“Ungalokothi ungabaze ukuthi iqembu elincane lezakhamuzi ezicabangayo nezizinikele lingawushintsha umhlaba.Eqinisweni, iyona yodwa ekhona.”
Umgomo kaCureus uwukushintsha imodeli yakudala yokushicilelwa kwezokwelapha, lapho ukuthunyelwa kocwaningo kungase kubize, kube nzima, futhi kudle isikhathi.
Ugqinsi olugcwele lwe-mucoperiosteal flap, i-mop, i-piezotomy, i-corticotomy, i-lllt, i-prostaglandin, ukunyakaza kwamazinyo okusheshisiwe, i-orthodontic, ukungahlinzeki, ukuhlinzwa
Doaa Tahsin Alfaylani, Mohammad Y. Hajir, Ahmad S. Burhan, Luai Mahahini, Khaldun Darwich, Ossama Aljabban
Calula lesi sihloko ngokuthi: Alfailany D, Hajeer MY, Burhan AS, et al.(Meyi 27, 2022) Ukuhlola ukusebenza kokungenelela kokuhlinzwa nokungahlinzeki lapho kusetshenziswa ngokuhambisana nezigcini ukuze kusheshiswe ukunyakaza kwamazinyo amazinyo: ukubuyekezwa okuhlelekile.Ukwelapha 14(5): e25381.doi:10.7759/cureus.25381
Inhloso yalokhu kubuyekezwa kwakuwukuhlola ubufakazi obukhona njengamanje bokusebenza kwezindlela zokusheshisa ukuhlinzwa nezingezona zokuhlinzwa kanye nemiphumela emibi ehambisana nalezi zindlela.Kuseshwe izizindalwazi eziyisishiyagalolunye: I-Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE®, Scopus®, PubMed®, Web of Science™, Google™ Scholar, Trip, OpenGrey kanye ne-PQDT OPEN ye-pro-Quest®.I-ClinicalTrials.gov kanye nengosi yokusesha ye-International Clinical Trials Registry Platform (ICTRP) ibuyekezwe ukuze kubuyekezwe ucwaningo lwamanje nezincwadi ezingashicilelwe.Ukuhlola okulawulwa ngokungahleliwe (RCTs) kanye nokuhlolwa komtholampilo okulawulwayo (CCTs) kweziguli ezihlinzwa (amasu ahlaselayo noma ahlasela kancane) kuhlanganiswe namadivayisi amisiwe endabuko futhi uma kuqhathaniswa nokungenelela okungahlinzeki.Ithuluzi le-Cochrane Risk of Bias (RoB.2) lasetshenziselwa ukuhlola ama-RCT, kuyilapho ithuluzi le-ROBINS-I lisetshenziselwa i-CCT.
Ama-RCT amane nama-CCT amabili (iziguli ze-154) afakwe kulokhu kubuyekezwa okuhlelekile.Izivivinyo ezine zathola ukuthi ukungenelela kokuhlinzwa nokungahlinzeki kwaba nomthelela ofanayo ekusheshiseni ukunyakaza kwamazinyo kwamazinyo (OTM).Ngokuphambene, ukuhlinzwa kwakuphumelela kakhulu kwezinye izifundo ezimbili.Izinga eliphezulu lokungafani phakathi kwezifundo ezifakiwe livimbele ukuhlanganiswa kobuningi bemiphumela.Imiphumela emibi ebikiwe ehlobene nokungenelela kokuhlinzwa nokungahlinzeki yayifana.
Kube khona ubufakazi 'obuphansi kakhulu' ukuya 'obuphansi' bokuthi ukungenelela kokuhlinzwa nokungahlinzeki kwasebenza ngokulinganayo ekusheshiseni ukunyakaza kwamazinyo ngaphandle komehluko emiphumeleni emibi.Kudingeka izivivinyo zomtholampilo zekhwalithi ephezulu ukuze kuqhathaniswe imiphumela yokusheshisa lezi zindlela ezimbili ezinhlotsheni ezihlukene ze-malocclusion.
Ubude besikhathi sokwelashwa kwanoma yikuphi ukungenelela kwe-orthodontic kungenye yezinto ezibalulekile iziguli ezizicabangela lapho zenza isinqumo [1].Isibonelo, ukuhoxiswa kwama-canine abambelele kakhulu ngemva kokukhipha ama-premolars aphezulu kungathatha cishe izinyanga ezingu-7, kuyilapho izinga lokunyakaza kwamazinyo e-bioorthodontic (OTM) licishe libe ngu-1 mm ngenyanga, okuholela esikhathini esiphelele sokwelashwa cishe iminyaka emibili [2, 3] ] .Ubuhlungu, ukungakhululeki, ama-caries, ukuwohloka kwe-gingival kanye ne-root resorption yimiphumela emibi eyandisa ubude besikhathi sokwelashwa kwamathambo [4].Ngaphezu kwalokho, izizathu zobuhle nezenhlalo zenza iziguli eziningi zifune ukuqedwa ngokushesha kokwelashwa kwe-orthodontic [5].Ngakho-ke, bobabili odokotela bamazinyo kanye neziguli bafuna ukusheshisa ukunyakaza kwamazinyo nokunciphisa isikhathi sokwelashwa [6].
Indlela yokusheshisa ukunyakaza kwamazinyo incike ekusebenzeni kokusabela kwezicubu zezinto eziphilayo.Ngokwezinga lokuhlasela, lezi zindlela zingahlukaniswa ngamaqembu amabili: izindlela zokulondoloza (i-biological, ngokomzimba, kanye ne-biomechanical) kanye nezindlela zokuhlinza [7].
