePROSPERO kugqityiwe (inombolo yesazisi: CRD42021274312).Le SR ihlanganiswe ngokuhambelana neNcwadana ye-Cochrane yokuHlolwa okuCwangcisiweyo kwamaNgenelelo [26] kunye nezinto eziKhethekileyo zokuNika iNgxelo yeZikhokelo zokuPhononongwa okuCwangcisiweyo kunye nohlalutyo lweMeta (PRISMA) [27,28].
Uphononongo lwalubandakanya izigulane eziphilileyo zamadoda kunye nabasetyhini abafumana unyango olusisigxina lwe-orthodontic, kungakhathaliseki ubudala, uhlobo lwe-malocclusion, okanye ubuhlanga, ngokutsho koMthathi-nxaxheba wokuNgenelela, ukuFaniswa, iZiphumo, kunye noYilo lokufunda (PICOS) umzekelo.Utyando olongezelelweyo (oluhlaselayo okanye olungephi) kunyango lwesithethe olusisigxina lwamathambo lwaqwalaselwa.Uphononongo lubandakanya izigulane ezifumene unyango olusisigxina lwe-orthodontic (OT) ngokudibanisa nokungenelela okungenalo utyando.Olu ngenelelo lunokubandakanya iindlela ze-pharmacological (indawo okanye i-systemic) kunye neendlela eziphathekayo (i-laser irradiation, i-electro current, i-pulsed electromagnetic fields (PEMF) kunye ne-vibration).
Isiphumo esiphambili salo mgaqo yisantya sokuhamba kwamazinyo (RTM) okanye nayiphi na isalathisi esifanayo esinokusazisa malunga nokusebenza kokungenelela kokuhlinzwa kunye nokungabikho kokuhlinzwa.Iziphumo zesibini zibandakanya iziphumo ezibi ezifana neziphumo ezichazwe ngesigulane (intlungu, ukungahambi kakuhle, ukwaneliseka, umgangatho wobomi obunxulumene nempilo yomlomo, ubunzima bokuhlafuna, kunye namanye amava), iziphumo ezinxulumene nezicubu ze-periodontal njengoko zilinganiswe yi-periodontal index (PI), iingxaki , I-Index ye-Gingival (GI), ukulahlekelwa kwe-attachment (AT), i-gingival recession (GR), ubunzulu be-periodontal (PD), ukulahlekelwa kwenkxaso kunye nokunyakaza kwamazinyo okungafunekiyo (i-tilting, twisting, rotation) okanye i-iatrogenic tooth trauma ezifana nokulahlekelwa kwezinyo Ubomi. , Ingcambu Resorption.Zimbini kuphela izicwangciso zophononongo ezamkelweyo - Iimvavanyo eziLawulwayo eziLawulwayo (RCTs) kunye neZilingo eziLawulwayo zeKliniki (CCTs), ezibhalwe ngesiNgesi kuphela, ngaphandle kwezithintelo kunyaka wokupapashwa.
La manqaku alandelayo ayengabandakanywanga: izifundo ezibuyela emva, izifundo ngeelwimi ezingezizo isiNgesi, iimvavanyo zezilwanyana, izifundo ze-in vitro, iingxelo zamatyala okanye iingxelo zeziganeko, abahleli, amanqaku anophononongo kunye namaphepha amhlophe, izimvo zomntu, izilingo ngaphandle kweesampuli ezixeliweyo, akukho. iqela lokulawula, okanye ubukho beqela elingenakulawulwa kunye neqela lokulinga kunye nezigulane ezingaphantsi kwe-10 zafundwa ngendlela yokugqiba into.
Uphendlo lwe-elektroniki lwenziwe kolu gcino-lwazi lulandelayo (ngo-Agasti ka-2021, akukho mda wexesha, isiNgesi kuphela): Irejista ye-Cochrane Central ye-Controlled Trials, i-PubMed®, i-Scopus®, i-Web of Science™, i-EMBASE®, i-Google™ Scholar, i-Trip, i-OpenGrey (ukuchonga uncwadi olungwevu) kunye ne-PQDT OPEN evela kwi-pro-Quest® (ukuchonga amaphepha kunye ne-dissertations).Uluhlu loncwadi lwamanqaku akhethiweyo lukwakhangelwe kulo naluphi na ulingo olunokubakho olunokuba aluzange lufunyanwe kukhangelo lwe-elektroniki kwi-Intanethi.Kwangaxeshanye, uphendlo lwezandla lwenziwa kwiJenali yeAngle Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics™, European Journal of Orthodontics and Orthodontics and Craniofacial Research.I-ClinicalTrials.gov kunye ne-World Health Organization's International Clinical Trials Registry Platform (ICTRP) yokukhangela i-portal iqhube iitshekhi ze-elektroniki ukufumana ulingo olungapapashwanga okanye izifundo ezigqityiweyo ngoku.Iinkcukacha ezithe vetshe ngeqhinga lokukhangela i-e-search zinikwe kwiThebhile yoku-1.
