【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)。 方法計算機檢索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、相關期刊論文(CNKI)、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)。同時手動檢索中國循證醫(yī)學、中華口腔正畸學及NLM、Campbell Library、WHOLIS雜志，檢索時間截止至2012年12月30日，并查找已檢索文獻的參考文獻，利用搜索引擎如Google等進行查漏，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。由兩名研究人員獨立完成文獻篩選、資料提取和方法學質量評價，，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。對納入文獻采用RevMan5.2軟件進行Meta分析。 結果共納入文獻12篇，其中有2篇隨機對照試驗，10篇前后對照試驗，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個試驗），下頜尖牙間的寬度變化（12個試驗），上頜磨牙間的寬度變化（10個試驗），下頜磨牙間寬度的變化（10個試驗）。另外，其中有一篇試驗將研究對象分為男性組和女性組分別進行統(tǒng)計分析，因此在Meta分析前采用統(tǒng)計學公式將兩組數(shù)據(jù)合并后再進行數(shù)據(jù)輸入。通過對納入研究進行方法學質量評價，2篇隨機對照試驗評價結果均為高質量，10篇臨床對照試驗評價結果均為B級。Meta分析結果： ①上頜尖牙間寬度的變化 拔牙組與非拔牙組相比，Meta分析結果顯示上頜尖牙間寬度的變化差異有統(tǒng)計學意義（WMD=0.55mm，95%CI[0.31,0.79]），異質性檢驗結果顯示有輕度異質性(I2=21%, p=0.24)。 ②下頜尖牙間寬度的變化 Meta分析結果顯示下頜尖牙間寬度的變化差異有統(tǒng)計學意義（WMD=0.62mm，95%CI[0.43,0.81]），異質性檢驗結果顯示各研究間有輕度異質性(I2=1%, p=0.43)。 ③上頜磨牙間寬度的變化 Meta分析結果顯示上頜磨牙間寬度的變化差異有統(tǒng)計學意義（WMD=-2.24mm，95%CI [-2.72,-1.76]）異質性檢驗結果顯示有明顯異質性(I2=58%, p=0.01)。 ④下頜磨牙間寬度的變化 Meta分析結果顯示下頜磨牙間寬度的變化差異有統(tǒng)計學意義（WMD=-1.91mm，95%CI [-2.13,-1.68]）異質性檢驗結果顯示各研究間同質性好(I2=0%, p=0.69)。 結論 ①與非拔牙矯治相比，拔牙矯治不會導致上頜尖牙間的寬度縮��； 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)計學意義，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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R783.5

【參考文獻】

相關期刊論文 前7條

1 魏麗娟;董惠娟;;Meta分析中異質性的識別與處理[J];第二軍醫(yī)大學學報;2006年04期

2 袁元;;安氏Ⅰ類拔牙與非拔牙病例牙弓寬度變化的對比研究[J];遼寧醫(yī)學院學報;2007年02期

3 董作英;劉東旭;王鐵軍;劉莉;;拔牙與非拔牙矯治前后牙弓寬度的變化[J];上海口腔醫(yī)學;2007年04期

4 林有籟;劉月華;曾韶華;李強;;正畸治療對錯鉭畸形患者牙弓形態(tài)的影響[J];同濟大學學報(醫(yī)學版);2007年03期

5 王珍;張永紅;徐巧巧;;幾種發(fā)表性偏倚評估方法介紹[J];中國衛(wèi)生統(tǒng)計;2009年05期

6 方志欣;周嫣;陳世穩(wěn);黃敏方;;拔牙與非拔牙矯治牙弓寬度變化的研究[J];中國現(xiàn)代醫(yī)學雜志;2006年21期

7 劉建平;非隨機研究的系統(tǒng)評價方法(一)[J];中國循證醫(yī)學;2001年04期

本文編號：2298223