“Musakayikire konse kuti kagulu kakang’ono ka nzika zolingalira, zodzipatulira zingathe kusintha dziko.M’malo mwake, ndi yekhayo amene alipo.”
Ntchito ya Cureus ndikusintha chitsanzo chomwe chakhalapo nthawi yayitali cha kusindikiza kwachipatala, momwe kuperekera kafukufuku kungakhale kodula, kovuta, komanso nthawi yambiri.
Full makulidwe a mucoperiosteal flap, mop, piezotomy, corticotomy, lllt, prostaglandin, kuthamanga kwa mano, orthodontic, osapanga opaleshoni, opaleshoni
Doaa Tahsin Alfaylani, Mohammad Y. Hajir, Ahmad S. Burhan, Luai Mahahini, Khaldun Darwich, Ossama Aljabban
Tchulani nkhaniyi monga: Alfailany D, Hajeer MY, Burhan AS, et al.(May 27, 2022) Kuwunika momwe maopaleshoni amathandizira komanso osapanga opaleshoni akagwiritsidwa ntchito limodzi ndi zosungira kuti zithandizire kusuntha kwa mano a orthodontic: kuwunika mwadongosolo.Kuchiza 14(5): e25381.doi:10.7759/cureus.25381
Cholinga cha ndemangayi chinali kuyesa umboni womwe ulipo pakali pano kuti ukhale wogwira mtima wa njira zofulumizitsa opaleshoni komanso zopanda opaleshoni komanso zotsatirapo zomwe zimagwirizanitsidwa ndi njirazi.Madatabase asanu ndi anayi adafufuzidwa: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE®, Scopus®, PubMed®, Web of Science™, Google™ Scholar, Trip, OpenGrey ndi PQDT OPEN ya pro-Quest®.ClinicalTrials.gov ndi malo ofufuzira a International Clinical Trials Registry Platform (ICTRP) adawunikiridwa kuti awonenso kafukufuku wamakono ndi mabuku osasindikizidwa.Mayesero olamulidwa mwachisawawa (RCTs) ndi mayesero achipatala (CCTs) a odwala omwe akuchitidwa opaleshoni (njira zowonongeka kapena zochepa) kuphatikizapo zipangizo zamakono zokhazikika komanso poyerekeza ndi njira zopanda opaleshoni.Chida cha Cochrane Risk of Bias (RoB.2) chinagwiritsidwa ntchito poyesa ma RCTs, pamene chida cha ROBINS-I chinagwiritsidwa ntchito ku CCT.
Ma RCT anayi ndi ma CCT awiri (odwala 154) adaphatikizidwa mu ndondomekoyi.Mayesero anayi adapeza kuti njira zothandizira opaleshoni komanso zopanda opaleshoni zinali ndi zotsatira zofanana pa kufulumizitsa kayendedwe ka mano a orthodontic (OTM).Mosiyana ndi zimenezi, opaleshoni inali yothandiza kwambiri mu maphunziro ena awiri.Kuchuluka kwa kusiyana pakati pa maphunziro omwe anaphatikizidwa kunkalepheretsa kuchuluka kwa zotsatira.Zotsatira zomwe zanenedwa zokhudzana ndi opaleshoni komanso zopanda opaleshoni zinali zofanana.
Panali umboni 'wotsika kwambiri' mpaka 'wochepa' wosonyeza kuti maopaleshoni ndi osachita opaleshoni anali othandiza mofanana pofulumizitsa kayendedwe ka dzino la orthodontic popanda kusiyana kwa zotsatira zake.Mayesero achipatala apamwamba kwambiri amafunikira kuti afanizire zotsatira za kufulumira kwa njira ziwiri mu mitundu yosiyanasiyana ya malocclusion.
Kutalika kwa chithandizo chamankhwala aliwonse a orthodontic ndi chimodzi mwazinthu zofunika zomwe odwala amaziganizira popanga chisankho [1].Mwachitsanzo, kubweza kwa canines zomangika kwambiri pambuyo pochotsa ma premolars kumtunda kumatha kutenga pafupifupi miyezi 7, pomwe kuchuluka kwa bioorthodontic tooth movement (OTM) kumakhala pafupifupi 1 mm pamwezi, zomwe zimapangitsa kuti nthawi yonse ya chithandizo ikhale pafupifupi zaka ziwiri [2,3] ] .Ululu, kusapeza bwino, caries, gingival recession ndi root resorption ndi zotsatira zomwe zimawonjezera nthawi ya chithandizo cha orthodontic [4].Kuphatikiza apo, zifukwa zokometsera komanso zamagulu zimapangitsa odwala ambiri kufuna kutha msanga kwa chithandizo cha orthodontic [5].Choncho, onse orthodontists ndi odwala amafuna kufulumizitsa kayendedwe ka mano ndi kuchepetsa nthawi mankhwala [6].
Njira yomwe kusuntha kwa mano kumapititsira patsogolo kumadalira kuyambitsa kwachilengedwe kwa minofu.Malinga ndi kuchuluka kwa kuwononga, njirazi zitha kugawidwa m'magulu awiri: zodziwikiratu (zachilengedwe, zakuthupi, komanso zamankhwala) ndi njira zopangira opaleshoni [7].
