【摘要】：目的系統(tǒng)分析比較拔牙與非拔牙矯治對牙弓寬度的影響，為口腔正畸臨床工作者制定正畸矯治方案提供決策依據(jù)。 方法計(jì)算機(jī)檢索PubMed、Embase、Cochrane library、Web ofScience, CENTRAL, SIGLE，中文科技期刊數(shù)據(jù)庫(VIP)、萬方數(shù)據(jù)庫、相關(guān)期刊論文(CNKI)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)。同時(shí)手動檢索中國循證醫(yī)學(xué)、中華口腔正畸學(xué)及NLM、Campbell Library、WHOLIS雜志，檢索時(shí)間截止至2012年12月30日，并查找已檢索文獻(xiàn)的參考文獻(xiàn)，利用搜索引擎如Google等進(jìn)行查漏，全面收集通過模型測量拔牙與非拔牙矯治對牙弓寬度影響的所有文獻(xiàn)。由兩名研究人員獨(dú)立完成文獻(xiàn)篩選、資料提取和方法學(xué)質(zhì)量評價(jià)，，并交叉核對；然后通過討論或征求第三方意見來解決分歧，統(tǒng)一意見。對納入文獻(xiàn)采用RevMan5.2軟件進(jìn)行Meta分析。 結(jié)果共納入文獻(xiàn)12篇，其中有2篇隨機(jī)對照試驗(yàn)，10篇前后對照試驗(yàn)，共包括846例患者。分別比較分析了上頜尖牙間的寬度變化（12個(gè)試驗(yàn)），下頜尖牙間的寬度變化（12個(gè)試驗(yàn)），上頜磨牙間的寬度變化（10個(gè)試驗(yàn)），下頜磨牙間寬度的變化（10個(gè)試驗(yàn)）。另外，其中有一篇試驗(yàn)將研究對象分為男性組和女性組分別進(jìn)行統(tǒng)計(jì)分析，因此在Meta分析前采用統(tǒng)計(jì)學(xué)公式將兩組數(shù)據(jù)合并后再進(jìn)行數(shù)據(jù)輸入。通過對納入研究進(jìn)行方法學(xué)質(zhì)量評價(jià)，2篇隨機(jī)對照試驗(yàn)評價(jià)結(jié)果均為高質(zhì)量，10篇臨床對照試驗(yàn)評價(jià)結(jié)果均為B級。Meta分析結(jié)果： ①上頜尖牙間寬度的變化 拔牙組與非拔牙組相比，Meta分析結(jié)果顯示上頜尖牙間寬度的變化差異有統(tǒng)計(jì)學(xué)意義（WMD=0.55mm，95%CI[0.31,0.79]），異質(zhì)性檢驗(yàn)結(jié)果顯示有輕度異質(zhì)性(I2=21%, p=0.24)。 ②下頜尖牙間寬度的變化 Meta分析結(jié)果顯示下頜尖牙間寬度的變化差異有統(tǒng)計(jì)學(xué)意義（WMD=0.62mm，95%CI[0.43,0.81]），異質(zhì)性檢驗(yàn)結(jié)果顯示各研究間有輕度異質(zhì)性(I2=1%, p=0.43)。 ③上頜磨牙間寬度的變化 Meta分析結(jié)果顯示上頜磨牙間寬度的變化差異有統(tǒng)計(jì)學(xué)意義（WMD=-2.24mm，95%CI [-2.72,-1.76]）異質(zhì)性檢驗(yàn)結(jié)果顯示有明顯異質(zhì)性(I2=58%, p=0.01)。 ④下頜磨牙間寬度的變化 Meta分析結(jié)果顯示下頜磨牙間寬度的變化差異有統(tǒng)計(jì)學(xué)意義（WMD=-1.91mm，95%CI [-2.13,-1.68]）異質(zhì)性檢驗(yàn)結(jié)果顯示各研究間同質(zhì)性好(I2=0%, p=0.69)。 結(jié)論 ①與非拔牙矯治相比，拔牙矯治不會導(dǎo)致上頜尖牙間的寬度縮小； ②與非拔牙矯治相比，拔牙矯治下頜尖牙間的寬度增大，差異有統(tǒng)計(jì)學(xué)意義，但臨床差異不明顯； ③與非拔牙矯治相比，拔牙矯治上下頜磨牙間的寬度均明顯縮小。
[Abstract]:Objective to analyze and compare the effects of extraction and non-extraction on the width of dental arch, and to provide decision basis for orthodontic clinical workers to formulate orthodontic treatment. Methods PubMed,Embase,Cochrane library,Web ofScience, CENTRAL, SIGLE, Chinese scientific and technological journal database (VIP), Wanfang database, Chinese journal full text database (CNKI), Chinese biomedical literature database (CBM). At the same time, the Chinese Evidence-based Medicine, Chinese Orthodontics and NLM,Campbell Library,WHOLIS Journal were searched manually until December 30, 2012. All literatures were collected to measure the effect of tooth extraction and non-extraction on the width of dental arch. Two researchers independently completed the literature screening, data extraction and methodological quality evaluation, and cross-check, and then through discussion or soliciting the views of third parties to resolve differences, unified opinions. RevMan5.2 software was used for Meta analysis. Results A total of 12 articles were included, including 2 randomized controlled trials and 10 pre and post controlled trials, including 846 patients. The width changes of maxillary canines (12 experiments), mandibular canines (12 experiments), maxillary molars (10 experiments) and mandibular molars (10 experiments) were compared and analyzed. In addition, one of the subjects was divided into male group and female group for statistical analysis, so statistical formula was used to combine the two groups of data before Meta analysis and then input the data. The results of two randomized controlled trials were of high quality. The results of 10 clinical controlled trials were all B grade. The results of Meta analysis were as follows: 1 the changes of maxillary canine width in the extraction group were compared with those in the non-extraction group. Meta analysis showed that there was significant difference in the width of maxillary canine teeth (WMD=0.55mm,95%CI [0.31 鹵0.79]), and the heterogeneity test showed slight heterogeneity (I _ 2i _ (21), p ~ (0.24). 2the change of the width of mandibular canine teeth by Meta analysis showed that there was significant difference in the width of mandibular canine teeth (WMD=0.62mm,95%CI [0.43 鹵0.81]). The results of heterogeneity test showed that there was slight heterogeneity among the studies (I _ 2 ~ (1), p ~ (0.43). (3) Meta analysis showed that there was significant difference in the width of maxillary molars (WMD=-2.24mm,95%CI [-2.72], P < 0.05). The results of heterogeneity test showed obvious heterogeneity (I _ (2) N _ (58), p ~ (0.01). (4) the change of the width of mandibular molars by Meta analysis showed that there was a significant difference in the width of mandibular molars (WMD=-1.91mm,95%CI [-2.13, -2.13], P < 0.05). The results of heterogeneity test showed that there was good homogeneity among the studies (I _ 2 / 0, p _ (0.69). Conclusion (1) the width of maxillary canine teeth will not be reduced after extraction compared with non-extraction orthodontics. 2Compared with non-extraction correction, the width of mandibular canine was larger and the difference was statistically significant, but the clinical difference was not obvious. 3Compared with the non-extraction correction, the width of the upper and lower molars was significantly reduced.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R783.5

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