I-RANKL: i-nuclear factor kappa-beta ligand receptor activator;I-RANK: i-nuclear factor kappa-beta ligand receptor activator
Abahlalutyi ababini (i-DTA kunye ne-MYH) bavavanya ngokuzimeleyo ukufaneleka kwesifundo, kwaye kwimeko yokungahambelani, umbhali wesithathu (LM) wamenywa ukuba enze isigqibo.Inyathelo lokuqala libandakanya ukukhangela kuphela isihloko kunye nesichasiselo.Inyathelo lesibini kuzo zonke izifundo yayikukukala isicatshulwa esipheleleyo njengento efanelekileyo kunye nesihluzo sokubandakanywa okanye xa isihloko okanye i-abstract ingacacanga ukunceda ukwenza isigwebo esicacileyo.Amanqaku ayengabandakanywanga ukuba awazange ahlangabezane nenye okanye ngaphezulu kweekhrayitheriya zokubandakanywa.Ukufumana ingcaciso engaphezulu okanye idatha eyongezelelweyo, nceda ubhalele umbhali ochaphazelekayo.Ababhali abafanayo (i-DTA kunye ne-MYH) bakhuphe idatha ngokuzimeleyo kwi-pilot kunye neetafile zokukhutshwa kwedatha.Xa abahlalutyi ababini abakhokelayo bengavumelani, umbhali wesithathu (LM) wacelwa ukuba abancede.Itheyibhile yedatha yesishwankathelo ibandakanya ezi zinto zilandelayo: ulwazi jikelele malunga nenqaku (igama lombhali, unyaka wokupapashwa kunye nemvelaphi yesifundo);iindlela (uyilo lofundo, iqela elivavanyiweyo);abathathi-nxaxheba (inani lezigulane eziqeshwe, iminyaka yobudala kunye noluhlu lweminyaka)., umgangatho);Amanyathelo okungenelela (uhlobo lwenkqubo, indawo yenkqubo, imiba yobugcisa benkqubo);Iimpawu ze-Orthodontic (i-degree of malocclusion, uhlobo lwe-orthodontic tooth movement, i-frequency of orthodontic adjustments, ixesha lokujonga);kunye neMilinganiselo yeZiphumo (iziphumo eziziiprayimari neziziisekondari ezikhankanyiweyo, iindlela zokulinganisa, kunye nokunikwa kwengxelo yomahluko obalulekileyo ngokweenkcukacha-manani).
