“Usambokahadzika kuti boka duku revagari vemo vane pfungwa, vakazvipira vanogona kuchinja nyika.Kutaura zvazviri, ndiyo chete iripo.”
Chinangwa cheCureus ndechekushandura iyo yakagara iripo modhi yekudhindisa yezvokurapa, umo kuendesa kutsvagisa kunogona kudhura, kwakaoma, uye kutora nguva.
Ukobvu hwakazara mucoperiosteal flap, mop, piezotomy, corticotomy, lllt, prostaglandin, kukurumidza kufamba kwemazino, orthodontic, kusavhiya, kuvhiya.
Doaa Tahsin Alfaylani, Mohammad Y. Hajir, Ahmad S. Burhan, Luai Mahahini, Khaldun Darwich, Ossama Aljabban
Taura chinyorwa ichi se: Alfailany D, Hajeer MY, Burhan AS, et al.(Chivabvu 27, 2022) Kuongorora kushanda kwekuvhiya uye kusiri-kuvhiya kupindira kana kuchishandiswa pamwe chete nevanochengeta kuti vakurumidze orthodontic mazino kufamba: ongororo yakarongeka.Kurapa 14(5): e25381.doi:10.7759/cureus.25381
Chinangwa chekuongorora uku chaiva chekuongorora humbowo huripo huripo hwekubudirira kwekuvhiya uye kusina kuvhiyiwa nzira dzekukurumidza uye nemigumisiro yemigumisiro inobatanidza nenzira idzi.Madhatabheti mapfumbamwe akatsvagwa: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE®, Scopus®, PubMed®, Web of Science™, Google™ Scholar, Trip, OpenGrey uye PQDT OPEN yepro-Quest®.ClinicalTrials.gov uye yekutsvaga portal yeInternational Clinical Trials Registry Platform (ICTRP) yakaongororwa kuti iongorore tsvakurudzo yezvino uye mabhuku asina kubudiswa.Randomized controlled trials (RCTs) uye controlled clinical trials (CCTs) yevarwere vari kuvhiyiwa (invasive or minimally invasive techniques) pamwe chete nemichina yakagadziriswa yakagadziriswa uye ichienzaniswa nekusapindira kwekuvhiya.Iyo Cochrane Risk yeBias (RoB.2) chiridzwa chakashandiswa kuongorora RCTs, nepo ROBINS-I chiridzwa chakashandiswa kuCCT.
MaRCT mana uye maCCT maviri (varwere ve154) akabatanidzwa muongororo iyi yakarongeka.Miedzo ina yakawana kuti kupindira kwekuvhiya uye kusiri kwekuvhiya kwakave nemhedzisiro imwechete pakumhanyisa orthodontic zino kufamba (OTM).Kusiyana neizvi, kuvhiyiwa kwainyanya kushanda mune zvimwe zvidzidzo zviviri.A high degree of heterogeneity pakati pezvidzidzo zvakabatanidzwa zvakadzivisa kuwanda kwehuwandu hwemigumisiro.Migumisiro yemigumisiro yakataurwa yakabatanidzwa nekuvhiya uye kusapindira kwekuvhiya kwakafanana.
Paive neumbowo 'hwakaderera' kusvika 'hwakaderera' hwekuti kuvhiya uye kusavhiya kwakabatsira zvakaenzana mukumhanyisa kufamba kwemazino pasina mutsauko mumhedzisiro.Mimwe miedzo yekiriniki yepamusoro inodiwa kuenzanisa mhedzisiro yekukurumidza kwemaitiro maviri mumhando dzakasiyana dzemalocclusion.
Nguva yekurapa kune chero orthodontic kupindira ndechimwe chezvinhu zvakakosha izvo varwere vanofunga pavanenge vachiita sarudzo [1].Semuenzaniso, kudzoreredza kwemazino akanyanya anchored canines mushure mekubviswa kwepamusoro premolars kunogona kutora inenge mwedzi 7, nepo chiyero chebioorthodontic mazino kufamba (OTM) chinenge 1 mm pamwedzi, zvichikonzera nguva yekurapa yakazara yeanenge makore maviri [2, 3] ] .Marwadzo, kusagadzikana, caries, gingival recession uye midzi resorption ndiwo mhedzisiro inowedzera nguva yekurapa orthodontic [4].Pamusoro pezvo, zvikonzero zvekunaka uye zvemagariro zvinoita kuti varwere vazhinji vade kupedzwa nekukurumidza kwekurapa orthodontic [5].Nokudaro, vose orthodontists nevarwere vanotsvaka kukurumidza kufamba kwemazino uye kuderedza nguva yekurapa [6].
Nzira iyo kufamba kwemeno kunokurumidzira kunoenderana nekushandiswa kweiyo biological tissue reaction.Maererano nehuwandu hwekuvhiringidza, nzira idzi dzinogona kugoverwa kuva mapoka maviri: kuchengetedza (biological, physical, uye biomechanical nzira) uye nzira dzokuvhiya [7].