Izindlela zebhayoloji zihlanganisa ukusetshenziswa kwama-pharmacological agents ukwandisa ukuhamba kwamazinyo ekuhlolweni kwezilwane nakubantu.Ucwaningo oluningi lubonise ukusebenza ngempumelelo ngokumelene neningi lalezi zinto ezifana nama-cytokines, i-nuclear factor kappa-B ligand receptor activators/nuclear factor-kappa-B protein receptor activators (RANKL/RANK), prostaglandins, vitamin D, amahomoni afana ne-parathyroid hormone (PTH). ).) kanye ne-osteocalcin, kanye nemijovo yezinye izinto ezifana ne-relaxin, ayizange ibonise ukusebenza okusheshisiwe [8].
Izindlela ezingokomzimba zisekelwe ekusetshenzisweni kwe-apparatus therapy, okuhlanganisa okwamanje okuqondile [9], izinkambu ze-electromagnetic pulsed [10], vibration [11], kanye nokwelashwa kwe-laser okunamandla aphansi [12], okubonise imiphumela ethembisayo [8].].Izindlela zokuhlinza zibhekwa njengezisetshenziswa kakhulu futhi ezifakazelwe emtholampilo futhi zinganciphisa kakhulu isikhathi sokwelashwa [13,14].Kodwa-ke, bathembele ku-"Regional Acceleration Phenomenon (RAP)" kusukela ukuvela kokulimala kokuhlinzwa kwethambo le-alveolar kungasheshisa okwesikhashana i-OTM [15].Lokhu kungenelela kokuhlinzwa kuhlanganisa i-corticotomy yendabuko [16,17], ukuhlinzwa kwethambo le-alveolar ye-interstitial [18], i-osteogenic orthodontics esheshayo [19], i-alveolar traction [13] kanye ne-periodontal traction [20], i-compression electrotomy [14,21], i-cortical resection [ 19].22] kanye ne-microperforation [23].
Ukubuyekezwa okuningana okuhlelekile (SR) kokuhlolwa okulawulwa ngokungahleliwe (RCTs) kushicilelwe ekusebenzeni kokungenelela kokuhlinzwa nokungahlinzeki ekusheshiseni i-OTM [24,25].Kodwa-ke, ukuphakama kokuhlinzwa ngaphezu kwezindlela ezingezona zokuhlinzwa akufakazelwanga.Ngakho-ke, lokhu kubuyekezwa okuhlelekile (SR) kuhloswe ukuphendula lo mbuzo wokubuyekeza obalulekile olandelayo: Iyiphi ephumelela kakhulu ekusheshiseni ukunyakaza kwamazinyo e-orthodontic lapho usebenzisa izinto ezisebenzayo ze-orthodontic: izindlela zokuhlinza noma ezingezona zokuhlinzwa?
Okokuqala, ukusesha komshayeli kwenziwa ku-PubMed ukuze kuqinisekiswe ukuthi awekho ama-SRs afanayo kanye nokuhlola zonke izindatshana ezihlobene ngaphambi kokubhala isiphakamiso sokugcina se-SR.Kamuva, izivivinyo ezimbili ezingase zisebenze zahlonzwa futhi zahlolwa.Ukubhaliswa kwale phrothokholi ye-SR kusizindalwazi se-PROSPERO kuqediwe (inombolo kamazisi: CRD42021274312).Le SR yahlanganiswa ngokuhambisana ne-Cochrane Handbook of Systematic Reviews of Interventions [26] kanye Nezinto Ezithandwayo Zokubika Zemihlahlandlela Yokubuyekezwa Okuhlelekile kanye nokuhlaziywa kwe-Meta (PRISMA) [27,28].
Ucwaningo lwaluhlanganisa iziguli ezinempilo zesilisa nabesifazane ezithola ukwelashwa okuhleliwe kwe-orthodontic, kungakhathaliseki ubudala, uhlobo lwe-malocclusion, noma ubuhlanga, ngokusho koMbambiqhaza Wokungenelela, Ukuqhathanisa, Imiphumela, kanye Nomklamo Wokufunda (PICOS).Ukuhlinzwa okwengeziwe (okuhlaselayo noma okuhlasela kancane) ekwelashweni kwendabuko okugxilile kwamathambo kuye kwacatshangelwa.Ucwaningo lwaluhlanganisa iziguli ezathola ukwelashwa kwe-orthodontic (OT) okuhleliwe ngokuhlanganiswa nokungenelela okungezona ukuhlinzwa.Lokhu kungenelela kungabandakanya izindlela zemithi (yasendaweni noma yesistimu) kanye nezindlela zomzimba (i-laser irradiation, umbane kagesi, i-pulsed electromagnetic fields (PEMF) kanye nokudlidliza).