Abahlalutyi ababini (i-DTA kunye ne-MYH) bavavanya umngcipheko wokuxhatshazwa usebenzisa i-RoB-2 isixhobo se-RCTs efunyenweyo [29] kunye ne-ROBINS-I isixhobo se-CCTs [30].Kwimeko yokungavumelani, nceda uqhagamshelane nomnye wababhali abasebenzisanayo (ASB) ukufikelela kwisisombululo.Uvavanyo olungenamkhethe, silinganisele ezi ndawo zilandelayo "njengomngcipheko ophantsi", "umngcipheko omkhulu" okanye "ingxaki ethile yokuzikhethela": i-bias evela kwinkqubo ye-randomization, i-bias ngenxa yokuphambuka kungenelelo olulindelekileyo (iziphumo ezibangelwa kukungenelela; iziphumo ukubambelela kungenelelo ngoncedo), i-bias ngenxa yedatha yeziphumo ezilahlekileyo, ukulinganisa ukulinganisa, ukukhetha ukukhetha kwiziphumo zokunika ingxelo.Umngcipheko opheleleyo wokuchasana kwizifundo ezikhethiweyo ulinganiswe ngolu hlobo lulandelayo: "Ingozi ephantsi yokuxhatshazwa" ukuba zonke iindawo zilinganiswe "umngcipheko ophantsi we-bias";"Inkxalabo ethile" ukuba ubuncinci indawo enye ilinganiswe njenge "Inkxalabo ethile" kodwa ingeyiyo "Umngcipheko oMkhulu we-Bias kuyo nayiphi na indawo, uMngcipheko oMkhulu we-Bias: ukuba ubuncinci i-domain enye okanye ngaphezulu ilinganiswe njengoMngcipheko oMkhulu we-Bias" okanye ezinye iinkxalabo. phezu kweendawo ezininzi, ezinciphisa kakhulu ukuzithemba kwiziphumo.Nangona, kwiimvavanyo ezingenamkhethe, silinganise le mimandla ilandelayo njengomngcipheko ophantsi, ophakathi, kunye nomngcipheko ophezulu: ngexesha lokungenelela (i-intervention classification bias);emva kokungenelela (icala ngenxa yokutenxa kungenelelo olulindelekileyo; utyekelo ngenxa yokunqongophala kwedatha; iziphumo) ukuthambekela komlinganiselo;ukunika ingxelo kukhetho lweziphumo).Umngcipheko opheleleyo wokuchasana kwizifundo ezikhethiweyo ulinganiswe ngolu hlobo lulandelayo: "Ingozi ephantsi yokuxhatshazwa" ukuba zonke iindawo zilinganiswe "umngcipheko ophantsi we-bias";"Umngcipheko ophakathi wokuthatha icala" ukuba zonke iindawo zilinganiswe "njengengozi ephantsi okanye ephakathi yokuthatha icala".bias” “Umngcipheko omkhulu wokuthand’ icala”;"Umngcipheko oMbi we-Bias" ukuba ubuncinane i-domain enye inikwe i-"Risk eNkulu ye-Bias" kodwa akukho Mngcipheko oMbi we-Bias kuyo nayiphi na i-domain, "Umngcipheko oMbi we-Bias" ukuba ubuncinane i-domain enye ilinganiswe "Ingozi enkulu yempazamo ecwangcisiweyo";Uphononongo lwalucatshangelwa "ulwazi olulahlekileyo" ukuba akukho nto ibonisa ngokucacileyo ukuba isifundo "sasibalulekile okanye sisengozini enkulu yokuxhatshazwa" kwaye yayingekho ulwazi kwindawo enye okanye ezininzi eziphambili zokungakhethi.Ukuthembeka kobungqina kwavavanywa ngokwemigaqo yoVavanyo lweZikhokelo, uPhuhliso kunye noVavanyo (iGRADE), kunye neziphumo ezichazwe njengeziphezulu, eziphakathi, eziphantsi, okanye eziphantsi kakhulu [31].
Emva kophando lwe-elektroniki, amanqaku e-1972 apheleleyo achongiwe kunye nesicatshulwa esinye esivela kweminye imithombo.Emva kokususa imibhalo ekhutshelweyo, imibhalo-ngqangi engama-873 yaphononongwa.Izihloko kunye nee-abstracts zahlolwa ukufaneleka kwaye naziphi na izifundo ezingazange zihlangabezane neendlela zokufaneleka zanqatshwa.Ngenxa yoko, uphando olunzulu lwamaxwebhu ali-11 anokuthi afaneleke aqhutywe.Izilingo ezintlanu ezigqityiweyo kunye nezifundo ezintlanu eziqhubekayo azizange zihlangabezane neendlela zokubandakanywa.Izicatshulwa zamanqaku ezingabandakanyiyo emva kovavanyo olupheleleyo kunye nezizathu zokukhutshwa zinikwe kwitheyibhile ekwisihlomelo.Ekugqibeleni, izifundo ezintandathu (ii-RCT ezine kunye nee-CCT ezimbini) zifakwe kwi-SR [23,32-36].Umzobo webhloko we-PRISMA uboniswe kwi-Figure 1.
Iimpawu zezilingo ezintandathu ezibandakanyiweyo ziboniswa kwiiThebhile 2 kunye ne-3 [23,32-36].Kwachongwa uvavanyo olunye kuphela lomgaqo-nkqubo;jonga iTheyibhile 4 neye-5 ngolwazi oluthe vetshe ngale projekthi yophando iqhubekayo.