Biological approaches dzinosanganisira kushandiswa kwemishonga yemishonga kuwedzera mazino kufamba mukuedza kwemhuka uye muvanhu.Zvidzidzo zvakawanda zvakaratidza kushanda kunopesana nezvizhinji zvezvinhu izvi zvakaita semacytokines, nuclear factor kappa-B ligand receptor activators/nuclear factor-kappa-B protein receptor activators (RANKL/RANK), prostaglandins, vhitamini D, mahomoni akaita separathyroid hormone (PTH). )) uye osteocalcin, pamwe chete nemajekiseni ezvimwe zvinhu zvakadai sekuzorora, hazvina kuratidza chero kukurumidza kushanda [8].
Maitiro epanyama anobva pakushandiswa kwekushandisa kurapa kwemidziyo, kusanganisira yakananga ikozvino [9], pulsed electromagnetic fields [10], vibration [11], uye yakaderera-intensity laser therapy [12], iyo yakaratidza mhedzisiro inovimbisa [8].].Nzira dzekuvhiya dzinoonekwa sedzinonyanya kushandiswa uye dzinoratidzwa nekiriniki uye dzinogona kuderedza zvakanyanya nguva yekurapa [13,14].Zvisinei, vanovimba ne "Regional Acceleration Phenomenon (RAP)" kubva pakuitika kwekuvhiya kukuvadzwa kune alveolar bone kunogona kukurumidza kukurumidza OTM [15].Aya maitiro ekuvhiya anosanganisira zvechinyakare corticotomy [16,17], interstitial alveolar bone kuvhiyiwa [18], accelerated osteogenic orthodontics [19], alveolar traction [13] uye periodontal traction [20], compression electrotomy [14,21], cortical resection [ 19].22] uye microperforation [23].
Nhamba dzinoverengeka dzakarongeka (SR) dzezviyedzo zvakadzorwa (RCTs) zvakadhindwa pamusoro pekubudirira kwekuvhiya uye kusavhiya kupindira mukukurumidza OTM [24,25].Zvisinei, hukuru hwekuvhiya pamusoro penzira dzisina kuvhiyiwa hazvina kuratidzwa.Nokudaro, iyi ongororo yakarongeka (SR) ine chinangwa chekupindura mubvunzo unotevera wekuongorora unokosha: Ndeipi inonyanya kushanda mukukurumidzira orthodontic mazino kana uchishandisa yakagadziriswa orthodontic midziyo: nzira dzekuvhiya kana dzisiri dzekuvhiya?
Kutanga, tsvakiridzo yemutyairi yakaitwa paPubMed kuti ive nechokwadi chekuti pakanga pasina maSR akafanana uye kutarisa zvese zvine chekuita nenyaya isati yanyora yekupedzisira SR proposal.Gare gare, miedzo miviri inogona kushanda yakaonekwa uye yakaongororwa.Kunyoreswa kweiyi SR protocol muPROSPERO dhatabhesi kwapera (nhamba yekuzivikanwa: CRD42021274312).Iyi SR yakanyorwa maererano neCochrane Handbook of Systematic Reviews of Interventions [26] uye Inonyanya Kutaurwa Zvinhu zveNhungamiro Yekuongorora Kwakarongeka uye Meta-analysis (PRISMA) [27,28].
Chidzidzo chacho chaisanganisira varwere vane hutano hwevarume nevakadzi vane hutano hwakagadziriswa, pasinei nezera, rudzi rwemalocclusion, kana rudzi, maererano neMutori wechikamu Kupindira, Kuenzanisa, Zvigumisiro, uye Kudzidza Design (PICOS) muenzaniso.Kuwedzera kuvhiyiwa (kusiririsa kana kushoma invasive) kune yechinyakare fixed orthodontic kurapwa kwakaonekwa.Chidzidzo chacho chaisanganisira varwere vakagamuchira kugadziriswa kwe orthodontic (OT) pamwe chete nekusapindira kwekuvhiya.Kupindira uku kunogona kusanganisira nzira dzemishonga (yemunharaunda kana systemic) uye maitiro emuviri (laser irradiation, magetsi emagetsi, pulsed electromagnetic fields (PEMF) uye vibration).