Njira zachilengedwe zimaphatikizira kugwiritsa ntchito mankhwala opangira mankhwala kuti awonjezere kuyenda kwa dzino pakuyesa nyama komanso mwa anthu.Kafukufuku wambiri wawonetsa kuchita bwino polimbana ndi zinthu zambiri monga ma cytokines, nyukiliya factor kappa-B ligand receptor activators/nuclear factor-kappa-B protein receptor activators (RANKL/RANK), prostaglandins, vitamini D, mahomoni monga parathyroid hormone (PTH). ).) ndi osteocalcin, komanso jakisoni wazinthu zina monga relaxin, sanawonetse kuthandizira kulikonse [8].
Njira zolimbitsa thupi zimachokera pakugwiritsa ntchito zida zothandizira, kuphatikiza pakali pano [9], minda yamagetsi yamagetsi [10], vibration [11], ndi low-intensity laser therapy [12], zomwe zawonetsa zotsatira zabwino [8].].Njira zopangira opaleshoni zimaonedwa kuti ndizogwiritsidwa ntchito kwambiri komanso zotsimikiziridwa ndichipatala ndipo zimatha kuchepetsa kwambiri nthawi ya chithandizo [13,14].Komabe, amadalira "Regional Acceleration Phenomenon (RAP)" popeza kuwonongeka kwa opaleshoni ya fupa la alveolar kumatha kupititsa patsogolo OTM [15] kwakanthawi.Njira zopangira opaleshonizi zimaphatikizapo chikhalidwe cha corticotomy [16,17], opaleshoni ya mafupa a alveolar [18], kuthamanga kwa osteogenic orthodontics [19], alveolar traction [13] ndi periodontal traction [20], compression electrotomy [14,21], cortical resection [ 19].22] ndi microperforation [23].
Ndemanga zingapo zotsatizana (SR) za mayesero olamulidwa mwachisawawa (RCTs) zasindikizidwa pakugwira ntchito kwa opaleshoni komanso osachita opaleshoni popititsa patsogolo OTM [24,25].Komabe, kupambana kwa opaleshoni pa njira zopanda opaleshoni sikunatsimikizidwe.Choncho, ndondomekoyi (SR) ikufuna kuyankha funso lofotokozera lofunikira: Kodi ndi chiyani chomwe chili chothandiza kwambiri pofulumizitsa kayendetsedwe ka dzino la orthodontic pogwiritsa ntchito zipangizo zokhazikika za orthodontic: njira zopangira opaleshoni kapena zopanda opaleshoni?
Choyamba, kufufuza koyendetsa ndege kunachitika pa PubMed kuti atsimikizire kuti panalibe ma SR ofanana ndikuyang'ana zolemba zonse zokhudzana ndi nkhaniyi musanalembe ndondomeko yomaliza ya SR.Pambuyo pake, mayesero awiri omwe angakhale othandiza adadziwika ndikuwunikidwa.Kulembetsa kwa protocol iyi ya SR mu database ya PROSPERO kwamalizidwa (nambala yodziwika: CRD42021274312).SR iyi idapangidwa mogwirizana ndi Cochrane Handbook of Systematic Reviews of Interventions [26] ndi Zinthu Zokonda Kufotokozera za Malangizo Owunika Mwadongosolo ndi Meta-analysis (PRISMA) [27,28].
Phunziroli linaphatikizapo odwala aamuna ndi aakazi athanzi omwe amapatsidwa chithandizo chamankhwala chokhazikika, mosasamala kanthu za msinkhu, mtundu wa malocclusion, kapena fuko, malinga ndi chitsanzo cha Participant Intervention, Comparisons, Results, and Study Design (PICOS).Opaleshoni yowonjezereka (yosokoneza kapena yosokoneza pang'ono) ku chithandizo chamankhwala chokhazikika cha orthodontic chinaganiziridwa.Phunziroli linaphatikizapo odwala omwe adalandira chithandizo chokhazikika cha orthodontic (OT) pamodzi ndi njira zopanda opaleshoni.Izi zitha kuphatikiza njira zama pharmacological (zako kapena zadongosolo) ndi njira zakuthupi (kuyatsa kwa laser, magetsi amagetsi, minda yamagetsi yamagetsi (PEMF) ndi kugwedezeka).