I-RCT: uvavanyo lweklinikhi olungahleliwe;I-NAC: ulawulo olungakhawuleziswanga;SMD: uyilo lomlomo wokwahlula;Ii-MOPs: ukugqobhoza kwe-microosseous;I-LLLT: unyango lwe-laser oluphantsi;I-CFO: i-orthodontics kunye ne-corticotomy;I-FTMPF: i-flap ye-mucoperiosteal epheleleyo;Exp: yovavanyo;indoda: indoda;F: ibhinqa;U3: inja ephezulu;ED: ukuxinana kwamandla;I-RTM: isantya sokuhamba kwamazinyo;I-TTM: ixesha lokuhamba kwamazinyo;I-CTM: intshukumo yamazinyo eyongezelekayo;I-PICOS: abathathi-nxaxheba, ungenelelo, uthelekiso, iziphumo kunye noyilo lokufunda
Ii-TADs: isixhobo se-anchor sethutyana;I-RTM: isantya sokuhamba kwamazinyo;I-TTM: ixesha lokuhamba kwamazinyo;I-CTM: intshukumo yamazinyo eyongezelekayo;EXP: umfuniselo;NR: ayixelwanga;U3: inja ephezulu;U6: i-molar yokuqala ephezulu;SS: intsimbi engenasici;NiTi: nickel-titanium;Ii-MOPs: i-microbial bone perforation;I-LLLT: unyango lwe-laser oluphantsi;I-CFO: i-orthodontics kunye ne-corticotomy;I-FTMPF: i-flap ye-mucoperiosteal epheleleyo
NR: Ayixelwanga;I-WHO ICTRP: Khangela i-Portal ye-WHO International Clinical Trials Registry Platform
Olu hlaziyo lubandakanya ii-RCTs23,32-34 ezine ezigqityiweyo kunye neeCCT ezimbini35,36 ezibandakanya izigulane ze-154.Ubudala busukela kwi-15 ukuya kwi-29 yeminyaka ubudala.Olunye uphando lubandakanya izigulane zabasetyhini kuphela [32], ngelixa olunye uphando lubandakanya abafazi abambalwa kunamadoda [35].Kwakukho abafazi abaninzi kunamadoda kwizifundo ezintathu [33,34,36].Isifundo esinye kuphela asizange sinikeze ukuhanjiswa ngokwesini [23].
Izifundo ezine ezibandakanyiweyo zaziyi-split-port (SMD) uyilo [33-36] kwaye ezimbini ziyi-composite (COMP) ziyilo (ezifanayo kunye neziqhekezayo) [23,32].Kuphononongo loyilo oluhlanganisiweyo, icala elisebenzayo leqela lokulinga lifaniswa necala elingasebenziyo lamanye amaqela okulinga, njengoko icala elichaseneyo lala maqela alizange libe nakho ukukhawulezisa (kuphela unyango oluqhelekileyo lwe-orthodontic) [23,32].Kwezinye izifundo ezine, olu thelekiso lwenziwa ngokuthe ngqo ngaphandle kweqela elingenalo ukukhawuleza [33-36].
Izifundo ezihlanu zithelekisa utyando kunye nongenelelo lomzimba (oko kukuthi, unyango lwe-laser oluphantsi kakhulu {LILT}), kunye nophononongo lwesithandathu luthelekisa utyando kunye nongenelelo lwezonyango (okt, prostaglandin E1).Ungenelelo lotyando luvela kwi-overtly invasive (i-corticotomy yendabuko [33-35], i-FTMPF epheleleyo yobuninzi be-mucoperiosteal flap [32]) ukuya kungenelelo oluncinci (iinkqubo ezincinci ezihlaselayo {MOPs} [23] kunye neenkqubo ze-piezotomy ezingenasiphako [36]).