Umphumela oyinhloko walo mbandela izinga lokunyakaza kwamazinyo (RTM) noma noma iyiphi inkomba efanayo engasazisa ngokusebenza kokungenelela kokuhlinzwa nokungahlinzeki.Imiphumela yesibili yayihlanganisa imiphumela emibi efana nemiphumela ebikwe isiguli (ubuhlungu, ukungakhululeki, ukwaneliseka, izinga lokuphila elihlobene nempilo yomlomo, ubunzima bokuhlafuna, nokunye okuhlangenwe nakho), imiphumela ehlobene nezicubu ze-periodontal njengoba kulinganiswa inkomba ye-periodontal (PI), izinkinga , I-Gingival Index (GI), ukulahlekelwa kokunamathiselwe (AT), ukwehla kwe-gingival (GR), ukujula kwe-periodontal (PD), ukulahlekelwa ukusekelwa nokunyakaza kwamazinyo okungafuneki (i-tilting, twisting, rotation) noma ukuhlukumezeka kwamazinyo e-iatrogenic okufana nokulahlekelwa kwamazinyo Abalulekile , Izimpande Resorption.Imiklamo yocwaningo emibili kuphela eyamukelwe - Izilingo Ezilawulwa Ngokungahleliwe (RCTs) kanye Nezivivinyo Zomtholampilo Ezilawulwayo (CCTs), ezibhalwe ngesiNgisi kuphela, ngaphandle kwemikhawulo ngonyaka wokushicilelwa.
Lezi zihloko ezilandelayo azifakwanga: izifundo ezibuyela emuva, izifundo ngezilimi ezingezona isiNgisi, ukuhlolwa kwezilwane, izifundo ze-in vitro, imibiko yamacala noma imibiko yochungechunge lwamacala, okuhleliwe, izindatshana ezinokubuyekezwa namaphepha amhlophe, imibono yomuntu siqu, izivivinyo ngaphandle kwamasampula abikiwe, cha. iqembu lokulawula, noma ukuba khona kweqembu lokulawula elingalashwa kanye neqembu lokuhlola elineziguli ezingaphansi kwe-10 lifundwe ngendlela yesici esilinganiselwe.
Ukusesha nge-elekthronikhi kudalwe kuzinqolobane ezilandelayo (Agasti 2021, asikho umkhawulo wesikhathi, isiNgisi kuphela): Irejista Emaphakathi ye-Cochrane Yezilingo Ezilawulwayo, i-PubMed®, i-Scopus®, i-Web of Science™, i-EMBASE®, i-Google™ Scholar, i-Trip, i-OpenGrey (yokuhlonza izincwadi ezimpunga) kanye ne-PQDT OPEN evela ku-pro-Quest® (yokuhlonza amaphepha nama-dissertations).Uhlu lwezincwadi zama-athikili akhethiwe luphinde lwahlolelwa noma yiziphi izivivinyo ezinamandla okungenzeka azitholakalanga ngokusesha ngogesi ku-inthanethi.Ngesikhathi esifanayo, ukusesha okwenziwa ngesandla kwenziwa ku-Journal of Angle Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics™, European Journal of Orthodontics and Orthodontics and Craniofacial Research.Ingosi yokusesha ye-ClinicalTrials.gov kanye ne-World Health Organization's International Clinical Trials Registry Registry Platform (ICTRP) yenze ukuhlola nge-elekthronikhi ukuze kutholwe izinhlolo ezingashicilelwe noma izifundo eziqediwe njengamanje.Imininingwane eyengeziwe ngesu le-e-search inikezwe kuThebula 1.
I-RANKL: i-nuclear factor kappa-beta ligand receptor activator;I-RANK: i-nuclear factor kappa-beta ligand receptor activator
Ababuyekezi ababili (i-DTA kanye ne-MYH) bahlole ngokuzimela ukufaneleka kocwaningo, futhi uma kunokungafani, umbhali wesithathu (LM) wamenywa ukuba enze isinqumo.Isinyathelo sokuqala sihlanganisa ukuhlola kuphela isihloko nesichasiselo.Isinyathelo sesibili sazo zonke izifundo kwakuwukukala umbhalo ogcwele njengofanele nesihlungi ukuze ufakwe noma lapho isihloko noma i-abstract ingacacile ukuze kusize ekwenzeni isinqumo esicacile.Ama-athikili ayekhishiwe uma engazange ahlangabezane nenqubo eyodwa noma ngaphezulu yokufakwa.Ukuze uthole izincazelo ezengeziwe noma idatha eyengeziwe, sicela ubhalele umbhali ofanele.Ababhali abafanayo (i-DTA kanye ne-MYH) bakhiphe idatha ngokuzimela kumathebula okuhlola kanye namathebula okukhishwa kwedatha achazwe ngaphambilini.Lapho ababuyekezi ababili abaholayo bengavumelani, umbhali wesithathu (LM) wacelwa ukuthi asize ukuzixazulula.Ithebula ledatha yesifinyezo lihlanganisa izici ezilandelayo: ulwazi olujwayelekile mayelana ne-athikili (igama lombhali, unyaka wokushicilelwa kanye nesizinda socwaningo);izindlela (umklamo wocwaningo, iqembu elihloliwe);ababambiqhaza (inani leziguli ezibuthiwe, isilinganiso seminyaka yobudala kanye nebanga lobudala)., phansi);Ukungenelela (uhlobo lwenqubo, indawo yenqubo, izici zobuchwepheshe zenqubo);Izici ze-Orthodontic (izinga le-malocclusion, uhlobo lokunyakaza kwamazinyo e-orthodontic, imvamisa yokulungiswa kwe-orthodontic, ubude bokubuka);kanye nezilinganiso zomphumela (imiphumela eyinhloko neyesibili ebaluliwe, izindlela zokulinganisa, nokubikwa komehluko obalulekile ngokwezibalo).