Chotsatira chachikulu cha ndondomekoyi ndi kuchuluka kwa kayendedwe ka dzino (RTM) kapena chizindikiro chilichonse chofanana chomwe chingatidziwitse za momwe opaleshoni imagwirira ntchito komanso osachita opaleshoni.Zotsatira zachiwiri zinaphatikizapo zotsatira zoipa monga zotsatira za odwala (zowawa, kusapeza bwino, kukhutira, moyo wokhudzana ndi thanzi la m'kamwa, zovuta zakutafuna, ndi zochitika zina), zotsatira zokhudzana ndi minofu ya periodontal monga momwe zimayesedwera ndi ndondomeko ya periodontal (PI), zovuta. , Gingival Index (GI), kutaya kwa attachment (AT), gingival recession (GR), periodontal deep (PD), kutaya chithandizo ndi kayendetsedwe ka dzino kosafunikira (kupendekera, kupindika, kuzungulira) kapena kupwetekedwa kwa dzino la iatrogenic monga kuwonongeka kwa dzino. , Root Resorption.Mapangidwe awiri okha ophunzirira anavomerezedwa - Mayesero Olamulidwa Osasinthika (RCTs) ndi Controlled Clinical Trials (CCTs), olembedwa m'Chingelezi chokha, popanda zoletsa pa chaka chofalitsidwa.
Zolemba zotsatirazi sizinaphatikizidwe: maphunziro obwerezabwereza, maphunziro azilankhulo zina osati Chingerezi, kuyesa kwa nyama, maphunziro a in vitro, malipoti amilandu kapena malipoti amilandu, zosintha, zolemba zokhala ndi ndemanga ndi mapepala oyera, malingaliro amunthu, mayesero opanda zitsanzo, ayi. gulu lolamulira, kapena kukhalapo kwa gulu lolamulira losagwiritsidwa ntchito komanso gulu loyesera ndi odwala osachepera 10 linaphunziridwa ndi njira yomaliza.
Kusaka pakompyuta kwapangidwa pamasamba otsatirawa (August 2021, palibe malire a nthawi, Chingerezi chokha): Cochrane Central Register of Controlled Trials, PubMed®, Scopus®, Web of Science™, EMBASE®, Google™ Scholar, Trip, OpenGrey (pozindikira zolemba za imvi) ndi PQDT OPEN kuchokera ku pro-Quest® (pozindikiritsa mapepala ndi zolemba).Mindandanda yazolembedwa zankhani zosankhidwa idawunikidwanso pamayesero omwe angakhale ofunikira omwe mwina sanapezeke pakufufuza pakompyuta pa intaneti.Nthawi yomweyo, kufufuza pamanja kunachitika mu Journal of Angle Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics™, European Journal of Orthodontics and Orthodontics and Craniofacial Research.ClinicalTrials.gov ndi bungwe la World Health Organization's International Clinical Trials Registry Platform (ICTRP) linafufuza pakompyuta kuti lipeze mayesero omwe sanasindikizidwe kapena maphunziro omwe anamaliza.Tsatanetsatane wa njira yakusaka pa intaneti yaperekedwa mu Gulu 1.
RANKL: nyukiliya factor kappa-beta ligand receptor activator;RANK: nyukiliya factor kappa-beta ligand receptor activator
Owunikira awiri (DTA ndi MYH) adadziyesa okha kuyenera kwa phunziroli, ndipo ngati pali kusiyana, wolemba wachitatu (LM) adaitanidwa kuti apange chisankho.Gawo loyamba ndikuyang'ana mutu ndi mawu okha.Gawo lachiwiri la maphunziro onse linali loti muwerenge zolemba zonse kuti ndi zoyenera komanso zosefera kuti ziphatikizidwe kapena pomwe mutu kapena mawu osamveka bwino kuti athandizire kupanga chigamulo chomveka.Zolemba sizinaphatikizidwe ngati sizinakwaniritse chimodzi kapena zingapo zomwe zikuphatikizidwa.Kuti mumve zambiri kapena zambiri, chonde lembani kwa wolemba.Olemba omwewo (DTA ndi MYH) adatulutsa deta pawokha kuchokera kumatebulo oyendetsa ndi ofotokozeratu.Pamene otsogolera awiriwa sanagwirizane, wolemba wachitatu (LM) adafunsidwa kuti awathandize.Dongosolo lachidule lachidule limaphatikizapo zinthu zotsatirazi: zambiri zokhudza nkhaniyi (dzina la wolemba, chaka chofalitsidwa ndi maziko a phunziro);njira (mapangidwe ophunzirira, gulu loyesedwa);otenga nawo mbali (chiwerengero cha odwala omwe alembedwa, zaka zoyambira ndi zaka)., pansi);Zochita (mtundu wa ndondomeko, malo opangira, luso la ndondomeko);Makhalidwe a Orthodontic (digiri ya malocclusion, mtundu wa kayendedwe ka mano a orthodontic, pafupipafupi kusintha kwa orthodontic, nthawi yowonera);ndi Zotsatira za zotsatira (zotsatira zoyambirira ndi zachiwiri zomwe zatchulidwa, njira zoyezera, ndi lipoti la kusiyana kwakukulu).