Zonke izifundo ezifunyenweyo zibandakanya izigulane ezifuna ukuchithwa kwe-canine emva kwe-premolar extraction [23,32-36].Zonke zibandakanya izigulane zafumana unyango olusekelwe kwi-extraction.I-canines yasuswa emva kokukhutshwa kwe-premolars yokuqala yomhlathi ophezulu.Ukukhutshwa kwenziwa ekuqaleni kwonyango de kugqitywe ukulinganisa kunye nokulinganisa kwizifundo ezintathu [23, 35, 36] kunye nabanye abathathu [32-34].Uvavanyo olulandelwayo luvela kwiiveki ezimbini [34], iinyanga ezintathu [23,36], kunye neenyanga ezine [33] ukugqitywa kwe-canine retraction [32,35].Kwizifundo ezine [23, 33, 35, 36], umlinganiselo wokuhamba kwezinyo wachazwa ngokuthi "izinga lokuhamba kwamazinyo" (RTM), kwaye kwelinye isifundo, "ixesha lokuhamba kwamazinyo" (CTM) libonakaliswe "njengentshukumo yezinyo" ."Ixesha" (TTM).) kwizifundo ezimbini [32,35], enye ihlolwe i-sRANKL concentrations [34].Izifundo ezihlanu zisebenzise isixhobo se-ankile ye-TAD yethutyana [23,32-34,36], ngelixa isifundo sesithandathu sisebenzise ukugoba kwengcebiso ebuyela umva ukulungiswa [35].Ngokubhekiselele kwiindlela ezisetyenziselwa ukulinganisa isantya sezinyo, uphando oluthile lusebenzisa i-digital intraoral calipers [23], uphando oluthile lusebenzisa iteknoloji ye-ELISA ukufumana iisampuli ze-gingival sulcus fluid (GCF) [34], kunye nezifundo ezimbini zavavanya ukusetyenziswa kwe-electronic digital cast..iphosa i-caliper [33,35], ngelixa izifundo ezimbini zisebenzisa i-3D iimodeli zokufunda ezikheniweyo ukufumana imilinganiselo [32,36].
Umngcipheko wokungabandakanywa kwi-RCT uboniswe kwi-Figure 2, kwaye umngcipheko jikelele we-bias kwi-domain nganye uboniswe kwi-Figure 3. Zonke ii-RCT zilinganiswe ngokuba "zinokukhathazeka okuthile" [23,32-35]."Ezinye iinkxalabo malunga necala" luphawu oluphambili lwee-RCTs.I-bias ngenxa yokutenxa kungenelelo olulindelekileyo (iziphumo ezinxulumene nongenelelo; iziphumo zokubambelela kungenelelo) yayiyeyona ndawo ikrokrelayo (okt, "inkxalabo ethile" yayikhona kwi-100% yezifundo ezine).Umngcipheko wokuqikelelwa kwe-bias kwisifundo seCCT kuboniswe kuMzobo 4. Ezi zifundo zazinomngcipheko ophantsi "wokungakhethi".
Umzobo osekelwe kwidatha evela ku-Abdelhameed kunye noRefai, 2018 [23], El-Ashmawi et al., 2018 [33], Sedky et al., 2019 [34], kunye no-Abdarazik et al., 2020 [32].
Utyando oluchasene nokungenelela ngokomzimba: Izifundo ezihlanu zithelekisa iintlobo ezahlukeneyo zotyando kunye ne-low-intensity laser therapy (LILT) ukukhawuleza ukurhoxiswa kwe-canine [23,32-34].El-Ashmawy et al.Imiphumo ye "corticotomy yendabuko" ngokuchasene ne "LLT" yavavanywa kwi-cleft RCT [33].Ngokumalunga nesantya sokurhoxisa i-canine, akukho mahluko abalulekileyo afunyenwe phakathi kwe-corticotomy kunye namacala e-LILI nakweyiphi na indawo yokuvavanya (ithetha i-0.23 mm, i-95% CI: -0.7 ukuya ku-1.2, p = 0.64).
Turker et al.ivavanye isiphumo se-piezocision kunye ne-LILT kwi-RTM kwi-TBI evulekileyo [36].Ngenyanga yokuqala, i-frequency ye-canine ephezulu yokurhoxiswa kwicala le-LILI yayiphezulu ngokwezibalo kunecala le-piezocision (p = 0.002).Nangona kunjalo, akukho mmahluko obalulekileyo oye wabonwa phakathi kwamacala amabini kwinyanga yesibini neyesithathu yokurhoxiswa kwe-canine ephezulu, ngokulandelanayo (p = 0.377, p = 0.667).Ukuqwalasela ixesha elipheleleyo lokuvavanya, iziphumo ze-LILI kunye ne-Piezocisia kwi-OTM zifana (p = 0.124), nangona i-LILI yayisebenza ngakumbi kunenkqubo ye-Piezocisia kwinyanga yokuqala.
