Stability improvement in adult maxillary transverse deficiency after surgically assisted rapid maxillary expansion: a Meta-analysis

doi:10.3969/j.issn.2095-4344.2017.32.026

Abstract

Abstract:

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) has been proved to exert good
therapeutic efficacy on maxillary transverse deficiency (MTD) in adults, but its long-term efficacy and stability still remain controversial.
OBJECTIVE: To analyze the stability improvement in adult MTD after SARME through a Meta-analysis.
METHODS: A computer-based search of PubMed, Medline, EMBASE, Central Register of Controlled Trials, CNKI, and WanFang databases was conducted for the randomized, quasi-randomized controlled trials and clinical case-control trials published before May 31st, 2015. The quality evaluation and data extraction in the middle- and high-quality literature were performed by two professional researchers independently, and a Meta-analysis was then performed using Revman5.3 software.
RESULTS AND CONCLUSION: Totally 13 articles involving 513 cases were included. The results of Meta-analysis showed that: (1) the stability of the teeth: the difference of the first molar (WMD=-1.03, 95%CI: -2.00--0.06), canine (WMD=-1.26, 95%CI: -2.02 to -0.49) had significant difference after surgery and the follow-up; (2) the stability of the bone: the maxillary alveolar width of the first molar (WMD=-0.43, 95%CI: -1.82 to 0.97) at post-operation and the follow-up had no significant difference; (3) the stability of the nasal airway: in the short-term, the function of the nasal airway was improved significantly, while the long-term efficacy needed to be confirmed further. To conclude, after SARME, the dental and the maxillary alveolar in adult MTD have kept long-term stability, and the nasal airway is improved significantly in short-term.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Maxillofacial Development, Evidence-Based Medicine, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Fei Lu, Bai Yang, Yuan Xiao-ping. Stability improvement in adult maxillary transverse deficiency after surgically assisted rapid maxillary expansion: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(32): 5240-5248.

Figures/Tables 3

2.1 文献筛选结果及纳入文献的特征初检后获得769篇相关文献，2名研究员通过阅读文题和摘要筛出与本研究相关的文献42篇，阅读全文后排除23篇研究，对纳入19篇文献进行质量评价后[2-3，5-21]，排除5篇低等质量的研究后，纳入14篇文献，其中2篇为高等质量，12篇为中等质量，在提取资料的过程中，Northway[18]的表中数据与文中叙述不一致，予以排除，最终纳入13篇研究。纳入研究的方法学质量评价见表2，纳入研究的基本特征见表3。 2.2 Meta分析结果本文主要从牙、上颌骨、鼻气道几个方面来分析手术辅助上颌扩弓矫治上颌横向发育不足的稳定性。选取治疗前、去除扩弓器后正畸治疗前、随访3个时期的数据进行Meta分析，共9篇研究进行比较。 2.2.1 术后牙的稳定性主要对磨牙、尖牙间距离的变化进行分析。 5个研究报道了随访期磨牙间距离的变化[2-3，12-13，17]。各研究结果间同质性较好(P=0.97，I2=0%)，采用固定效应模型，合并后结果显示，随访期磨牙间距离的变化差异有显著性意义(WMD=-1.03，95%CI：-2.00至-0.06)，提示在随访期磨牙间距离有少量复发，约为1.03 mm(图1)。 7个研究报道了磨牙间距离的长期变化[2-3，12-15，17]。异质性检验显示各研究间有较大异质性(P=0.04，I2=51%)，产生异质性的原因可能是由于Prado[3]的研究在随访期内一直佩戴腭弓对扩弓效果进行保持，术后复发较少。按照随访期内是否佩戴保持期分为两个亚组进行分析，非保持组数据合并后，各结果间无统计学异质性(P=0.26，I2=21%)。采用随机效应模型合并后，磨牙间距离的变化差异有显著性意义(WMD=5.15，95%CI：4.03-6.28)，提示手术辅助上颌快速扩弓术后的长期观察中，磨牙间距离较术前平均增加了约5.15 mm(图2)。 5个研究报道了随访期尖牙间距离的变化[2，7，12-13，17]，各研究结果间同质性较好(P=0.58，I2=0%)，采用固定效应模型合并，Meta分析结果显示，随访期尖牙间距离的变化差异有显著性意义(WMD=-1.26，95%CI：-2.02至-0.49)，提示在随访期尖牙间距离有所减小，约为1.26 mm(图3)。 6个研究报道了尖牙间距离的长期变化[2，7，12-13，15，17]。"

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