Owunikira awiri (DTA ndi MYH) adayesa kuopsa kwa kukondera pogwiritsa ntchito chida cha RoB-2 cha RCTs [29] ndi ROBINS-I chida cha CCTs [30].Pakakhala kusagwirizana, chonde funsani m'modzi mwa olemba anzawo (ASB) kuti mupeze yankho.Kwa mayesero osasinthika, tinavotera madera otsatirawa monga "chiopsezo chochepa", "chiopsezo chachikulu" kapena "vuto lina la tsankho": kukondera komwe kumachokera ku ndondomeko yowonongeka, kukondera chifukwa cha kupatukana ndi zomwe zimayembekezeredwa (zotsatira zomwe zimachitika chifukwa cha kulowererapo; zotsatira za kumamatira kuzinthu zothandizira), kukondera chifukwa cha kusowa kwa zotsatira za zotsatira, kukondera kwa miyeso, kusankha kosankha pazotsatira za malipoti.Chiwopsezo chonse cha kukondera kwa maphunziro osankhidwa chidawerengedwa motere: "Chiwopsezo chochepa cha tsankho" ngati madera onse adavotera "chiwopsezo chochepa cha kukondera";"Nkhawa Zina" ngati dera limodzi lidavoteredwa ngati "Nkhawa Zina" koma osati "Chiwopsezo Chambiri Chokondera m'dera lililonse, Chiwopsezo Chambiri Chokondera: ngati gawo limodzi kapena angapo adavoteledwa ngati Chiwopsezo Chambiri" kapena nkhawa zina. pa madera angapo, zomwe zimachepetsa kwambiri chidaliro pazotsatira.Pamene, chifukwa cha mayesero omwe sali osankhidwa mwachisawawa, tinayesa madera otsatirawa kukhala otsika, ochepetsetsa, komanso owopsa kwambiri: panthawi yothandizira (kulowererapo kwamagulu);pambuyo pochitapo kanthu (kukondera chifukwa cha kupatuka kwa kulowererapo kuyembekezera; kukondera chifukwa cha kusowa kwa deta; zotsatira) kukondera kwa kuyeza;kupereka lipoti kukondera pakusankha zotsatira).Chiwopsezo chonse cha kukondera kwa maphunziro osankhidwa chidawerengedwa motere: "Chiwopsezo chochepa cha tsankho" ngati madera onse adavotera "chiwopsezo chochepa cha kukondera";"Chiwopsezo chochepa chokondera" ngati madera onse adavoteledwa ngati "chiwopsezo chochepa kapena chochepa chokondera".kukondera” “Chiwopsezo chachikulu cha kukondera”;"Chiwopsezo Chachikulu Chokondera" ngati dera limodzi lidavoteredwa "Kuwopsa Kwambiri Kwa Tsankho" koma palibe Chiwopsezo Chachiwopsezo cha Tsankho m'malo aliwonse, "Kuopsa Kwambiri Kwa Tsankho" ngati dera limodzi lidavoteredwa "Kuopsa kwakukulu kwa zolakwika mwadongosolo";kafukufuku ankaonedwa kuti ndi "chidziwitso chosowa" ngati panalibe chisonyezero chodziwikiratu kuti phunziroli linali "lofunika kwambiri kapena linali pachiopsezo chachikulu cha kukondera" ndipo linali lopanda chidziwitso m'madera amodzi kapena angapo ofunika kwambiri.Kudalirika kwa umboniwo kunayesedwa molingana ndi njira ya Guidelines Assessment, Development and Evaluation (GRADE), ndipo zotsatira zake zimakhala zapamwamba, zochepetsetsa, zotsika, kapena zotsika kwambiri [31].
Pambuyo pakufufuza pakompyuta, zolemba zonse za 1972 zidadziwika ndi mawu amodzi okha kuchokera kuzinthu zina.Pambuyo pochotsa zobwereza, zolembedwa pamanja 873 zinawunikidwanso.Mitu ndi zidule zidafufuzidwa kuti ziyenere ndipo maphunziro aliwonse omwe sanakwaniritse zofunikira adakanidwa.Zotsatira zake, kafukufuku wozama wa zolemba 11 zomwe zingakhale zofunikira zidachitika.Mayesero asanu omalizidwa ndi maphunziro asanu omwe akupitirirabe sanakwaniritse zofunikira zophatikizira.Ndemanga za nkhani zomwe sizinaphatikizidwe pambuyo pakuwunikidwa kwathunthu ndi zifukwa zochotsera zaperekedwa patebulo la zowonjezera.Pomaliza, maphunziro asanu ndi limodzi (ma RCT anayi ndi ma CCT awiri) adaphatikizidwa mu SR [23,32-36].Chithunzi cha block cha PRISMA chikuwonetsedwa Chithunzi 1.
Makhalidwe a mayesero asanu ndi limodzi omwe akuphatikizidwa akuwonetsedwa mu Table 2 ndi 3 [23,32-36].Chiyeso chimodzi chokha cha protocol chidadziwika;onani Table 4 ndi 5 kuti mudziwe zambiri za polojekiti yomwe ikuchitikayi.