U-Abdelhameed noRefai bafunda umphumo we "MOPs" xa kuthelekiswa ne "LLLT" kunye ne "MOPs + LLLT" kwi-RTM kwi-RCT yoyilo oludibeneyo [23]. Bafumene ukunyuka kwezinga lokurhoxiswa kwe-canine ephezulu kumacala akhawulezayo ("i-MOPs" kunye ne "LLLT") xa kuthelekiswa namacala angenawo ukukhawuleza, kunye nokwahlukana kwezibalo kuwo onke amaxesha ovavanyo (p<0.05). Bafumene ukunyuka kwezinga lokurhoxiswa kwe-canine ephezulu kumacala akhawulezayo ("i-MOPs" kunye ne "LLLT") xa kuthelekiswa namacala angenawo ukukhawuleza, kunye nokwahlukana kwezibalo kuwo onke amaxesha ovavanyo (p<0.05). Они обнаружили ускоренное увеличение скорости ретракции верхних клыков в боковых сторонах («MOPs», а также «LLLT») по сравнению с неускоренными боковыми ретракциями со статистически значимыми различиями во все времена оценки (p<0,05). Bafumene ukunyuka okukhawulezileyo kwisantya sokurhoxiswa kwecala leecanine eziphezulu ("MOPs" kunye ne "LLLT") xa kuthelekiswa nokuhlehliswa kwecala okungakhawulezileyo kunye nokwahlukana okuphawulekayo kwezibalo kuwo onke amaxesha ovavanyo (p<0.05).他們发现，与非加速侧相比，加速侧（“MOPs”和“LLLT”) Baye bafumanisa ukuba, xa kuthelekiswa necala elingenalo ukukhawuleza, amazinyo aphezulu e-canine yecala elikhawulezayo ("i-MOPs" kunye ne "LLLT") yandisa izinga lokunciphisa, kwaye kukho ukuhluka okuphawulekayo (p <0.05) kuwo onke amaxesha okuvavanya. . Они обнаружили, что ретракция верхнего клыка была выше на стороне акселерации («MOPs» и «LLLT») по сравнению со стороной без акселерации со статистически значимой разницей (p<0,05) во все оцениваемые моменты времени. Ufumene ukuba ukurhoxiswa kwamalungu aphezulu kwakuphezulu kwicala kunye nokukhawuleza ("MOPs" kunye ne "LLLT") xa kuthelekiswa necala ngaphandle kokukhawuleza kunye nokwahlukana okuphawulekayo kwezibalo (p <0.05) kuwo onke amanqaku avavanyiweyo.Xa kuthelekiswa necala elingenalo ukukhawuleza, ukurhoxiswa kwe-clavicle kwakhawuleza ngama-1.6 kunye namaxesha e-1.3 kumacala "SS" kunye ne "NILT", ngokulandelanayo.Ukongeza, baye babonisa ukuba inkqubo ye-MOPs yayisebenza ngakumbi kunenkqubo ye-LLLT ekukhawuleziseni ukuhlehliswa kwee-clavicles eziphezulu, nangona umahluko wawungabalulekanga ngokwezibalo.I-heterogeneity ephezulu kunye nokungafani kokungenelela okusetyenziswayo phakathi kwezifundo zangaphambili kuthintele ukuhlanganiswa kobuninzi bedatha [23,33,36].Abdalazik et al.I-RCI enengalo ephindwe kabini ene-composite design [32] ivavanye umphumo we-full-thickness mucoperiosteal flap (ubude be-FTMPF kuphela nge-LLLT) kwi-cumulative tooth movement (CTM) kunye nexesha lokuhamba kwezinyo (TTM)."Ixesha lokuhamba kwezinyo" xa kuthelekiswa namacala akhawulezayo kunye namacala angakhawulezileyo, ukunciphisa okuphawulekayo kwixesha elipheleleyo lokurhoxiswa kwamazinyo kwabonwa.Kulo lonke uphononongo, akukho mahluko obalulekileyo phakathi kwe-"FTMPF" kunye ne "LLLT" ngokubhekiselele "kwentshukumo yezinyo ekhulayo" (p = 0.728) kunye "nexesha lokuhamba kwezinyo" (p = 0.298).Ukongeza, i-“FTMPF” kunye ne-“LLLT” » zinokufikelela kwi-25% kunye ne-20% ye-OTM yokunyusa isantya ngokulandelelanayo.