Ababuyekezi ababili (i-DTA ne-MYH) bahlole ubungozi bokuchema kusetshenziswa ithuluzi le-RoB-2 lama-RCT atholiwe [29] kanye nethuluzi le-ROBINS-I lama-CCT [30].Esimeni sokungaboni ngaso linye, sicela uthinte omunye wababhali ababambisene nabo (ASB) ukuze ufinyelele isixazululo.Ezivivinyweni ezingahleliwe, silinganisele lezi zindawo ezilandelayo “njengengcuphe ephansi”, “ingozi enkulu” noma “inkinga ethile yokuchema”: ukuchema okuvela enqubweni ye-randomization, ukuchema ngenxa yokuphambuka ekungeneleleni okulindelekile (imithelela ngenxa yokungenelela; imiphumela ukubambelela ekungeneleleni), ukuchema ngenxa yedatha yemiphumela engekho, ukuchema kokulinganisa, ukukhetha emiphumeleni yokubika.Ingozi iyonke yokuchema ezifundweni ezikhethiwe ikalwe ngale ndlela elandelayo: “Ingozi ephansi yokuchema” uma zonke izizinda bezikalwa ngokuthi “ingozi ephansi yokuchema”;"Okunye Ukukhathazeka" uma okungenani indawo eyodwa ilinganiselwe ngokuthi "Okunye Ukukhathazeka" kodwa hhayi "Ingozi Ephezulu Yokuchema kunoma iyiphi indawo, Ingozi Ephezulu Yokuchema: uma okungenani isizinda esisodwa noma ngaphezulu silinganiselwe njengeNgcuphe Ephezulu Yokuchema" noma okunye ukukhathazeka. phezu kwezizinda eziningi, okunciphisa kakhulu ukuzethemba emiphumeleni.Nakuba, ezivivinyweni ezingahleliwe, silinganisele izindawo ezilandelayo njengezisengozini ephansi, emaphakathi, kanye nephezulu: ngesikhathi sokungenelela (ukuchema ngezigaba zokungenelela);ngemva kokungenelela (ukuchema ngenxa yokuphambuka ekungeneleleni okulindelekile; ukuchema ngenxa yokuntuleka kwedatha; imiphumela) ukuchema kokulinganisa;ukubika ukuchema ekukhethweni kwemiphumela).Ingozi iyonke yokuchema ezifundweni ezikhethiwe ikalwe ngale ndlela elandelayo: “Ingozi ephansi yokuchema” uma zonke izizinda bezikalwa ngokuthi “ingozi ephansi yokuchema”;"ingozi emaphakathi yokuchema" uma zonke izizinda bezilinganiselwe "njengengozi ephansi noma emaphakathi yokuchema".ukuchema” “Ingozi enkulu yokuchema”;“Ingozi Enkulu Yokuchema” uma okungenani isizinda esisodwa silinganiselwe “Ingozi Enkulu Yokuchema” kodwa kungekho Ingozi Enzima Yokuchema kunoma yisiphi isizinda, “Ingozi Enkulu Yokuchema” uma okungenani isizinda esisodwa silinganiselwe “Ingozi enkulu yephutha elihlelekile”;ucwaningo lwalubhekwa "njengolwazi olulahlekile" uma kungekho inkomba ecacile yokuthi ucwaningo "lwalubalulekile noma lusengozini enkulu yokuchema" futhi lwalushoda ngolwazi endaweni eyodwa noma ngaphezulu ebalulekile yokuchema.Ukuthembeka kobufakazi kwahlolwa ngokwendlela Yokuhlola Izinkombandlela, Ukuthuthukiswa Nokuhlola (GRADE), ngemiphumela ehlukaniswa njengephezulu, emaphakathi, ephansi, noma ephansi kakhulu [31].
Ngemva kokusesha nge-elekthronikhi, inani lama-athikili angu-1972 likhonjwe kanye nokucaphuna okukodwa okuvela kweminye imithombo.Ngemva kokukhipha izimpinda, imibhalo yesandla engu-873 yabuyekezwa.Izihloko nezifinyezo zahlolelwa ukufaneleka futhi noma yiziphi izifundo ezingahlangabezani nemibandela yokufaneleka zinqatshiwe.Ngenxa yalokho, kwenziwa ucwaningo olunzulu lwemibhalo engu-11 okungenzeka ifanele.Izilingo ezinhlanu eziqediwe kanye nezifundo ezinhlanu eziqhubekayo azizange zihlangabezane nenqubo yokufaka.Izifushaniso zama-athikili ezingafakwanga ngemva kokuhlaziywa kombhalo ogcwele kanye nezizathu zokukhishwa zinikezwe kuthebula elisesithasiselweni.Ekugcineni, izifundo eziyisithupha (ama-RCT amane nama-CCT amabili) afakwe ku-SR [23,32-36].Umdwebo we-block ye-PRISMA uboniswa kuMfanekiso 1.
Izici zezilingo eziyisithupha ezifakiwe ziboniswa kuThebula 2 no-3 [23,32-36].Isilingo esisodwa kuphela sephrothokholi esikhonjiwe;bheka iThebula lesi-4 nelesi-5 ukuze uthole ulwazi olwengeziwe ngale phrojekthi yocwaningo eqhubekayo.