RCT: kuyesedwa kwachisawawa kwachipatala;NAC: kulamulira kosafulumizitsa;SMD: kapangidwe kakamwa kagawanika;MOPs: microosseous perforation;LLLT: mankhwala otsika kwambiri a laser;CFO: orthodontics ndi corticotomy;FTMPF: makulidwe athunthu mucoperiosteal flap;Exp: kuyesa;mwamuna: mwamuna;F: wamkazi;U3: canine wapamwamba;ED: kuchuluka kwa mphamvu;RTM: kuthamanga kwa mano;TTM: nthawi yoyenda mano;CTM: kuchulukitsidwa kwa dzino;PICOS: otenga nawo mbali, kulowererapo, kufananitsa, zotsatira ndi kapangidwe ka maphunziro
TADs: chipangizo cha nangula chosakhalitsa;RTM: kuthamanga kwa mano;TTM: nthawi yoyenda mano;CTM: kuchulukitsidwa kwa dzino;EXP: kuyesa;NR: sinafotokozedwe;U3: canine wapamwamba;U6: chapamwamba choyamba molar;SS: chitsulo chosapanga dzimbiri;NiTi: nickel-titaniyamu;MOPs: kuwonongeka kwa fupa la tizilombo tating'onoting'ono;LLLT: mankhwala otsika kwambiri a laser;CFO: orthodontics ndi corticotomy;FTMPF: makulidwe athunthu a mucoperiosteal flap
NR: Osanenedwa;WHO ICTRP: Fufuzani Portal ya WHO International Clinical Trials Registry Platform
Ndemangayi inaphatikizapo RCTs23,32-34 yomaliza inayi ndi ma CCTs35,36 awiri okhudza odwala 154.Zaka kuyambira 15 mpaka 29 zaka.Kafukufuku wina anaphatikizapo odwala achikazi okha [32], pamene kafukufuku wina anaphatikizapo amayi ochepa kuposa amuna [35].Panali akazi ambiri kuposa amuna m'maphunziro atatu [33,34,36].Phunziro limodzi lokha silinapereke kugawa kwa amuna ndi akazi [23].
Maphunziro anayi omwe adaphatikizidwa anali mapangidwe a doko (SMD) [33-36] ndipo awiri anali mapangidwe apangidwe (COMP) (ma doko ofananira ndi ogawanika) [23,32].Mu kafukufuku wamagulu ophatikizika, mbali yogwira ntchito ya gulu loyesera idafaniziridwa ndi mbali yosagwira ntchito yamagulu ena oyesera, popeza mbali yotsutsana ya maguluwa sinapeze mathamangitsidwe (mankhwala ochiritsira ochiritsira okha) [23,32].M'maphunziro ena anayi, kufananitsa uku kunapangidwa mwachindunji popanda gulu lililonse losafulumizitsa [33-36].
Maphunziro asanu anayerekezera opaleshoni ndi kulowererapo kwa thupi (ie, low-intensity laser therapy {LILT}), ndi kafukufuku wachisanu ndi chimodzi poyerekeza opaleshoni ndi chithandizo chamankhwala (ie, prostaglandin E1).Njira zopangira opaleshoni zimachokera ku zowonongeka (traditional corticotomy [33-35], FTMPF full thickness mucoperiosteal flap [32]) mpaka kulowerera pang'ono (njira zochepa zowonongeka {MOPs} [23] ndi njira zopanda piezotomy [36]).
Maphunziro onse omwe adapezeka adaphatikizapo odwala omwe amafunikira kuchotsedwa kwa canine pambuyo pochotsa premolar [23,32-36].Odwala onse ophatikizidwa adalandira chithandizo chochokera m'zigawo.The canines anachotsedwa pambuyo m'zigawo za premolars woyamba chapamwamba nsagwada.Kutulutsa kunkachitika kumayambiriro kwa chithandizo mpaka kumapeto kwa msinkhu ndi msinkhu mu maphunziro atatu [23, 35, 36] ndi ena atatu [32-34].Mayesero otsatiridwa adachokera ku masabata awiri [34], miyezi itatu [23,36], ndi miyezi inayi [33] mpaka kumapeto kwa canine retraction [32,35].M'maphunziro anayi [23, 33, 35, 36], kuyeza kwa kayendedwe ka dzino kunasonyezedwa ngati "kuthamanga kwa dzino" (RTM), ndipo mu phunziro limodzi, "nthawi yosuntha dzino" (CTM) inafotokozedwa ngati "kuyenda kwa dzino" ."Nthawi" (TTM).) pamaphunziro awiri [32,35], wina adawunika kuchuluka kwa sRANKL [34].Maphunziro asanu adagwiritsa ntchito chipangizo cha nangula cha TAD kwakanthawi [23,32-34,36], pomwe kafukufuku wachisanu ndi chimodzi adagwiritsa ntchito nsonga yokhotakhota kuti ikonzekere [35].Pankhani ya njira zomwe zimagwiritsidwa ntchito poyeza kuthamanga kwa dzino, kafukufuku wina adagwiritsa ntchito digito ya intraoral calipers [23], kafukufuku wina adagwiritsa ntchito teknoloji ya ELISA kuti azindikire zitsanzo za gingival sulcus fluid (GCF) [34], ndipo maphunziro awiri adayesa kugwiritsa ntchito makina a digito..amaponya caliper [33,35], pamene maphunziro awiri adagwiritsa ntchito zitsanzo zowerengera za 3D kuti apeze miyeso [32,36].