Mhedzisiro yekutanga yeiyi chiyero ndiyo chiyero chekufamba kwezino (RTM) kana chero chiratidzo chakafanana chinogona kutizivisa nezvekubudirira kwekuvhiya uye kusavhiya kupindira.Zvigumisiro zvechipiri zvinosanganisira migumisiro yakaipa yakadai semigumisiro yakataurwa nemurwere (marwadzo, kusagadzikana, kugutsikana, hutano hwemuromo-hune hutano hwehupenyu, kutsenga kutsenga, uye zvimwe zviitiko), migumisiro ye periodontal-inoenderana nekuyerwa ne periodontal index (PI), matambudziko. , Gingival Index (GI), kurasikirwa kwekunamatira (AT), gingival recession (GR), periodontal kudzika (PD), kurasikirwa kwerutsigiro uye kusingadiwi mazino kufamba (kutenderera, kutenderera, kutenderera) kana iatrogenic mazino kushungurudza zvakadai sokurasikirwa kwezino Kusimba. , Root Resorption.Zvidzidzo zviviri chete zvakagamuchirwa - Randomized Controlled Trials (RCTs) uye Controlled Clinical Trials (CCTs), yakanyorwa muChirungu chete, pasina zvibvumirano mugore rekubudiswa.
Zvinyorwa zvinotevera zvakange zvisingabatanidzwe: zvidzidzo zvekare, zvidzidzo mumitauro isiri yeChirungu, kuedza kwemhuka, in vitro zvidzidzo, nyaya dzenyaya kana nyaya dzakatevedzana, zvinyorwa, zvinyorwa zvine wongororo uye mapepa machena, maonero emunhu, miedzo isina masampuli akashumwa, kwete. boka rekutonga, kana kuvapo kweboka risingatarisirwi rinodzora uye boka rekuedza rine vashoma pane varwere ve10 rakadzidzwa neine finite element method.
Tsvakiridzo yemagetsi yakagadzirwa pane anotevera dhatabhesi (Nyamavhuvhu 2021, hapana muganhu wenguva, Chirungu chete): Cochrane Central Register of Controlled Trials, PubMed®, Scopus®, Web of Science™, EMBASE®, Google™ Scholar, Trip, OpenGrey (yekuziva mabhuku egrey) uye PQDT Vhura kubva kupro-Quest® (yekuzivisa mapepa uye dissertation).Zvinyorwa zvinyorwa zvezvinyorwa zvakasarudzwa zvakaongororwawo kune chero zvingangove zviedzo zvingave zvisina kuwanikwa nemagetsi ekutsvaga paInternet.Panguva imwecheteyo, kutsvaga kwemaoko kwakaitwa mu Journal of Angle Orthodontics, American Journal of Orthodontics uye Dentofacial Orthopedics™, European Journal yeOrthodontics uye Orthodontics uye Craniofacial Research.ClinicalTrials.gov neWorld Health Organisation's International Clinical Trials Registry Platform (ICTRP) yekutsvaga portal yakaita macheki emagetsi kuti vawane miedzo isina kuburitswa kana zvidzidzo zvakapedzwa parizvino.Rumwe ruzivo nezve e-search zano rinopihwa muTafura 1.
RANKL: nuclear factor kappa-beta ligand receptor activator;RANK: nuclear factor kappa-beta ligand receptor activator
Vaongorori vaviri (DTA neMYH) vakazvimiririra vakaongorora kukodzera kwechidzidzo, uye kana paine kusawirirana, munyori wechitatu (LM) akakokwa kuti aite sarudzo.Danho rekutanga rine kutarisa chete musoro uye zvirevo.Danho rechipiri rezvidzidzo zvese raive rekuyera chinyorwa chakazara sechakoshera uye sefa yekubatanidzwa kana iyo musoro kana chidimbu chaive chisina kujeka kubatsira kuita mutongo wakajeka.Zvinyorwa hazvina kubatanidzwa kana vasina kusangana neimwe kana kupfuura yemaitiro ekuiswa.Kuti uwane dzimwe tsananguro kana imwe data, ndapota nyorera kune iye munyori.Vanyori vakafanana (DTA neMYH) vakaburitsa data vakazvimirira kubva kumutyairi uye akafanotsanangurwa matafura ekubvisa data.Pakapokana vaviri vanoongorora vanoongorora, munyori wechitatu (LM) akakumbirwa kuti abatsire kuzvigadzirisa.Iyo pfupiso data tafura inosanganisira zvinotevera zvinhu: ruzivo rwese nezvechinyorwa (zita remunyori, gore rekuburitswa uye kumashure kwechidzidzo);nzira (magadzirirwo ezvidzidzo, boka rakaongororwa);vatori vechikamu (nhamba yevarwere vakanyoreswa, zvinoreva makore uye zera rezera)., pasi);Kupindira (rudzi rwemaitiro, nzvimbo yemaitiro, hunyanzvi hwekuita);Orthodontic maitiro (degree of malocclusion, rudzi rwe orthodontic mazino kufamba, kuwanda kwekugadzirisa orthodontic, nguva yekucherechedza);uye Mhedzisiro yezviyero (yekutanga neyechipiri mhedzisiro yakataurwa, nzira dzekuyera, uye kuzivisa kwehuwandu hwakakosha kusiyana).
