Reinforcement of anchorage during orthodontic brace treatment with implants or other surgical methods

  • Review
  • Intervention

Authors


Abstract

Background

The term anchorage in orthodontic treatment refers to the control of unwanted tooth movement. This is conventionally provided either by anchor sites within the mouth, such as the teeth and the palate or from outside the mouth (headgear). Orthodontic implants which are surgically inserted to bone in the mouth are increasingly being used as an alternative form of anchorage reinforcement in orthodontics.

Objectives

The primary objective of this review was to evaluate the effectiveness of surgical methods for preventing unwanted tooth movement compared with conventional anchorage reinforcement techniques. The secondary objectives were to examine patient acceptance, discomfort and failure rates associated with these techniques.

Search methods

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. No language restrictions were applied. Authors were identified and contacted to identify unpublished trials. The most recent search was conducted in February 2006.

Selection criteria

Randomised or quasi-randomised clinical trials involving the use of surgically assisted means of anchorage reinforcement on orthodontic patients. Inclusion and exclusion criteria were applied when considering the studies to be included in this review.

Data collection and analysis

Data extraction was performed by two review authors working independently using a previously piloted data collection form. Data were entered into RevMan with planned analysis of mean differences (MD) and 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) and 95% CI for dichotomous outcomes. Pooling of data and meta-analysis were not performed due to an insufficient number of similar studies.

Main results

At present few trials have been carried out in this field and there are little data of adequate quality in the literature to meet the objectives of the review. The review authors were only able to find one study assessing the use of surgical anchorage reinforcement systems.

This trial examined 51 patients with 'absolute anchorage' requirements treated in two centres. Patients were randomly allocated to receive either headgear or a mid-palatal osseointegrated implant. Anchorage loss was measured cephalometrically by mesial movement of dental and skeletal reference points between T1 (treatment start) and T2 (end of anchorage reinforcement). All skeletal and dental points moved mesially more in the headgear group than the implant group. Results showed significant differences for mesial movement of the maxillary molar in both groups. The mean change in the implant group was 1.5 mm (standard deviation (SD) 2.6; 95% CI 0.4 to 2.7) and for the headgear group 3.0 mm (SD 3.4; 95% CI 1.6 to 4.5). The trial was designed to test a clinically significant difference of 2 mm, so the result was not statistically significant, but the authors conclude that mid-palatal implants do effectively reinforce anchorage and are an acceptable alternative to headgear in absolute anchorage cases.

Authors' conclusions

There is limited evidence that osseointegrated palatal implants are an acceptable means of reinforcing anchorage. The review authors were unable to identify trials addressing the secondary objectives of the review relating to patient acceptance, discomfort and failure rates. In view of the fact that this is a dynamic area of orthodontic practice we feel there is a need for high quality, randomised controlled trials. There are financial restrictions in running trials of this nature. However it would be in the interest of implant manufacturers to fund high quality, independently conducted, trials of their products.

摘要

背景

利用植體或其他手術方法來強化矯正治療中的錨定

錨定一詞所指的是在矯正治療中對於非所預期之牙齒移動的控制。傳統上錨定一般來自於口內如:牙齒、上顎或是口外裝置如:頭套(headgear)等等。而在近年來越來越多人使用的,則是在骨頭內植入矯正用植體,作為另一種強化錨定的方式。

目標

這篇論文回顧主要的目的是在於評估手術植入植體與一般傳統錨定方法對於預防發生非預期性牙齒移動的效果的比較。次要目標是同時檢測這些錨定方法在病患的接受度、舒適度以及失敗率的不同。

搜尋策略

搜尋資料庫包含The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE以及EMBASE等,沒有語言種之限制。並與文獻作者連繫並確認尚未發表的實驗。最新一篇的研究是於2006年2月所做的實驗。

選擇標準

隨機或是類隨機臨床試驗,實驗範圍涵蓋矯正病患使用手術植入的植體作為錨定。有採用選取及排除條件做為選定回顧文獻的標準。

資料收集與分析

資料分別由兩位回顧文獻的作者,各自獨立根據之前的前導資料收集格式,來進行資料匯集。資料輸入RevMan程式,依設定的分析,連續變項之結果計算平均差(Mean Differences, MD)及95%信賴區間(Confidence Intervals, CI),而二分變項之結果則分析其風險比及95%信賴區間。在此並沒有將所有資料加總並做整合分析,因為相似實驗的數量不足。

主要結論

至目前為止,在這個領域所做的臨床試驗是比較少的,也因此符合此文獻回顧條件的資料也相對很少;文獻回顧的作者們只能找到一篇運用植體強化錨定的研究。這個試驗包含了兩個醫學單位、共51位有絕對錨定需求的病人。病人並被隨機分配成兩組:帶頭套,以及在上顎中央植入骨整合植體兩組。錨定的喪失由側顱分析中,牙齒及骨骼上的參考點,分別在時間點1(療程開始)及時間點2(錨定使用結束)相對近心的移動量來決定。結果:所有的牙齒及骨骼參考點往近心移動的量,在頭帽組皆大於植體組。在兩組中上顎臼齒往近心移動的量皆是統計上顯著的;在植體組的平均變化量是1.5釐米(標準差2.6;95%信賴區間由0.4−2.7)而頭帽組是3.0釐米(標準差3.4;95%信賴區間由1.6−4.5)。然而此研究的設計若欲達到臨床上顯著,組間之差異需達2釐米,所以實驗結果是沒有統計上顯著的意義,但是作者們的結論仍認為上顎中央的植體可以有效強化錨定,並且對於錨定有絕對需求的病例中,植體是一個可接受的替代頭帽的方法。

作者結論

目前對於骨整合性上顎植體作為可接受的強化錨定方法的實證仍很有限;而回顧文獻的作者們無法找出關於次要目標,病患的接受度、舒適度及失敗率的研究。然而因為這是一個在矯正治療中功能性的部份,我們認為高品質的隨機臨床試驗是有需要的。要實施這樣的臨床實驗在經費上易顯得拮据,但對於植體的製造廠商而言去贊助這樣高品質、獨立實施的臨床試驗對於他們的產品是有助益價值的。

翻譯人

本摘要由臺灣大學附設醫院徐儷芳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

錨定的定義是在矯正治療中,對於非預期的牙齒移動的阻抗能力。在治療計劃中對於錨定的控制是很重要的,也同時支配了治療目標的成功與否。手術植入暫時性的錨定裝置被建議用來作為有效的強化錨定方法;但對於這樣的錨定系統是否優於傳統的矯正用錨定裝置的實證是很少的。然而在一篇最近的臨床試驗中可得到證實,在上顎中央的植體對於傳統的強化錨定方法是一個可接受的取代方法。本文獻回顧的作者們對於使用手術方式預防錨定喪失與傳統方式的比較,只能找到很有限的文獻資料;而此資料顯示兩者之間提供的是同等程度的效果,而非優劣之關係。

Plain language summary

Reinforcement of anchorage during orthodontic brace treatment with implants or other surgical methods

Anchorage is the resistance to unwanted tooth movement during orthodontic treatment. Control of anchorage is important in treatment planning and often dictates treatment objectives. It has been suggested that more effective anchorage reinforcement may be offered by surgically placed temporary anchorage devices.

There is little evidence to support the use of surgical anchorage systems over conventional means of orthodontic anchorage reinforcement. However there is evidence from one recent trial that showed mid-palatal implants are an acceptable alternative to conventional techniques for reinforcing anchorage.

The review authors were able to find only limited evidence on the use of surgical means of preventing anchorage loss compared with conventional techniques and the data showed equivalence, but not superiority of either type.