Seki et al.Umphumo "we-corticotomy yendabuko" ngokuchasene ne "LLT" ekukhululweni kwe-RANKL ngexesha le-OTM kwi-RCT ene-orotomy yavavanywa kwaye yathelekiswa [34].Uphononongo luchaze ukuba zombini i-corticotomy kunye ne-LILI yandisa ukukhululwa kwe-RANKL ngexesha le-OTM, eyachaphazela ngokuthe ngqo ukulungiswa kwamathambo kunye nezinga le-OTM.Umahluko wamazwe amabini awubalulekanga ngokwezibalo kwi-3 kunye neentsuku ze-15 emva kokungenelela (p = 0.685 kunye ne-p = 0.400, ngokulandelanayo).Ukwahluka kwixesha okanye indlela yokuvavanya iziphumo kuthintele ukubandakanywa kwezifundo ezimbini zangaphambili kwi-meta-analysis [32,34].
Ungenelelo lotyando kunye ne-pharmacological: U-Rajasekaran kunye no-Nayak bavavanya umphumo we-corticotomy ngokumelene ne-prostaglandin i-E1 injection kwi-RTM kunye nexesha lokuhamba kwezinyo (TTM) kwi-CCT yomlomo wokwahlukana [35].Baye babonisa ukuba i-corticotomy iphucule i-RTM engcono kune-prostaglandin, kunye nokwahlukana okuphawulekayo (p = 0.003), ekubeni i-RTM ephakathi kwicala le-prostaglandin yayingu-0.36 ± 0.05 mm / ngeveki, ngelixa i-corticotomy yayingu-0.40 ± 0 .04mm / i-perimeter.Kwakhona kukho ukungafani kwixesha lokuhamba kwamazinyo phakathi kokungenelela okubini.Iqela le-corticotomy (iiveki ze-13) zinexesha elifutshane "lokunyakaza kwamazinyo" kuneqela le-prostaglandin (iiveki ze-15).Ukufumana iinkcukacha ezithe vetshe, isishwankathelo seziphumo zobungakanani beziphumo ezingundoqo zophononongo ngalunye zinikezelwe kwiThebhile 6.
I-RTM: isantya sokuhamba kwamazinyo;I-TTM: ixesha lokuhamba kwamazinyo;I-CTM: intshukumo yamazinyo eyongezelekayo;I-NAC: ulawulo olungakhawuleziswanga;Ii-MOPs: i-microbial bone perforation;I-LLLT: unyango lwe-laser oluphantsi;I-CFO: i-orthodontics kunye ne-corticotomy;I-FTMPF: i-flap ye-mucoperiosteal epheleleyo;NR: ayixelwanga
Izifundo ezine zivavanye iziphumo zesibini [32,33,35,36].Izifundo ezintathu zivavanye ukulahlekelwa kwenkxaso ye-molar [32,33,35].U-Rajasekaran no-Nayak abafumananga mahluko abalulekileyo phakathi kwe-corticotomy kunye namaqela e-prostaglandin (p = 0.67) [35].El-Ashmawi et al.Akukho mmahluko obalulekileyo ofunyenweyo phakathi kwe-corticotomy kunye necala le-LLLT nangaliphi na ixesha lovavanyo (MD 0.33 mm, 95% CI: -1.22-0.55, p = 0.45) [33].Kunoko, u-Abdarazik et al.Umahluko obalulekileyo ngokwezibalo waxelwa phakathi kweFTMPF kunye namaqela eLLLT, kunye neqela leLLLT likhulu [32].
Ubuhlungu kunye nokuvuvukala kwavavanywa kwiimvavanyo ezimbini ezibandakanyiweyo [33,35].Ngokutsho kukaRajasekaran kunye noNayak, izigulane zabika ukuvuvukala okuncinci kunye neentlungu ngeveki yokuqala kwicala le-corticotomy [35].Kwimeko ye-prostaglandin, zonke izigulana zifumana iintlungu ezibuhlungu xa zihlatywa.Kwizigulane ezininzi, ubunzima buphezulu kwaye buhlala ukuya kwiintsuku ezintathu ukusuka kumhla wokutofa.Nangona kunjalo, u-El-Ashmawi et al.[33] yabika ukuba i-70% yezigulane zikhalaza ngokuvuvukala kwicala le-corticotomy, ngelixa i-10% yayinokuvuvukala kwicala le-corticotomy kunye ne-LILI.Intlungu ye-postoperative yaphawulwa yi-85% yezigulane.Icala le-corticotomy linzima kakhulu.