Vaongorori vaviri (DTA neMYH) vakaongorora njodzi yekusarura vachishandisa RoB-2 chiridzwa cheRCTs yakatorwa [29] uye ROBINS-I chiridzwa cheCCTs [30].Kana muine kusawirirana, ndapota bvunza mumwe wevanyori-vanyori (ASB) kuti muwane mhinduro.Pamiyedzo yakasarudzika, takatara nzvimbo dzinotevera se "ngozi yakaderera", "njodzi huru" kana "rimwe dambudziko rekurerekera": kurerekera kunobva kune randomisation process, rusaruro nekuda kwekutsauka kubva kune inotarisirwa kupindira (mhedzisiro inokonzerwa nekupindira; mhedzisiro ye kuomerera kune zvinopindira), kurerekera nekuda kwekushaikwa kwemhedzisiro data, kuyerwa kwekuyerwa, kusarudzika kusarudzwa mukubika mhedzisiro.Njodzi yose yekusarura kwezvidzidzo zvakasarudzwa yakarongwa sezvinotevera: "Njodzi yakaderera yekusarura" kana nzvimbo dzose dzakanzi "ngozi shoma yekusarura";"Kumwe Kunetsekana" kana imwe nzvimbo yakaverengerwa se "Dzimwe Kunetsekana" asi kwete "Njodzi Yakanyanya Kusarura munzvimbo ipi neipi, Njodzi Yakanyanya yeBias: kana dunhu rimwe chete kana anopfuura akaverengerwa seHigh Risk yeBias" kana zvimwe zvinonetsa. pamusoro penzvimbo dzakawanda, izvo zvinoderedza zvakanyanya kuvimba mumigumisiro.Kunyange zvazvo, nokuda kwemiedzo isina-randomized, takaronga nzvimbo dzinotevera seyakaderera, ine mwero, uye ine ngozi yakawanda: panguva yekupindira (kupindira kwechikamu chekusarura);mushure mekupindira (kusarura nekuda kwekutsauka kubva kune zvinotarisirwa kupindira; kusarura nekuda kwekushayikwa kwemashoko; migumisiro) kuyerwa kwekuyera;kushuma zvakarerekera pakusarudzwa kwezviwanikwa).Njodzi yose yekusarura kwezvidzidzo zvakasarudzwa yakarongwa sezvinotevera: "Njodzi yakaderera yekusarura" kana nzvimbo dzose dzakanzi "ngozi shoma yekusarura";"Njodzi ine mwero yekusarura" kana matunhu ese akaverengerwa se "yakaderera kana ine mwero njodzi yekusarura".bias” “Njodzi yakakomba yokusarura”;"Njodzi Yakanyanya Kusarura" kana imwechete domain yakaverengerwa "Njodzi Yakanyanya Kusarura" asi pasina Njodzi Yakakura yeBias mune chero dura, "Njodzi Yakanyanya Kusarura" kana imwechete domain yakarongwa "Njodzi Yakanyanya yekukanganisa kwakarongeka";chidzidzo chaionekwa se "ruzivo rusipo" kana pakanga pasina chiratidzo chakajeka chokuti chidzidzo chacho "chakakosha kana kuti pangozi yakakura yekusarura" uye yakanga isipo ruzivo mune imwe kana kupfuura dzimwe nzvimbo dzinokosha dzekusarura.Kuvimbika kweuchapupu kwakaongororwa maererano neNhungamiro Yekuongorora, Kubudirira uye Kuongorora (GRADE) nzira, nemigumisiro yakarongerwa sepamusoro, pakati, pasi, kana kuti yakaderera zvikuru [31].
Mushure mekutsvaga kwemagetsi, huwandu hwezvinyorwa zve1972 zvakaonekwa uye chirevo chimwe chete kubva kune mamwe masosi.Mushure mekubvisa zvakapetwa, 873 manyoro akaongororwa.Mazita uye zvinyorwa zvakaongororwa kuti zvinokodzera uye chero zvidzidzo zvisina kuzadzisa maitiro ekukodzera zvakarambwa.Nekuda kweizvozvo, chidzidzo chakadzama chemagwaro gumi nerimwe angangove akakodzera chakaitwa.Miedzo mishanu yakapedzwa uye zvishanu zvidzidzo zvinoenderera mberi hazvina kusangana nemaitiro ekubatanidzwa.Zvidimbu zvezvinyorwa zvisingabatanidzwi mushure mekuongorora zvizere-zvinyorwa uye zvikonzero zvekusabatanidzwa zvinopihwa mutafura iri muapendikisi.Pakupedzisira, zvidzidzo zvitanhatu (mana RCTs uye maviri CCTs) zvakabatanidzwa muSR [23,32-36].Iyo block diagram yePRISMA inoratidzwa muMufananidzo 1.
Maitiro ezvitanhatu zvakabatanidzwa miedzo zvinoratidzwa muTables 2 uye 3 [23,32-36].Muedzo mumwe chete weprotocol wakaonekwa;ona Table 4 ne5 kuti uwane rumwe ruzivo nezve chirongwa chetsvakiridzo chirikuenderera mberi ichi.