Chiwopsezo cha kukondera kuti chiphatikizidwe mu RCTs chikuwonetsedwa mu Chithunzi 2, ndipo chiopsezo chonse cha kukondera kwa dera lililonse chikuwonetsedwa mu Chithunzi 3. Ma RCT onse adayesedwa kuti ali ndi "kukhudzidwa kwina" [23,32-35]."Nkhawa zina za kukondera" ndi mbali yofunika kwambiri ya RCTs.Kukondera chifukwa cha kupatuka kuchokera kuzinthu zomwe zikuyembekezeka (zotsatira zokhudzana ndi kulowererapo; zotsatira zotsatiridwa) zinali malo omwe amakayikira kwambiri (ie, "nkhawa zina" zinalipo mu 100% mwa maphunziro anayiwo).Chiwopsezo cha kuyerekeza kwachiwonetsero cha CCT chikuwonetsedwa mu Chithunzi 4. Maphunzirowa anali ndi "chiwopsezo chochepa cha kukondera".
Chithunzi chochokera ku Abdelhameed ndi Refai, 2018 [23], El-Ashmawi et al., 2018 [33], Sedky et al., 2019 [34], ndi Abdarazik et al., 2020 [32].
Kuchita opaleshoni motsutsana ndi thupi: Maphunziro asanu anayerekezera mitundu yosiyanasiyana ya opaleshoni ndi low-intensity laser therapy (LILT) kuti ifulumizitse kubweza kwa canine [23,32-34].El-Ashmawy et al.Zotsatira za "traditional corticotomy" motsutsana ndi "LLT" zidawunikidwa mu RCT [33].Ponena za kuthamanga kwa canine, palibe kusiyana kwakukulu komwe kunapezeka pakati pa corticotomy ndi LILI mbali iliyonse pakuwunika (kutanthauza 0.23 mm, 95% CI: -0.7 mpaka 1.2, p = 0.64).
Turker et al.adawunika momwe piezocision ndi LILT pa RTM mu cleft TBI [36].M'mwezi woyamba, mafupipafupi a kumtunda kwa canine kumbali ya LILI anali okwera kwambiri kuposa mbali ya piezocision (p = 0.002).Komabe, palibe kusiyana kwakukulu komwe kunawonedwa pakati pa mbali ziwirizi pa mwezi wachiwiri ndi wachitatu wa kumtunda kwa canine, motsatira (p = 0.377, p = 0.667).Poganizira nthawi yonse yowunika, zotsatira za LILI ndi Piezocisia pa OTM zinali zofanana (p = 0.124), ngakhale kuti LILI inali yothandiza kwambiri kuposa njira ya Piezocisia mwezi woyamba.
Abdelhameed ndi Refai adaphunzira zotsatira za "MOPs" poyerekeza ndi "LLLT" ndi "MOPs+LLLT" pa RTM pamapangidwe a RCT [23]. Iwo adapeza kuwonjezeka kwa chiwongola dzanja chapamwamba cha canine m'mbali zofulumira ("MOPs" komanso "LLLT") poyerekeza ndi mbali zomwe sizinafulumizitse, ndi kusiyana kwakukulu kowerengera nthawi zonse zowunika (p<0.05). Iwo adapeza kuwonjezeka kwa chiwongola dzanja chapamwamba cha canine m'mbali zofulumira ("MOPs" komanso "LLLT") poyerekeza ndi mbali zomwe sizinafulumizitse, ndi kusiyana kwakukulu kowerengera nthawi zonse zowunika (p<0.05). Они обнаружили ускоренное увеличение скорости ретракции верхних клыков в боковых сторонах («MOPs», а также «LLLT») по сравнековых сторонах («MOPs», а также «LLLT») по сравнековых сторонах тистически значимыми различиями во все времена оценки (p<0,05). Iwo adapeza chiwonjezeko chofulumira cha liwiro lakubwerera kumbuyo kwa canines zakumtunda ("MOPs" komanso "LLLT") poyerekeza ndi kubweza komwe sikunafulumire ndi kusiyana kwakukulu pamawerengero nthawi zonse zowunika (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，在所有诀计坐时间都） p<0.05. Iwo adapeza kuti, poyerekeza ndi mbali yosafulumizitsa, mano apamwamba a canine a mbali yofulumira ("MOPs" ndi "LLLT") amachulukitsa kuchepetsa, ndipo panali kusiyana kwakukulu (p <0.05) nthawi zonse zowunika. . Они обнаружили, что ретракция верхнего клыка была выше на стороне акселерации («MOPs» ndi «LLLT») сравнению стороной без акселерации p<0,05) во все оцениваемые моменты времени. Anapeza kuti kutsika kwa miyendo yam'mwamba kunali kokwera pambali ndi kuthamanga ("MOPs" ndi "LLLT") poyerekeza ndi mbali popanda kuthamanga ndi kusiyana kwakukulu (p <0.05) pa nthawi zonse zomwe zimayesedwa.Poyerekeza ndi mbali yosathamanga, kubweza kwa clavicle kunafulumizitsidwa ndi 1.6 ndi 1.3 pa mbali za "SS" ndi "NILT", motsatira.Kuphatikiza apo, adawonetsanso kuti njira ya MOPs inali yothandiza kwambiri kuposa njira ya LLLT pofulumizitsa kubweza kwa ma clavicles apamwamba, ngakhale kusiyana kwake sikunali kofunikira.Kusiyanasiyana kwakukulu ndi kusiyana kwa njira zomwe zimagwiritsidwa ntchito pakati pa maphunziro apitalo zimalepheretsa kaphatikizidwe kachulukidwe ka deta [23,33,36].Abdalazik et al.RCI ya mikono iwiri yokhala ndi mapangidwe ophatikizika [32] idawunika momwe chiwombankhanga cha mucoperiosteal chotalikirapo (FTMPF kutalika ndi LLLT) pakuyenda kwa dzino (CTM) ndi nthawi yosuntha dzino (TTM)."Nthawi yosuntha dzino" poyerekezera mbali zofulumira komanso zosafulumizitsa, kuchepa kwakukulu kwa nthawi yonse yochotsa dzino kunawonedwa.Mu phunziro lonse, panalibe kusiyana kwakukulu pakati pa "FTMPF" ndi "LLLT" ponena za "kusuntha kwa dzino" (p = 0.728) ndi "nthawi yosuntha dzino" (p = 0.298).Komanso, "FTMPF" ndi "LLLT" » akhoza kukwaniritsa 25% ndi 20% mathamangitsidwe OTM motero.
Seki et al.Zotsatira za "traditional corticotomy" motsutsana ndi "LLT" pakutulutsidwa kwa RANKL pa OTM mu RCT yokhala ndi orotomy idawunikidwa ndikuyerekeza [34].Kafukufukuyu adanenanso kuti corticotomy ndi LILI zinachulukitsa kumasulidwa kwa RANKL pa OTM, zomwe zinakhudza mwachindunji kukonzanso mafupa ndi mlingo wa OTM.Kusiyana kwa mayiko awiriwa sikunali kofunika kwambiri pa 3 ndi 15 masiku atatha kulowererapo (p = 0.685 ndi p = 0.400, motsatira).Kusiyanasiyana kwa nthawi kapena njira yowunikira zotsatira kunalepheretsa kuphatikizika kwa maphunziro awiri am'mbuyomu mu meta-analysis [32,34].
Njira zopangira opaleshoni ndi zamankhwala: Rajasekaran ndi Nayak adawunika momwe corticotomy motsutsana ndi jekeseni wa prostaglandin E1 pa RTM ndi nthawi yoyenda dzino (TTM) mu CCT yogawanika [35].Iwo anasonyeza kuti corticotomy bwino RTM kuposa prostaglandins, ndi statistically kusiyana (p = 0.003), popeza pafupifupi RTM pa prostaglandin mbali anali 0.36 ± 0.05 mm/sabata, pamene corticotomy anali 0.40 ± 0 .04mm/wozungulira.Panalinso kusiyana kwa nthawi yosuntha dzino pakati pa njira ziwirizi.Gulu la corticotomy (masabata a 13) linali ndi "nthawi yoyenda dzino" lalifupi kuposa gulu la prostaglandin (masabata 15).Kuti mumve zambiri, chidule cha kuchuluka kwa zomwe zapezedwa kuchokera muzopeza zazikulu za kafukufuku aliyense zaperekedwa mu Gulu 6.
RTM: kuthamanga kwa mano;TTM: nthawi yoyenda mano;CTM: kuchulukitsidwa kwa dzino;NAC: kulamulira kosafulumizitsa;MOPs: kuwonongeka kwa fupa la tizilombo tating'onoting'ono;LLLT: mankhwala otsika kwambiri a laser;CFO: orthodontics ndi corticotomy;FTMPF: makulidwe athunthu mucoperiosteal flap;NR: sizinafotokozedwe
Maphunziro anayi adayesa zotsatira zachiwiri [32,33,35,36].Maphunziro atatu adayesa kutayika kwa chithandizo cha molar [32,33,35].Rajasekaran ndi Nayak sanapeze kusiyana kwakukulu pakati pa magulu a corticotomy ndi prostaglandin (p = 0.67) [35].El-Ashmawi et al.Palibe kusiyana kwakukulu komwe kunapezeka pakati pa corticotomy ndi mbali ya LLLT pa nthawi iliyonse yowunika (MD 0.33 mm, 95% CI: -1.22-0.55, p = 0.45) [33].M'malo mwake, Abdarazik et al.Kusiyana kwakukulu kunanenedwa pakati pa magulu a FTMPF ndi LLLT, gulu la LLLT linali lalikulu [32].