U-Rajasekaran kunye no-Nayak bavavanya utshintsho ekuphakameni kwe-ridge kunye nobude beengcambu kwaye abazange bafumane nantlukwano ephawulekayo phakathi kwe-corticotomy kunye namaqela e-prostaglandin (p = 0.08) [35].Ubunzulu bovavanyo lweperiodontal lwavavanywa kwisifundo esinye kuphela kwaye akukho mahluko abalulekileyo phakathi kwe-FTMPF kunye ne-LLLT [32].
U-Türker et al uhlolisise utshintsho kwi-canine kunye nee-angles zokuqala ze-molar kwaye akafumananga mahluko abalulekileyo kwi-canine kunye nee-angles zokuqala ze-molar phakathi kwecala le-piezotomy kunye necala le-LLLT ngexesha lokulandelwa kweenyanga ezintathu [36].
Amandla obungqina be-orthodontic misalignment kunye nemiphumo emibi ukusuka "kuphantsi kakhulu" ukuya "phantsi" ngokwemigaqo ye-GRADE (Itheyibhile 7).Ukunciphisa amandla obungqina kuhambelana nomngcipheko we-bias [23,32,33,35,36], ngokungathanga ngqo [23,32] kunye nokungachaneki [23,32,33,35,36].
a, g Ukunciphisa umngcipheko we-bias kwinqanaba elinye (i-bias ngenxa yokuphambuka kumanyathelo alindelekileyo, ilahleko enkulu ekulandeleni) kunye nokunciphisa ukungachaneki kwinqanaba elilodwa * [33].
c, f, i, j Ingozi ye-bias iyancipha kwinqanaba elinye (izifundo ezingezona i-randomized) kunye nomda wephutha wehla ngenqanaba elinye * [35].
d Ukunciphisa umngcipheko we-bias (ngenxa yokutenxa kungenelelo olulindelekileyo) kwinqanaba elinye, ngokungathanga ngqo kwinqanaba elinye **, kunye nokungachaneki kwinqanaba elinye * [23].
e, h, k Ukunciphisa umngcipheko wecala (i-bias ehambelana nenkqubo yokwenza i-randomization, i-bias ngenxa yokuphambuka kungenelelo olucetywayo) kwinqanaba elinye, ngokungathanga ngqo kwinqanaba elinye **, kunye nokungachaneki kwinqanaba elilodwa * [32].
CI: ixesha lokuzithemba;I-SMD: uyilo lwezibuko lokwahlula;I-COMP: uyilo oludibeneyo;MD: uthetha umahluko;I-LLLT: unyango lwe-laser oluphantsi;I-FTMPF: i-flap ye-mucoperiosteal epheleleyo
Kubekho ukwanda okubalulekileyo kuphando malunga nokukhawuleziswa kwentshukumo yamathambo kusetyenziswa iindlela ezahlukeneyo zokukhawulezisa.Nangona iindlela zokukhawulezisa utyando ziye zafundwa ngokubanzi, iindlela ezingezizo utyando ziye zafumana indlela yazo kuphando olubanzi.Ulwazi kunye nobungqina bokuba enye indlela yokunyusa isantya ingcono kunenye ihlala ixutywe.
Ngokwale SR, akukho mvumelwano phakathi kwezifundo kwi-predominance yeendlela zotyando okanye ezingezizo utyando ekukhawuleziseni i-OTM.U-Abdelhameed noRefai, uRajasekaran noNayak bafumanisa ukuba kwi-OTM, utyando lwalusebenza ngakumbi kunokungenelela okungenalo utyando [23,35].Endaweni yoko, uTürker et al.Ungenelelo olungelulo utyando lubonakalise ukuba lusebenza ngakumbi kunongenelelo lotyando kwinyanga yokuqala yokuhoxiswa kwe-canine ephezulu [36].Nangona kunjalo, ngokuqwalasela lonke ixesha lovavanyo, bafumanisa ukuba impembelelo yokungenelela ngokuhlinzwa kunye nokungabikho kokuhlinzwa kwi-OTM yayifana.Ukongeza, Abdarazik et al., El-Ashmawi et al., kunye noSedki et al.kuphawulwe ukuba akukho mahluko phakathi kokungenelela kokuhlinzwa kunye nokungabikho kokuhlinzwa ngokwemiqathango yokukhawuleza kwe-OTM [32-34].