RCT: randomized clinical trial;NAC: kwete-kukurumidza kudzora;SMD: kupatsanurwa kwemuromo kugadzira;MOPs: microosseous perforation;LLLT: yakaderera intensity laser therapy;CFO: orthodontics ne corticotomy;FTMPF: yakazara ukobvu mucoperiosteal flap;Exp: kuedza;murume: murume;F: mukadzi;U3: canine yepamusoro;ED: simba guru;RTM: zino kufamba nekukurumidza;TTM: nguva yekufamba kwezino;CTM: cumulative zino kufamba;PICOS: vatori vechikamu, kupindira, kuenzanisa, mhedzisiro uye dhizaini yekudzidza
TADs: mudziyo wenguva pfupi anchor;RTM: zino kufamba nekukurumidza;TTM: nguva yekufamba kwezino;CTM: cumulative zino kufamba;EXP: kuedza;NR: haina kutaurwa;U3: canine yepamusoro;U6: yepamusoro yekutanga molar;SS: simbi isina tsvina;NiTi: nickel-titanium;MOPs: microbial bone perforation;LLLT: yakaderera intensity laser therapy;CFO: orthodontics ne corticotomy;FTMPF: yakazara ukobvu mucoperiosteal flap
NR: Haina kutaurwa;WHO ICTRP: Tsvaga Portal yeWHO International Clinical Trials Registry Platform
Ongororo iyi yaisanganisira mana akapedzwa RCTs23,32-34 uye maCCT maviri35,36 anosanganisira varwere ve154.Zera rinobva pamakore 15 kusvika 29.Chimwe chidzidzo chaisanganisira varwere vechikadzi chete [32], asi imwe chidzidzo chaisanganisira vakadzi vashoma kupfuura varume [35].Paiva nevakadzi vakawanda kupfuura varume muzvidzidzo zvitatu [33,34,36].Chidzidzo chimwe chete hachina kupa kugoverwa kwevakadzi [23].
Zvina zvezvidzidzo zvakasanganisirwa zvaive zvakapatsanurwa-chiteshi (SMD) magadzirirwo [33-36] uye maviri aive akaumbwa (COMP) madhizaini (parallel uye kupatsanurwa ports) [23,32].Muchidzidzo chekugadzira chakaumbwa, rutivi runoshanda rweboka rekuedza rwakafananidzwa nerutivi rusina-kushanda rwemamwe mapoka ekuedza, sezvo rutivi rwakapesana rwemapoka aya haruna kuwana kukurumidza (chete kurapa orthodontic) [23,32].Mune zvimwe zvidzidzo zvina, kuenzanisa uku kwakaitwa zvakananga pasina chero boka risingakurumidze kutonga [33-36].
Zvidzidzo zvishanu zvakaenzanisa kuvhiyiwa nekupindira kwemuviri (kureva, low-intensity laser therapy {LILT}), uye chidzidzo chechitanhatu chakaenzanisa kuvhiyiwa nekupindira kwechiremba (kureva, prostaglandin E1).Kupindira kwekuvhiya kunobva kune yakanyanyisa invasive (traditional corticotomy [33-35], FTMPF yakazara yakazara mucoperiosteal flap [32]) kusvika kune zvishoma zvishoma zvinopindira (zvishoma zvinopinda maitiro {MOPs} [23] uye flapless piezotomy maitiro [36]).
Zvose zvidzidzo zvakawanikwa zvinosanganisira varwere vanoda canine retraction mushure me premolar extraction [23,32-36].Vese vaisanganisira varwere vakagamuchira extraction-based therapy.Iyo canines yakabviswa mushure mekubudiswa kwekutanga premolars yeshaya yepamusoro.Kubudiswa kwakaitwa pakutanga kwekurapa kusvika pakupera kwekuenzanisa uye kuenzanisa mune zvidzidzo zvitatu [23, 35, 36] nevamwe vatatu [32-34].Ongororo dzekutevera dzakabva kumavhiki maviri [34], mwedzi mitatu [23,36], uye mwedzi mina [33] kusvika pakupera kwe canine retraction [32,35].Mune zvidzidzo zvina [23, 33, 35, 36], kuyerwa kwekufamba kwezino kwakaratidzwa se "meno kufamba kwezino" (RTM), uye mune imwe tsvakurudzo, "nguva yekufamba kwezino" (CTM) yakaratidzwa se "meno kufamba" ."Nguva" (TTM).) yezvidzidzo zviviri [32,35], imwe yakaongorora sRANKL concentrations [34].Zvidzidzo zvishanu zvakashandisa chidimbu cheTAD anchor device [23,32-34,36], nepo chidzidzo chechitanhatu chakashandisa reverse tip bending for fixation [35].Nezve nzira dzinoshandiswa kuyera kukurumidza kwemazino, imwe ongororo yakashandisa digital intraoral calipers [23], imwe ongororo yakashandisa ELISA tekinoroji kuona gingival sulcus fluid (GCF) samples [34], uye zvidzidzo zviviri zvakaongorora kushandiswa kwemagetsi dhijitari..inokanda caliper [33,35], nepo zvidzidzo zviviri zvakashandisa 3D scanned modhi yekudzidza kuwana zviyero [32,36].