Ululu ndi kutupa zinayesedwa m'mayesero awiri omwe anaphatikizapo [33,35].Malingana ndi Rajasekaran ndi Nayak, odwala adanena kutupa ndi kupweteka pang'ono pa sabata yoyamba pa mbali ya corticotomy [35].Pankhani ya prostaglandin, odwala onse ankamva kupweteka kwambiri atapatsidwa jekeseni.Odwala ambiri, mphamvu yake ndi yayikulu ndipo imatha mpaka masiku atatu kuchokera tsiku la jakisoni.Komabe, El-Ashmawi et al.[33] inanena kuti 70% ya odwala amadandaula za kutupa kumbali ya corticotomy, pamene 10% anali ndi kutupa kumbali zonse za corticotomy ndi LILI mbali.Ululu wa postoperative udadziwika ndi 85% ya odwala.Mbali ya corticotomy ndi yovuta kwambiri.
Rajasekaran ndi Nayak adawunika kusintha kwa kutalika kwa mtunda ndi kutalika kwa mizu ndipo sanapeze kusiyana kwakukulu pakati pa magulu a corticotomy ndi prostaglandin (p = 0.08) [35].Kuzama kwa kafukufuku wa periodontal kunayesedwa mu kafukufuku umodzi wokha ndipo sanapeze kusiyana kwakukulu pakati pa FTMPF ndi LLLT [32].
Türker et al anafufuza kusintha kwa canine ndi ma angles oyambirira a molar ndipo sanapeze kusiyana kwakukulu kwa canine ndi ma angles oyambirira a molar pakati pa mbali ya piezotomy ndi mbali ya LLLT panthawi yotsatila kwa miyezi itatu [36].
Mphamvu ya umboni wa kusokonezeka kwa orthodontic ndi zotsatira zake zinachokera ku "otsika kwambiri" mpaka "otsika" molingana ndi malangizo a GRADE (Table 7).Kuchepetsa mphamvu ya umboni kumayenderana ndi chiopsezo cha kukondera [23,32,33,35,36], kusalunjika [23,32] ndi kusatsimikizika [23,32,33,35,36].
a, g Kuchepetsa chiopsezo cha kukondera ndi mlingo umodzi (kukondera chifukwa cha kupatuka kuchokera kuzinthu zomwe zikuyembekezeredwa, kutayika kwakukulu kukutsatira) ndi kuchepetsa kusalongosoka ndi mlingo umodzi * [33].
c, f, i, j Kuopsa kwa tsankho kunachepa ndi mlingo umodzi (maphunziro osasinthika) ndipo malire a zolakwika adachepa ndi mlingo umodzi * [35].
d Kuchepetsa chiopsezo cha kukondera (chifukwa cha kupatuka kuchokera kuzinthu zomwe zikuyembekezeredwa) ndi mlingo umodzi, kusalunjika ndi mlingo umodzi **, ndi kusalinganika ndi mlingo umodzi * [23].
e, h, k Kuchepetsa chiopsezo cha kukondera (kukondera komwe kumayenderana ndi ndondomeko yowonongeka, kukondera chifukwa cha kupatuka kuchokera ku cholinga chofuna kuchitapo kanthu) ndi mlingo umodzi, kusalunjika ndi mlingo umodzi **, ndi kusayenerera ndi mlingo umodzi * [32].
CI: nthawi yodalirika;SMD: kapangidwe ka doko logawanika;COMP: mapangidwe apangidwe;MD: zikutanthauza kusiyana;LLLT: mankhwala otsika kwambiri a laser;FTMPF: makulidwe athunthu a mucoperiosteal flap
Pakhala pali chiwonjezeko chachikulu cha kafukufuku wokhudza kufulumira kwa kayendedwe ka orthodontic pogwiritsa ntchito njira zosiyanasiyana zothamangitsira.Ngakhale kuti njira zofulumizitsa opaleshoni zaphunziridwa kwambiri, njira zopanda opaleshoni zapezanso njira yawo yofufuza zambiri.Chidziwitso ndi umboni wosonyeza kuti njira imodzi yopititsira patsogolo ndiyabwino kuposa ina imakhalabe yosakanizika.
Malinga ndi SR iyi, palibe mgwirizano pakati pa maphunziro okhudza kukula kwa njira zopangira opaleshoni kapena zopanda opaleshoni pakufulumizitsa OTM.Abdelhameed ndi Refai, Rajasekaran ndi Nayak adapeza kuti mu OTM, opaleshoni inali yothandiza kwambiri kuposa kusachita opaleshoni [23,35].M'malo mwake, Türker et al.Kuchitapo kanthu kosachita opaleshoni kunakhala kothandiza kwambiri kuposa kuchita opaleshoni m'mwezi woyamba wa kumtunda kwa canine [36].Komabe, poganizira nthawi yonse yoyesedwa, adapeza kuti zotsatira za opaleshoni ndi zopanda opaleshoni pa OTM zinali zofanana.Kuphatikiza apo, Abdarazik et al., El-Ashmawi et al., ndi Sedki et al.adazindikira kuti panalibe kusiyana pakati pa njira zopangira opaleshoni komanso zopanda opaleshoni potsata mathamangitsidwe a OTM [32-34].