I-RCT: isilingo somtholampilo esingahleliwe;I-NAC: ukulawula okungasheshisiwe;I-SMD: umklamo womlomo wokuhlukanisa;I-MOPs: ukubhoboza okuncane;I-LLLT: ukwelashwa kwe-laser okunamandla aphansi;I-CFO: i-orthodontics ene-corticotomy;I-FTMPF: ukujiya okugcwele kwe-mucoperiosteal flap;Iphelelwa yisikhathi: okokuhlola;owesilisa: owesilisa;F: owesifazane;U3: inja engenhla;ED: ukuminyana kwamandla;I-RTM: isivinini sokunyakaza kwamazinyo;I-TTM: isikhathi sokunyakaza kwamazinyo;I-CTM: ukunyakaza kwamazinyo okukhulayo;I-PICOS: ababambiqhaza, ukungenelela, ukuqhathanisa, imiphumela kanye nomklamo wocwaningo
Ama-TAD: idivayisi ye-anchor yesikhashana;I-RTM: isivinini sokunyakaza kwamazinyo;I-TTM: isikhathi sokunyakaza kwamazinyo;I-CTM: ukunyakaza kwamazinyo okukhulayo;EXP: okokuhlola;I-NR: ayibikwanga;U3: inja engenhla;I-U6: i-molar yokuqala ephezulu;SS: insimbi engagqwali;I-NiTi: i-nickel-titanium;Ama-MOP: ukubhobozwa kwamathambo e-microbial;I-LLLT: ukwelashwa kwe-laser okunamandla aphansi;I-CFO: i-orthodontics ene-corticotomy;I-FTMPF: ukujiya okugcwele kwe-mucoperiosteal flap
I-NR: Akubikwanga;I-WHO ICTRP: Sesha Iphothali ye-WHO International Clinical Trials Registry Platform
Lokhu kubuyekezwa kufaka ama-RCT amane aqediwe angama-23,32-34 kanye nama-CCT amabili35,36 abandakanya iziguli ze-154.Iminyaka yobudala isukela ku-15 kuya ku-29.Ucwaningo olulodwa lwaluhlanganisa iziguli zesifazane kuphela [32], kanti olunye ucwaningo lwaluhlanganisa abesifazane abambalwa kunamadoda [35].Kwakukhona abesifazane abaningi kunamadoda ezifundweni ezintathu [33,34,36].Ucwaningo olulodwa kuphela aluzange lunikeze ukusatshalaliswa kobulili [23].
Izifundo ezine ezifakiwe kwakuyimiklamo ye-split-port (SMD) [33-36] kanti ezimbili zaziyimiklamo eyinhlanganisela (COMP) (amachweba ahambisanayo nahlukene) [23,32].Esicwaningweni sokuklama esiyinhlanganisela, uhlangothi olusebenzayo lweqembu lokuhlola luqhathaniswe nohlangothi olungasebenzi lwamanye amaqembu okuhlola, njengoba uhlangothi oluphikisanayo lwala maqembu aluzange lube nokusheshisa (ukwelashwa okuvamile kwe-orthodontic kuphela) [23,32].Kwezinye izifundo ezine, lokhu kuqhathanisa kwenziwa ngokuqondile ngaphandle kweqembu lokulawula elingasheshi [33-36].
Izifundo ezinhlanu ziqhathanise ukuhlinzwa nokungenelela ngokomzimba (okungukuthi, ukwelapha nge-laser okunamandla aphansi {LILT}), kanye nocwaningo lwesithupha lwaqhathanisa ukuhlinzwa nokungenelela kwezokwelapha (okungukuthi, i-prostaglandin E1).Ukungenelela kokuhlinzwa kusuka ekuhlaseleni ngokweqile (i-corticotomy yendabuko [33-35], i-FTMPF egcwele ukujiya kwe-mucoperiosteal flap [32]) kuya ekungeneleleni okuncane (izinqubo zokuhlasela ezincane {MOPs} [23] nezinqubo ze-piezotomy ezingenasici [36]).
Zonke izifundo ezitholakele zihlanganisa iziguli ezidinga ukuhoxiswa kwe-canine ngemva kokukhipha i-premolar [23,32-36].Zonke iziguli ezihlanganisiwe zithole ukwelashwa okusekelwe ekukhishweni.Ama-canines asuswa ngemuva kokukhishwa kwe-premolars yokuqala yomhlathi ongaphezulu.Ukukhishwa kwenziwa ekuqaleni kokwelashwa kuze kuphothulwe izinga kanye nokulinganisa ezifundweni ezintathu [23, 35, 36] nabanye abathathu [32-34].Ukuhlola okulandelwayo kwakusukela emasontweni amabili [34], izinyanga ezintathu [23,36], nezinyanga ezine [33] kuze kuphothulwe ukuhoxiswa kwe-canine [32,35].Ezifundweni ezine [23, 33, 35, 36], ukukalwa kokunyakaza kwamazinyo kwachazwa ngokuthi "izinga lokunyakaza kwamazinyo" (RTM), futhi kwesinye isifundo, "isikhathi sokunyakaza kwamazinyo" (CTM) saboniswa ngokuthi "ukunyakaza kwamazinyo" ."Isikhathi" (TTM).) zezifundo ezimbili [32,35], eyodwa yahlola ukugxila kwe-sRANKL [34].Izifundo ezinhlanu zisebenzise idivayisi ye-TAD yehange yesikhashana [23,32-34,36], kuyilapho ucwaningo lwesithupha lisebenzisa ukugoba kwethiphu elihlehlayo ukuze kulungiswe [35].Mayelana nezindlela ezisetshenziselwa ukukala ukushesha kwamazinyo, ucwaningo olulodwa lwasebenzisa i-digital intraoral calipers [23], ucwaningo olulodwa lwasebenzisa ubuchwepheshe be-ELISA ukuthola amasampula e-gingival sulcus fluid (GCF) [34], futhi izifundo ezimbili zahlola ukusetshenziswa kwe-electronic cast cast..iphonsa i-caliper [33,35], kuyilapho izifundo ezimbili zisebenzisa amamodeli ocwaningo ahlolwe i-3D ukuze zithole izilinganiso [32,36].