Ngozi yekusarura kwekubatanidzwa muRCTs inoratidzwa muMufananidzo 2, uye njodzi yakawanda yekusarura kune imwe neimwe domain inoratidzwa muMufananidzo 3. Zvose zveRCTs zvakanzi "zvine hanya nekusarura" [23,32-35]."Zvimwe zvinonetsa pamusoro pekusarura" chinhu chakakosha cheRCTs.Rusarura nekuda kwekutsauka kubva kune zvinotarisirwa kupindira (kupindira-zvine chekuita nemhedzisiro; kupindira kwekuomerera mhedzisiro) ndiyo yainyanya kufungidzirwa nzvimbo (kureva, "imwe kunetseka" yaivepo mu100% yezvidzidzo zvina).Ngozi yekusarura kufungidzira kweCCT yekudzidza inoratidzwa muMufananidzo 4. Izvi zvidzidzo zvaive ne "ngozi shoma yekusarura".
Mufananidzo wakavakirwa pane data kubva kuna Abdelhameed naRefai, 2018 [23], El-Ashmawi et al., 2018 [33], Sedky et al., 2019 [34], uye Abdarazik et al., 2020 [32].
Kuvhiya kunopesana nekupindira kwepanyama: Zvidzidzo zvishanu zvakaenzanisa marudzi akasiyana-siyana ekuvhiyiwa ne-low-intensity laser therapy (LILT) kuti ikurumidze kudzorera canine [23,32-34].El-Ashmawy et al.Mhedzisiro ye "traditional corticotomy" maringe ne "LLT" yakaongororwa mune cleft RCT [33].Nezve canine retraction speed, hapana mutsauko wakakosha wakawanikwa pakati pecorticotomy neLILI mativi chero ipi zvayo pakuongorora (kureva 0.23 mm, 95% CI: -0.7 kusvika 1.2, p = 0 .64).
Turker et al.akaongorora mhedzisiro yepiezocision uye LILT paRTM mune cleft TBI [36].Mumwedzi wekutanga, kuwanda kwepamusoro canine kudzokororwa kudivi reLILI kwaive kwakakwira zvakanyanya kupfuura kudivi repiezocision (p = 0.002).Zvisinei, hapana mutsauko wakakosha wakaonekwa pakati pemativi maviri pamwedzi wechipiri uye wechitatu wepamusoro canine retraction, maererano (p = 0.377, p = 0.667).Tichifunga nezvenguva yekuongorora yose, migumisiro yeLILI nePiezocisia paOTM yakanga yakafanana (p = 0.124), kunyange zvazvo LILI yakanga yakabudirira kupfuura nzira yePiezocisia mumwedzi wokutanga.
Abdelhameed naRefai vakadzidza maitiro e "MOPs" achienzaniswa ne "LLLT" uye "MOPs+LLLT" paRTM mune inoumbwa dhizaini RCT [23]. Vakawana kuwedzera kwechiyero chepamusoro che canine retraction mumativi akakurumidza ("MOPs" pamwe ne "LLLT") kana zvichienzaniswa nemativi asina kukurumidza, ane nhamba yakasiyana-siyana panguva dzose dzekuongorora (p<0.05). Vakawana kuwedzera kwechiyero chepamusoro che canine retraction mumativi akakurumidza ("MOPs" pamwe ne "LLLT") kana zvichienzaniswa nemativi asina kukurumidza, ane nhamba yakasiyana-siyana panguva dzose dzekuongorora (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). Vakawana kukurumidza kuwedzera kwevelocity ye lateral retraction yepamusoro canines ("MOPs" pamwe ne "LLLT") zvichienzaniswa nekusakurumidza kukurumidza kudzoka kwemashure nekusiyana kwakakosha panguva dzese dzekuongorora (p <0.05).他們发现，与非加速侧相比，加速侧（“MOPs”和“LLLT”）的上犬齿回缩率增加，在所有诀估时间都有公平时门。 Vakaona kuti, zvichienzaniswa nerutivi rusina kukurumidza, mazino epamusoro e canine erutivi rwakakurumidza ("MOPs" uye "LLLT") akawedzera chiyero chekuderedza, uye pakanga pane mutsauko wakakosha (p <0.05) panguva dzose dzekuongorora. . 