本文選題：微種植體　切入點(diǎn)：口外弓　出處：《重慶醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：對(duì)微種植體支抗與口外弓支抗對(duì)上頜或雙頜前突患者正畸治療前后的牙齒指標(biāo)及側(cè)貌變化進(jìn)行系統(tǒng)評(píng)價(jià)。評(píng)價(jià)利用微種植體和傳統(tǒng)口外支抗對(duì)前突患者的臨床治療效果，為治療安氏Ⅰ類上頜前突或安氏Ⅱ類雙頜前突的錯(cuò)合畸形提供決策依據(jù)。方法：全面檢索相關(guān)中英文文獻(xiàn)（包括隨機(jī)/半隨機(jī)對(duì)照試驗(yàn)和前后對(duì)照試驗(yàn)），檢索相關(guān)數(shù)據(jù)庫包括：Cochrane library(2009Issue4)、MEDLINE、EMBASE、ISI Webof science、Science Direct、CBM、VIP、CNKI和Wangfang,同時(shí)手動(dòng)檢索Campbell Library、NLM、WHOLIS及循證醫(yī)學(xué)及口腔正畸學(xué)雜志,檢索截止2011年12月30日,并追蹤參考文獻(xiàn),利用Google等搜索引擎進(jìn)行檢索,收集國內(nèi)外關(guān)于微種植體支抗與傳統(tǒng)口外支抗治療安氏Ⅰ類上頜前突或安氏Ⅱ類雙頜前突的錯(cuò)合畸形進(jìn)行對(duì)比研究的相關(guān)文獻(xiàn)。文獻(xiàn)的篩選，數(shù)據(jù)的提取，以及方法學(xué)質(zhì)量評(píng)估均由2位研究人員分別進(jìn)行，對(duì)實(shí)驗(yàn)設(shè)計(jì)，干預(yù)措施和結(jié)局指標(biāo)采用RevMan5.1.2軟件進(jìn)行meta分析。結(jié)果：根據(jù)納入排除標(biāo)準(zhǔn)，本研究最終納入13篇文獻(xiàn)，其中有8篇隨機(jī)對(duì)照試驗(yàn)，5篇前后對(duì)照試驗(yàn)。參考“Jadad量表”及“非隨機(jī)對(duì)照試驗(yàn)的質(zhì)量評(píng)價(jià)表”對(duì)納入文獻(xiàn)進(jìn)行進(jìn)一步的方法學(xué)質(zhì)量評(píng)價(jià)，其中隨機(jī)對(duì)照試驗(yàn)中有3篇為高質(zhì)量，5篇為低質(zhì)量；前后對(duì)照試驗(yàn)中有1篇為C級(jí)，4篇為B級(jí)。納入3篇高質(zhì)量隨機(jī)對(duì)照試驗(yàn)及4篇B及以上前后對(duì)照試驗(yàn)分別進(jìn)行meta分析，共包括209例患者，其中隨機(jī)對(duì)照試驗(yàn)共72例，包括微種植體支抗36例，口外支抗36例；前后對(duì)照試驗(yàn)共137例，包括微種植支抗70例，口外弓支抗67例。微種植支抗為實(shí)驗(yàn)組，傳統(tǒng)口外支抗組為對(duì)照組，兩組在SNA°方面，隨機(jī)對(duì)照試驗(yàn)結(jié)果為兩組差異沒有統(tǒng)計(jì)學(xué)意義（P=0.085），4篇前后對(duì)照試驗(yàn)Meta分析結(jié)果顯示納入文獻(xiàn)的同質(zhì)性較好（P=0.23,I2=31%），兩組差別具有統(tǒng)計(jì)學(xué)意義，其WMD及其95%CI為：0.32[0.07,0.56]（P=0.01），提示：傳統(tǒng)口外支抗比微種植支抗對(duì)上頜基骨相對(duì)于顱骨的前后向位置有更多的向后移動(dòng)。在SN-MP°方面，3篇前后對(duì)照試驗(yàn)進(jìn)行Meta分析后結(jié)果顯示文獻(xiàn)異質(zhì)性較大（P=0.003,I2=83%），進(jìn)行敏感性分析和亞組分析結(jié)果：其中1人研究較其余2人研究異質(zhì)性較大；高角亞組和低角/均角亞組納入文獻(xiàn)同質(zhì)性均好，對(duì)高角組Meta分析結(jié)果顯示，微種植支抗比口外支抗可以更好的使下頜逆時(shí)針旋轉(zhuǎn)，且兩組差異具有高度統(tǒng)計(jì)學(xué)意義（P=0.002）；低角/均角亞組中，兩組對(duì)下頜平面角的改變差異沒有統(tǒng)計(jì)學(xué)意義（P=0.18）。在U1-SN°方面，，納入3篇隨機(jī)對(duì)照試驗(yàn)和3篇前后對(duì)照試驗(yàn)，分別進(jìn)行Meta分析結(jié)果為：隨機(jī)對(duì)照試驗(yàn)中于世德等人的研究較其他2人研究的異質(zhì)性較大（P0.0001,I2=90%），其他2人研究結(jié)果為口外弓支抗比微種植支抗對(duì)U1-SN°的改變更大，且差異具有顯著統(tǒng)計(jì)學(xué)意義（P=0.0008）；前后對(duì)照實(shí)驗(yàn)納入的3篇文獻(xiàn)同質(zhì)性較好（P=0.17,I2=43%）,其WMD及其95%CI為：-2.61[-5.05,-0.17],兩組差異具有統(tǒng)計(jì)學(xué)意義（P=0.04），進(jìn)行年齡亞組分析顯示，微種植支抗組納入的研究對(duì)象年齡要大于口外支抗的研究對(duì)象年齡，且差異具有高度統(tǒng)計(jì)學(xué)意義（P=0.004）。而在NLA°,UL-E Line(mm)和G-Sn-Pg°方面的結(jié)果僅有1篇前后對(duì)照實(shí)驗(yàn)提及，結(jié)果為兩組在UL-E Line(mm)方面差異具有統(tǒng)計(jì)學(xué)意義（P=0.028），提示：微種植支抗可以更好的內(nèi)收上唇；在NLA°和G-Sn-Pg°方面兩組差別則沒有統(tǒng)計(jì)學(xué)差別（P=0.123，P=0.818），提示：在鼻唇角和面突角方面，微種植支抗和口外支抗均能達(dá)到良好的治療效果。結(jié)論:微種植體支抗和傳統(tǒng)口外弓支抗對(duì)于上頜或雙頜前突患者均可達(dá)到良好的治療效果，但相對(duì)于傳統(tǒng)口外強(qiáng)支抗而言，微種植體支抗可以更好的改善患者前突的上唇，特別是對(duì)于高角病例，微種植支抗可以使下頜平面角逆時(shí)針旋轉(zhuǎn)，跟有利于高角患者的治療。而在上頜基骨相對(duì)于顱骨前后向位置及鼻唇角，上中切牙傾斜度以及面突角方面，由于本系統(tǒng)評(píng)價(jià)納入的文獻(xiàn)數(shù)量和質(zhì)量有限，還需國內(nèi)外有關(guān)微種植支抗的臨床研究質(zhì)量有待提高，開展更多高質(zhì)量的隨機(jī)對(duì)照研究以提供更好的評(píng)價(jià)依據(jù)。