Ingozi yokukhetha ukufakwa kuma-RCT iboniswa ku-Figure 2, futhi ingozi yonke yokubandlulula kwesizinda ngasinye iboniswa kuMfanekiso 3. Wonke ama-RCT alinganiswe ngokuthi "anokukhathazeka okuthile ngokuchema" [23,32-35]."Okunye ukukhathazeka mayelana nokuchema" kuyisici esibalulekile sama-RCT.Ukuchema ngenxa yokuphambuka kokungenelela okulindelekile (imiphumela ehlobene nokungenelela; imiphumela yokubambelela ekungeneleleni) kwakuyizindawo ezazisolwa kakhulu (okungukuthi, “ukukhathazeka okuthile” kwakukhona ku-100% wezifundo ezine).Ingozi yokulinganisa ukulinganisa ocwaningweni lwe-CCT iboniswa kuMfanekiso 4. Lezi zifundo zazine "ingozi ephansi yokuchema".
Umfanekiso osuselwe kudatha evela ku-Abdelhameed noRefai, 2018 [23], El-Ashmawi et al., 2018 [33], Sedky et al., 2019 [34], kanye no-Abdarazik et al., 2020 [32].
Ukuhlinzwa okuphambene nokungenelela ngokomzimba: Izifundo ezinhlanu ziqhathanisa izinhlobo ezahlukene zokuhlinzwa nge-low-intensity laser therapy (LILT) ukusheshisa ukuhoxiswa kwe-canine [23,32-34].El-Ashmawy et al.Imiphumela ye-"corticotomy yendabuko" ngokumelene ne-"LLT" yahlolwa ku-cleft RCT [33].Ngokuphathelene nesivinini sokuhoxisa i-canine, awukho umehluko obalulekile ngokwezibalo otholakele phakathi kwezinhlangothi ze-corticotomy ne-LILI nganoma yisiphi isikhathi ekuhlolweni (kusho u-0.23 mm, 95% CI: -0.7 kuya ku-1.2, p = 0 .64).
Turker et al.ihlole umphumela we-piezocision ne-LILT ku-RTM ku-cleft TBI [36].Ngenyanga yokuqala, imvamisa yokuhlehla kwe-canine engenhla ohlangothini lwe-LILI yayiphezulu ngokwezibalo kunasohlangothini lwe-piezocision (p = 0.002).Kodwa-ke, awukho umehluko ophawulekayo wezibalo owabonwa phakathi kwezinhlangothi ezimbili ngenyanga yesibili neyesithathu yokuhlehla kwe-canine ephezulu, ngokulandelana (p = 0.377, p = 0.667).Uma kucatshangelwa isikhathi esiphelele sokuhlola, imiphumela ye-LILI ne-Piezocisia ku-OTM yayifana (p = 0.124), nakuba i-LILI yayisebenza kangcono kunenqubo ye-Piezocisia ngenyanga yokuqala.
U-Abdelhameed noRefai bafunde umphumela we-“MOPs” uma kuqhathaniswa ne-“LLLT” kanye “ne-MOPs+LLLT” ku-RTM kumklamo oyinhlanganisela we-RCT [23]. Bathole ukukhuphuka kwezinga lokuhlehla kwe-canine ephezulu ezinhlangothini ezisheshisiwe (“ama-MOP” kanye “no-“LLLT”) uma kuqhathaniswa nezinhlangothi ezingasheshiswanga, ezinomehluko ophawulekayo wezibalo kuzo zonke izikhathi zokuhlola (p< 0.05). Bathole ukukhuphuka kwezinga lokuhlehla kwe-canine ephezulu ezinhlangothini ezisheshisiwe (“ama-MOP” kanye “no-“LLLT”) uma kuqhathaniswa nezinhlangothi ezingasheshiswanga, ezinomehluko ophawulekayo wezibalo kuzo zonke izikhathi zokuhlola (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 сравнековы сторонах тистически значимыми различиями во все времена оценки (p<0,05). Bathole ukukhuphuka okusheshayo kwesivinini sokuhlehla okungemuva kwama-canine angaphezulu (“ama-MOP” kanye “ne-LLLT”) uma kuqhathaniswa nokuhlehliswa okungemuva okungasheshisiwe okunomehluko ophawulekayo wezibalo ngazo zonke izikhathi zokuhlola (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，在所有诀计坡坐时闘都） p <0.05. Bathole ukuthi, uma kuqhathaniswa nohlangothi olungasheshiswanga, amazinyo e-canine angaphezulu ohlangothini olusheshisiwe (“MOPs” kanye ne-“LLLT”) akhuphule izinga lokunciphisa, futhi kube nomehluko obalulekile ngokwezibalo (p<0.05) kuzo zonke izikhathi zokuhlola . Они обнаружили, что ретракция верхнего клыка была выше на стороне акселерации («MOPs» и «LLLT») p<0,05) во все оцениваемые моменты времени. Uthole ukuthi ukuhlehla kwemilenze engaphezulu kwakuphezulu ohlangothini ngokusheshisa ("MOPs" kanye "LLLT") uma kuqhathaniswa nohlangothi ngaphandle kokusheshisa okunomehluko ophawulekayo wezibalo (p<0.05) kuzo zonke izikhathi amaphuzu