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. Akaona kuti kudzoreredza nhengo yepamusoro kwaive kwakakwira padivi nekukasira ("MOPs" uye "LLLT") zvichienzaniswa nedivi pasina kukurumidza nemusiyano wakakosha (p <0.05) panguva dzese dzakaongororwa.Kuenzaniswa nerutivi rusina kukurumidza, kudzoka kwe clavicle kwakakurumidza ne 1.6 uye 1.3 nguva pa "SS" uye "NILT" mativi, maererano.Pamusoro pezvo, vakaratidzawo kuti maitiro eMOPs ainyanya kushanda kupfuura maitiro eLLLT mukumhanyisa kudzoreredza kwepamusoro clavicles, kunyangwe mutsauko wanga usina kukosha.Iyo yakakwira heterogeneity uye misiyano mukupindira kwakashandiswa pakati pezvidzidzo zvekare yakadzivirira kuwanda kwehuwandu hwe data [23,33,36].Abdalazik et al.RCI ine maoko maviri ane dhizaini yakaumbwa [32] yakaongorora mhedzisiro ye-full-thickness mucoperiosteal flap (FTMPF kureba chete neLLLT) pane cumulative zino kufamba (CTM) uye zino kufamba nguva (TTM)."Nguva yekufamba kwezino" pakuenzanisa mativi akakurumidza uye asina kukurumidza, kuderera kukuru munguva yose yekubvisa mazino kwakaonekwa.Muchidzidzo chese, pakanga pasina musiyano wakakosha pakati pe "FTMPF" ne "LLLT" maererano ne "cumulative zino kufamba" (p = 0.728) uye "nguva yekufamba kwezino" (p = 0.298).Pamusoro pezvo, "FTMPF" uye "LLLT" » inogona kuwana 25% uye 20% yekumhanyisa OTM zvichiteerana.
Seki et al.Mhedzisiro ye "traditional corticotomy" maringe ne "LLT" pakuburitswa kweRANKL panguva yeOTM muRCT ine orotomy yakaongororwa nekuenzaniswa [34].Chidzidzo chacho chakashuma kuti zvose corticotomy uye LILI yakawedzera RANKL kusunungurwa panguva yeOTM, iyo yakakanganisa zvakananga kugadziriswa kwemapfupa uye chiyero cheOTM.Kusiyana kwepakati penyika kwakanga kusingaverengeki kune 3 uye 15 mazuva mushure mekupindira (p = 0.685 uye p = 0.400, maererano).Misiyano yenguva kana nzira yekuongorora mhedzisiro yakadzivirira kubatanidzwa kwezvidzidzo zviviri zvekare mune meta-analysis [32,34].
Kupindira kwekuvhiya uye kwemishonga: Rajasekaran naNayak vakaongorora mhedzisiro yecorticotomy versus prostaglandin E1 jekiseni paRTM uye zino kufamba nguva (TTM) mukupatsanurwa-muromo CCT [35].Vakaratidza kuti corticotomy yakavandudza RTM zviri nani pane prostaglandin, ine mutsauko wakakosha (p = 0.003), sezvo zvinoreva RTM kudivi reprostaglandin yaive 0.36 ± 0.05 mm/vhiki, nepo corticotomy yaive 0.40 ± 0 .04mm/perimeter.Pakanga panewo misiyano yekufamba kwezino nguva pakati pezviviri izvi.Boka re corticotomy (masvondo e13) raiva ne "nguva yekufamba kwezino" shoma pane boka re prostaglandin (vhiki dze15).Kuti uwane rumwe ruzivo, pfupiso yezviwanikwa zvehuwandu kubva pane zvakawanikwa pachidzidzo chega chega inoratidzwa muTebhu 6.
RTM: zino kufamba nekukurumidza;TTM: nguva yekufamba kwezino;CTM: cumulative zino kufamba;NAC: kwete-kukurumidza kudzora;MOPs: microbial bone perforation;LLLT: yakaderera intensity laser therapy;CFO: orthodontics ne corticotomy;FTMPF: yakazara ukobvu mucoperiosteal flap;NR: haina kutaurwa
Zvidzidzo zvina zvakaongorora mhedzisiro yechipiri [32,33,35,36].Zvidzidzo zvitatu zvakaongorora kurasikirwa kwekutsigirwa kwemolar [32,33,35].Rajasekaran naNayak havana kuwana mutsauko wakakosha pakati pecorticotomy nemapoka eprostaglandin (p = 0.67) [35].El-Ashmawi et al.Hapana mutsauko wakakosha wakawanikwa pakati pecorticotomy uye rutivi rweLLLT panguva ipi zvayo yekuongorora (MD 0.33 mm, 95% CI: -1.22-0.55, p = 0.45) [33].Pane kudaro, Abdarazik et al.Musiyano wakakosha wakataurwa pakati pemapoka eFTMPF neLLLT, neboka reLLLT richikura [32].