[Abstract]:Objective: the micro implant anchorage and anchorage of maxillary or bimaxillary teeth index and profile changes before and after the process of orthodontic treatment were evaluated. The evaluation of Micro Implant and traditional extraoral anchorage clinical effect in the treatment of patients with protrusion, for the treatment of skeletal class on maxillary protrusion or class II bimaxillary protrusion malocclusion to provide decision-making basis. Methods: a comprehensive search for relevant documents in English (including randomized or quasi randomized controlled trials and controlled trials), we searched relevant databases including: Cochrane Library (2009Issue4), MEDLINE, EMBASE, ISI Webof science, Science Direct, CBM, VIP, CNKI at the same time, Campbell and Wangfang, Library NLM, manual retrieval, WHOLIS and evidence-based medicine and Journal of Orthodontics and retrieval, as of December 30, 2011, and track the reference, using Google and other search engines for retrieval, collection of domestic and international. In the literature of Micro Implant Anchorage and traditional extraoral anchorage in the treatment of class I malocclusion with maxillary protrusion or bimaxillary protrusion malocclusion were studied. The literature screening, data extraction and assessment of methodological quality by 2 researchers respectively, the experimental design. Interventions and outcomes of using RevMan5.1.2 software for meta analysis. Results: according to the inclusion and exclusion criteria, this study included 13 papers, including 8 RCTs, 5 case control study. Reference "Jadad scale" and "non randomized controlled trial quality evaluation test table for further methods included in the literature quality evaluation, including randomized controlled trials in 3 to 5 for high quality, low quality; control before and after 1 articles for class C test, 4 B. The 3 included high quality randomized controlled trials and 4 B and above before and after The control experiments were analyzed by meta, including 209 patients, including randomized controlled trials involving 72 cases, including 36 cases of Micro Implant Anchorage and extraoral anchorage in 36 cases; 137 cases of control before and after the test, including the micro implant anchorage in 70 cases, 67 cases of micro implant anchorage for the experiment. Group, traditional extraoral anchorage group for the control group, two groups in SNA degrees, results of randomized controlled trials for the difference between the two groups was not statistically significant (P=0.085), 4 articles were compared before and after in the homogeneity test of Meta display analysis results (P=0.23, I2=31%), statistically significant difference between the two groups, the WMD and 95%CI: 0.32[0.07,0.56] (P=0.01), suggested that traditional extraoral anchorage micro implant anchorage for maxillary than the skull base bone relative to the position before and after to move back more. In SN-MP degrees, 3 