ahlolwe.Uma kuqhathaniswa nohlangothi olungasheshi, ukuhoxiswa kwe-clavicle kusheshiswe izikhathi ezingu-1.6 nezingu-1.3 ezinhlangothini ze-"SS" kanye ne "NILT", ngokulandelana.Ngaphezu kwalokho, baphinde babonisa ukuthi inqubo ye-MOPs yayisebenza kangcono kunenqubo ye-LLLT ekusheshiseni ukuhlehla kwama-clavicles angaphezulu, nakuba umehluko wawungabalulekanga ngokwezibalo.I-heterogeneity ephezulu kanye nokwehluka kokungenelela okusetshenzisiwe phakathi kwezifundo zangaphambilini kuvimbele ukuhlanganiswa komthamo wedatha [23,33,36].Abdalazik et al.I-RCI enezingalo ezimbili enomklamo oyinhlanganisela [32] ihlole umphumela we-full-thickness mucoperiosteal flap (ubude be-FTMPF kuphela nge-LLLT) ekunyakazeni kwamazinyo okukhulayo (CTM) kanye nesikhathi sokunyakaza kwamazinyo (TTM)."Isikhathi sokunyakaza kwamazinyo" uma kuqhathaniswa nezinhlangothi ezisheshayo nezingasheshiswanga, ukuncipha okuphawulekayo kwenani lesikhathi sokuhoxiswa kwamazinyo kwabonwa.Kuso sonke isifundo, awukho umehluko obalulekile ngokwezibalo phakathi kwe-“FTMPF” kanye ne-“LLLT” ngokwemibandela “ye-cumulative tooth movement” (p = 0.728) kanye “nesikhathi sokunyakaza kwamazinyo” (p = 0.298).Ukwengeza, i-“FTMPF” kanye ne-“LLLT” » ingafinyelela i-OTM yokusheshisa engu-25% no-20% ngokulandelana.
Seki et al.Umphumela we-“traditional corticotomy” ngokumelene ne-“LLT” ekukhishweni kwe-RANKL ngesikhathi se-OTM ku-RCT ene-orotomy uye wahlolwa futhi waqhathaniswa [34].Ucwaningo lubike ukuthi kokubili i-corticotomy ne-LILI yanda ukukhululwa kwe-RANKL ngesikhathi se-OTM, okwathinta ngokuqondile ukulungiswa kwamathambo kanye nesilinganiso se-OTM.Umehluko wamazwe amabili awuzange ubaluleke ngokwezibalo ku-3 kanye nezinsuku ze-15 ngemuva kokungenelela (p = 0.685 kanye ne-p = 0.400, ngokulandelana).Umehluko ngesikhathi noma indlela yokuhlola imiphumela ivimbele ukufakwa kwezifundo ezimbili zangaphambilini ekuhlaziyweni kwe-meta [32,34].
Ukungenelela kokuhlinzwa nokwemithi: U-Rajasekaran no-Nayak bahlole umphumela we-corticotomy ngokumelene nomjovo we-prostaglandin E1 ku-RTM kanye nesikhathi sokunyakaza kwamazinyo (TTM) ku-CCT yomlomo wokuhlukanisa [35].Babonise ukuthi i-corticotomy ithuthukise i-RTM kangcono kune-prostaglandin, enomehluko obalulekile ngokwezibalo (p = 0.003), njengoba isilinganiso se-RTM ohlangothini lwe-prostaglandin sasingu-0.36 ± 0.05 mm/ngesonto, kuyilapho i-corticotomy ingu-0.40 ± 0 .04mm/umjikelezo.Kwakukhona futhi umehluko ngesikhathi sokunyakaza kwamazinyo phakathi kokungenelela okubili.Iqembu le-corticotomy (amasonto angu-13) libe "nesikhathi esifushane sokunyakaza kwamazinyo" kuneqembu le-prostaglandin (amasonto angu-15).Ukuze uthole imininingwane eyengeziwe, isifinyezo semiphumela yobuningi emithonjeni eyinhloko yocwaningo ngalunye yethulwe kuThebula lesi-6.
I-RTM: isivinini sokunyakaza kwamazinyo;I-TTM: isikhathi sokunyakaza kwamazinyo;I-CTM: ukunyakaza kwamazinyo okukhulayo;I-NAC: ukulawula okungasheshisiwe;Ama-MOP: ukubhobozwa kwamathambo e-microbial;I-LLLT: ukwelashwa kwe-laser okunamandla aphansi;I-CFO: i-orthodontics ene-corticotomy;I-FTMPF: ukujiya okugcwele kwe-mucoperiosteal flap;NR: akubikwanga
Izifundo ezine zihlole imiphumela yesibili [32,33,35,36].Izifundo ezintathu zihlole ukulahlekelwa kokusekelwa kwe-molar [32,33,35].U-Rajasekaran no-Nayak abatholanga umehluko ophawulekayo phakathi kwe-corticotomy namaqembu e-prostaglandin (p = 0.67) [35].El-Ashmawi et al.Awukho umehluko ophawulekayo otholakala phakathi kwe-corticotomy kanye nohlangothi lwe-LLLT nganoma yisiphi isikhathi sokuhlola (MD 0.33 mm, 95% CI: -1.22-0.55, p = 0.45) [33].Kunalokho, u-Abdarazik et al.Umehluko obalulekile ngokwezibalo ubikwe phakathi kwamaqembu e-FTMPF ne-LLLT, neqembu le-LLLT likhulu [32].