Marwadzo uye kuzvimba zvakaongororwa mune maviri aisanganisira miedzo [33,35].Maererano naRajasekaran naNayak, varwere vakarondedzera kuzvimba zvishoma uye kurwadziwa mukati mevhiki yekutanga padivi re corticotomy [35].Munyaya ye prostaglandin, varwere vese vakanzwa kurwadziwa kwakanyanya pajekiseni.Mune varwere vazhinji, kusimba kwakakwira uye kunotora kusvika mazuva matatu kubva pazuva rejekiseni.Nekudaro, El-Ashmawi et al.[33] yakashuma kuti 70% yevarwere vakanyunyuta nekuzvimba padivi re corticotomy, nepo 10% yaive nekuzvimba pamativi ese ecorticotomy uye nedivi reLILI.Kurwadziwa kwepashure kwakaonekwa ne85% yevarwere.Rutivi rwekorticotomy rwakanyanya kuoma.
Rajasekaran naNayak vakaongorora shanduko yehurefu uye kureba kwemidzi uye havana kuwana misiyano yakakosha pakati pecorticotomy nemapoka eprostaglandin (p = 0.08) [35].Kudzika kwekuongororwa kweperiodontal kwakaongororwa muchidzidzo chimwe chete uye hakuna kuwana mutsauko wakakosha pakati peFTMPF neLLLT [32].
Türker et al vakaongorora shanduko mu canine uye yekutanga molar angles uye havana kuwana mutsauko wakakosha mune canine uye yekutanga molar angles pakati pepiezotomy side uye LLLT side mukati memwedzi mitatu yekutevera [36].
Simba reuchapupu hwekusaruramisa orthodontic uye mhedzisiro yakabva kune "yakanyanya pasi" kusvika "pasi" maererano neGRADE mirayiridzo (Table 7).Kuderedza simba reuchapupu kunobatanidza nengozi yekusarura [23,32,33,35,36], kusarurama [23,32] uye kusarurama [23,32,33,35,36].
a, g Kuderedzwa kwengozi yekusarura neimwe nhanho (kusarura nekuda kwekutsauka kubva kune zvinotarisirwa kupindira, kurasikirwa kukuru kwekutevera) uye kuderedzwa kusanzwisisika kune imwe nhanho * [33].
c, f, i, j Ngozi yekusarura yakadzikira neimwe nhanho (zvisina-randomized zvidzidzo) uye muganhu wekukanganisa wakaderera nenhanho imwe * [35].
d Deredzai njodzi yekusarura (nekuda kwekutsauka kubva kune zvinotarisirwa kupindira) nemwero imwe, kusarurama kune imwe nhanho **, uye kusarurama kune imwe nhanho * [23].
e, h, k Deredzai njodzi yekusarura (kusarura kunobatanidza nemaitiro ekugadzirisa, kukanganisa kunokonzerwa nekutsauka kubva kune chinangwa chekupindira) nechepamusoro, kusaruramisa kune imwe nhanho **, uye kusarurama kune imwe nhanho * [32].
CI: nguva yekuvimba;SMD: kupatsanurwa kwechiteshi dhizaini;COMP: dhizaini yakagadzirwa;MD: zvinoreva kusiyana;LLLT: yakaderera intensity laser therapy;FTMPF: yakazara ukobvu mucoperiosteal flap
Pakave nekuwedzera kwakakosha mukutsvaga kwekukurumidza kwe orthodontic kufamba uchishandisa nzira dzakasiyana dzekumhanyisa.Kunyangwe nzira dzekuvhiya dzekuvhiya dzakadzidzwa zvakanyanya, nzira dzisiri dzekuvhiya dzakawanawo nzira yavo mukutsvaga kwakadzama.Ruzivo uye humbowo hwekuti imwe nzira yekumhanyisa iri nani pane imwe inoramba yakasanganiswa.
Zvinoenderana neiyo SR, hapana kubvumirana pakati pezvidzidzo pamusoro pekunyanya kwekuvhiya kana kusavhiya nzira mukumhanyisa OTM.Abdelhameed naRefai, Rajasekaran naNayak vakawana kuti muOTM, kuvhiyiwa kwakashanda kupfuura kupindira kusina kuvhiyiwa [23,35].Pane kudaro, Türker et al.Kupindira kusina-kuvhiya kwakaratidza kuti kunobatsira kudarika kupindira kwekuvhiya mumwedzi wokutanga wepamusoro we canine retraction [36].Zvisinei, vachifunga nezvenguva yose yekuedza, vakaona kuti kukanganisa kwekuvhiya uye kusina kuvhiyiwa kupindira kweOTM kwakafanana.Pamusoro pezvo, Abdarazik et al., El-Ashmawi et al., uye Sedki et al.akacherechedza kuti pakanga pasina mutsauko pakati pekuvhiya uye kusavhiya kupindira maererano neOTM kukurumidza [32-34].