articles before and after controlled test Meta analysis showed greater heterogeneity of literature (P=0.003, I2=83%), sensitivity analysis and subgroup analysis results: 1 of them on the remaining 2 people of great heterogeneity; high angle group and low angle / angle sub group included in the literature on the homogeneity was good, the high angle group, Meta analysis showed that the micro implant anchorage than extraoral anchorage can better the mandibular clockwise rotation, and the difference between the two groups has statistical significance (P=0.002); low angle / angle subgroup, two groups of mandibular plane angle change was not statistically significant difference (P=0.18). At U1-SN, a total of 3 randomized controlled trials and 3 articles before and after control. The results of Meta analysis were as follows: in the randomized controlled trials, Shide compared to the other 2 people on the heterogeneity (P0.0001, I2=90%), the other 2 Results for anchorage Micro Implant Anchorage ratio on U1-SN degrees greater change, and the difference was statistically significant. Yi (P=0.0008) before and after the experiment; 3 articles included homogeneity (P=0.17, I2=43%), WMD and 95%CI: -2.61[-5.05, -0.17], with significant difference between two groups (P=0.04), subgroup analysis showed age, micro implant group into the research object to study the age of age. Anchorage is greater than, and the difference was highly statistically significant (P=0.004). At NLA degrees, UL-E Line (mm) and G-Sn-Pg ~ the result of only 1 pieces before and after the experiment mentioned, the results for the two groups in UL-E Line (mm) difference was statistically significant (P=0.028), tip: Micro implants anti can better adduction of upper lip; at NLA DEG and G-Sn-Pg DEG on the difference between the two groups was not statistically significant difference (P=0.123, P=0.818), tip: in the nasolabial angle and face angle, micro implant anchorage and extraoral anchorage can achieve a good therapeutic effect. Conclusion: the micro implant Anchorage and traditional anchorage for the maxillary or bimaxillary protrusion patients can achieve good treatment effect, but compared with the traditional extraoral anchorage, micro implant anchorage can improve patients with upper lip protrusion, especially for high angle cases, micro implant anchorage can make mandibular plane angle counter clockwise rotation, and is conducive to the treatment of patients with high angle. In the maxilla relative to the skull anteroposterior position and nasolabial angle, upper incisor inclination and face angle, because the system evaluation in the literature is limited in quantity and quality, the domestic and foreign related micro implant anchorage to the quality of clinical research improve, carry out more high quality randomized controlled study to provide the basis for a better evaluation.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R783.5

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