Ubuhlungu nokuvuvukala kwahlolwa ezivivinyweni ezimbili ezifakiwe [33,35].Ngokusho kukaRajasekaran noNayak, iziguli zibike ukuvuvukala okuncane nobuhlungu phakathi nesonto lokuqala ohlangothini lwe-corticotomy [35].Endabeni ye-prostaglandin, zonke iziguli zaba nobuhlungu obukhulu lapho zijova.Ezigulini eziningi, umfutho uphakeme futhi uhlala izinsuku ezintathu kusukela osukwini lomjovo.Nokho, u-El-Ashmawi et al.[I-33] ibike ukuthi i-70% yeziguli zikhala ngokuvuvukala ohlangothini lwe-corticotomy, kuyilapho i-10% inokuvuvukala ohlangothini lwe-corticotomy kanye nohlangothi lwe-LILI.Ubuhlungu be-postoperative buphawulwe yi-85% yeziguli.Uhlangothi lwe-corticotomy lunzima kakhulu.
U-Rajasekaran no-Nayak bahlole ushintsho ekuphakameni kwe-ridge nobude bezimpande futhi abatholanga umehluko obalulekile ngokwezibalo phakathi kwamaqembu e-corticotomy ne-prostaglandin (p = 0.08) [35].Ukujula kokuhlolwa kwe-periodontal kwahlolwa ocwaningweni olulodwa kuphela futhi akutholanga umehluko obalulekile ngokwezibalo phakathi kwe-FTMPF ne-LLLT [32].
U-Türker et al uhlole izinguquko kuma-canine nama-engeli okuqala e-molar futhi akatholanga umehluko ophawulekayo wezibalo kuma-canine nama-engeli okuqala e-molar phakathi kohlangothi lwe-piezotomy nohlangothi lwe-LLLT phakathi nenkathi yokulandelela yezinyanga ezintathu [36].
Amandla obufakazi bokungahambi kahle kwe-orthodontic kanye nemiphumela emibi isukela "ephansi kakhulu" kuya "ephansi" ngokweziqondiso ze-GRADE (Ithebula 7).Ukunciphisa amandla obufakazi kuhlotshaniswa nengozi yokuzikhethela [23,32,33,35,36], ukungaqondile [23,32] nokungaqondile [23,32,33,35,36].
a, g Ingcuphe encishisiwe yokuchema ngezinga elilodwa (ukuchema ngenxa yokuchezuka kokungenelela okulindelekile, ukulahlekelwa okukhulu ekulandeleleni) nokunciphisa ukungaqondi kahle ngezinga elilodwa* [33].
c, f, i, j Ingozi yokuchema yehle ngezinga elilodwa (izifundo ezingahleliwe) kanye nomkhawulo wephutha wehla ngezinga elilodwa* [35].
d Yehlisa ubungozi bokuchema (ngenxa yokuchezuka ekungeneleleni okulindelekile) ngezinga elilodwa, ukungaqondile ngezinga elilodwa**, nokungaqondile ngezinga* [23].
e, h, k Nciphisa ubungozi bokuchema (ukuchema okuhambisana nenqubo ye-randomization, ukuchema ngenxa yokuphambuka ekungeneleleni okuhlosiwe) ngezinga elilodwa, ukungaqondile ngezinga elilodwa**, nokungaqondile ngezinga elilodwa* [32].
CI: isikhathi sokuzethemba;I-SMD: ukuhlukaniswa kwe-port design;I-COMP: idizayini eyinhlanganisela;MD: umehluko omkhulu;I-LLLT: ukwelashwa kwe-laser okunamandla aphansi;I-FTMPF: ukujiya okugcwele kwe-mucoperiosteal flap
Kube nokwanda okuphawulekayo kocwaningo mayelana nokusheshisa ukunyakaza kwamathambo kusetshenziswa izindlela ezihlukahlukene zokusheshisa.Nakuba izindlela zokusheshisa ukuhlinzwa ziye zafundwa kabanzi, izindlela ezingahlinzeki nazo zithole indlela yazo ocwaningweni olubanzi.Ulwazi nobufakazi bokuthi indlela eyodwa yokusheshisa ingcono kunenye ihlala ixubile.
Ngokwale SR, akukho ukuvumelana phakathi kwezifundo ngokubaluleka kwezindlela zokuhlinza noma ezingahlinzeki ekusheshiseni i-OTM.U-Abdelhameed noRefai, uRajasekaran noNayak bathola ukuthi ku-OTM, ukuhlinzwa kwakuphumelela kakhulu kunokungenelela okungahlinzeki [23,35].Kunalokho, uTürker et al.Ukungenelela okungezona ukuhlinzwa kubonakale kuphumelela kakhulu kunokungenelela kokuhlinzwa phakathi nenyanga yokuqala yokuhoxiswa kwe-canine ephezulu [36].Kodwa-ke, ngokucabangela sonke isikhathi sokuhlolwa, bathola ukuthi umthelela wokungenelela kokuhlinzwa nokungahlinzeki ku-OTM wawufana.Ngaphezu kwalokho, u-Abdarazik et al., El-Ashmawi et al., kanye no-Sedki et al.waphawula ukuthi kwakungekho mehluko phakathi kokungenelela kokuhlinzwa nokungahlinzeki ngokwemibandela yokusheshisa kwe-OTM [32-34].